Multiple sclerosis (MS) is a progressive disease. One of the lesser known symptoms of MS is cognitive decline. In fact, as MS progresses, approximately 50% of people diagnosed with a type of MS will experience some form of cognitive challenges over time with attention span, processing of information, memory, verbal fluency or decision making.¹ Recent studies suggest that cognitive dysfunction can occur earlier in the disease than previously thought.² These challenges can impact the ability to work, drive, socialize and even live independently.¹

How Does MS Impact Brain Health and Cognitive Functioning?
As all adults age, they generally lose a small amount of brain tissue. In people living with MS, this loss may happen at a faster pace. In addition, the brain's ability to adapt to MS damage (such as brain lesions) can be slowly used up over time. This decline in "brain health" results in increased symptoms of MS, including decreased mobility and cognitive functioning.³

What are the Signs of Cognitive Impairment?
The National Multiple Sclerosis Association describes six different categories of cognitive impairment.

• Memory or recall - including difficulty learning new material, forgetting appointments or someone's name or feeling disoriented and not knowing where you are.

• Attention and concentration - including difficulty focusing or inability to stick to one task without getting distracted.

• Information processing - being unable to respond quickly when a lot of information is being presented or trouble handling deadlines.

• Problem-solving and dealing with complex tasks - including missing the point in conversations or trouble following through with complicated tasks.

• Visual-spatial abilities - including getting confused about right/left and north/south or trouble with depth-perception.

• Verbal fluency - including finding the right words or mixing words up.

When Do Signs Appear?
Cognitive impairment symptoms may be observed one or more years before your MS diagnosis.³ However, the decline may start to occur years before symptoms are even noticed.

In a 2018 survey of 443 MyMSTeam members, half said that they began to experience cognitive impairment symptoms well before being officially diagnosed with MS.⁴

Maintaining Your "Brain Health" - Importance of Early Intervention
There are important lifestyle changes you can make as soon as you are diagnosed with MS. This can include changes to your diet and exercise, as well as adding puzzles or other brain games to your daily routine to help keep your mind active. While further research is needed, studies have shown that working with your healthcare team to get on a comprehensive treatment intervention plan early on and staying on treatment, along with lifestyle changes, may help slow down the decline in brain health over time. Making changes even later – such as starting treatment well after diagnosis – may still help to reduce brain lesions and lead to a lower level of physical disability later in life (example: decline in mobility). For example, some studies have shown that early intervention with a disease modifying therapy (DMT) in MS is thought to give an improved long-term prognosis.²

See Steps You Can Take Today that May Help with Brain Health and talk to your healthcare specialists to learn more about what you can do.

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References:

1. Courtney SW. Cover Story: Cognitive Issues with Multiple Sclerosis: Research, Strategies and Support. Multiple Sclerosis Association of America. https://mymsaa.org/publications/motivator/ winter-spring15/cover-story/. Published Spring 2015. Accessed March 2018.
2. Giovannoni G, Butzkueven H, Dhib-Jalbut S, et al. Brain Health: Time Matters in Multiple Sclerosis. MS Brain Health. https://msbrainhealth.org/perch/resources/ brain-health-time-matters-in-multiple-sclerosis-sep-17-1.pdf. Published 2015. Updated September 2017. Accessed March 2018.
3. Costello K, Halper J, Kalb R, et al. The Use of Disease Modifying Therapies in Multiple Sclerosis: Principles and Current Evidence. MS Coalition. http://www.nationalmssociety.org/getmedia/ 5ca284d3-fc7c-4ba5-b005-ab537d495c3c/ DMT_Consensus_MS_Coalition_color. Published July 2014. Updated March 2017. Accessed March 2018.
4. MyMSTeam Study on Cognitive Symptoms, March-April 2018. n=443