Problems with cognition and cognitive decline are common among people with multiple sclerosis (MS). An estimated 40 percent to 65 percent of people with MS experience cognitive symptoms.
Problems with cognition can include difficulties with working memory (the information you hold in your mind at a given time) or episodic memory (remembering specific events from the past), as well as attention and the ability to think and reason.
Cognitive impairments can be a frustrating aspect of life with MS. Changes to your cognition can affect personal relationships, work, and the ability to perform daily tasks.
Proactive steps recommended by the National Multiple Sclerosis Society can help you manage MS-related cognitive deficits and their impact on your quality of life. Cognition testing can be an early step to supporting your cognitive function.
Cognition testing is used to understand a person’s cognitive capabilities. Cognition tests for multiple sclerosis fall under the umbrella of neuropsychological testing and are designed to:
Neuropsychological tests can be used for a diverse range of neurological conditions. A neuropsychological test is not the same as a mental health evaluation, although some tests may include a section aimed at assessing mood disorders such as depression.
Several types of tests have been developed to evaluate cognition in people with MS. You may receive short screening tests in the doctor’s office or a more formal assessment supervised by a neuropsychologist.
You might also hear your doctor refer to cognition testing as “testing batteries” or “batteries of tests” — this simply means taking several tests that assess different areas of cognitive function in people with MS.
Cognition testing can help you and your doctor understand the challenges you’re experiencing and identify opportunities to support you.
Cognition testing has many benefits for individuals with multiple sclerosis, including informing your treatment plan and monitoring symptoms of MS over time. Following are some of the things cognition testing can do.
A baseline allows your health care provider to understand how your cognition changes over time. The National Multiple Sclerosis Society recommends that adults with MS undergo annual cognition testing to monitor disease progression, identify cognition changes, and see how well treatments are working.
Cognition testing can help determine the areas of cognition where you have the most challenges. This allows your provider to recommend the best interventions to help strengthen your cognitive function. Additionally, understanding your cognition can help you and your health care provider evaluate and tailor your treatment plan to your needs.
A comprehensive evaluation can help determine if depression, anxiety, fatigue, other health problems, or medication side effects are affecting cognition.
A thorough evaluation from a particular type of provider (such as a neuropsychologist or neurologist) may be necessary to qualify for government disability programs.
Having more information about your cognition helps you and your doctor choose interventions, exercises, and other strategies that can support cognitive function.
As you consider cognitive evaluation, it’s helpful to know what to expect. You can’t study for a cognition test, but you can prepare by getting a good night’s sleep and avoiding alcohol 24 hours before the test.
The time it takes to complete a cognition test can vary. Some tests can be done in a few minutes, while others may take several hours.
Comprehensive neuropsychological tests often include physical assessments. Longer testing times and physical activities can cause some people to feel tired afterward. Ask your provider how long testing will last.
You may be given a tablet such as an iPad or a paper form to take a test on your own — sometimes during a regular medical appointment or even while waiting to be seen. In other cases, your doctor may ask you questions verbally. Some testing batteries combine cognitive and physical assessments.
There are several types of cognitive screening. Your doctor will help determine which tests are best for you. Below are examples of commonly used cognition tests.
Introduced in 1982, the Symbol Digit Modalities Test (SDMT) is one of the most widely used rapid cognition tests for adults with MS. A person with MS is shown a key that pairs numbers with symbols and is then given 90 seconds to match the symbols and numbers. The entire test can be completed in five minutes or less. The SDMT can be performed verbally or in writing.
This test is often used as a front-line assessment before someone with MS is referred to other forms of cognition testing or to other professionals who can work with cognitive problems. Also, the SDMT helps assess cognitive changes during MS relapses.
The Processing Speed Test (PST) takes two minutes to complete, plus a few minutes for explanation. This test is similar to the SDMT, but it is self-administered on a tablet in your provider’s office. In one single-center study, there was some evidence that the PST was slightly more sensitive than the SDMT to certain brain lesions.
The Computerized Speed Cognitive Test (CSCT), which takes five minutes to finish, is a verbal assessment rather than a written or tablet test. The CSCT is particularly good for identifying information-processing impairment.
The Multiple Sclerosis Neuropsychological Questionnaire (MSNQ) takes five minutes. This self-reported survey about cognitive function can be filled out by either a person with MS or someone with whom they interact regularly. The MSNQ can help identify symptoms of depression and assess a person’s level of awareness about their own cognitive abilities.
The Multiple Sclerosis Functional Composite (MSFC) includes one cognitive test, a timed walking test, and a test of arm function. This test can be performed by a trained professional and does not require a physician or neuropsychologist. The National Multiple Sclerosis Society’s Clinical Assessment Task Force developed the MSFC for use in clinical trials.
The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) includes the SDMT and other tests to evaluate language ability and spatial recall. The BICAMS requires 15 minutes to complete.
The Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) is a comprehensive evaluation that can last 90 minutes. It includes the SDMT, as well as a battery of tests that evaluate language ability, working and spatial memory, and executive function — known as “cognitive domains.” The MACFIMS is unique in its ability to also assess executive function. This exam is administered by or under the supervision of a neuropsychologist.
Cognition testing is the first step. Based on the results, your doctor may recommend further evaluations and follow-ups with other health care providers. Other interventions may be prescribed to improve your cognitive performance, such as:
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Have you talked with your doctor about cognition testing? Have you taken any of these tests? Share your experience in the comments below, or start a conversation by posting in Activities.