When considering a cognitive evaluation, it’s helpful to know what to expect. Cognitive testing is used to understand a person’s ability to think and reason.

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 some kind of cognitive symptoms (involving brain processes like thinking, memory, and attention).

Cognitive tests vary quite a bit, depending on what functions they’re assessing and how comprehensive the evaluation is. Read on to learn what you might expect if you or a loved one is thinking about having one.

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What Is a Cognitive Test for MS?

A cognition test for multiple sclerosis is considered a neuropsychological assessment, which can help evaluate a diverse range of neurological conditions.

A neuropsychological test isn’t the same as a mental health evaluation, although some tests may include a section aimed at assessing mood disorders such as depression.

Cognitive tests can:

• Detect impairments across multiple cognitive areas
• Improve understanding of changes happening in the brain
• Assist in recommendations for treatment planning

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 (specialist who assesses and treats cognitive, emotional, and behavioral changes related to brain function).

Your doctor might discuss cognition testing as “testing batteries” or “batteries of tests.” These phrases simply refer to 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.

What Cognitive Problems Are Common in People With MS?

Problems with cognition can include difficulties with:

• Working memory (the information you hold in your mind at a given time)
• Episodic memory (remembering specific events from the past)
• Attention and the ability to think and reason

MS memory and cognition tests can detect problems in these areas, such as memory loss.

Cognitive impairments can be a frustrating aspect of life with MS. Changes to cognition can affect personal relationships, work, and the ability to perform daily tasks.

What To Expect During a Cognitive Test

Here are some things you can expect from cognition testing.

How Long Does a Cognition Test Last?

The length of a cognition test can vary — it might take just a few minutes or several hours. You can ask your provider how long testing will last so you know what to expect.

What Might You Be Asked To Do in a Cognition Test?

During a cognition test, your healthcare provider may ask you to do tasks that assess your:

• Memory
• Language and speaking abilities
• Motor skills
• Ability to concentrate

To do these tests, you may be asked to:

• Do a puzzle
• Write or draw
• Answer questions

You may be given a tablet, such as an iPad, or a paper form to take a test on your own. Some people may take this test during a regular medical appointment or while waiting to be seen. Your doctor may also ask you questions verbally.

Some tests combine cognitive and physical assessments. Comprehensive neuropsychological tests check motor skills in addition to thinking and reasoning, which means they may involve physical activities. Because of this, some people feel tired afterward.

Types of Cognition Tests for MS

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.

Symbol Digit Modalities Test

Introduced in 1982, the Symbol Digit Modalities Test (SDMT) is a quick and widely used cognition test for adults with MS.

The SDMT involves matching numbers with symbols based on a provided key. You have 90 seconds to complete as many matches as possible. The entire test takes five minutes or less and can be done verbally or in writing.

Doctors often use the SDMT as a first step to check for cognitive changes before recommending further testing or specialists. It can also help track cognitive changes during MS relapses.

Processing Speed Test

The Processing Speed Test (PST) is self-administered on a tablet in your provider’s office and takes about two minutes, plus a few minutes for instruction.

One study found the PST to be an effective predictor for certain brain lesions (areas of nerve damage). Cognitive test performance can’t directly detect lesions, so an MRI is still needed for diagnosis.

Computerized Speed Cognitive Test

The Computerized Speed Cognitive Test (CSCT) is a 90-second test in which you verbally answer questions on a computer. The CSCT is especially useful for detecting problems with processing information.

Multiple Sclerosis Neuropsychological Questionnaire

The Multiple Sclerosis Neuropsychological Questionnaire (MSNQ) is a 15-question survey about symptoms. The MSNQ can be completed by either a person with MS or someone who knows them well.

This symptom questionnaire can be influenced by your mood that day (especially depression) and may not reliably reflect objective cognitive impairment on its own.

This self-reported test helps identify signs of depression and shows how aware a person is at that moment of their own cognitive abilities.

Multiple Sclerosis Functional Composite

The Multiple Sclerosis Functional Composite (MSFC) includes one cognitive test, a timed walking test, and a test of arm function.

The MSFC can be given by a trained professional and doesn’t require a physician or neuropsychologist. The National Multiple Sclerosis Society’s Clinical Assessment Task Force developed the MSFC for use in clinical trials.

Brief International Cognitive Assessment for Multiple Sclerosis

The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) includes the SDMT and other tests to evaluate language ability and spatial recall (the ability to remember locations, shapes, and object positions).

The BICAMS is short, simple, and requires no equipment.

Minimal Assessment of Cognitive Function in Multiple Sclerosis

The Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) is a comprehensive evaluation that can last 90 minutes.

It includes seven neuropsychological tests designed to evaluate language ability, working and spatial memory, and executive function — known as “cognitive domains.”

The MACFIMS is unique in its ability to assess executive function, which refers to a set of mental skills that help with:

• Planning
• Decision-making
• Problem-solving
• Organizing
• Self-control
• Flexible thinking

This test is administered or supervised by a neuropsychologist.

How Can You Prepare for Cognitive Testing?

You can’t study for a cognition test, but you can prepare by getting a good night’s sleep and eating a nutritious breakfast beforehand. Take your regular medications beforehand unless you’re told not to.

Why Is Cognition Testing for MS Important?

Cognition testing offers many benefits for individuals with multiple sclerosis. It can help inform your treatment plan and monitor symptoms of MS over time.

Here are some key ways cognition testing can help:

• Establish a baseline of cognitive function — The National Multiple Sclerosis Society recommends that adults with MS undergo baseline screening when stable.
• Evaluate disease progression — Your healthcare provider may recommend taking the same test annually or more often if needed to assess treatment and monitor symptoms.
• Determine potential interventions — Cognition testing can help pinpoint the areas of cognition where you have the most challenges.
• Evaluate and tailor your treatment plan to your needs.
• Narrow down the cause of cognitive challenges — A comprehensive evaluation can help determine what factors are affecting cognition.
• Meet requirements for government disability programs — An evaluation may be necessary to qualify for government disability programs.

Proactive steps recommended by the National Muliple 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 understanding your cognitive function and getting the support you need.

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