Multiple Sclerosis and Your Mind

By

Christopher Iliades, MD

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It's no secret that multiple sclerosis (MS) affects your brain. The disease attacks the central nervous system, disrupting signals to and from the brain and producing an array of symptoms. This includes movement issues, bowel and bladder problems, fatigue, numbness, vision troubles, and more.

But MS can alter the mental functions within the brain itself or what you think of as your mind. As a result, you may experience its effects on the type of mind function called cognition. Cognition is knowledge acquired through thoughts, experiences and the senses.

Cognitive dysfunction is the name for when MS impairs your cognition, especially your memory. Except in rare cases, MS cognitive dysfunction is not severe enough to interfere with day-to-day activities. You might notice it when you're trying to multitask or jog your memory for a name. However, more than half of all people with MS notice some cognitive symptoms.

Cognitive Dysfunction Symptoms

Cognitive symptoms do not seem to have much relation to other MS symptoms. You could have no other symptoms and still have cognitive symptoms, or you could have lots of other symptoms and your mind could be clear as a bell. Cognitive symptoms may include:

  • Difficulty finding the right words in conversation

  • Difficulty multitasking

  • Difficulty paying attention or concentrating

  • Short-term memory lapses

  • Trouble processing new information or learning new tasks

Cognitive dysfunction does not make you less intelligent. It doesn’t mean you can’t read, remember your past, or carry on an intelligent conversation. But for about 5-10% of people with MS, it can have a significant impact. In fact, cognitive dysfunction and fatigue are the main reasons people with MS drop out of the work force.

Diagnosing and Treating Cognitive Dysfunction

There's no simple way to diagnose cognitive dysfunction. The best way is to sit down with a neuropsychologist. A neuropsychologist specializes in the relationship between the brain and human behavior. You may take a group of tests that evaluate your memory, attention, and other mental tasks.

If you have significant cognitive dysfunction, your doctor may try to eliminate any factors that could be making your cognitive function worse. These factors may include:

  • Anxiety

  • Depression

  • Excessive use of alcohol

  • Fatigue

  • Low thyroid function

  • Medications

  • Sleep disorders

  • Stress

You also might benefit from cognitive training, like doing memory exercises on a computer or learning how to use strategies to avoid cognitive lapses. These strategies include using such things as organizing systems and programmed reminders.
Your doctor might suggest that you take donepezil (Aricept). It has had some success in treating MS cognitive dysfunction. Aricept works by increasing a chemical in the brain that carries messages between nerve cells. A study in the Journal of the Neurological Sciences compared Aricept with a placebo in 69 people with MS cognitive dysfunction. After 24 weeks, those taking Aricept had better improvement in memory and other areas of cognition than the people taking the placebo.

Cognitive Dysfunction and Depression

Depression is common in people with MS. In fact, about half of all people with MS need some treatment for depression at some point. Depression in MS often goes hand-in-hand with anxiety and fatigue. And it can make cognitive dysfunction worse. Treating depression may improve cognitive dysfunction.

A study in the Multiple Sclerosis Journal found that depression, anxiety and fatigue were all common in people with MS. More than 18% of the study participants had depression, about 44% had anxiety, and almost 54% had fatigue. All of these conditions can make cognitive dysfunction worse.


Any unpredictable, long-term disease is stressful, and MS is no exception. MS may cause changes in your brain that set you up for depression. The stress and anxiety you may be feeling can also lead to depression. Some of your MS drugs, such as interferon and steroids, may also increase your risk for depression.

Watch for these symptoms of depression:

  • Changes in eating patterns

  • Changes in sleep patterns

  • Feelings of hopelessness

  • Lack of energy

  • Persistent sadness

  • Trouble concentrating

  • Thoughts of death or suicide

If you experience any of these signs, talk with your doctor. Get an evaluation so you can get depression under control.

Key Takeaways

  • Cognitive dysfunction affects more than half of all people with MS.

  • Symptoms of cognitive dysfunction include forgetfulness, disorganization, and difficulty multitasking.

  • Cognitive dysfunction does not affect long-term memory or intelligence. But you should see your doctor for a diagnosis and treatment.

  • Eliminating conditions that contribute to cognitive dysfunction, especially depression, is an important part of your MS treatment.

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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Jan 19, 2018

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Medical References

  1. Wood B, et al. Prevalence and concurrence of anxiety, depression and fatigue over time in multiple sclerosisMult Scler 201319(2): 217224.
  2. Depression & Multiple Sclerosis. Cleveland Clinic. http://my.clevelandclinic.org/services/neurological_institute/mellen-center-multiple-sclerosis/patie...
  3. Impaired Cognition in Multiple Sclerosis. Cleveland Clinic. http://my.clevelandclinic.org/services/neurological_institute/mellen-center-multiple-sclerosis/patie...
  4. Donepezil. Multiple Sclerosis Trust. https://www.mstrust.org.uk/a-z/donepezil
  5. Cognitive Dysfunction. National Multiple Sclerosis Society. http://www.nationalmssociety.org/For-Professionals/Clinical-Care/Managing-MS/Symptom-Management/Cogn...
  6. Christodoulou C, et al. Effects of donepezil on memory and cognition in multiple sclerosis.  J Neurol Sci 2006;245(1-2):127-36.

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