Cognitive problems

MS can affect your thinking. Let’s put our heads together to help you think more clearly.

MS can cause problems with thinking or remembering things. These are known as ‘cognitive problems’ and are often referred to as ‘cog fog’ or ‘brain fog’.^1,2 Around 40–60% of people living with MS have difficulty with thinking, learning or memory at some point.¹

It’s often hard to know if these ‘invisible’ symptoms are related to MS or just part of normal life. For example, you may just put these thinking problems down to stress at work or being tired.² Cognitive problems can have quite an impact on your daily life and work, but can be difficult to explain to friends, family and employers.² That’s because they’re not as easy to see or describe as the more physical symptoms of MS, like coordination and balance problems.

Cognitive issues are the invisible MS symptoms that make you doubt whether it’s related to your MS or not.

Mike

Living with MS since 2014

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When it comes to problems thinking, I never know if this is my MS or if it’s me. For example, if I’ve had a long day at work and I’m tired, I’ll have problems concentrating or difficulty finding or spelling the right word, but this would be the same for anyone – with or without MS. I think it’s important to be aware if these sorts of things are happening more often, and if they are, mention them at your next clinic visit.

Conor

Living with MS since 2003

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It could also be that your family, friends, employer or colleagues notice a change in you. For example, if you start to struggle with work or miss appointments, people might start to wonder what’s wrong.³

Although you might put your cognitive problems down to being tired or stressed, they could be a sign of nerve damage and disease progression.^1,4If you’re having cognitive problems, like trouble concentrating or thinking clearly, tell your healthcare team, even if you’re not sure if they’re caused by your MS.Remember, if you notice and report these things early, there are ways to manage your MS and help slow down your disease progression.⁵

Read on to find out how and why MS can affect your thinking and how you can manage it.

The technical term for the processes involved with thinking is called ‘cognition’. These processes include:^2,6–8

• Storing and processing information
• Memory
• Planning and decision making
• Reasoning and problem-solving abilities
• Language processing

MS can affect these cognitive processes and cause problems with your thinking. Around half of people living with MS may experience some form of cognitive problem.⁷ For example, you might notice that you:⁹

• Forget why you entered a room
• Have trouble finding the right word while in conversation
• Have difficulty concentrating and are more easily distracted
• Have trouble judging the speed or distance of things
• Are slower to process information
• Have difficulty multitasking, prioritising tasks or managing your day
• Have difficulty retaining information or remembering things

I often find it difficult to keep my concentration. When reading a book, my mind starts wandering and I often have to read the same page again and again!

Katie

Living with MS since 2016

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For my job as an actor I have to learn lines. I initially knew something was wrong because I started having problems learning my lines – even the tricks I learnt at drama school didn’t help. These were MS symptoms and I didn’t even realise.

Grace

Living with MS since 2017

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Cognitive problems can affect you in several ways and these will be unique to you and your lifestyle. Cognitive problems can affect your relationships, your work, and your day-to-day activities.²

Cognitive problems may be due to damage in the brain caused by MS.^8,10 However, there are many other factors that can affect your thinking and cognitive issues are not all caused by MS.

Side effects from certain medications

Cognitive problems in people living with MS are usually due to the damage caused by MS directly, but can also be related to the side effects of some medications.¹¹ Medications that can affect memory and thinking include:¹¹

• Steroids
• Muscle relaxants
• Some antidepressants
• Some painkillers
• Anti-seizure medicines

If you’re on any of these types of medications and you’re experiencing cognitive problems, speak to your healthcare team. They can help you work out if your problems are caused by your medications or your MS and help you come up with the best plan to manage them.

Other MS symptoms

It’s possible that some of your other MS symptoms may add to your cognitive problems – for example, fatigue and not getting enough sleep can make it harder to stay alert. Depression and anxiety can also make it harder to think clearly.^2,11

Other factors

Other factors that are not directly related to your MS can cause cognitive problems too. Not getting enough sleep, feeling stressed, having an infection, drinking too much alcohol, or even just being too hot, can all affect your memory and ability to think.^2,11,12

You might be tempted to put your cognitive problems down to something else or try to deal with them on your own.² But if you can, look to trusted family and friends as a source of support – they won’t know what you are experiencing unless you tell them.

If you are having any cognitive issues, talking to people can also help you understand your symptoms better. They can give you an outside opinion on whether they have also noticed a change in you, which can be helpful to confirm the things you’re feeling.^3,13

If it’s affecting your work, you may also want to tell trusted colleagues or an understanding boss to help them understand what is going on. Depending on the kind of work you do and who you work for, you might want to weigh up the potential benefits of telling them, or whether it’s best to keep your diagnosis private. See our page on work for more information and advice.

Lately, I’ve made a few mistakes at work because of problems concentrating, but I don’t want to tell my colleagues it’s related to my MS. But if these problems continue, I will definitely have to tell them and explain it to them to help them understand.

Mike

Living with MS since 2014

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It’s important to tell your healthcare team as soon as you notice things like problems with memory or thinking. Even if you’re not sure if it’s related to your MS, it’s important to tell them what you are experiencing, so that they can help you find a way to manage these cognitive problems that is right for you.³

Cognitive rehabilitation and exercise

Cognitive problems can be treated with specific brain training exercises, known as cognitive rehabilitation.^3,6,8 This may include a combination of two types of activities:

• Activities to help regain your cognitive abilities – this might include repeating and verifying information
• Activities to help you manage day to day – including things like setting reminders.³

Although cognitive rehabilitation is currently the most effective way to help combat cognitive problems, there is also some evidence that exercise can help too.¹⁴ Getting an exercise plan in place is a good idea, as it can help with a wide range of MS symptoms. Read our exercise page for further details.

If you try to fight it, it’s almost as if it gets harder. The moment I accepted that my memory problems were due to my MS was the moment I found my memory got better.

Grace

Living with MS since 2017

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Tips to help stay organised and on top of your cognitive problems

Outside of cognitive rehabilitation and exercise, there are a few things you can try to help deal with your cognitive problems, and to help you stay organised and on top of things in your daily life:^2,3,15

• Have a fixed routine – perform certain activities at the same time each day or always putting things back in the same place
• Use calendars – to help with planning and setting reminders
• Making to-do lists –to remember things and prioritise tasks
• Take notes – take written notes or make voice recordings
• Reduce distractions – by working in quiet spaces and focusing on one task at a time
• Try brain and memory games – play games, puzzles or crosswords on your phone
• Read and write regularly – to help keep your mind active
• Learn something new – like a new skill or even a language
• Live a healthy lifestyle – including eating healthily and getting more sleep

Someone told me to try activities on my phone (e.g. brain teasers) to help with cognitive problems. I have used these myself and have played games that are ridiculously addictive! I like them because you have to think about what to do next and it keeps your mind focused on that.

Katie

Living with MS since 2016

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MS may or may not always be the cause of your cognitive problems, but it’s important to talk to your healthcare team about them all the same. This will help them understand what’s causing these symptoms and help you work out how best to manage them. Don’t forget to tell them about any medications you take, since some side effects can also affect your thinking.^2,11

1. NICE Clinical Knowledge Summary: Multiple Sclerosis. https://cks.nice.org.uk/multiple-sclerosis. Updated October 2019 [accessed July 2020].
2. MS Trust. Thinking and memory problems. https://www.mstrust.org.uk/life-ms/wellbeing/thinking-and-memory-problems [accessed July 2020].
3. National MS Society. Cognitive changes. https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Cognitive-Changes [accessed July 2020].
4. Gelfand JM. Handb Clin Neurol. 2014;122:269–90.
5. Giovannoni G, et al. Mult Scler Relat Disord. 2016;9:S5–48.
6. Thomas PW, et al. Psychological interventions for Multiple Sclerosis. Cochrane Database Syst Rev. 2006;1:CD004431.
7. Sumowski JF, et al. Neurology. 2018;90:278–88.
8. Perez-Martin MY, et al. Neuropsych Dis Treat. 2017;13:245–52.
9. MS Society. Cognitive problems in MS. https://www.mssociety.org.uk/about-ms/signs-and-symptoms/memory-and-thinking/cognitive-problems-in-ms [accessed July 2020].
10. Jonkman LE, et al. PLoS One. 2015;10:e0129380.
11. Cleveland Clini, Multiple sclerosis (MS): Impaired cognition. https://my.clevelandclinic.org/health/diseases/14455-multiple-sclerosis-ms-impaired-cognition [accessed July 2020].
12. Lynch SG, et al. Mult Scler. 2005;11:469–76.
13. VeryWellHealth. An Overview of Cognitive Impairment in Multiple Sclerosis. https://www.verywellhealth.com/cognitive-impairment-in-ms-2440794 [accessed July 2020].
14. DeLuca J, Chiaravalloti ND, Sandroff BM. Nat Rev Neurol. 2020;16,319–32.
15. Healthline. Cog Fog: How to Deal with This Frequent MS Symptom. https://www.healthline.com/health/multiple-sclerosis/cog-fog-science-and-tips#1 [accessed July 2020].