World MS Day: Cognitive Function in Multiple Sclerosis

Meghan Beier, PhD, MA

Each year, on May 30th, World MS Day, is recognized globally to raise awareness of the lives that are impacted by multiple sclerosis (MS). The disease not only affects physical functioning in patients but also has a significant impact on their cognitive functioning.

Depending on where the patient is in the progression of the disease, the cognitive changes in them can range from mild difficulties to more pronounced impairments in different cognitive domains. Therefore, by gaining a deeper understanding of how MS affects cognition, patients with MS can feel more empowered to proactively manage their cognitive health and enhance their overall well-being.

In honor of World MS Day, Meghan Beier, PhD, MA, health and rehabilitation psychologist at the Rowan Center for Behavioral Medicine, sat down in an interview with NeurologyLive® to discuss how cognition changes vary in MS based on the stage of the disease She also talked about some of the effective interventions and therapies that patients with MS use to improve their cognitive function. In addition, Beier spoke about how psychological well-being, including mood and anxiety disorders, influences cognitive function in patients with MS.

NeurologyLive®: How does MS affect cognitive function and what areas of cognition are typically affected in patients?

Meghan Beier, PhD, MA: About 65% of patients with multiple sclerosis experienced some form of cognitive change throughout their life. About 33% of people with MS are even experiencing cognitive changes at the time of their diagnosis. We see the most amount of cognitive change in individuals with secondary progressive, which isn't too surprising, because that follows people living with relapsing remitting for quite a while. It is quite common. The most common domains that people with MS experience include changes are processing speed, and how fast the brain is processing information. Also learning, acquisition or encoding of new information, as well as executive function and working memory are some of the primary areas. A lot of individuals with MS will also describe word finding problems, so that can be a combination of some of the other domains I've already mentioned.

How can patients improve their cognitive function or reduce risk of cognitive decline?

A first step is figuring out what is driving the cognitive changes. We want to find out if there's any emotional symptoms that are impacting cognition. We want to find out if there's any MS symptoms themselves, things like fatigue that are exacerbating symptoms. Either a screening a cognitive screening, or a comprehensive neuropsychological evaluation is really ideal so we can understand fully what's happening. Then, we can use that information to figure out what is the best type of intervention. Cognitive rehabilitation has gotten a lot of attention over the last decade. There's some great information out there on improving learning acquisition with studies coming out of the Kessler Institute. We've looked at overall improving cognitive functioning with some online type programs, including brain HQ, but there are many others. Working with speech pathologist or occupational therapists, or even some neuropsychologist that [can] do these interventions, are great options for improving cognitive functioning. If there are medications or there's emotional challenges or other factors that are exacerbating cognitive challenges, then we want to address those with the right specialist who has that expertise.

Is there anything else that patients can do themselves in terms of lifestyle behaviors that can help them maintain their cognitive function?

There's many things that patients can do themselves. I tend to tell the people that I work with that one of the best things you can do is to keep your brain active and engaged. What that means is, are you stretching your mind if you're still working? If an individual is still working, that's ideal because they're using their mind every day in unique types of ways. If they're not working, then we want to have a structured environment where they're getting lots of contact with other individuals such as loved ones or friends, getting out into the community, doing things like going to visit a museum, watching a documentary, or reading books. This is person by person, whatever helps them the most. But it's really stretching your brain a little bit and keeping it active and engaged. Beyond that, we want to do what helps all of us keep our brains healthy, which is things like exercise, eating healthy, working with your physicians to make sure they all have any comorbidities, such as high blood pressure, or cardiac issues are addressed. What helps the general population keep their brain healthy, helps people with MS. All of those things are really important, the over and above or even just as a starting point to help slow down or even improve cognitive functioning.

What role does psychological well-being and mental health play in cognitive function for individuals with MS?

Often, when I'm talking to individuals with multiple sclerosis who have concerns about both mood and cognition, I give examples that are universal to all individuals. For example, if you've ever lost a loved one and felt really grieved, and had trouble coming up with words or thinking straight during that time, that's a great example of how mood can impact cognition. Similarly, if you're put on the spot, or you're triggered physiologically, such as in an angry argument. Sometimes it's hard to think straight to problem solve to come up with words, those are justhow they play out. But there's some great research out there showing that individuals with MS who are depressed or who have other kinds of mood symptoms like anxiety, also are much more distractible. For example, if somebody's trying to work, and the phone rings, or a dog barks, and they also have depression, they're much more likely to get distracted. It's much harder to get back on track when have depression. We also know that there's brain changes for individuals who have different mood disorders like depression. There's the living with depression is hard, living with anxiety is hard it interrupts our thinking skills. We also know that those factors have a direct impact on the brain and how it works as well.

Transcript edited for clarity.