Multiple sclerosis (MS) is a disease that affects your central nervous system, which is made up of your brain and spine. In MS, your immune system attacks myelin, the tissue that covers your nerves. Myelin acts like the rubber coating on an electrical wire to protect the nerves and help signals travel from your brain to your body.

When myelin is destroyed, it’s replaced by scar tissue or lesions. You might have trouble with a wide range of things, from movement and vision to memory and emotions.

MS affects nerves (and the myelin that covers them) in the two types of tissue that make up the brain:

Gray Matter. This tissue makes up the outer layer of your brain, called the cerebral cortex. It’s also found deep inside the brain. Gray matter mostly contains nerve cells, which helps you process information. It controls your emotions, movement, and memory.

White Matter. Found inside the brain, white matter is made of nerve fibers. They connect nerve cells. They’re covered in myelin.

MS and Cognition Problems

Cognition is the high-level jobs your brain does, like processing information, problem solving, and remembering things.

Damage to your brain from MS, like lesions and loss of nerve tissue, can lead to cognition problems.

Research shows that damage to gray matter plays a role. About half of people with MS have some kind of cognitive change. It can happen with any type of MS, but it’s slightly more common with progressive MS. You’re more likely to have problems during a flare as well as in later disease stages.

When your brain signals are interrupted, you may have trouble:

Finding the right words.

They’re on the tip of your tongue, but you can’t call them up.

Remembering things.

You have trouble recalling things that happened recently. For example, you may have no problem remembering a teacher from grade school but forget your new neighbor’s name.

Concentrating.

Your mind wanders, especially when a lot of people are talking at once. It’s difficult to do more than one thing at once, like talking on the phone while cooking dinner.

Problem solving and planning.

MS can affect your judgment. It’s often harder to see the consequences of your actions.

Processing information.

You’re thinking and reacting slower. You may not be able to follow a complex set of instructions.

Judging size and distance.

You can’t tell where things are in the world around you. This affects your ability to drive and read a map. Your doctor might call it visual-spatial skills.

How Do You Diagnose Cognitive Problems?

Ask your doctor to check your cognition each year. You should also tell them if you notice any cognitive changes.

If the doctor sees a change or if you’re struggling with work or school, you’ll need a detailed cognitive evaluation from a neuropsychologist. These are doctors who specialize in behavioral changes caused by disease or trauma. You might also see a speech-language pathologist and occupational therapist for testing.

It’s important that these doctors have experience working with people with MS. This helps them choose the right tests and interpret them.

The evaluation includes a variety of tests. They check different parts of your cognitive function, like your processing speed, memory, problem solving, and more. The whole process can take several hours.

How to Manage Cognitive Changes

Right now, there aren’t any drugs to treat cognitive changes in MS. If you have a relapsing kind of MS, your doctor may prescribe a treatment called disease-modifying therapy to prevent more lesions.

Or the doctor could recommend cognitive rehabilitation. These are sessions where you do different activities to help you live life with your cognitive changes. They can help boost your memory, concentration, or spatial skills.

You might have these sessions at a clinic or hospital. Or you may meet with individual health care professionals, like neuropsychologists, occupational therapists, and speech pathologists. It usually involves hourly sessions for several weeks or months.

Cognitive rehabilitation often focuses on:

Retraining exercises. These mental exercises are meant to improve attention, concentration, and more. One promising example is the modified Story Memory Technique, a 10 session program that uses computer software to boost verbal learning and memory.

Compensatory strategies. These moves can help make up for some of your cognitive changes. They include tried and true tips that will jog your memory, help you manage time and keep you organized.

Tips to Help Manage Cognitive Challenges

Make a note of it

Set reminders, keep notes, and record messages to yourself on your phone. Or leave sticky notes for yourself around the house, office, or anywhere else you need them.

Manage time wisely

Do the most mentally demanding tasks when your brain is the least foggy. Break big tasks in to small, easy-to-achieve chunks. Give yourself more time to complete tasks for days when you aren’t at your best. If you’re tired or can’t focus, chill for a while. Cut out distractions like TV in the background.

Talk back

If your mind wanders during conversations, start repeating a small part of what the person just said. I may seem weird at first, but you’ll get used to it. And they’ll love it that you’re paying attention.

Play mind games

If you have trouble with names, make visual and verbal associations, like picturing a crown on someone named Mr. King.

Create routines

Keep items like your keys or phone in the same places and do things in the same order.

MS and Your Moods

MS can affect your mood in different ways. It can be mentally hard to adjust to a chronic, constantly changing disease. Changes in your brain may also affect your emotions. Scientists think damage to nerves in your limbic system, the part of the brain that controls emotions, may be to blame.

Sometimes the medications used for MS can also affect your emotions. Corticosteroids, which help control inflammation, can cause mania, depression, anxiety, panic disorder, delirium, suicidal thoughts, and aggression. They can also cause problems with paying attention, concentration, and finding the right word.

You could feel some or all of these emotions:

Grief and sadness

You may mourn the loss of the life you had before MS.

Depression

It’s one of the most common MS symptoms. With clinical depression, you have lasting signs, such as feeling blue or hopeless, for at least 2 weeks.

Anxiety, worry, and fear

MS is unpredictable. Your symptoms can appear or change suddenly. These emotions are natural reactions to the uncertainty.

Stress

Getting through the day with MS can be taxing. And stress can make your MS symptoms worse.

Moodiness, irritability, and anger

Living with MS and depression can lead to these emotions.

Low self-esteem

Not being able to do certain things anymore can take a toll on your confidence.

These emotional changes are less common:

Euphoria

Changes in your brain can lead to unrealistic happiness in a small number of people with MS.

Uncontrollable laughing or crying

About 10% of people with MS have pseudobulbar affect (PBA). That’s a condition where you cry or laugh uncontrollably, often out of sync of your mood.

Diagnosing and Treating Mood Changes

If you or your friends or family notice a shift in mood, talk to your doctor. Also ask them to check your mood at least once a year.

Your doctor may refer you to a mental health professional, like a psychiatrist, psychologist, counselor, or social worker. They may prescribe medication, such as antidepressants for depression or anxiety. Your health care team will follow you closely to make sure the medicine is working.

Your doctor may also recommend talk therapy, like cognitive behavioral therapy. That helps you notice negative thoughts and replace them with positive ones. Joining a support group may also ease stress and help you feel less alone.

Setting a self-care routine can also help. When your mood dips, you can do things that help you feel nourished, like taking a bubble bath, listening to music, or having a date night.

MS and Physical Problems

In addition to brain fog, memory problems and emotional changes, damage to nerves in your brain can also cause problems like:

Optic neuritis

Symptoms include blurry vision and eye pain. It usually goes away on its own.

Diplopia

You might see double.

Nystagmus

These rapid, uncontrollable eye movements can be side to side, up and down, or in circles.

Trigeminal neuralgia

It can hurt to do anything that involves touching your face -- even something as simple as brushing your teeth.

Usually a physical exam and an MRI can diagnose these conditions. Medications to treat them include steroids and drugs that stop convulsions.

MS can also affect your brain stem (the doctor will call this your cerebellum). It drives your movements based on signals from your brain and feedback from your nerves. When nerve fibers in the cerebellum get damaged, you can have a number of problems including:

Ataxia

This umbrella term means uncontrolled movements. You might sound a little slurred when you speak, or you might be unintelligible. Your hands might shake and you could have problems with balance or weakness in your limbs. There are no drugs that treat ataxia, so doctors often use medications for other conditions. Strengthening exercises, yoga and tai chi can help. So can walking aids like canes.

Hearing loss

This only affects a small number of people with MS. A doctor called an audiologist can diagnose it.

Trouble swallowing

This happens when the nerves that control muscles in your mouth and throat get damaged. You may have trouble with liquids or solids, feel like something is struck in your throat, or cough and choke when you eat or drink. Experts called speech language pathologists can diagnose and treat it. They’ll give you a drink that shows up on X-rays and watch while you swallow and chew to find out where the problem areas are. Treatment includes changing your diet and the way you eat, plus exercises to help you swallow.

Tremor

Nerve damage in parts of your brain called the thalamus and the basal ganglia, which are both involved in controlling movement, can also cause tremor. Surgery to disrupt nerves cells in the thalamus can help with tremor, but it’s risky.