Cognitive Changes and Mental Health

Keeping your brain active is an important part of managing multiple sclerosis (MS). MS can sometimes affect your thinking, memory, and concentration, but there are many ways to help maintain your cognitive health and stay sharp.

Why Brain Health Matters

  • Cognitive changes: MS can cause difficulties with memory, attention, processing speed, and problem-solving.
  • Brain health benefits: Staying mentally active can help slow cognitive decline and improve your overall quality of life.

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Cognitive changes are common in people with multiple sclerosis (MS), affecting around half of those diagnosed and impacting daily activities such as memory, attention, and problem-solving. These difficulties can be subtle at first but may become more pronounced over time, reducing independence and quality of life.

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Cognitive Changes

Cognitive changes are common in people with multiple sclerosis (MS), affecting around half of those diagnosed and impacting daily activities such as memory, attention, and problem-solving. These difficulties can be subtle at first but may become more pronounced over time, reducing independence and quality of life.

What Are Cognitive Changes?
Cognitive changes refer to difficulties with mental processes including memory, information processing speed, attention, executive function, visual–spatial skills, and word-finding. People may notice slower thinking, trouble recalling recent conversations, difficulty planning tasks, or finding the right words in conversation.

Demyelination and neurodegeneration in the brain interrupt communication between nerve cells, leading to slowed information processing and memory deficits. Lesions in the frontal lobes and widespread white and grey matter changes particularly affect executive function, decision-making, and complex problem-solving.

Other factors, such as medication side effects, lack of sleep, depression, anxiety, stress, and fatigue, can also influence cognitive function but are not always directly caused by MS itself. For most people, cognitive symptoms are relatively mild and can fluctuate from day to day.

If you notice difficulties with memory, planning, or concentration, discuss these symptoms with your neurologist, MS nurse, or GP promptly to rule out other causes and plan assessment. Routine cognitive screening using validated tools can detect early impairment and guide referral to neuropsychologists or cognitive rehabilitation services.
  • Use memory aids: Diaries, calendars, and smartphone apps can help track appointments and tasks.
  • Implement structured routines: Clear task lists and consistent daily schedules simplify day-to-day activities.
  • Practice cognitive exercises: Computer-based training programmes or mental exercises can strengthen attention and processing speed.
  • Engage in regular physical activity: Aerobic exercise has been shown to support cognitive function in MS.
  • Prioritise good sleep hygiene: Regular sleep patterns and a restful environment improve mental clarity.
  • Manage stress: Mindfulness, meditation, or relaxation techniques can help reduce stress-related cognitive difficulties.
Cognitive rehabilitation led by occupational therapists, neuropsychologists, or speech therapists can use restorative and compensatory strategies to improve function and adapt routines. Restorative approaches focus on exercises to enhance memory, attention, and executive skills, while compensatory strategies teach the use of external aids and environmental modifications. Pharmacological options for cognitive symptoms are limited, although some clinicians may trial medications such as memantine or stimulants on a case-by-case basis under specialist supervision.

Practical Ways to Keep Your Brain Active

Engage in Mental Challenges

  • Reading, doing crosswords, puzzles, and playing games are great ways to keep your mind engaged.
  • Try learning new skills or hobbies that interest you.

Stay Socially Connected

  • Social activities and conversations stimulate your brain and support emotional well-being.
  • Join clubs, groups, or online communities to stay connected with others.

Use Memory Aids

  • Use calendars, reminders, and apps on your phone to help you stay organised and remember important tasks.
  • Write notes, take photos, or send yourself messages to jog your memory.

Plan and Set Goals

  • Break tasks into smaller steps and set achievable goals.
  • Planning ahead helps reduce stress and keeps your mind focused.

Exercise Regularly

  • Physical activity supports brain health by improving blood flow and reducing stress.
  • Regular exercise can help with memory, mood, and overall well-being.

Manage Fatigue and Distractions

  • Take regular breaks to recharge your brain and body.
  • Avoid noisy or distracting environments when you need to concentrate.
  • Schedule challenging tasks for times when you have the most energy.

Positive Thinking and Self-Care

  • Practice positive reframing and focus on what you can do.
  • Look after your emotional health depression and anxiety can affect your thinking and memory.

Emotional and Mood Changes

Emotional and mood changes are common in people with multiple sclerosis (MS), affecting a significant proportion of those diagnosed and influencing quality of life and daily functioning.

These changes can range from feelings of sadness, anxiety, and irritability to sudden, uncontrollable episodes of laughing or crying known as pseudobulbar affect. Recognizing and managing these symptoms early is crucial for maintaining emotional well-being and overall health.

What Are Emotional and Mood Changes?

Emotional and mood changes in MS include:

  • Persistent low mood or depression: Feeling sad, hopeless, or losing interest in activities you once enjoyed.
  • Heightened anxiety: Excessive worry, nervousness, or fear about the future.
  • Irritability and mood swings: Feeling easily annoyed, frustrated, or experiencing rapid shifts in mood.
  • Pseudobulbar affect (PBA): Sudden, involuntary laughing or crying episodes that are disproportionate or unrelated to actual feelings.

These changes can be subtle or pronounced and may fluctuate over time.

Emotional and mood changes in MS have multiple causes:

  • Neurological changes: MS lesions in the brain’s frontal lobes and limbic system disrupt neural networks responsible for regulating mood and emotions, leading directly to mood disturbances.
  • Psychological factors: The stress of living with a chronic illness, uncertainty about the future, grief over loss of function, and social isolation can all contribute to depression, anxiety, and mood swings.
  • Medication side effects: Some medications used to treat MS or its symptoms can affect mood and emotional control.
  • Physical symptoms: Fatigue, pain, sleep disturbances, and reduced mobility can indirectly exacerbate emotional symptoms.
  • Talk to your healthcare team: Discuss any new or worsening mood symptoms with your neurologist, MS nurse, or GP promptly to rule out other causes and adjust your treatment plan.
  • Keep a mood diary: Track the frequency, duration, and triggers of emotional episodes to help your healthcare team tailor interventions.
  • Communicate with loved ones: Be open with family and friends about how you feel to build understanding and support within your personal network.
  • Psychological therapies: Engage in cognitive behavioural therapy or counselling to develop coping skills and address negative thought patterns.
  • Mindfulness and relaxation: Practice meditation, deep-breathing exercises, or progressive muscle relaxation to reduce stress and anxiety.
  • Regular physical activity: Participate in tailored exercise programmes, such as walking or gentle yoga, to boost mood and alleviate tension.
  • Sleep hygiene: Establish a consistent sleep schedule and a restful bedroom environment to improve sleep quality and emotional resilience.
  • Social support: Join MS support groups or peer-led networks to share experiences, reduce isolation, and gain practical advice.
  • Healthy lifestyle: Maintain a balanced diet, limit caffeine and alcohol, and stay hydrated to support brain health and emotional stability.
  • Gratitude and grounding: Keep a gratitude journal or practice grounding exercises to focus on positive aspects and stay present.
  • Delegate tasks: Reduce stress by asking for help with daily tasks when needed.

Treatment plans are personalised and may combine non-pharmacological and pharmacological approaches:

  • Antidepressants and anxiolytics: Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are commonly prescribed for depression and anxiety in MS.
  • Mood stabilisers: Medications like lithium or valproate may be used for bipolar symptoms or severe mood swings.
  • PBA management: Dextromethorphan-quinidine (Nuedexta) or off-label antidepressants at lower doses can significantly reduce frequency and severity of involuntary laughing or crying episodes.
  • Therapy referral: Referral to clinical psychologists, psychiatrists, or specialised neuropsychiatric services ensures comprehensive assessment and ongoing support.

General Information

Living with cognitive changes and emotional mood changes can be challenging, but support is available:

Always consult your healthcare team before starting any new treatment or therapy to ensure it fits your individual needs and MS management plan.

Frequently Asked Questions (FAQs)

How can I keep my brain active if I have MS?

Reading, puzzles, learning new skills, staying socially connected, and using memory aids are all effective ways to keep your brain active.

Yes, regular exercise supports brain health by improving blood flow, reducing stress, and helping with memory and mood
Talk to your GP or MS nurse. They can help you access strategies and support to manage cognitive changes.

Yes, using calendars, reminders, and memory apps on your phone can help you stay organised and remember important tasks.

Find a quiet space, take regular breaks, and avoid multitasking. Schedule complex tasks for times when you have the most energy.

Symptom Management