The signs of early cognitive disorders in multiple sclerosis
Multiple sclerosis (MS) is often perceived as a disease that primarily affects the body: walking, balance, muscle strength. However, there is a less visible but equally impactful dimension: cognitive disorders. This "cognitive fog" is not imaginary; these are real symptoms directly related to the disease.
Recognizing the early signs of these disorders is the first crucial step to take action and implement appropriate strategies. These cognitive difficulties affect about 50 to 60% of people with MS, but their severity varies considerably.
Our brain has an extraordinary capacity called neuroplasticity: it can create new connections to bypass damaged areas. This is where cognitive stimulation and appropriate strategies become essential to preserve your quality of life and autonomy.
of MS patients develop cognitive disorders
cognitive areas primarily affected
of cases remain mild to moderate
of patients can benefit from appropriate strategies
1. Understanding the mechanism of cognitive disorders in MS
Multiple sclerosis is a disease where the immune system attacks the myelin, the protective sheath that surrounds nerve fibers in the brain and spinal cord. Imagine the nerves in your brain as complex electrical cables: myelin is the insulation that surrounds them. When this insulation is damaged, information travels more slowly, less effectively, or gets lost along the way.
The process of demyelination and its consequences
This demyelination process slows communication between different areas of the brain. Think of a phone conversation with a poor connection: the words are chopped, information is missing, and it takes considerable effort to understand the overall message.
Most affected brain areas
Lesions in the white matter particularly affect the connections between the frontal cortex and other brain regions, explaining why executive functions and processing speed are often the first to be impacted.
Tasks that once seemed automatic, like following a conversation or remembering a shopping list, suddenly require considerable mental energy. This is not a lack of willpower, but a very real neurological challenge that requires adaptation and specific strategies.
💡 Practical advice
Understanding the mechanism of your disease helps you better accept these changes and adopt a proactive approach. This knowledge is the first step towards effective management of your cognitive symptoms.
2. The cognitive areas most frequently affected
Cognitive disorders in MS are not a form of dementia like Alzheimer's disease. They affect specific functions, and identifying them will help you put a name to what you are experiencing and develop appropriate strategies.
🎯 The 5 primarily affected areas
- The speed of information processing: the brain's ability to receive, analyze, and respond quickly
- Memory: primarily short-term memory and working memory
- Attention and concentration: the ability to focus without being distracted
- Executive functions: planning, organization, problem-solving
- Visuospatial abilities: perception of distances, shapes, and orientation in space
Processing speed: mental slowing
This is often the first and most common disorder. Your brain is still functioning correctly, but it takes longer to process information. This slowness can be frustrating as it affects all other cognitive areas.
Give yourself more time for complex tasks and don't hesitate to ask your conversation partners to repeat or slow down the pace of conversations.
Memory disorders: more than just forgetfulness
This is not about forgetting who you are or your personal history, but rather about difficulties in retaining new information or quickly retrieving recent memories. Long-term memory generally remains preserved.
These disorders primarily affect working memory, the ability to temporarily hold information in mind for mental manipulation. For example, remembering a phone number long enough to dial it or following the steps of a complex recipe.
3. Identifying early signs in your daily life
The first signs are often subtle and can be attributed to fatigue, stress, or normal aging. However, if these situations become recurrent and require an unusual constant effort, it is important to pay attention to them.
Alert signal: If you notice that tasks that were once automatic now require intense concentration, or if you feel mentally exhausted after simple intellectual activities, these signals deserve your attention.
Processing speed: when the brain operates slowly
It's as if your brain, which was once a race car, is now running in second gear. You still reach your destination, but it takes more time and energy.
📝 Concrete examples to watch for
In meetings or groups: You have difficulty keeping up with the flow of fast conversations. By the time you understand a joke, everyone has already moved on to another topic. You feel out of sync, one step behind the others.
When faced with questions: Someone asks you a simple question. You know the answer, but it takes a few extra seconds to "come up" to the surface. This latency can be frustrating.
Memory disorders in real situations
Forgetting your keys happens to everyone. In MS, the problem is different: it's less about total forgetfulness and more about difficulty in "retrieving" the information stored in your brain or encoding new information.
Types of memory affected in MS
Research shows that MS primarily affects episodic memory (memories of specific events) and working memory, while semantic memory (general knowledge) and procedural memory (automatic skills) often remain preserved.
Compensation strategies
Cognitive training can help develop alternative strategies for encoding and retrieving information, leveraging preserved memory systems.
You are in the middle of telling an anecdote and suddenly, your train of thought cuts off. You know where you wanted to go, but the word or the next idea has evaporated. It's the famous phenomenon of "tip of the tongue," but it happens more frequently.
4. Attention and concentration difficulties
Your attention becomes like a butterfly struggling to land on a single flower. It is easily diverted by the slightest external stimulus, making tasks that require sustained concentration particularly exhausting.
🎯 Typical situations of attention difficulties
Reading and concentration: You try to read a book or an article. After a few lines, your mind wanders. You reread the same paragraph three times without understanding its meaning, as external noise or a distracting thought has captured your attention.
Multitasking: Doing two things simultaneously becomes a real challenge. Cooking while listening to the news can lead to mistakes, such as forgetting an ingredient or salting the dish twice.
These attention difficulties are particularly frustrating because they affect everyday activities. Divided attention, the ability to share attention between multiple tasks, becomes problematic. It becomes preferable to focus on one thing at a time.
Create a calm and distraction-free environment for important tasks. Turn off notifications, close the television, and inform those around you that you need peace and quiet.
5. Executive functions: when planning becomes complex
Executive functions are the "conductor" of your brain. They coordinate all other cognitive functions to allow you to plan, organize, solve problems, and make decisions. When they are affected, organizing a simple day can feel like climbing a mountain.
🧠 Executive functions include
- Planning and organizing tasks
- Solving complex problems
- Cognitive flexibility (adapting to changes)
- Inhibition (resisting distractions)
- Decision making
- Time management
Concrete examples of executive difficulties
🍳 Preparing a complete meal
You need to manage the shopping list, prepare the ingredients, cook several items simultaneously, and time everything to be ready at the same time... This logical sequence, once automatic, can seem insurmountable. You may feel overwhelmed and opt for an easier solution.
💰 Managing the monthly budget
Sorting bills, planning payments, anticipating expenses, comparing prices... All of this requires mental organization that may have become exhausting. The steps seem to get tangled, and the cognitive load becomes significant.
These executive difficulties can have a significant impact on autonomy and self-confidence. It is important to recognize them in order to develop appropriate compensation strategies and preserve your independence.
6. The impact on personal and professional life
These cognitive difficulties, although invisible to others, have very real repercussions on your daily life. They can generate frustration, a loss of self-confidence, and a gradual feeling of isolation that requires special attention.
At work: navigating a demanding environment
The professional world, often fast-paced and multitasking, can become a minefield. The fear of making a mistake, missing a deadline, or appearing less competent can generate considerable stress that paradoxically worsens cognitive symptoms.
Possible accommodations at work
Many accommodations can be put in place: additional break times, a calm work environment, organizing tasks by priority, using digital tools to aid organization.
Dialogue with the employer
Don't hesitate to discuss with your employer or human resources. Acknowledgment of the disability can entitle you to legal accommodations that will allow you to maintain your professional activity under better conditions.
You can develop compensation strategies like writing everything down, working longer, or checking your work multiple times, but this significantly increases your cognitive fatigue and can create a vicious cycle.
In social life: preserving connections
Group outings, noisy dinners, fast conversations can become a source of stress rather than pleasure. The constant effort to keep up, to not lose the thread, is mentally exhausting and may lead you to decline invitations.
Favor small gatherings in quiet places. Explain your difficulties to your loved ones so they can adjust the pace of conversations. The quality of exchanges takes precedence over quantity.
7. Cognitive fatigue: a symptom in its own right
It is essential to differentiate physical fatigue from cognitive fatigue. The latter is not just simple drowsiness or a lack of physical energy. It is the feeling that your brain is "saturated," "emptied," unable to process additional information.
Recognizing cognitive fatigue: After an intellectually demanding task (even if it seemed simple before), you feel completely drained, unable to think clearly, sometimes with headaches or a feeling of "mental fog".
Understanding its mechanisms
Cognitive fatigue in MS results from the extra effort your brain must exert to compensate for damaged connections. It's like having to constantly take detours to reach your destination: the result is the same, but the journey is longer and more exhausting.
⚡ Warning signs of cognitive fatigue
Morning: You wake up already mentally tired, as if your brain hasn't recovered overnight.
Progressive: Throughout the day, your concentration capacity noticeably decreases.
Disproportionate: Moderate mental effort exhausts you excessively.
Learning to recognize this fatigue and to respect it is a key skill. It is crucial to adapt your pace and plan for moments of cognitive rest, just as you would for intense physical effort.
8. The importance of diagnosis and assessment
Recognizing the signs is the first step, but obtaining a professional assessment is crucial to precisely understand your cognitive profile and develop personalized strategies. This process will also help rule out other possible causes of cognitive disorders.
Talk to your medical team
Your neurologist is your first point of contact. Don't hesitate to describe precisely what you are experiencing, using concrete examples from your daily life. Keep a journal of your difficulties for a few weeks before the consultation to have specific elements to present.
The neuropsychological assessment in MS
This comprehensive assessment evaluates all cognitive areas and provides an accurate map of your strengths and weaknesses. It helps distinguish MS-related disorders from other causes such as depression, anxiety, or medication side effects.
What to expect from this assessment?
The assessment includes standardized tests of memory, attention, executive functions, and processing speed. The results guide rehabilitation strategies and allow for objective monitoring of progress.
Ruling out other causes
Several factors can exacerbate or mimic cognitive disorders: medication side effects, sleep disorders, depression, anxiety, or even nutritional deficiencies. A comprehensive assessment will help identify and address these correctable factors.
🔍 Other causes to explore
- Side effects of background or symptomatic treatments
- Sleep disorders (apnea, insomnia)
- Depression or anxiety
- Deficiencies in vitamins B12, D or iron
- Thyroid disorders
- Substance use (alcohol, cannabis)
9. Speech therapy: a valuable ally for cognitive rehabilitation
The speech therapist is not just the language specialist consulted for speech disorders. They are a true professional in cognitive rehabilitation who can become your personalized brain coach to develop effective and sustainable strategies.
Understanding the role of the speech therapist in neurology
In the context of MS, the speech therapist assesses your specific cognitive difficulties and helps you develop tailored compensation strategies. Their approach is personalized, taking into account your cognitive profile, lifestyle, and personal goals.
🎯 Examples of speech therapy interventions
Organization: Learning to use a planner effectively, creating reminder systems, structuring your environment to reduce cognitive load.
Task breakdown: Transforming a complex task into several simple and manageable steps.
Specific training: Targeted exercises to improve working memory, sustained attention, or cognitive flexibility.
The speech therapist can also help you develop metacognitive strategies: learning to understand your cognitive functioning, identifying your peak performance moments, recognizing your limits to manage them better.
Long-term support
Cognitive rehabilitation is not a quick process, but a gradual support that adapts to the evolution of your illness and your needs. The speech therapist can adjust strategies over time and help you maintain your autonomy.
10. Cognitive stimulation: training your brain daily
Just like a muscle, the brain needs to be regularly challenged to maintain its abilities and develop new connections. This is the principle of "brain training": regular, progressive, and varied training to stimulate neuroplasticity.
Cognitive training does not aim to "cure" disorders, but to maintain preserved abilities, slow down decline, and develop effective compensation strategies through brain plasticity.
DYNSEO programs: a scientific and playful approach
It is precisely to meet these needs that we developed our applications COCO THINKS and COCO MOVES. They are designed to be both effective and enjoyable tools, usable alone or in collaboration with your speech therapist.
Our brain training programs SCARLETT & CLINT
We have created two distinct universes, SCARLETT for women and CLINT for men, with cultural content and games tailored to make the training relevant and motivating. These programs are not like other games: they have been co-constructed with health professionals.
Specific targeting of cognitive functions
Each exercise specifically targets the functions that may be affected by ADHD: processing speed, working memory, divided attention, executive functions, and cognitive flexibility.
An integrated professional follow-up
One of the great advantages of our programs is their integration with professional follow-up. Your speech therapist or occupational therapist can access your results, observe your progress, identify areas needing more work, and personalize your rehabilitation program, even remotely.
🎮 Advantages of digital training
- Available 24/7 at home
- Automatic adjustment of difficulty
- Precise tracking of performance and progress
- Variety of exercises to maintain motivation
- Possible collaboration with professionals
- Affordable cost compared to individual sessions
11. A lifestyle favorable to cognitive health
Cognitive stimulation tools are powerful, but they are even more effective when integrated into an overall lifestyle that is favorable to brain health. Think of it as an ecosystem where each element supports and enhances the others.
Physical activity: a medicine for the brain
Physical activity, even gentle and adapted to your abilities (walking, yoga, swimming, aquagym), is one of the most effective ways to protect your brain. It improves cerebral blood circulation, bringing more oxygen and nutrients to the neurons.
🏃♀️ Neurological benefits of exercise
Neuroplasticity: Exercise stimulates the production of BDNF (brain-derived neurotrophic factor), a protein that promotes the growth of new neural connections.
Neuroprotection: Physical activity protects existing neurons and can even promote remyelination in some cases.
Mood and cognition: Exercise releases endorphins that improve mood and indirectly cognitive performance.
Our app COCO MOVES also offers adapted physical exercises that you can perform even with motor limitations, thus combining cognitive stimulation and physical activity.
Stress management and sleep quality
Chronic stress and lack of sleep are formidable enemies for your cognitive functions. They exacerbate "mental fog" and cognitive fatigue, creating a vicious cycle that is important to break.
Mindfulness meditation, sophrology, cardiac coherence, or simply deep breathing techniques can help you better manage daily stress and improve your mental clarity.
The importance of sleep hygiene
Quality sleep is crucial for memory consolidation and cognitive recovery. Be sure to maintain regular schedules, create a calm and dark environment, and avoid screens before bedtime.
💤 Tips for better sleep
- Regular bed and wake-up times, even on weekends
- Cool (18-19°C), dark, and quiet room
- Stop screens 1 hour before bedtime
- Avoid caffeine after 4 PM
- Relaxation or quiet reading before sleeping
- Medical consultation if sleep disorders persist
12. Social connection: natural stimulation and emotional support
Never underestimate the power of social interactions to maintain your cognitive abilities. Discussing, exchanging, and sharing activities with your loved ones constitutes a very complete and natural form of cognitive stimulation that simultaneously engages multiple cognitive areas.
The cognitive richness of social exchanges
A simple conversation activates your memory (to remember the topic), your attention (to follow the discussion), your language (to express yourself), your executive functions (to organize your ideas), and your cognitive flexibility (to adapt to the pace of the exchange).
👥 Adapting your social life
Quality vs quantity: If large groups have become difficult, prioritize small gatherings in quiet places.
Open communication: Explain your difficulties to your loved ones so they can adjust the pace of conversations.
Structured activities: Participate in organized group activities (book clubs, creative workshops) that provide a reassuring framework.
Support groups or patient associations can also be valuable, not only for emotional support but also to share practical strategies with people facing the same challenges.
13. Nutrition and supplementation: nourishing your brain
A balanced diet plays an important role in cognitive health. Certain nutrients are particularly beneficial for the brain and can help maintain your cognitive functions or slow their decline.
Essential nutrients for the brain
Omega-3s, particularly abundant in fatty fish, are essential for neuron health. Antioxidants found in colorful fruits and vegetables protect against oxidative stress. Vitamin D, often deficient in MS patients, plays an important role in cognitive function.
Diet and cognitive health in MS
Some diets, such as the Mediterranean diet, have shown benefits for cognitive health. They combine omega-3 intake, antioxidants, and inflammation reduction.
Supplements to consider
Vitamin D, omega-3, B vitamins (especially B12), magnesium. Always discuss with your doctor before starting supplementation, as some supplements may interact with your treatments.
🥗 Brain-beneficial foods
- Fatty fish: salmon, sardines, mackerel (omega-3)
- Red fruits: blueberries, blackberries (antioxidants)
- Nuts and seeds: walnuts, almonds, flaxseeds (good fats)
- Green vegetables: spinach, broccoli (folates, vitamins)
- Turmeric: anti-inflammatory properties
- Dark chocolate: neuroprotective flavonoids
14. Manage progression and adapt strategies
MS is a progressive disease, which means your cognitive needs and challenges may change over time. It is important to develop a flexible approach and regularly reassess your strategies to ensure they remain effective and suited to your current situation.
The importance of regular follow-up
An annual cognitive assessment can be useful to objectively track the evolution of your abilities and adjust your strategies. It also allows for the early detection of new difficulties and the rapid implementation of appropriate compensations.
Keep a journal of your cognitive difficulties and successes. Note which strategies work best, under what conditions, and at what times of the day you are most effective.
Our applications COCO THINKS and COCO MOVES automatically adapt to your level and allow for precise tracking of your performance over time, facilitating this continuous adaptation process.
Anticipate and prevent
The earlier you intervene, the more likely you are to maintain your cognitive abilities. Even if your difficulties are still mild, starting cognitive training can help you develop cognitive reserves that will be useful if the disease progresses.
❓ Frequently asked questions
If your cognitive difficulties interfere with your daily, professional, or social activities, or if they cause you significant distress, it is time to consult. Occasional forgetfulness is normal, but persistent and increasing difficulties deserve evaluation.
Although complete recovery is rare, many improvements are possible thanks to neuroplasticity, cognitive training, and the development of compensatory strategies. Some patients see their symptoms stabilize or even improve with appropriate care.
15 to 30 minutes per day is sufficient for effective training. The important thing is consistency rather than intensity. Better to have 15 minutes daily than an hour weekly. Our DYNSEO applications are designed to adapt to your pace and availability.
It is a personal decision that depends on the impact on your work. Informing your employer may allow for useful adjustments (breaks, quiet environment, work organization). Occupational medicine can assist you in this process while maintaining your confidentiality.
Currently, there is no medication specifically approved for cognitive disorders from MS. However, effectively treating the disease with modifying therapies can slow progression. Some symptomatic medications may help indirectly by improving fatigue or mood.
🚀 Start your cognitive training today
Discover how our COCO THINKS and COCO MOVES programs can help you maintain and improve your cognitive abilities. Thousands of patients trust us for their daily cognitive stimulation.
15. Conclusion: take control of your cognitive health
If you recognize
Did this content help you? Support DYNSEO 💙
We are a small team of 14 people based in Paris. For 13 years, we have been creating free content to help families, speech therapists, care homes and healthcare professionals.
Your feedback is the only way we know if our work is useful. A Google review helps us reach other families, caregivers and therapists who need it.
One action, 30 seconds: leave us a Google review ⭐⭐⭐⭐⭐. It costs nothing, and it changes everything for us.