Coping with cognitive changes in SPMS
Fact-checked by When you have secondary progressive multiple sclerosis (SPMS), everyday tasks such as following conversations, recalling recent events, or managing different responsibilities can become more challenging. These cognitive changes may feel confusing or frustrating, both for you and for those who care for you.
Recognizing these changes early, working closely with your SPMS healthcare team, and using available resources can help you support your cognitive health and adapt more effectively.
Cognitive changes across MS stages
Cognitive changes can begin early in multiple sclerosis (MS), including during the relapsing-remitting stage, highlighting the importance of early detection and management.
As MS progresses into the secondary progressive stage, these cognitive issues may become more frequent and pronounced.
In fact, studies show around 55% to 80% of people with SPMS experience some level of cognitive impairment. These changes are influenced by how long you’ve had MS and by the progressive nature of SPMS.
How cognitive changes affect thinking
Cognitive challenges in SPMS can affect thought processing speed, memory, and executive functions, including planning and problem-solving. Visual memory and attention can also be affected.
People with SPMS may notice:
- slower information processing speed, making it harder to keep up with conversations or tasks
- problems recalling episodic verbal information, making it difficult to remember recent conversations or what was said during a doctor’s appointment
- difficulty with working memory, which affects the ability to hold and manipulate information mentally for a short period of time
- reduced verbal fluency, or trouble finding the right words quickly.
Other abilities, such as multitasking, can also be affected, influencing your daily life and relationships.
In SPMS, these thinking skills may decline gradually, but even slow changes can affect several aspects of cognition at once, making everyday activities feel more demanding.
Responding to cognitive changes
Staying aware of changes in your thinking and staying connected with your MS healthcare team and loved ones can help you take proactive steps to support your cognitive health.
The first step is awareness. Discuss any changes you notice with your healthcare providers and ask about options for assessment or cognitive testing.
Strategies to support cognition may include:
- enrolling in cognitive training programs, either computer-based or guided by a therapist, to target memory, attention, and thinking speed
- using practical tools such as calendars, reminder lists, or note-taking apps to reduce demands on memory
- simplifying daily habits and routines to help with planning, organization, and time management
- seeking care for mental health challenges and fatigue, as both can worsen thinking difficulties
- getting regular physical activity to support your brain and body health
- learning about these changes and using clear and straightforward communication strategies.
Your doctor can regularly assess your thinking skills — for example, by using tools such as the Symbol Digit Modalities Test — to help track changes over time and adjust your care plan as needed.
A combination of self-care, counseling, medications, and support from your team may help you better manage the cognitive effects of SPMS.
Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
