Four Possible Indicators of Cognitive Involvement in Early-Stage Multiple Sclerosis

Tilburg, Netherlands. Living room portrait of a mature adult woman suffering from Multiple Sclerosis sitting besides her wheelchair.
The cognitive effects of multiple sclerosis are often associated with later stages of the disease. However, there may be some indicators of its involvement in patients with early stages. Understanding these factors — some of which are psychological and some of which are clinical — could help with treating and monitoring patients.

A recent study published in the Journal of the Neurological Sciences found that computer-based assessments of reaction time can help medical professionals detect cognitive impairment in patients with early multiple sclerosis (MS).¹ The study authors found this to be an important endeavor, saying that detecting this early cognitive impairment was necessary for treatment, monitoring, and intervention.

In another recent study published in Neuropsychiatric Disease and Treatment, researchers examined data to find potential indicators of cognitive involvement in early MS.² They found a number of possible indicators, both neuropsychological and clinical. For example, they also found slower reaction time to be a significant indicator. 

In addition, here are some other factors that neurologists may want to screen for in their patients with early MS.

Difficulty Remembering Verbal Information

In the course of this study, researchers analyzed patient data in 80 studies detailing patients with early MS who were experiencing impairment. During this analysis, the researchers found a number of potential factors. 

One consistent factor they attributed to early MS was difficulty with memory and information retention, particularly if that information was delivered verbally. Many of the studies that noted this symptom used the Selective Reminding Test, while other studies that employed tests like the Spatial Recall Test reported patients who have difficulty learning and retaining information they receive visually.

Education Level

The researchers also examined a number of clinical and demographic factors to identify any potential correlations with cognitive involvement. For example, when sampling for level of patient education,10 studies found more significant impairment in people with fewer years of education, whereas 7 other studies did not find any association between cognitive involvement and amount of education. 

One particular study published in the Journal of the Neurological Sciences found that patients with higher levels of education had low scores on only 3 of the 15 tests, while less educated patients performed more poorly, with low scores on 13 of the 15 tests.³ Though these studies overall show mixed results, the latter findings do suggest that clinicians may want to consider demographic factors in their assessment of the cognitive involvement of patients. 

Disability and Depression

The level of disability or depression a person with early MS experiences can negatively affect their quality of life in many ways. As discussed, this decreased quality of life may include higher levels of cognitive impairment. Of the many studies examined by the researchers, 15 of them found a correlation between disability level and cognition, while 14 suggested a link between higher depression levels and a negative effect on cognition. 

While additional research is needed, the evidence suggests that the improvement of a patient’s quality of life via mental health support may proportionately improve their cognitive abilities.

Vocational Anxiety

As many patients with MS are of working age, employment concerns are common. Serious vocational anxieties can cause significant stress and further damage a patient’s cognitive abilities. In some studies, the researchers found that patients who experienced a decrease in both processing speed and ability to maintain focused attention also wanted to work fewer hours. In addition, patients with MS who were looking for a career change often had a decreased episodic memory. Though inconclusive, such studies do support theories that MS can affect patients’ level of employment.

Taken as a whole, this body of research implies that it is worth monitoring anxiety levels in your patients with early MS, particularly if they are already presenting with signs of stress and depression. In conclusion, clinicians should conduct early cognitive screenings and routine comprehensive neuropsychological assessments of their patients.


  1. Eilam-Stock T, Shaw MT, Krupp LB, Charvet LE. Early neuropsychological markers of cognitive involvement in multiple sclerosis. J Neurol Sci. 2021;423:117349. doi:10.1016/j.jns.2021.117349
  2. Gromisch ES, Dhari Z. Identifying early neuropsychological indicators of cognitive involvement in multiple sclerosis. Neuropsychiatr Dis Treat. 2021;17:323-337. Published February 5, 2021. doi:10.2147/NDT.S256689
  3. Bonnet MC, Deloire MSA, Salort E, Dousset V, Petry KG, Brochet B. Evidence of cognitive compensation associated with educational level in early relapsing–remitting multiple sclerosis. J Neurol Sci. 2006;251(1-2):23-28. doi:10.1016/j.jns.2006.08.002