Understanding and Managing Cognitive Challenges in MS
Adapted from a talk delivered by Dr Sarah Rudebeck, Senior Clinical Psychologist and Co-founder of Recallify, at the invitation of MS-UK, July 2025.
Cognitive changes in MS are real and clinically significant
Approximately 65% of individuals living with multiple sclerosis (MS) experience cognitive symptoms at some point during the course of their condition. These symptoms may affect memory, attention, processing speed, and executive functioning. Although often less visible than physical impairments, they can significantly impact day-to-day functioning, work, relationships, and quality of life.
These cognitive difficulties arise when MS-related inflammation and demyelination disrupt neural pathways in the brain and spinal cord that support higher-order cognitive processes.
Common Cognitive Symptoms in MS
Cognitive impairment in MS can present with a range of features, including:
- Reduced attention and concentration: Difficulty maintaining focus, particularly in distracting environments.
- Working memory impairment: Challenges holding and manipulating information over short periods (e.g. remembering verbal instructions or tasks).
- Verbal processing and fluency issues: Word-finding difficulties, slowed verbal output, or increased frequency of “tip of the tongue” experiences.
- Executive dysfunction: Problems with planning, organising, initiating, or sequencing tasks.
- Visuospatial difficulties: Impaired ability to interpret spatial relationships, visual patterns, or environmental cues.
Cognitive fatigue often co-occurs and may exacerbate these symptoms. It is a major barrier to maintaining cognitive performance over time.
Emotional and Psychological Impact
Cognitive changes in MS frequently occur alongside affective symptoms. Approximately 50–60% of people with MS experience depression, 30–40% report anxiety, and emotional lability (e.g. rapid mood shifts, irritability, apathy) is not uncommon. These issues may arise from both the neurobiological effects of MS and the psychological adjustment to living with a chronic condition.
Clinical Assessment of Cognitive Function
Assessment of cognitive changes is typically conducted by a neuropsychologist as part of a multidisciplinary care pathway. This includes:
- Clinical Interview: Gathering information on day-to-day cognitive difficulties, with input from family members where appropriate.
- Standardised Cognitive Testing: Objective assessment of memory, attention, language, and executive functioning using validated neuropsychological tools.
- Comprehensive Reporting: A written report highlighting cognitive strengths and weaknesses, with clear recommendations for workplace, educational, or rehabilitation support.
Assessments can support medical decision-making, guide cognitive rehabilitation planning, and provide evidence for workplace or educational accommodations.
Interventions for Cognitive Symptoms in MS
There is no singular treatment for cognitive impairment in MS; however, a number of approaches are considered clinically beneficial and evidence-based:
1. Cognitive Rehabilitation Strategies
These approaches aim to mitigate cognitive impairment through a combination of compensatory techniques and skill-building. Examples include:
- External Memory Aids: Use of structured tools such as diaries, calendars, alarms, and digital reminders to support memory and planning.
- Routine Formation: Establishing consistent daily routines to reduce the cognitive demand associated with decision-making and sequencing.
- Environmental Modification: Reducing external distractions and organising physical environments to support sustained attention and task efficiency.
- Task Simplification: Breaking down complex tasks into smaller, more manageable components.
- Strategy Training: Use of techniques such as categorisation, rehearsal, and visual imagery to support memory encoding and retrieval.
These interventions are typically delivered by neuropsychologists, occupational therapists, or through structured self-management programmes.
2. Psychological Therapies
- Acceptance and Commitment Therapy (ACT): ACT supports individuals in developing psychological flexibility, enabling them to live in alignment with personal values despite the presence of symptoms. It is particularly helpful for managing distress, fatigue, and adjustment to diagnosis.
- Compassion-Focused Therapy (CFT): CFT promotes emotional regulation and self-kindness, especially in individuals with elevated shame or self-criticism. It can be beneficial for individuals navigating identity changes related to cognitive decline.
3. Cognitive Remediation Therapy (CRT)
CRT is a structured, often computer-assisted intervention designed to enhance cognitive function through repeated practice and adaptive training. Key features include:
- Targeted training of attention, memory, and executive function
- Use of adaptive difficulty to ensure tasks remain appropriately challenging
- Generalisation of skills to everyday activities
A Cochrane review (Campbell et al., 2016) found moderate evidence supporting CRT in improving cognitive performance in MS, particularly in attention and memory. CRT is considered a valuable component of multidisciplinary care where available.
Lifestyle Modifications
There is growing evidence that lifestyle interventions can positively influence cognitive and neurological outcomes in MS:
- Dietary Adjustments: Reducing intake of ultra-processed foods, sugar, and alcohol, and increasing intake of whole foods and vegetables may support overall brain health.
- Physical Activity: Engaging in regular, manageable physical exercise can improve fatigue, mood, and cognitive performance.
- Sleep and Stress Management: Prioritising rest and adopting stress-reduction strategies (e.g. mindfulness, pacing) are essential for optimising cognitive functioning.
- Avoiding Risk Factors: Smoking cessation and maintaining hydration are recommended as part of broader disease management.
Technology-Assisted Strategies
Digital tools can provide highly supportive, evidence-informed strategies to manage cognitive difficulties:
- Smart Calendars and Reminders: Tools like Google Calendar, Cozi, or Apple Reminders can help schedule tasks and prompt actions.
- Location-Based Prompts: Geofencing-based reminders can trigger notifications based on your location (e.g. “Remind me to buy milk when I get to Tesco”).
- Assistive Devices: Including smart pillboxes, wearable devices with alarms, and voice-controlled assistants to support day-to-day functioning.
- Brain Training Apps: Apps such as BrainHQ, Lumosity, and CogniFit offer cognitive exercises; while evidence for generalisation remains limited, they may support mental stimulation.
How Recallify can help
Recallify is an AI-powered memory and learning support app developed for individuals with cognitive challenges due to neurological conditions—including MS.
Key features include:
- Live Recording and Transcription: Capture meetings, conversations, or events and generate instant plain-English summaries.
- Personalised Recall Tools: AI-generated quizzes and memory checks to reinforce important content.
- Integrated Reminders: Convert recorded information into time- or location-based reminders within your own calendar.
- Encrypted Personal Vault: All data is stored privately and securely—content is doubly encrypted and not accessible to anyone but the user.
“With Recallify, I could record a four-hour session and later read a summary. It filled in the gaps my brain missed.” – Julie, Recallify user with neurological fatigue
Recallify is designed to support cognitive independence and reduce reliance on others for information retention and retrieval.
Get Involved
We are actively seeking feedback from individuals with MS to further refine and tailor Recallify for this community. If you are living with MS and would like to share your experience, we would welcome your input.
Please get in touch @ sarah [at] recallify [dot] ai .