Ask the Expert – Cognition

Featuring Randall T. Schapiro, M.D., FAAN
President, The Schapiro MS Advisory Group
Clinical Professor of Neurology (Retired), University of Minnesota

Question: What are some ways to address and treat MS-related cognitive issues?

Answer: Cognitive issues in multiple sclerosis were basically unheard of before 1983.  That was not because they did not exist but because they were not studied.  Subsequently they have been studied extensively and problems with memory, planning, foresight and judgement are clearly present in over sixty percent of those with MS.  It is important to emphasize that everyone with MS is different and all do NOT have cognitive issues.  When evaluating cognition in MS it is extremely important to take into consideration any additional issues of fatigue, depression, and anxiety.  These may falsely lead to a cognitive impairment diagnosis and certainly can contribute to making cognitive impairment appear worse.  There are neuropsychological tests that can objectify cognitive function and are clearly superior to more subjective testing done at the “bedside” or in the office.  Investigators have tried to correlate MRI anatomy with cognitive function with varying degrees of success.  At the present it is very hard to predict cognition by looking at an MRI although clinicians often try to do so.  In my opinion, the best way to manage cognitive problems is to avoid them entirely by prevention with disease modifying medication.  That is one of the reasons we recommend early treatment with these effective medications.  Cognitive rehabilitation through a speech pathologist or neuropsychologist can, at times, be helpful but may be less that satisfying.  Like many symptoms of MS an answer to disability is mobility and remaining mobile and staying active, using your mind is essential.

Question: How can you tell if the “cog fog” is related to MS or other health issues?

Answer: “Cog-fog” is a somewhat slang expression for the feeling that may intermittently layer onto those with MS giving the feeling of increasing cognitive problems.  There is no “officially” accepted physiological explanation for this other than increased fatigue, depression, anxiety.  Medically, accompanying issues such as infection or other medical illnesses e.g. thyroid disease should be explored.  When there is an acute, sudden onset of “cog-fog” or any new symptom, the treating neurologist should be called to review the situation for something that might be contributing to this relapse.

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The Multiple Sclerosis Association of America (MSAA) is a national nonprofit organization and leading resource for the entire MS community, improving lives today through vital services and support. MSAA provides free programs and services, such as: a Helpline with trained specialists; award-winning publications, including, The Motivator; MSAA’s nationally recognized website, featuring educational videos, webinars, and research updates; a mobile phone app, My MS Manager™; safety and mobility equipment products; cooling accessories for heat-sensitive individuals; MRI funding; My MSAA Community, a peer-to-peer online support forum; MS Conversations blog; a clinical trial search tool; podcasts; and more. For additional information, please visit or call (800) 532-7667.


  • Stacey L Pedone says:

    I most certainly have cognitive issues and it is not Cog/Fog. It is loss of short term memory as opposed to long term memory If there would be a single reason I need to stop working this would be it.

  • Sue says:

    No matter what you call or why- it is what it is….I would like to hear from other people how it has affected their work if they are still employed.

  • JaneDenzer says:

    For 1 week I had a problem with short term memory loss. It lifted on the 8th day like all my relapses.

  • Lisa says:

    I absolutely agree with Stacey – I left an employer after 10 years because of short term memory loss, being brow beaten and belittled on a daily basis and only having eyesight in 1 eye. The stress affected my health. I had another job before I gave my 2 weeks notice – and I am happy and much more relaxed – thank the good lord!!!!!!!

  • Debbie S says:

    I have have severe cognition issues along with the horrible fatigue, constipation, brain fog,balance, eyesight, bathroom issues I have them all. I miss the old me and because it is not visible my family doesnt understand any of it which makes it worse. My daughter and husband donot help at all only add to my problems. They think I am lying because i cant give an instant answer to some questions. I want to just run away because they dont realize its not my fault. thank the Lord my best friend Keith whom I love to death and lives with us sees it all – is my caretaker – my everything I guess I should be glad to have one person although dealing with the stress caused by my family matters make things worsel. I am on 21 meds and just want to be left to do what I want with any negative comments. my husband if the worse stressosr inn y life – my daughter is the second and I have had it. I leave it to the Lord but sometimes I just wonder

    • MSAA says:

      Hi Debbie,

      I’m sorry to hear about your frustrations and the difficulties you have been having. If you ever have any questions, or just want to hear a friendly voice on the other end of the line, please feel free to reach out to our Client Services Specialists at our toll-free Hotline (800) 532-7667, ext. 154, or you can email them directly at

      Take care,

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