Ask the Expert – Cognitive Issues

Featuring Barry A. Hendin, MD
MSAA’s Chief Medical Officer

Headshot of doctor Barry Hendin, chief medical officer for MSAA
Barry Hendin, MD

Question: What strategies can you recommend to help with cognitive issues? 

Answer: First, let’s define cognition. Simply, it is all of the processes involved in learning, remembering, and expressing knowledge. It involves how we perceive, how we think, and how we convey knowledge verbally and nonverbally. 

Although many people with MS, and at all stages of MS, express cognitive symptoms or problems, they are generally mild in nature. The most common complaints that I hear involve difficulties in memory, multitasking, learning new information, and processing speed.

Some cognitive changes may be due to MS itself. Often, however, the problems are due to, or are compounded by, other factors such as poor sleep, medication effect, pain, or depression. The first strategy, therefore, is to assess the contribution of mood, pain, medications, and sleep – and then treat them appropriately. 

After those contributing factors have been assessed and managed, many people are still left with cognitive symptoms. It could be helpful to understand the nature and severity of the cognitive problems by formal testing. Sometimes the tests are simple, such as the widely used Symbol Digit Modalities Test (SDMT). But when problems are more severe, formal neuropsychometric testing can help to define the specific problems and the best strategies for dealing with those problems. Treatments may involve cognitive rehabilitation with speech therapists or neuropsychologists. 

In formal trials, some disease-modifying therapies have shown benefit in preserving and reducing decline in memory and cognition. Disease-modifying therapies are always a corner stone of treatment! Non-pharmacologically, wellness protocols help to maintain physical, emotional, and intellectual function. Wellness includes regular exercise, healthy diet, managing mood and psychological health, managing medical problems, staying socially engaged, and staying intellectually engaged. Ultimately, cognitive symptoms occur during the lifetime in many people with MS, but there is much that we can do to understand and manage them. 

Barry A. Hendin, MD is a neurologist and Director of the Multiple Sclerosis Center of Arizona. He is also Director of the Multiple Sclerosis Clinic at Banner University Medical Center and Clinical Professor of Neurology at the University of Arizona Medical School. 

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About MSAA

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.


  • Tom Jenner says:

    Just wanted to say I think it’s wonderful the amount of research and everything else that has happened over the last several yrs it’s wonderful for the younger folks that are getting hit with M.S. they actually get a fighting chance. I’m 63. I was diagnosed back in 82. Or 83. I was able to work full-time till around 2005 so I consider myself pretty lucky with all the m.s. therapy meds they had back then. Now I’m a 63 yr old guy who can hardly walk. The M.S. made it a point to catch up to me. It gets lonely alot,. I mean there’s not to many women out there these days looking for a relationship with someone who’s fighting this. My wife actually divorced me 20 yrs ago cause of the m.s. she got tired of helping me with my injections. I could never do the one that went into the muscle. So she gave up helping and that was that. Unbelievable. I so believe in Karma. Ok. Thanks for letting me get some of this off my mind. Again. I’m really excited for the younger folks and all the strides the M.s. Society has made especially with all this help. Awesome. Please keep up the fantastic work. And God Bless to All

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