Cognitive Impairment in Multiple Sclerosis Systems

Cognitive impairment affects approximately 40–70 per cent of individuals with multiple sclerosis (MS), manifesting early in the disease course and often progressing independently of physical disability. Core deficits include reduced processing speed, episodic memory dysfunction, executive control disturbances and impaired visuospatial abilities. Underlying mechanisms encompass focal demyelination of white matter tracts, grey matter atrophy—particularly in the hippocampus and prefrontal cortex—and maladaptive changes in functional connectivity. Neuroinflammatory processes, glial activation and synaptic loss further exacerbate neuronal network dysfunction, leading to impaired neural synchrony and compensatory reorganisation. Clinically, these impairments correlate with reduced employment rates, lower quality of life and accelerated cognitive ageing. A range of neuropsychological batteries and digital assessment tools have been developed to detect subtle declines, while advances in neuroimaging and fluid biomarkers aim to track pathological processes in vivo. Understanding the interplay between neurodegeneration, inflammation and circuit reorganisation is critical to guide therapeutic strategies that preserve cognitive function and promote neural repair in MS.

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Cognitive Impairment in Multiple Sclerosis Systems publication trend

The graph below shows the total number of articles in cognitive impairment in multiple sclerosis systems across all publications each year (not limited to Nature Index journals).

Technical terms

Demyelination: Loss or damage of the myelin sheath surrounding axons, impairing nerve conduction.

Hippocampus: A medial temporal lobe structure critical for learning, memory encoding and spatial navigation.

Neurogenesis: The process by which new neurons are generated from neural stem or progenitor cells.

Biomarker: A measurable indicator of biological processes, used for diagnosis, prognosis or monitoring of disease.

Cerebrospinal fluid (CSF): The clear fluid surrounding the brain and spinal cord, sampled to assess central nervous system pathology.

References

1. Astrocyte-derived CHI3L1 signaling impairs neurogenesis and cognition in the demyelinated hippocampus. Cell Reports (2024).
2. Cerebrospinal fluid inflammatory biomarkers for disease progression in Alzheimer’s disease and multiple sclerosis: a systematic review. Frontiers in Immunology (2023).
3. Causes, effects and connectivity changes in MS-related cognitive decline. Dementia & Neuropsychologia (2016).
4. Cognitive Decline in Older People with Multiple Sclerosis—A Narrative Review of the Literature. Geriatrics (2022).