b'Medicine and ResearchMMiinnddOOvveerrMMaatttteerrRReetthhiinnkkiinnggccooggnniittiivveehheeaalltthhi nmmuullttiipplleesscclleerroossiissinBy Marissa A. Barrera, Ph.D., MSCS, CCC-SLPWhen most people think about multipleParticipants reported challenges with sclerosis, images of mobility aids, fatigue, andattention, mental processing speed, and short-physical disability frequently come to mind.term memory, all of which were frequently But what about the symptoms we cant see?accompanied by fatigue and depression. These The invisible symptoms. For many individualsndings suggest that cognitive impairment, living with MS, some of the most frustrating anddepression, and fatigue may be among the life-altering challenges are the invisible onesearliest clinical indicators of MS and not associated with cognition, including changes insecondary consequences. memory and concentration, decision-making,This has signicant implications for diagnosis and self-awareness.and treatment. Cognitive decline in MS is not An international, interdisciplinary researcha late-stage issue. By screening for cognitive team led by Dr. Mark Gudesblatt of NYU Langonesymptoms at the time of diagnosis, clinicians can implement targeted therapies and emotional South Shore Neurologic Associates investigatedsupport sooner, potentially altering long-term how cognitive impairment manifests in MS,outcomes and developing personalized care how it inuences daily functioning, and whyplans. understanding the brain-body connection isThe perception gap: The perception gap: critical to improving patient care. The ndingsThighlight how cognition plays a central and oftenThhiinnkkiinnggvveerrssuussrreeaalliittyyunder-recognized role in disease progression,One of the more surprising insights emerged physical safety, and quality of life for peoplefrom our 2025 investigation into fall risk. Falls with MS.are one of the leading causes of injury and reduced independence for individuals with MS. CooggnniittiivveessyymmppttoommssmmaayyccoommeerrssttC Our study revealed a disturbing disconnect: MS is often associated with balance issues,many individuals had poor insight into their muscle spasms, and fatigue. However, cognitivefall risk levels. impairment often begins much earlier thanWhenwecomparedobjectivephysical clinicians may realize. In a 2023 study, wemeasures, such as balance and mobility, with examined a group of individuals in the earlyparticipants self-perceived fall risk, a mismatch stagesofMStoassesswhethercognitivewas found. Why the gap? In many cases, it changes could be detected before signicantcame down to cognition. Specically, we found that attention, executive functioning, and physical symptoms emerged or manifested.information processing speed were linked to The results were eye-opening. the accuracy with which someone could assess msfocusmagazine.org 6'