1. Psychological Aspects of MS:
Cognitive & Emotional Challenges
Justin C. Koenitzer, Psy.D.
Clinical Psychologist
Orlando Department of Veterans Affairs
Primary Care Mental Health Integration

2. General Overview of Multiple Sclerosis
Immune-related Disorder of the central nervous system
White matter plaques: inflammation and demyelination
Plaques become “active” and cause “flare ups”; chronic
plaques can produce chronic symptoms
50 per 100,000 people are have MS
More common in women than in men
Symptom onset between ages 20-40

3. Brain Cell: Neuron

4. Cognitive Symptoms vary among and within people
30-50% will develop mild cognitive impairments
20-30% will develop more significant cognitive
impairments
Memory is most common cognitive complaint; severity
of memory impairment does not correlate with severity
of neurological symptoms or duration of illness
Cognitive Impacts
Fatigue is also a very common symptom
20-50% will not develop cognitive impairments

5. Cognitive Impacts
• Spastic muscle weakness
• Numbness
• Paresis
• Trouble with walking
• Dysarthria (slurred speech)
• Diplopia (double vision) or other vision symptoms
• Facial pain
• Incontinence
• Less common: seizures, vertigo, language
problems,

6. Emotional Impacts
1.) Depression –in approximate 25% of individuals with MS
Two Types: Reactive and or direct consequence of plaques
2.) Euphoria –in approximate 25%+ of individuals with MS
One patient bedridden and unable to stand remarked: “you
will not believe me when I say I feel thundering well”
3.) Anxiety—there can be so much UNCERTAINTY with MS
Other major emotional impacts include emotions
typical of grief: denial, anger, loss , fear

7. Impacts on the Family
• Pre-existing underlying difficulties can be
exacerbated by MS
• Role shifts within the family
• Sense of burden—caregivers, children
• Children of individual with MS may have
fears/embarrassment
Chronic Illnesses are not diseases of the
individual but rather diseases within a family

8. What can be done?
Individuals with MS and their families should be open about
their thoughts and Feelings
Focus on what you CAN do as opposed to what you CAN’T
Engage in Healthy Lifestyle Behaviors to combat
cognitive/emotional impacts:
• Exercise
• Social connectedness
• Cognitive exercise—reading, writing, games,
• Coping Skills—avoid catastrophizing; stay realistic and positive
Take care of caregivers to avoid burnout—seek professional
help when needed