Can MS impact memory or thinking abilities in a 47-year-old?

Question

Hello doctor,

I am 47 and was recently diagnosed with relapsing-remitting multiple sclerosis (RRMS) after an MRI (magnetic resonance imaging) showed lesions. I had symptoms like vision changes and numbness in my leg. My neurologist has recommended starting Ocrelizumab, but I am concerned about long-term immune suppression and whether it could increase my risk of infections. Also, I would like to know, can MS (multiple sclerosis) affect thinking or memory even in the early stages?

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern. Being told you have relapsing-remitting multiple sclerosis (RRMS) can be overwhelming, but asking thoughtful questions about treatment and its long-term effects is an important first step.

Ocrelizumab (Ocrevus) is a B-cell depleting therapy that targets CD20-positive B cells (cluster of differentiation 20-positive B lymphocytes) to reduce immune attacks on the nervous system. It is highly effective at reducing relapses and slowing new lesion formation. But it does carry an increased risk of infections, most commonly upper respiratory infections, urinary tract infections, and shingles (herpes zoster), especially if you are not vaccinated.

The overall infection risk is generally considered moderate, and many people tolerate the medication well. Serious infections are relatively rare but may become more likely with long-term use. Your doctor will likely monitor your immunoglobulin levels (especially IgG) and may adjust or pause treatment if levels drop too low. Getting recommended vaccinations, such as COVID-19 (coronavirus disease 2019), flu, pneumococcal, and the shingles vaccine (Shingrix), before starting therapy is strongly advised.

As for cognitive changes, MS (multiple sclerosis) can affect thinking and memory even early in the disease. Common early issues include slower processing speed, difficulty finding words, trouble with attention or concentration, and mild memory lapses. These changes are often subtle at first and may go unnoticed unless you are actively looking for them. However, they can become more apparent over time or during relapses. Screening tools like the Symbol Digit Modalities Test (SDMT) or BICAMS (Brief International Cognitive Assessment for Multiple Sclerosis) can help detect early cognitive changes and guide support strategies.

The good news is that many lifestyle measures, such as:

Staying mentally active.
Getting enough sleep.
Regular exercise.
Managing mood.

These can help protect cognitive function. You are taking all the right steps by being proactive and informed. Early treatment can make a significant difference, and Ocrelizumab remains one of the most effective therapies available today.

I hope this information helps you.

Thank you.