UB research targets hidden symptoms of multiple sclerosis

The impacts of living with a chronic health condition, such as multiple sclerosis (MS), are not always visible to others. This can create unique challenges as individuals navigate treatment plans and adapt to their changing needs.

It can also complicate medical care and socialization, as people may not recognize that certain symptoms are related to their condition and may not discuss them during appointments or among friends. This underscores the importance of recognizing the connection between physical and behavioral health when managing any health condition.

MS, which affects about 1 million people in the U.S., is an autoimmune disorder of the brain and spinal cord where the immune system mistakenly attacks neurons, and the protective cells that surround them. This damage disrupts communication between nerves. Symptoms such as difficulty walking, loss of sensation in the limbs, vision changes and balance problems are common.

However, MS also causes less noticeable symptoms, including memory issues, difficulty concentrating, mood changes, and fatigue. These are known as cognitive symptoms, and are experienced by about 50% of people with MS. Because these symptoms are less visible than physical ones, they are often overlooked, despite having a significant impact on quality of life and health outcomes.

UB researchers are working to better understand the extent of these cognitive effects and how to treat them. Ralph Benedict, SUNY Distinguished Professor in the Department of Neurology at the Jacobs School of Medicine and Biomedical Sciences and lead faculty in the Recruitment and Special Populations Core at the UB Clinical and Translational Science Institute (CTSI), has conducted studies looking at how changes seen on brain magnetic resonance imaging (MRI) scans can help predict cognitive impairment, how cognitive problems contribute to job loss, and the benefits of cognitive training. These cognitive training programs include brain exercises and activities designed to improve memory, problem solving, and concentration.

Benedict and his team have developed an app called the “Conscientiousness Coach” designed to improve conscientiousness by helping people identify core values and set meaningful goals. Benedict says conscientious individuals are those who “tend to be more organized, goal-directed, and consistent in their health behaviors.”

Greater conscientiousness can help people stick with treatment plans, such as taking medication and completing physical or occupational therapy. When individuals are motivated to take an active role in their treatment, it often leads to improved quality of life. Recent work has shown that this personality trait can influence how the disease progresses in people with MS as well as other brain disorders.

Benedict is involved in a new international clinical trial that is exploring whether conscientiousness coaching before formal cognitive rehabilitation can improve treatment outcomes. This approach supports personalized health management, giving individuals more control over their care.

The coaching phase focuses on mindset training, encouraging individuals to be more organized and goal directed. The subsequent cognitive rehabilitation targets memory and processing speed. Previous studies have shown observable changes in brain activation after completing cognitive rehabilitation, further supporting the benefits of these programs.

Supporting cognitive function is important for many reasons, particularly for maintaining a job. Studies have shown that cognitive impairment is a primary cause of job loss among people with MS.

“Because it is often a 'hidden’ deficit, patients and employers may not recognize that difficulties in the workplace are symptoms of the disease and may warrant accommodations,” Benedict says, adding that losing a job can put significant strain on quality of life, affecting income, health insurance and sense of purpose.

When discussing MS, it is important to acknowledge that this condition creates physical limitations, often requiring individuals to adapt their daily lives. Routine tasks such as cleaning the house or going to the grocery store can become more difficult. For someone who once loved hiking with friends, this activity may feel impossible now.

Being unable to participate in activities you once enjoyed, whether due to physical or cognitive reasons, can lead to social isolation. Uncertainty about when or if the condition will progress creates additional stress. However, there are resources to help manage symptoms and maintain quality of life, including nutrition counseling, physical therapy, and support groups for people living with MS.

Recognizing that cognitive impairment is a common symptom of MS may help individuals feel less isolated, encourage them to seek accommodations at work, and pursue cognitive training tailored to their needs.

“It is important to focus on what can be controlled. This includes maintaining a healthy lifestyle — regular exercise, cognitive engagement in daily activities, and practices such as mindfulness meditation — which can help support brain health and reduce depression and anxiety,” Benedict says.

Living with a chronic condition like MS involves navigating both visible and invisible challenges, but greater awareness of these hidden symptoms can lead to better support, more effective care, and improved daily functioning. Treatments continue to evolve, and many people with MS in Buffalo and beyond are living fulfilling lives.