Mind Matters: how MS is changing what we know about brain health

For too long, the emotional and cognitive toll of multiple sclerosis (MS) was an afterthought. At CMSC's landmark 40th annual meeting, the inaugural June Halper Memorial Lecture made clear that the field is catching up – and the best is still ahead [1].

Dr. Feinstein's lecture reframed everything I thought I knew. Four decades ago, depression in MS was dismissed as natural sadness. Not a neurological symptom, just an understandable reaction to a hard diagnosis.

MRI transformed the conversation. The widespread adoption of neuroimaging in the 1980s was a watershed. For the first time, scientists could observe changes in living brains and connect those structural shifts directly to what patients had been reporting all along. The hippocampus, it turned out, is closely linked to depression [2]. The thalamus has emerged as a key player in cognitive dysfunction [3] – the kind of mental fog patients know intimately but rarely have language for. What had been dismissed as psychological became undeniably physiological. It felt like an important moment of recognition. Something that patients had been describing for years was finally being acknowledged out loud.

Strip away the clinical language and the stakes are simple: does a person with MS get to feel whole? That matters as much as any clinical breakthrough – drug, imaging, or biomarker. It’s the difference between treating a disease and caring for a human being.

And the numbers demand that urgency. People with MS experience depression at two to three times the rate of the general population [4]. Suicide rates are twice as high [5]. Nearly half of those with relapsing-remitting MS face cognitive impairment, a figure that climbs to roughly 90% in primary progressive MS [6].

Treatment has evolved accordingly. Antidepressants remain part of the toolkit, but the real momentum is elsewhere. CBT helps patients identify and reframe negative thought patterns [7]. Mindfulness helps patients stay present and accept difficult moments without judgment [8]. Cognitive rehabilitation combines targeted exercises with real-world strategies to compensate for cognitive deficits that interfere with daily life [9]. And on the horizon, transcranial magnetic stimulation and deep brain stimulation represent the next frontier: approaches that could help reset the brain circuits involved in mood regulation [1].

But treatment alone may not be the whole answer. Emerging research increasingly suggests that lifestyle plays an important role in brain health. Smoking is associated with worse clinical outcomes and poorer MRI findings in MS [10]. Exercise can be a beneficial rehabilitation approach, helping to manage symptoms, restore function, optimize quality of life, and support participation in everyday life [11]. Diet, too, is gaining clinical attention: higher overall dietary quality is linked to lower rates of disability progression, while increased fruit and vegetable intake correlates with reduced patient-reported disease activity. Omega-3 fatty acids may even delay MS onset [12].

At CMSC 2026, an entire session, "The Critical Role of Diet in MS Management: An Evidence-Based Clinical Perspective", tackled the persistent gap in clinical guidance. Speakers offered practical frameworks for integrating nutrition into multidisciplinary MS care and explored its potential influence on cognitive function and quality of life [1]. Those discussions reflected a broader shift taking place across neurology.

The cognitive burden of MS, its emotional weight, and the need for whole-person care have forced questions the entire field is now grappling with.

Brain health is part of something far larger than MS alone. The American Academy of Neurology has made it a centerpiece of its 2024–2028 Strategic Plan [13]. Its definition is deliberately expansive, describing brain health as "a continuous state of attaining and maintaining optimal neurological function that best supports one's physical, mental, and social well-being through every stage of life" [14]. The emphasis is not on any single diagnosis or disease-prevention strategy, but on preserving function, slowing neurodegeneration, and empowering patients for the long haul.

The cognitive burden of MS, its emotional weight, and the need for whole-person care have forced questions the entire field is now grappling with. What does truly supporting brain health look like? How do we measure what matters to patients, not just what shows up radiologically or biologically? And what do we owe the caregivers quietly shouldering the rest?

We've come a long way. But more than the science, what moves me is the growing recognition that patients deserve more than fewer relapses. They deserve the fullest lives possible. That’s a goal worth fighting for.

References

[1] Consortium of Multiple Sclerosis Centers. (2026). 2026 annual meeting program announcement [Conference program].

[2] Colasanti, A., Guo, Q., Giannetti, P., Wall, M. B., Newbould, R. D., Bishop, C., Onega, M., Nicholas, R., Ciccarelli, O., Muraro, P. A., Malik, O., Owen, D. R., Young, A. H., Gunn, R. N., Piccini, P., Matthews, P. M., & Rabiner, E. A. (2016). Hippocampal neuroinflammation, functional connectivity, and depressive symptoms in multiple sclerosis. Biological Psychiatry, 80(1), 62–72.

[3] Houtchens, M. K., Benedict, R. H., Killiany, R., Sharma, J., Jaisani, Z., Singh, B., Weinstock-Guttman, B., Guttmann, C. R., & Bakshi, R. (2007). Thalamic atrophy and cognition in multiple sclerosis. Neurology, 69(12), 1213–1223.

[4] Persson, R., Lee, S., Yood, M. U., Wagner, M. R., Minton, N., Niemcryk, S., Lindholm, A., Evans, A. M., & Jick, S. (2020). Incident depression in patients diagnosed with multiple sclerosis: A multi-database study. European Journal of Neurology, 27(8), 1556–1560.

[5] Feinstein, A., & Pavisian, B. (2017). Multiple sclerosis and suicide. Multiple Sclerosis Journal, 23(7), 923–927.

[6] Ruano, L., Portaccio, E., Goretti, B., Niccolai, C., Severo, M., Patti, F., Cilia, S., Gallo, P., Grossi, P., Ghezzi, A., Roscio, M., Mattioli, F., Stampatori, C., Trojano, M., Viterbo, R. G., & Amato, M. P. (2017). Age and disability drive cognitive impairment in multiple sclerosis across disease subtypes. Multiple Sclerosis Journal, 23(9), 1258–1267.

[7] Minden, S. L., Feinstein, A., Kalb, R. C., Miller, D., Mohr, D. C., Patten, S. B., Bever, C., Schiffer, R. B., Gronseth, G. S., & Narayanaswami, P. (2014). Evidence-based guideline: Assessment and management of psychiatric disorders in individuals with MS. Neurology, 82(2), 174–181.

[8] Grossman, P., Kappos, L., Gensicke, H., D'Souza, M., Mohr, D. C., Penner, I. K., & Steiner, C. (2010). MS quality of life, depression, and fatigue improve after mindfulness training: A randomized trial. Neurology, 75(13), 1141–1149.

[9] Klein, O. A., Drummond, A., Mhizha-Murira, J. R., Mansford, L., & dasNair, R. (2017). Effectiveness of cognitive rehabilitation for people with multiple sclerosis: A meta-synthesis of patient perspectives. Neuropsychological Rehabilitation, 29(4), 491–512.

[10] Marrie, R. A. (2017). Comorbidity in multiple sclerosis: Implications for patient care. Nature Reviews Neurology, 13(6), 375–382.

[11] Motl, R. W., Sandroff, B. M., Kwakkel, G., Dalgas, U., Feinstein, A., Heesen, C., Feys, P., & Thompson, A. J. (2017). Exercise in patients with multiple sclerosis. The Lancet Neurology, 16(10), 848–856.

[12] Katz Sand, I. (2018). The role of diet in multiple sclerosis: Mechanistic connections and current evidence. Current Nutrition Reports, 7(3), 150–160.

[13] American Academy of Neurology. (n.d.). AAN mission, vision, values, and goals. Retrieved June 8, 2026, from AAN Site.

[14] American Academy of Neurology. (n.d.). AAN brain health initiative. Retrieved June 8, 2026, from AAN Site.

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Mind Matters: how MS is changing what we know about brain health

For too long, MS-related brain fog and depression were dismissed as mere reactions to diagnosis. Now, revolutionary neuroimaging and holistic research prove these cognitive and emotional challenges are deeply rooted physical symptoms of the disease.

References

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