Is it possible to have mainly cognitive issues when diagnosed with multiple sclerosis?

Here is My Question:
Is it possible to have mainly cognitive issues when diagnosed with MS? I have recently started having issues with painful legs and hips but I can walk. My balance is a bit off (comes and goes) and I have terrible depression. I had an MRI couple months ago and they said I have a lot more lesions now than when I was originally diagnosed 4 years ago. I also a spinal tap at that time which helped diagnose it. I have memory issues, short term and memory looking back (such as my sister's wedding that I thew reception and baked cake...no memory of that and was shocked when I saw pictures with me in them!). I wrote a question earlier, so I apologize but failed to mention my depression. I get things so confused sometimes, like with directions, etc. So many I read talk about difficulty walking, like using a cane, etc. I don't have that problem thank goodness, although, I can't walk long or I get the pain. Anyway, just wondering, can I still have this disease if I don't have all that, but just cognitive (or mainly that is).

When I was first diagnosed 4 years ago, I had terrible vertigo. Things were just spinning. I would wake up at night and things were spinning. I haven't had that for quite a long time. I get pins and needles, but the numbness and tingling I used to get a lot of, I haven't had for awhile. Yet, they are saying I have a lot more lesions. Been on Rebif, gilenya, copaxone and aubagio. I also had an aneurysm in 2015. They said that had nothing to do with my MS. In hospital for 2 months, so feeling very blessed to be here today. I just don't know what to do about ms. I want to take nothing. I don't know what this new neuro will tell me. I just wanted another opinion. I feel I may have repeated things here but don't remember, so again apologize for that.

I stopped Aubagio due to High blood pressure that I am still being treated for. That was a few months ago that I stopped. Do I really have to take something? Would things get worse? I am 68. Thanks you for your kindness and answer.


Answer:
Yes, cognitive dysfunction can be a presenting complaint and the predominant feature of MS.  In fact, the unfortunately coined term "benign MS" which defined patients with longer duration of disease with little residual disability in physical function (i.e., walking) have demonstrated cognitive disability which in some patients can be quite disabling.

Depression, however, can mimic cognitive dysfunction, which can significantly improve with successful treatment of the depression.  In cases of confusion, undergoing neuropsychological testing can help determining what is the cause of the cognitive complaints and offer rehabilitative strategies.

At the age of 68, it is possible that you may not benefit from DMTs.  There are blogs about this on this site.  Ultimately, working with an MS specialist to carefully document your clinical course and response to therapies via MRI can help answer the question if DMTs are indicated in your specific case.

A. Scott Nielsen MD MMSc
Neurologist and MS Specialist at Kaiser Permanente