Researchers say MS can impair cognitive functions in the brain and can lead to poor decisions.

Decision-making is a complex process.

We use it from the moment we wake until we fall asleep. It can even keep us from sleeping. Depending on what is at stake, decisions can be easy or difficult.

In order to make a choice, a person first must decide that a decision is going to be necessary. Second, the person must be able to visually and mentally search their brains for how this decision will result based on previous experiences and learned behaviors.

And then, if the decision leads to undesirable results, the person must consider long-term results, future actions, and additional decisions.

The last component to enter the mix is emotions. In addition to what is needed for the decision-making process, the person must consider how the results may invoke negative or positive emotions.

This whole process can get difficult, sometimes impossible, for people with multiple sclerosis (MS).

The disease is known to cause cognitive problems in patients. In fact, 43 to 70 percent of MS patients experience difficulties with attention, information-processing speed and efficiency, executive functioning, and long-term memory.

MS patients can also experience a variety of emotional issues, depending upon lesion location and other factors.

A group of researchers out of the University of Geneva in Switzerland recently published a systematic review that looked at 12 studies, ranging from 12 to 165 participants.

Criteria were chosen to statistically show the connection between decision-making problems and progression in MS patients. The data was also used to investigate the difference between risk-based decisions versus their ambiguous counterpart.

Overall, about 65 percent of the participants across all studies showed decreased performance in decision-making.

But the type of decision makes a difference.

When a decision is risk-based, it takes 17 measurable steps for a person to complete the task. The review found that 66 percent of MS patients showed impairment in 11 of them. Six tasks remained preserved in those with MS.

For ambiguous decisions, only 11 steps were measured. Those with MS found difficulty with seven of them.

“The paper brings to point the subtle areas in the brain that we take for granted in decision-making,” explained Dr. Jaime Imitola, the director of the Progressive Multiple Sclerosis Multidisciplinary Clinic and Translational Research Program at The Ohio State University Wexner Medical Center. “They are different for those with MS.”

“[Decision-making] performance might be influenced by MS activity and disease progression.” Imitola told Healthline. “Doctors need to take this into consideration when seeing patients, as they may not be aware they are having [decision-making] deficits.”

Fatigue, lesion location, and other factors all play a role.

“This is different than cog fog,” said Imitola, emphasizing this is about the subtle nuances in the decision-making process.

Imitola suggests that both doctors and patients become aware of the subtle changes in other domains of the brain where they may not previously have noticed.

“Understanding patients and establishing baselines” are a way to start, he suggests.

Recording thoughts and observations along with battery tests could help determine if patients are changing.

Decision-making is a function of cognitive and emotional complexity.

“Cognitive alterations are common with MS. Patients who have lesions in those areas of the brain,” said Imitola.

Doctors “have the ability to review location of lesions with their patients, and show how these locations can affect cognition,” he added.

The impact of impaired decision-making could be dangerous to the patient, causing poor choices.

To combat this with regards to making decisions about disease therapy, the American Academy of Neurology created guidelines to help patients and doctors work together.

Understanding decision-making and MS is “important, useful to others, and will open new avenues to understand these subtle cognitive issues,” said Imitola. “This is something that will be relevant for future studies.”

Editor’s note: Caroline Craven is a patient expert living with MS. Her award-winning blog is, and she can be found @thegirlwithms.