Multiple Sclerosis

When the Brain Starts Shrinking with MS

October 27, 2023

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When the Brain Starts Shrinks with MS

Research suggests that your brain starts shrinking 5 YEARS before your first symptoms appear.

Nobody wants to hear that their brain has been shrinking.

What does that even mean?

How does it affect you?

Well, it’s common with Multiple Sclerosis.

Lucky us, right?

Prior to getting diagnosed with MS, I never thought about my brain shrinking.

But, when I started hearing about it, my first question was why does the brain shrink – specifically for those of us living with MS?

Why Does the Brain Shrink?

It turns out, there are several reasons why our brain may shrink with MS.


MS is considered both an inflammatory and neurodegenerative disease.

Neurodegeneration is basically the progressive loss of nerve cells and their connections.

So, over time, the cumulative loss of neurons and axons can cause the brain to shrink or atrophy.


Another reason the brain may shrink with MS is the repeated cycles of demyelination (loss of myelin) and remyelination (recovery of myelin).

It can disrupt the normal structure and function of the brain.

This ongoing process can contribute to tissue damage and atrophy.

Age-Related Factors

And of course, good old aging can affect our brains.

Normal aging is associated with some degree of brain atrophy.

So add MS into the mix and we may experience accelerated brain volume loss compared to healthy individuals of the same age.

Lesion Load

The presence of lesions or plaques in the brain can also influence the rate of brain atrophy in MS.

The larger the lesions are and the more lesions you have often correlate with more significant brain volume loss.

So, I guess the answer to my question about why the brain shrinks with MS, is… for many reasons!

Remember Everyone’s Experience is Unique

Now, it’s important to remember that not everyone with MS will experience the same degree of brain shrinkage.

The extent of brain atrophy is influenced by factors including these here. 

MS Type

The type of MS you have can influence the degree of brain atrophy. Primary progressive MS and secondary progressive MS are often associated with more pronounced brain atrophy over time compared to relapsing-remitting MS.

Disease Duration

Brain atrophy tends to progress more as the duration of the disease increases. Having MS for a longer time may have more significant brain volume loss.

Age at Diagnosis

The age at which you are diagnosed with MS can impact the baseline brain volume. Older individuals with MS may already have some age-related brain volume loss, making it challenging to differentiate MS-related atrophy.

Disease Activity

Frequent relapses and active inflammation in the central nervous system can contribute to more rapid brain atrophy. Effective disease-modifying treatments that reduce inflammation may slow the rate of brain volume loss.

Individual Variability

Every person’s MS experience is unique. Some of us may have a more aggressive form of the disease with faster brain atrophy, while others may experience a milder course.

Treatment Response

The response to disease-modifying therapies (DMTs) can impact brain atrophy. Some DMTs are more effective at slowing disease progression and brain volume loss than others.

Genetic Factors

Genetic factors can influence disease severity and the rate of brain atrophy in MS. Some genetic markers are associated with a higher risk of brain volume loss.

Overall Health

Lifestyle factors such as diet, exercise, stress management, and sleep quality can also play a role in brain health and atrophy.

How Does Brain Shrinkage Affect Us?

My next question is how does that affect us?

It can have several effects on those of us living with MS, both in terms of symptoms and overall health.

Cognitive Function

Brain atrophy can impact cognitive function.

We may experience difficulties with:

  • Memory,
  • Attention,
  • Problem-solving, and
  • Processing speed.

These cognitive changes can affect daily activities and quality of life.

Physical Disability

Brain atrophy can contribute to physical disability.

It may lead to a decline in motor skills, coordination, and balance.

This can result in mobility issues and an increased risk of falls.

Disease Progression

The extent of brain atrophy is often associated with disease progression.

As the brain loses tissue, it may become less effective at compensating for MS-related damage. This can lead to increased disability over time.

Symptom Severity

Brain atrophy can exacerbate MS symptoms.

Individuals may experience more severe and frequent relapses, which can lead to increased disability and symptom burden.

Emotional and Psychological Impact

The cognitive and physical changes associated with brain atrophy can take a toll on emotional well-being.

Individuals with MS may experience increased stress, anxiety, depression, and a sense of frustration as their symptoms worsen.

Treatment Response

Brain atrophy can affect how individuals respond to MS treatments.

Those with more extensive brain atrophy may be less responsive to disease-modifying therapies, and treatment decisions may need to be adjusted accordingly.

Quality of Life

Overall, brain atrophy can have a significant impact on our quality of life.

It can limit our ability to work, engage in social activities, and maintain independence.

It’s obviously hard to make broad statements when it comes to MS and brain atrophy is no exception because it’s a bit complex.

It can be influenced by things like

  • The type of MS (relapsing-remitting, progressive),
  • The duration of the disease, and
  • Individual differences in disease course.

So, it’s common with MS, but its rate of progression and impact can vary from person to person.

How Do We Manage It?

Managing brain atrophy in MS often involves strategies to reduce inflammation, protect nerve cells, and promote overall brain health.

Here are some practical things you can do:

Disease-Modifying Therapies (DMTs)

These medications can help reduce inflammation and slow disease progression, potentially preserving brain tissue.

Regular Monitoring

MRIs can help our doctors to track changes in brain volume and lesion activity and adjust treatments accordingly.

Healthy Diet

As a nutrition coach, this is of course, my personal favorite – food! Following an anti-inflammatory diet that’s rich in antioxidants, omega-3 fatty acids, and a variety of fruits and vegetables can support brain health and overall well-being.


Regular physical activity can help to improve mood, cognitive function, and overall brain health.

Stress Management

Chronic stress can exacerbate MS symptoms and contribute to brain atrophy. So, practicing stress-reduction techniques such as mindfulness, meditation, deep breathing exercises, and yoga is important.

Adequate Sleep

Poor sleep quality can impact cognitive function and overall health. So, prioritize good sleep hygiene to ensure you get enough restorative sleep.

Cognitive Training

Puzzles anyone? Engage in cognitive training exercises and brain games to help maintain and improve cognitive function. These activities can challenge your brain and may help compensate for cognitive changes.

Regular Follow-Up

Stay in close communication with your healthcare team, including neurologists, physical therapists, and other specialists. Regular follow-up appointments can help ensure that your treatment plan remains effective.

Remember that MS management is highly individualized, and what works best for one person may not be suitable for another. 

Start Taking Action Today!

The last thought that I want to leave you with today is the importance of having a plan to manage MS and being consistent with it.

It’s easy to stray from it when you’re feeling well.

You start to think that maybe you don’t need to do all those healthy habits after all.

But just because you can’t feel something, doesn’t mean that it’s not happening.

So, whether it’s following a diet, starting a medication or managing stress… or all of the above, we need to keep our health as a priority.

Don’t wait until your health is failing you to start paying attention to it.

What’s ONE thing that you could start practicing today to support brain health?

Please share in the comments below. 

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I'm Alene, your MS Sister.

When I was diagnosed with MS in 2016, I was scared and felt alone. But as a Nutrition Coach, I knew there was more to healing than what I was being told. I took action and within six months the lesions I had on my brain shrunk and went inactive. Now, seven years later there has been no new lesions and no new activity. As a nutritionist specializing in multiple sclerosis, I help women take back control of their future.

That’s my story, but I’m not alone. It's your turn to start Thriving with MS. I’m here to show you the way. 

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