Cognition in MS

Early in the course of MS, patients may start to experience cognitive issues, especially in processing speed and handling complex information, which impair QoL by affecting employment, relationships, and other domains.4 Two assessment tools may be useful in evaluating cognition: the Symbol Digit Modality Test 5 and the Brief International Cognitive Assessment for MS.6

There are several modalities that can be helpful in enhancing or preserving cognition in patients with MS. These include leisure activities, such as reading, Tai Chi-mind-body exercise training, aerobic exercise and yoga, supplementation with vitamin D, and cognitive training.1,7-10


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Sexuality in MS

Sexual dysfunction (SD) is very common in patients with MS, affecting an estimated 40% to 80% of women and 50% to 90% of men.11 The proportion of SD in MS is greater than in other neurological disease, and close to five times higher than it is in the general population.11 SD may be primary (directly caused by the demyelinating lesions responsible for sexual response and feelings), secondary (indirectly caused by MS-related systems, such as fatigue, muscle weakness, pain, urinary dysfunction, and medication side effects), or tertiary (related to psychosocial issues that may impact sexual function).11  

Sexual dysfunction is one of the most major causes of distress in patients with MS, and has been shown to have an even more detrimental impact on QoL than the severity of disability.12 However, despite its high prevalence and the distress it causes, it is rarely discussed with clinicians, perhaps due to embarrassment on the patient’s part. Therefore, the conversation should be initiated by the clinician shortly after diagnosis, and should combine medical as well as psychosocial approaches.1 Interventions may include acknowledging the patient’s sexual needs, providing information and education, creating a safe forum for patients to express sexual concerns, and referring patients to specialists and other resources if appropriate.13