One of the most common concerns that I hear as a clinician from MS patients concerns their ability to organise and look after their lives. MS patients who have even the most mild degrees of physical disability report an alarmingly significant effect of the illness of their ability to multi-task and to just get things done in the course of a day. Due to the rapid rate of progress in developing new drugs for MS, we don’t see the levels of physical disability that we used to compared to patients who developed the condition in decades past. Yet, regardless of which medication an MS patient is taking, almost all report fatigue and some difficulty with decision making. The difficulty as a clinician is diagnosing this as there are no simple bedside tests to assess you go about making the sorts of daily decisions that one needs to as a functioning adult. Treatments? Don’t go there, there is simply nothing out there for this problem.

For any disease, you can’t really develop treatments that work without a very detailed knowledge of the mechanism that cause that disease. That’s my lead-in for telling MS patients that there is little I can offer them for any type of cognitive change that they may experience. Fortunately, Muhlert and colleagues http://jnnp.bmj.com/content/86/5/530.abstract have provided an interesting paper in the current issue of JNNP which provides the first evidence that changes in decision-making in MS patients are related to changes in specific parts of the brain’s grey and white matter. These are the studies that we need to make headway into a very prevalent issue for MS patients and their families.