Symptom management of patients with multiple sclerosis in primary care: focus on overlooked symptoms.

Multiple sclerosis (MS) is a chronic inflammatory and neurodegenerative condition of the central nervous system. Its prevalence varies from 50–300 per 100 000 people, and it is estimated that around 2.3 million people worldwide live with MS.1 In 2020, Public Health England released new MS prevalence data from GP records. This revealed that the number of adults with MS in the UK has risen to 131 720.2 Each year there are on average 4950 new cases of MS diagnosed and recorded in UK primary care records.2 Treatment of MS comprises disease-modifying drugs (DMDs) that reduce the inflammation and management of MS relapses and symptoms. The clinical decisions about DMDs and their complex monitoring dominate consultations with MS specialists, leaving less time for the management of patients’ daily symptoms. Therefore, GPs currently have a unique role in managing patients’ symptoms in primary care. This article focuses on the most under-recognised symptoms of MS. Cognitive dysfunction, fatigue, and depression are often overlooked by healthcare professionals.3–8 These symptoms are linked and profoundly affect patients’ quality of life, especially at the early stages of the disease.3–8 ### Cognitive dysfunction Cognitive impairment is prevalent in up to 65% of patients with MS.4 The most common cognitive domains affected are processing speed and memory.4 Other cognitive symptoms include deficits in attention, executive functioning, and verbal fluency.4,5 There is a robust correlation between cognitive deficits and quality of life, including employment status in patients with MS.4,5 Patients’ self-reported cognitive function is not considered a reliable measure, as it correlates with depression, rather than cognition.4 An informant report about patients’ cognition correlates better with objectively measured cognitive function …