58 msfocusmagazine.org Medicine & Research are due to better education about pregnancy andMS,orperhapsduetoanincreasedcomfort level in starting a family because of more effectiveMStherapies.Onadownside,thestudy didfindahigherrateofpregnancycomplications in women with MS. Recommendations for cognitive screening, management in MS care A new study by experts in cognitive dysfunction reviewed published literature to reach consensus on the best strategies for screening, monitoring, and treating cognitive changes, and to propose strategies to address barriers to optimal care. They recommend: • Increased professional and patient awareness/education about the prevalence, effects, and appropriate management of cognitive symptoms. • For adults and children with clinical or MRI evidence of neurologic damage consistent with MS, at a minimum, early baseline screening with the Symbol Digit Modalities Test or similarly validated test, when the patientisclinicallystable;annualreassessment with the same instrument, or more often as needed to detect acute disease activity; assess for treatment effects (e.g. starting/changing a disease-modifying therapy) or for relapse recovery; evaluate progression of cognitive impairment; and screen for new-onset cognitive problems. • For adults, more comprehensive assessment for anyone who tests positive on initial cognitivescreeningordemonstratessignificant cognitivedecline,especiallyifthereareconcerns about comorbidities or the individual is applying for disability because of cognitive impairment. • For children, neuropsychological evaluation for any unexplained change in school functioning (academic or behavioral). • Remedialinterventionsandaccommodations foradultsandchildrentoimprovefunctioning at home, work, or school. The findingswere published in the Multiple Sclerosis Journal. Dr.Thrower:Cognitive dysfunction is important and contributes significantly to declines in quality of life and to vocational disability. The medical community has not done a great job of recognizing this in years past, even though Jean Charcot, the father of modern neurology, noted that peoplewith MS could have cognitive troubleinhisoriginaldescriptionofMSin1868. We now know that about 65 percent of people with MS have changes in cognition and that these changes can begin early in the course of MS. Some of the more typical issues that peoplewith MS mayexperience include slowed processing speed, decreasedworking memory and word-finding difficulty. In a perfect world, all people with MS would have detailed neuro- psychological testing done on a regular basis. Unfortunately, this testing is expensive and may take hours to complete. Ihadtheopportunitytoparticipateinawork group that looked at how we might screen for cognitive dysfunction in people with MS in a fast and inexpensive fashion. After looking at available options and the current literature, the group decided that a tests called the Symbol Digit ModalityTestwould be the best screening tool.The SDMTis a timed testwhere the subject matches symbols with a corresponding digit. The test can be done on paper or electronically and only takes a few minutes. The group recommended annual testing. Hopefully, MS clinics and community healthcare providers will begin using this tool.