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Paradoxes in thalamic function and cognition in people with multiple sclerosis

Cognitive deficits occur in 40%–70% of people with multiple sclerosis (MS); they occur early in the clinical course of the disease, and may substantially reduce day-to-day functioning, affecting employment, instrumental activities of daily living, and adherence to medications.1 There are currently no treatments proven to slow cognitive decline in MS, and as such it is unsurprising that cognition is not usually assessed as part of a routine clinical review. However, given the substantial difficulties that cognitive dysfunction causes people with MS, it represents a highly clinically relevant target of further research and major unmet need. Increasingly, neuropsychological testing is considered in the development of new neurologic disability metrics for clinical trials2 and as measures of MS disease activity.3