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Cognitive impairment has been reported at all phases and all subtypes of multiple sclerosis. It remains a major cause of neurological disability in young and middle-aged adults suffering from the disease. The severity and type of cognitive impairment varies considerably among individuals and can be observed both in early and in later stages. The areas which have commonly shown more deficits are: information processing speed, complex attention, memory, and executive function. Even though an alteration in both the white matter and in the gray matter has been found in patients with multiple sclerosis and cognitive impairment, the underlying process still remains unknown. Standardized neurological examinations fail to detect emerging cognitive deficits and self-reported cognitive complaints by the patients can be confounded by other subjective symptoms. This review is a comprehensive and short update of the literature on cognitive dysfunctions, the possible confounders and the impact of quality of life in patients with multiple sclerosis.

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Background To evaluate whether preventive treatment can modify endothelial function and the oxidative stress profile of patients with migraines. Methods 88 treatment-naïve patients with migraines and 56 healthy sex/age matched controls underwent ultrasonography exams and blood tests at baseline, and again in the migraine patients after 3 months’ treatment with metoprolol or topiramate. Biomarkers for endothelial function and oxidative stress were analyzed. Results At baseline, patients with migraines had higher C-reactive protein (CRP; 2.55 vs. 1.64 mg/dL; p = 0.025) and lower high-density lipoprotein (HDL) cholesterol (61.7 vs. 66.8 mg/dL; p = 0.048), nitrate (19.4 vs. 27.3 µM; p = 0.037), and isoprostane levels (181 vs. 238 µM; p = 0.036) than matched controls. After treatment biomarker levels improved in patients with migraine, including CRP (2.55 mg/dL at baseline vs. 1.75 mg/dL at 3 months; p = 0.045); HDL cholesterol levels were the exception (significantly decreased). Treatment responders (> 50% reduction from baseline in migraine frequency) had higher nitrate (24.2 vs. 13.8 µM; p = 0.022) and nitrite levels (10.4 vs. 3.4 µM; p = 0.002) than non-responders after treatment. Conclusion Patients with migraines exhibit endothelial and oxidative dysfunction, which can be modified with prophylactic therapy.