Table 1.

Recommendations for healthcare professionals to maintain brain health in people with MS.

Promote prompt diagnosis and early treatment with DMT	Connect with primary care partners (e.g., general practitioners) to ensure prompt referral and early diagnosis and DMT initiation
Discuss infection prevention and treatment	Provide proactive advice to patients with MS on infection prevention and self-management (e.g., good oral hygiene, regular dental check-ups, annual vaccinations, urine self-monitoring for urinary tract infection) and advise people with MS to seek prompt treatment when an infection occurs
Discuss strategies to improve emotional well-being	Encourage people with MS to:
	Retain and increase social connections (e.g., with family, friends, community groups)
	Participate in well-being activities such as meditation, yoga or spending time outdoors
	Consider counselling and NHS talking therapies/CBT
Encourage people with MS to adopt lifestyle changes that preserve cognitive reserve and develop resilience to stress	Encourage people with MS to:
	Remain cognitively active (e.g., reading, continuous learning, creative pursuits, socialising with a variety of people)
	Remain physically active as much as possible (run, walk, swim or any other physical exercise) and encourage pacing through CBT interventions (e.g., behavioural activation)*
	Build their levels of resilience, hope and grit via counselling and involvement with peer support groups and social interactions
	Ensure they get good sleep *
	Eat healthily*
	Maintain good hygiene and balanced fluid intake
	Not smoke*
	Limit their alcohol intake*
	Maintain their emotional well-being*
Ensure regular monitoring of people with MS in MS clinic and via partners (e.g., GP)	Assess general health/comorbid conditions regularly to ensure early identification of conditions that impact vascular health, such as:*
	Hypertension
	Hypercholesterolaemia
	Dyslipidaemia
	Diabetes mellitus
	Hypothyroidism
	High body mass index

*See later section for more specific guidance.

CBT, cognitive behavioural therapy; DMT, disease modifying therapy; GP, general practitioner; NHS, National health System; MS, multiple sclerosis.