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The recognition of the importance of cognitive impairment in individuals with multiple sclerosis (MS) is increasing. Cognitive difficulties can occur early in the disease course1 and affect up to 65% of cases.2 Although the etiology of cognitive impairment in MS remains controversial, less debate exists regarding the significant impact on quality of life and disability.3
The early identification of cognitive impairment may provide opportunities for intervention. To this end, the article by Shi et al.4 is of interest as it reports an association of the APOE ε4 allele and cognitive impairment in MS, especially among younger individuals. How early the findings appear and how subtle they are continue to vex clinicians. As discussed by Shi et al., …
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