From knowledge to practical implementation: A multi-method investigation to advance lifestyle-related, brain health-focussed care for multiple sclerosis

Brain health is a global priority for neurodegenerative diseases, including multiple sclerosis (MS), a progressive, inflammatory disease of the central nervous system (CNS). MS presents with heterogenous cognitive, motor and sensory symptoms, with effective management necessitating a comprehensive approach to prioritise brain health to slow disability and disease progression and enhance overall quality of life. This can be achieved through (1) a timely and accurate MS diagnosis, (2) intervening early with a disease modifying therapy and (3) monitoring outcomes, while adopting a brain-healthy lifestyle.

For MS, brain health is often defined interchangeably with neurological reserve, as the brain’s compensatory ability to retain optimal neurologic function. This can explain why CNS damage might remain undetected, or why people living with MS (plwMS) may exhibit varying disease trajectories. While a cure for MS remains elusive, research is increasingly focussed on activities that buffer disease-related decline, hypothesising that MS disability and disease progression will be determined, to some extent, by a person’s brain health. Attention has, therefore, shifted towards activities or lifestyle behaviours (eg., diet, exercise) to maximise lifelong brain health for plwMS. However, the evidence for such activities remains in its infancy and there is a large degree of ambiguity in addressing lifestyle-related, brain health-focussed MS care as an essential part of person-centred management.

Therefore, the research described in this thesis pertains to the lack of, and need for, a unified definition for brain health and research regarding comprehensive MS care involving dietary and lifestyle-related factors when promoting optimal brain health for plwMS. The central aim of this thesis is twofold: 1) to synthesise and advance the current discourse of brain health for MS, and 2) to advocate for refinement and homogeneity in lifestyle-related MS brain health policy.