Background: Τhe majority of Multiple Sclerosis (MS) patients manifest cognitive impairment, stress, anxiety and depression. These factors affect the disease course and relapse as well as the adoption of maladaptive coping strategies. The purpose of the study is to evaluate the effect of the Pythagorean self-awareness intervention on MS patients. Methods: This was a parallel randomized controlled trial in MS patients (N = 55) who were randomized to intervention (IG) and control group (CG). The IG (N = 23) underwent, additional to standardized care, PSAI which consisted of 8 weekly sessions of dietary and physical exercise counselling, cognitive training and stress management. Self-reported questionnaires were used for stress, depression, anxiety, healthy lifestyle, ways of coping, fatigue, memory. Data were collected by pre-and post-intervention. Results: Participants were mostly women, married, of tertiary education and with a mean disease duration * Corresponding author. # These authors contributed equally and shared last authorship. C. Darviri et al. 573 of ten years. Statistical analyses revealed a significant amelioration of healthy lifestyle, stress, anxiety, depression, memory, an increase in positive approach and social support seeking, as well as, a decrease in physical, mental and cognitive fatigue. Conclusions: Participation in PSAI was strongly associated with enhancement of self-management abilities. We aspire that PSAI can be introduced in healthcare settings as a multifaceted, meta-cognitive process of stress management and self-empowerment.

Mild cognitive impairment (MCI) represents a pre-dementia stage. Currently, there is no evidence for long-term efficacy of pharmacological treatment for preventing conversion to clinical dementia. Healthy lifestyle modifications, cognitive training and psychosocial initiatives are strongly recommended. This was an 8-week parallel randomized two-armed study. Eligible patients were randomized to intervention and control group, with the intervention group receiving the PSAI intervention including cognitive training, healthy lifestyle and stress management. Standardized questionnaires were used pre-and post-intervention. The between group analysis revealed a significant improvement in cognitive aspects, depression, stress, anxiety and self-efficacy post-intervention (p < 0.05, r > 0.5). Nine patients in the intervention group had one point increase in the MMSE score and one patient had a two-point increment post-intervention. Future studies should expand these preliminary findings to larger samples, neuroimaging measurements and longer follow-up in order to ascertain PSAI's role in preventing conversion to clinical dementia.