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Approximately half of MS patients (pwMS) experience cognitive impairments including domains such as memory, concentrations, executive functions, which can be exacerbated by mood disturbances and fatigue. NICE guidelines (CG168) recommend proactive identification of cognitive symptoms, assessment and referral to neuropsychology services or occupational therapy.To assess the local departmental MS service with regards to diagnosis and management of cognitive and behavioural symptoms.We conducted a retrospective audit of pwMS attending the specialist MS clinic since March 2017. Records were reviewed for documented evidence of: a discussion about cognitive and behavioural changes; use of assessment tools; management; referral. Data was also collected on demographics, presence of comorbidities, use of disease modifying therapy, and cognition-modulating medication.69% of pwMS demonstrated cognitive or behavioural symptoms including: fatigue (71%), poor memory (28%), depression, sleep disturbance, and concentration difficulties. Almost half expressed multiple symptoms. 47% of patients were referred for further management with OT, psychology services, or counselling.This study highlights the ongoing need for greater focus on identification of cognitive and behavioural symptoms in the MS population. Furthermore, simple assessment tools such as questionnaires should be considered within the clinic for monitoring cognitive symptoms and response to intervention.