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In addition, as the total self-efficacy variability was for 65% explained by disease impact, our observations draw attention to the importance of considering early DMD treatment, in order to prevent an increase in disease impact. It may be hypothesized that cognitive functions positively affect self-efficacy, instead of self-efficacy affecting cognitive performance. Patients with better cognitive function could feel more capable of managing symptoms and coping with the demands of MS than patients with an impaired cognition. The most effective way of creating a strong sense of efficacy is through mastery experiences [7], and prima facie it is not clear how relatively slight changes in Power of Attention, Reaction Time Variability, and Speed of Memory could have an impact on the management of symptoms in patients [http://www.selleckchem.com/products/tenofovir-alafenamide-gs-7340.html buy GS-7340] with low levels of disability. The same holds for other factors contributing to self-efficacy, like vicarious experiences provided by social models and verbal persuasion. Future studies [http://en.wikipedia.org/wiki/Adenylyl_cyclase Adenylyl cyclase] on the relationship between self-efficacy and cognition should investigate this hypothesis. Our study has several limitations. First, we assessed MS-related self-efficacy, being self-efficacy with respect to functional abilities, management of symptoms, and coping with the demands of MS, and not specifically self-efficacy with respect to cognitive test performance. On the other hand, given the frequency and impact of cognitive impairment in MS, it may be expected that MS-related self-efficacy includes self-efficacy [http://www.selleckchem.com/products/BIBF1120.html Protein Tyrosine Kinase inhibitor] regarding cognitive functioning. Moreover, since we performed the cognitive tests in the context of a formal MS study on cognition and since the participants were aware of the fact that cognition may be impaired in MS, a relationship between MS-related self-efficacy and cognitive test performance is quite conceivable. Second, the analyses were explorative and to prevent relevant associations from going unnoticed we did no correction for multiple testing [37, 38]. However, the research questions on the relationship between self-efficacy and cognitive performance were predefined and in such a setting messages can be derived from patterns of exploratory P values or very small P values [39]. Our interpretation follows these rules, as we did not try not to overstress or overinterpret the findings and were conservative (r�� 0.50; P values