Fatigue and depression predict quality of life in patients with early multiple sclerosis: a longitudinal study

Eur J Neurol. 2016 Sep;23(9):1482-6. doi: 10.1111/ene.13102. Epub 2016 Jul 14.

Abstract

Background and purpose: The clinical predictors of health-related quality of life (HRQoL) in multiple sclerosis (MS) have mainly been studied in patients with long-standing disease. The objective of this study was to investigate the longitudinal association among HRQoL and clinical characteristics in early MS.

Methods: Relapsing MS patients within 12 months of clinical onset were enrolled in a neuroprotection trial of riluzole versus placebo as an add-on to weekly interferon with up to 36 months of follow-up. Serial clinical measures included Short Form-36 (SF-36) as the measure of HRQoL, MS Functional Composite (as a measure of disability), Modified Fatigue Impact Scale, Patient Health Questionnaire-9 (as a measure of depression) and a cognitive battery. Multivariable linear regression analyses assessed cross-sectional associations. Mixed model regressions with mutual adjustments were used to assess the longitudinal association of HRQoL components and clinical, cognitive and demographic variables.

Results: Forty-three patients were enrolled within 7.5 ± 4.9 months of clinical onset (72% female, mean age 36 years). The baseline severity of fatigue and depression predicted subsequent changes in SF-36 Physical Component Summary (PCS) (P values of 0.001 and 0.021, respectively). In longitudinal analyses, changes in disability and depression were associated with changes in SF-36 PCS (P values of 0.002 and 0.009, respectively), whereas changes in cognitive function and fatigue were associated with changes in SF-36 Mental Component Summary (P values of 0.037 and 0.001, respectively). A 1-unit increase in MS Functional Composite was associated with a 7.1-point increase in SF-36 PCS (95% CI, 2.6-11.6).

Conclusions: Fatigue, depression, cognition and disability are independently associated with HRQoL in early MS.

Keywords: depression; fatigue; longitudinal study; multiple sclerosis; quality of life.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Cross-Sectional Studies
  • Depression / etiology*
  • Depression / psychology
  • Fatigue / etiology*
  • Fatigue / psychology
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Multiple Sclerosis / complications*
  • Multiple Sclerosis / drug therapy
  • Multiple Sclerosis / psychology
  • Neuroprotective Agents / therapeutic use
  • Predictive Value of Tests
  • Prognosis
  • Quality of Life
  • Riluzole / therapeutic use

Substances

  • Neuroprotective Agents
  • Riluzole