title: Quality of life in multiple sclerosis is associated with lesion burden and brain volume measures.
abstract: BACKGROUND
  Health-related quality of life (HRQOL) is reduced in multiple sclerosis (MS). It is unclear whether HRQOL is associated with white matter lesion burden or measures of brain atrophy.
  
  
  METHODS
  A cross-sectional baseline analysis of 507 patients with MS in a prospective cohort study at the University of California, San Francisco was performed. Multivariate linear regression models were used to determine whether MRI measures were associated with the Emotional Well-Being and Thinking/Fatigue subscale scores of the Functional Assessment in Multiple Sclerosis, a validated HRQOL measure in MS. The difference in each MRI metric associated with a minimal clinically important difference in each HRQOL subscale was calculated.
  
  
  RESULTS
  Higher T1 lesion load (15 mL; p = 0.024), normalized T1 lesion volume (20 mL; p = 0.016), or T2 lesion load (25 mL; p = 0.028) was associated with worse scores for Emotional Well-Being. Meaningfully lower scores on this subscale were correlated with lower normalized gray matter volume (118 mL; p = 0.037). Reduced Thinking/Fatigue scores were associated with higher normalized T1 lesion volume (21 mL; p = 0.024), or T2 lesion load (22 mL; p = 0.010) and with lower normalized gray matter (87 mL; p = 0.004), white matter (85 mL; p = 0.025), or brain parenchymal (98 mL; p = 0.001) volume.
  
  
  CONCLUSIONS
  Aspects of health-related quality of life (HRQOL) in multiple sclerosis are associated with MRI evidence of white matter lesions and brain atrophy. These findings strengthen the argument for the use of HRQOL outcome measures in trials and suggest that lesion burden on conventional MRI is important for HRQOL.
authors.affiliation: Department of Neurology, University of California, San Francisco, 94117, USA. ellen.mowry@ucsf.edu
authors.forename: E M
authors.initials: EM
authors.lastname: Mowry
authors.forename: A
authors.initials: A
authors.lastname: Beheshtian
authors.forename: E
authors.initials: E
authors.lastname: Waubant
authors.forename: D S
authors.initials: DS
authors.lastname: Goodin
authors.forename: B A
authors.initials: BA
authors.lastname: Cree
authors.forename: P
authors.initials: P
authors.lastname: Qualley
authors.forename: R
authors.initials: R
authors.lastname: Lincoln
authors.forename: M F
authors.initials: MF
authors.lastname: George
authors.forename: R
authors.initials: R
authors.lastname: Gomez
authors.forename: S L
authors.initials: SL
authors.lastname: Hauser
authors.forename: D T
authors.initials: DT
authors.lastname: Okuda
authors.forename: D
authors.initials: D
authors.lastname: Pelletier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000033:anatomy & histology / Q000473:pathology; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000473:pathology* / Q000503:physiopathology; D009483:Neuropsychological Tests; D011788:Quality of Life; D055815:Young Adult