title: Autonomic symptom burden is associated with MS-related fatigue and quality of life.
abstract: BACKGROUND
  Nonspecific symptoms such as fatigue and dizziness are common in multiple sclerosis (MS), even in patients with normal exams. Little is known about the relationship of autonomic dysfunction with these symptoms and quality of life.
  
  
  OBJECTIVE
  Assess the association of autonomic symptom burden with fatigue, clinical status and quality of life.
  
  
  METHODS
  Subjects completed an autonomic symptom (COMPASS-31), quality of life (MSQOL-54) and fatigue (FSS) questionnaire at their routine MS clinic follow-up. Demographic and clinical data were collected from the medical record. Pearson correlations were assessed between autonomic symptoms and fatigue, quality of life, disability and disease duration.
  
  
  RESULTS
  One-hundred subjects completed the study (mean age 48 years; 78% female; 84% relapsing-remitting), mean disease duration was 14.7 years and mean EDSS 2.5. MSQOL-54 composite scores were 58 physical and 65 mental. COMPASS-31 correlated with MSQOL-54 (Physical R= -0.60; Mental -0.54; p<0.001) and FSS (R=0.51; p<0.001). There was no relationship between COMPASS-31 and EDSS (R=0, p=0.97) or disease duration (R= -0.02, p=0.84).
  
  
  CONCLUSIONS
  Autonomic symptom burden is correlated with decreased quality of life and increased fatigue. Autonomic symptoms are present early in the disease and at low disability and may reflect aspects of disease burden that are not well-captured by current disability measures.
authors.affiliation: Neurology, Mayo Clinic of Arizona, Scottsdale, AZ, USA. Electronic address: melissa.cortez@hsc.utah.edu.
authors.forename: M M
authors.initials: MM
authors.lastname: Cortez
authors.affiliation: Biostatistics, Mayo Clinic of Arizona, Scottsdale, AZ, USA. Electronic address: Nagireddy.Sravan@mayo.edu.
authors.forename: S K
authors.initials: SK
authors.lastname: Nagi Reddy
authors.affiliation: Neurology, Mayo Clinic of Arizona, Scottsdale, AZ, USA. Electronic address: Goodman.brent@mayo.edu.
authors.forename: B
authors.initials: B
authors.lastname: Goodman
authors.affiliation: Neurology, Mayo Clinic of Arizona, Scottsdale, AZ, USA. Electronic address: carter.jonathan@mayo.edu.
authors.forename: J L
authors.initials: JL
authors.lastname: Carter
authors.affiliation: Neurology, Mayo Clinic of Arizona, Scottsdale, AZ, USA. Electronic address: wingerchuk.dean@mayo.edu.
authors.forename: D M
authors.initials: DM
authors.lastname: Wingerchuk
mesh_terms: D000328:Adult; D000368:Aged; D001342:Autonomic Nervous System Diseases / Q000150:complications*; D004185:Disability Evaluation; D005221:Fatigue / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications* / Q000523:psychology*; D011788:Quality of Life; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Autonomic nervous system diseases; Fatigue; Multiple sclerosis; Orthostatic intolerance; Quality of Life; Symptom assessment