ORIGINAL COMMUNICATION Cognitive impairment, health-related quality of life and vocational status at early stages of multiple sclerosis: a 7-year longitudinal study Aure ´lie Ruet • Mathilde Deloire • Delphine Hamel • Jean-Christophe Ouallet • Klaus Petry • Bruno Brochet Received: 5 January 2012 / Revised: 4 October 2012 / Accepted: 6 October 2012 / Published online: 19 October 2012 Ó Springer-Verlag Berlin Heidelberg 2012 Abstract The association between cognitive impairment, health-related quality of life (HRQoL) and vocational sta- tus has been studied in recent years in cross-sectional studies in multiple sclerosis (MS), but longitudinal data are still lacking. This study assesses this association in a sample of 65 newly diagnosed MS patients followed lon- gitudinally. Each patient underwent a standardised clinical assessment, cognitive tests and the HRQoL SEP-59 ques- tionnaire six months after the MS diagnosis (baseline) and seven years later (y7).Vocational status was also estab- lished at baseline and at y7 in MS patients. The HRQoL at baseline was severely reduced in MS patients compared with healthy subjects. The independent predictors for HRQoL composite scores at y7 were the baseline depres- sion score and the memory Z-score. Accordingly, 81.5 % of MS patients worked at baseline and only 54.4 % worked at y7. Among the MS patients who did not work at y7, 72.7 % of them were cognitively impaired, while 27.3 % were unimpaired at baseline. The vocational status at y7 was significantly associated with the baseline IPS Z-score, EDSS and age. Vocational status at y7 and its change over 7 years was significantly associated with cognitive deteri- oration. IPS or memory dysfunction in the early stages of MS is correlated with a decreased level in health percep- tion, independent of fatigue, depression and physical disability. Cognitive impairment at the diagnosis of MS increases the risk of changing vocational status in MS patients seven years later. Keywords Multiple Sclerosis Á Information processing speed Á Cognition Á Quality of life Á Work Á Vocational status Introduction The goal of health-related quality of life (HRQoL) scales is to provide tools adapted to the evaluation of various dimensions of a given situation, including concerns that are not usually taken into account by standard medical assessment [1]. Many studies have used these scales to assess the perceived health in persons with multiple scle- rosis (PwMS) [2]. These studies consistently showed that PwMS have a significant decrease in HRQoL. The key factors for such low HRQoL scores have been studied, and low ratings of HRQoL have been associated with physical disability, fatigue and depression [2]. Physical HRQoL was associated with EDSS, fatigue and depression, while mental HRQoL was associated with only depression and fatigue [3]. Cognitive impairment is a prominent feature of multiple sclerosis (MS), and deficits occur in information processing speed (IPS), memory, attention, working memory and executive functions [4]. The contribution of cognitive disturbances to low HRQoL has been investigated in few studies [5–8]. One study including 92 patients with CIS and RRMS with a disease duration less than three years showed that after controlling for depression, three cognitive scores were associated with HRQoL measures. There were two tests of IPS (correlation between the PASAT and physical A. Ruet Á D. Hamel Á K. Petry Á B. Brochet (&) INSERM U.1049 Neuroinflammation, Imagerie et The ´rapie de la Scle ´rose en plaques, Universite ´ de Bordeaux, Case 78, 146 rue Le ´o Saignat, 33076 Bordeaux cedex, France e-mail: bruno.brochet@chu-bordeaux.fr A. Ruet Á M. Deloire Á J.-C. Ouallet Á B. Brochet CHU de Bordeaux, INSERM-CHU CIC-P 0005, and Services de Neurologie, 33076 Bordeaux, France 123 J Neurol (2013) 260:776–784 DOI 10.1007/s00415-012-6705-1