journal homepage: www.elsevier.com/locate/msard Available online at www.sciencedirect.com Autonomic symptom burden is associated with MS-related fatigue and quality of life M.M. Cortez a,n,1 , S.K. Nagi Reddy b , B. Goodman a , J.L. Carter a , D.M. Wingerchuk a a Neurology, Mayo Clinic of Arizona, Scottsdale, AZ, USA b Biostatistics, Mayo Clinic of Arizona, Scottsdale, AZ, USA Received 17 December 2014; received in revised form 19 January 2015; accepted 27 March 2015 KEYWORDS Quality of Life; Fatigue; Symptom assessment; Autonomic nervous system diseases; Multiple sclerosis; Orthostatic intolerance 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 = À 0.60; Mental À 0.54; po0.001) and FSS (R = 0.51; po0.001). There was no relationship between COMPASS-31 and EDSS (R =0, p =0.97) or disease duration (R = À 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. & 2015 Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.msard.2015.03.007 2211-0348/& 2015 Elsevier B.V. All rights reserved. Abbreviations: ASP, Autonomic Symptom Profile; CASS, Composite Autonomic Scoring Scale; COMPASS-31, 31-item Composite Autonomic Symptom Score; EDSS, Expanded Disability Severity Scale; FSS, Fatigue Severity Scale; IRB, Institutional Review Board; MRI, Magnetic Resonance Imaging; MHC, Mental Health Composite Score; MS, Multiple Sclerosis; MSQOL, MS-specific Quality of Life; PHC, Physical Health Composite Score; SD, Standard Deviation; QOL, Quality of Life n Corresponding author. Tel.: + 1 801 587 3848; fax: + 1 801 587 8113. E-mail addresses: melissa.cortez@hsc.utah.edu (M.M. Cortez), Nagireddy.Sravan@mayo.edu (S.K. Nagi Reddy), Goodman.brent@mayo.edu (B. Goodman), carter.jonathan@mayo.edu (J.L. Carter), wingerchuk.dean@mayo.edu (D.M. Wingerchuk). 1 Present address: 729 Arapeen Dr, Salt Lake City, UT 84108, USA. Multiple Sclerosis and Related Disorders (2015) 4, 258–263