Document Type : Original Article


1 Neuroscience Research Group, Universal Scientific Education and Research Network, Tehran, Iran

2 Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran

3 Department of Psychology, School of Humanities, Tarbiat Modares University, Tehran, Iran


Background: Cognitive impairments in patients with multiple sclerosis (MS) are suggested as a prognostic factor for disease development, and consequently higher disability and more deficits in daily and social activities. In this regard, we aimed to investigate the association between quality of life (QOL) and cognitive function in patients with MS.
Methods: We conducted a cross-sectional study on patients with relapsing-remitting MS (RRMS). General characteristic variables were carried out, and then all patients underwent assessments such as Multiple Sclerosis Quality of Life-54 (MSQOL-54), Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS), Expanded Disability Status Scale (EDSS), Beck Depression Inventory-II (BDI-II), and North American Adult Reading Test (NAART).
Results: In the present study, a total of 92 patients, including 76 women with a mean disease duration of 6.82 ± 4.80 years were involved. Results of simple Pearson correlation revealed a significant positive relation between California Verbal Learning Test (CVLT) total learning with MSQOL mental health (r = 0.267, P = 0.017) and physical health (r = 0.299, P = 0.007). After adjusting for potential confounders, there was a negative correlation between MSQOL mental health with Delis-Kaplan Executive Function System (D-KEFS) (r = -0.303, P = 0.015) and Judgment of Line Orientation (JLO) (r = -0.310, P = 0.013). Besides, MSQOL physical health was negatively associated with Brief Visuospatial Memory Test-Revised (BVMT-R) in the adjusted model (r = -0.270, P = 0.031).
Conclusion: There is a statistically significant association between specific aspects of cognitive decline and QOL. Therefore, more attention should be paid to cognitive impairment in patients with MS as based on our findings, it is significantly associated with QOL.


  1. Yamout BI, Alroughani R. Multiple sclerosis. Semin Neurol 2018; 38(2): 212-25.
  2. Amato MP, Portaccio E, Goretti B, Zipoli V, Iudice A, Della PD, et al. Relevance of cognitive deterioration in early relapsing-remitting MS: A 3-year follow-up study. Mult Scler 2010; 16(12): 1474-82.
  3. Achiron A, Chapman J, Magalashvili D, Dolev M, Lavie M, Bercovich E, et al. Modeling of cognitive impairment by disease duration in multiple sclerosis: A cross-sectional study. PLoS One 2013; 8(8): e71058.
  4. Kizlaitiene R, Kaubrys G, Giedraitiene N, Ramanauskas N, Dementaviciene J. Composite marker of cognitive dysfunction and brain atrophy is highly accurate in discriminating between relapsing-remitting and secondary progressive multiple sclerosis. Med Sci Monit 2017; 23: 588-97.
  5. Moccia M, Lanzillo R, Palladino R, Chang KC, Costabile T, Russo C, et al. Cognitive impairment at diagnosis predicts 10-year multiple sclerosis progression. Mult Scler 2016; 22(5): 659-67.
  6. Johnen A, Landmeyer NC, Burkner PC, Wiendl H, Meuth SG, Holling H. Distinct cognitive impairments in different disease courses of multiple sclerosis-A systematic review and meta-analysis. Neurosci Biobehav Rev 2017; 83: 568-78.
  7. Cortese M, Riise T, Bjornevik K, Bhan A, Farbu E, Grytten N, et al. Preclinical disease activity in multiple sclerosis: A prospective study of cognitive performance prior to first symptom. Ann Neurol 2016; 80(4): 616-24.
  8. Harel Y, Kalron A, Menascu S, Magalashvili D, Dolev M, Doniger G, et al. Cognitive function in multiple sclerosis: A long-term look on the bright side. PLoS One 2019; 14(8): e0221784.
  9. Alirezaei M, Forouzannia SM, Yarahmadi P, Sahraian MA, Owji M, Bidadian M, et al. Demographic features, behavioral measures, and clinical factors as predictors of cognitive function in patients with multiple sclerosis. Mult Scler Relat Disord 2021; 49: 102758.
  10. Santangelo G, Altieri M, Gallo A, Trojano L. Does cognitive reserve play any role in multiple sclerosis? A meta-analytic study. Mult Scler Relat Disord 2019; 30: 265-76.
  11. Amato MP, Ponziani G, Siracusa G, Sorbi S. Cognitive dysfunction in early-onset multiple sclerosis: a reappraisal after 10 years. Arch Neurol 2001; 58(10): 1602-6.
  12. Benedict RH, Wahlig E, Bakshi R, Fishman I, Munschauer F, Zivadinov R, et al. Predicting quality of life in multiple sclerosis: Accounting for physical disability, fatigue, cognition, mood disorder, personality, and behavior change. J Neurol Sci 2005; 231(1-2): 29-34.
  13. Duka GK, Titlic M, Vuletic G. Quality of life and health of patients in early stages of Multiple sclerosis. Psychiatr Danub 2019; 31(Suppl 1): 118-25.
  14. Guyatt G. Measuring health-related quality of life: General issues. Can Respir J 1997; 4(3): 123-30.
  15. Preedy VR. Multiple Sclerosis Quality of Life-54 Questionnaire. In: Kreutzer JS, DeLuca J, Caplan B, editors. Encyclopedia of Clinical Neuropsychology. New York, NY: Springer; 2011. p. 1684-5.
  16. Oset M, Stasiolek M, Matysiak M. cognitive dysfunction in the early stages of multiple sclerosis-how much and how important? Curr Neurol Neurosci Rep 2020; 20(7): 22.
  17. Kurtzke JF. Rating neurologic impairment in multiple sclerosis: An expanded disability status scale (EDSS). Neurology 1983; 33(11): 1444-52.
  18. Steer RA, Brown GK, Beck AT, Sanderson WC. Mean Beck Depression Inventory-II scores by severity of major depressive episode. Psychol Rep 2001; 88(3 Pt 2): 1075-6.
  19. Uttl B. North American Adult Reading Test: Age norms, reliability, and validity. J Clin Exp Neuropsychol 2002; 24(8): 1123-37.
  20. Blair JR, Spreen O. Predicting premorbid IQ: A revision of the national adult reading test. null 1989; 3(2): 129-36.
  21. Eshaghi A, Riyahi-Alam S, Roostaei T, Haeri G, Aghsaei A, Aidi MR, et al. Validity and reliability of a Persian translation of the Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS). Clin Neuropsychol 2012; 26(6): 975-84.
  22. Tombaugh TN. A comprehensive review of the Paced Auditory Serial Addition Test (PASAT). Arch Clin Neuropsychol 2006; 21(1): 53-76.
  23. Sheridan LK, Fitzgerald HE, Adams KM, Nigg JT, Martel MM, Puttler LI, et al. Normative Symbol Digit Modalities Test performance in a community-based sample. Arch Clin Neuropsychol 2006; 21(1): 23-8.
  24. Woods SP, Delis DC, Scott JC, Kramer JH, Holdnack JA. The California Verbal Learning Test--second edition: Test-retest reliability, practice effects, and reliable change indices for the standard and alternate forms. Arch Clin Neuropsychol 2006; 21(5): 413-20.
  25. Benedict RHB, Schretlen D, Groninger L, Dobraski M, Shpritz B. Revision of the Brief Visuospatial Memory Test: Studies of normal performance, reliability, and validity. Psychological Assessment 1996; 8(2): 145-53.
  26. Patterson J. Controlled Oral Word Association Test. In: Kreutzer JS, DeLuca J, Caplan B, editors. Encyclopedia of Clinical Neuropsychology. New York, NY: Springer; 2011. p. 703-6.
  27. Irani F. Judgment of line orientation. In: Kreutzer JS, DeLuca J, Caplan B, editors. Encyclopedia of Clinical Neuropsychology. New York, NY: Springer; 2011. p. 1372-4.
  28. Homack S, Lee D, Riccio CA. Test review: Delis-Kaplan executive function system. J Clin Exp Neuropsychol 2005; 27(5): 599-609.
  29. Cox D, Julian L. Cognitive Dysfunction in multiple sclerosis. In: Olek MJ, editor. Multiple sclerosis: Etiology, diagnosis, and new treatment strategies. Totowa, NJ: Humana Press; 2005. p. 91-102.
  30. Campbell J, Rashid W, Cercignani M, Langdon D. Cognitive impairment among patients with multiple sclerosis: Associations with employment and quality of life. Postgrad Med J 2017; 93(1097): 143-7.
  31. Benedict RH, Zivadinov R. Risk factors for and management of cognitive dysfunction in multiple sclerosis. Nat Rev Neurol 2011; 7(6): 332-42.
  32. Glanz BI, Holland CM, Gauthier SA, Amunwa EL, Liptak Z, Houtchens MK, et al. Cognitive dysfunction in patients with clinically isolated syndromes or newly diagnosed multiple sclerosis. Mult Scler 2007; 13(8): 1004-10.
  33. Carotenuto A, Moccia M, Costabile T, Signoriello E, Paolicelli D, Simone M, et al. Associations between cognitive impairment at onset and disability accrual in young people with multiple sclerosis. Sci Rep 2019; 9(1): 18074.
  34. Gold SM, Schulz H, Monch A, Schulz KH, Heesen C. Cognitive impairment in multiple sclerosis does not affect reliability and validity of self-report health measures. Mult Scler 2003; 9(4): 404-10.
  35. Samartzis L, Gavala E, Zoukos Y, Aspiotis A, Thomaides T. Perceived cognitive decline in multiple sclerosis impacts quality of life independently of depression. Rehabil Res Pract 2014; 2014: 128751.
  36. Grossi P, Portaccio E, Bellomi F, Bianchi V, Cilia S, Falautano M, et al. The minimal neuropsychological assessment of MS patients (MACFIMS): Normative data of the Italian population. Neurol Sci 2020; 41(6): 1489-96.
  37. Migliore S, Ghazaryan A, Simonelli I, Pasqualetti P, Landi D, Palmieri MG, et al. Validity of the minimal assessment of cognitive function in multiple sclerosis (MACFIMS) in the Italian population. Neurol Sci 2016; 37(8): 1261-70.
  38. Riccardi A, Puthenparampil M, Rinaldi F, Ermani M, Perini P, Gallo P. D-KEFS ST failure identifies multiple sclerosis patients with worse objective and self-perceived physical and cognitive disability. Front Psychol 2019; 10: 49.
  39. Denney DR, Sworowski LA, Lynch SG. Cognitive impairment in three subtypes of multiple sclerosis. Arch Clin Neuropsychol 2005; 20(8): 967-81.
  40. Grech LB, Kiropoulos LA, Kirby KM, Butler E, Paine M, Hester R. The effect of executive function on stress, depression, anxiety, and quality of life in multiple sclerosis. J Clin Exp Neuropsychol 2015; 37(5): 549-62.
  41. Cutajar R, Ferriani E, Scandellari C, Sabattini L, Trocino C, Marchello LP, et al. Cognitive function and quality of life in multiple sclerosis patients. J Neurovirol 2000; 6 Suppl 2: S186-S190.
  42. de Caneda MAG, Cuervo DLM, Marinho NE, de Vecino MCA. The reliability of the Brief Visuospatial Memory Test - Revised in Brazilian multiple sclerosis patients. Dement Neuropsychol 2018; 12(2): 205-11.
  43. Longoni G, Rocca MA, Pagani E, Riccitelli GC, Colombo B, Rodegher M, et al. Deficits in memory and visuospatial learning correlate with regional hippocampal atrophy in MS. Brain Struct Funct 2015; 220(1): 435-44.