51
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Ruffell TO, Martin NH, Janssen A, Wijesekera L, Knights C, Burman R, Oliver DJ, Al-Chalabi A, Goldstein LH. Healthcare Professionals’ Views on the provision of Gastrostomy and Noninvasive Ventilation to Amyotrophic Lateral Sclerosis Patients in England, Wales, and Northern Ireland. J Palliat Care 2018. [DOI: 10.1177/082585971302900404] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Gastrostomy and noninvasive ventilation (NIV) are recommended interventions for the management of symptoms associated with amyotrophic lateral sclerosis (ALS). This study aimed to quantify the views of a range of healthcare professionals (HCPs) on the provision of these interventions in the United Kingdom. A total of 177 HCPs participated in an online survey. Significant differences were found between medical and allied HCPs’ views on: whether HCPs adhere to policy and accept legal constraints when it comes to making gastrostomy available to people with ALS; the impressions that HCPs receive of the way patients and caregivers understand the effects of gastrostomy and NIV on symptoms and quality of life; and the challenges HCPs face when caring for patients who have refused gastrostomy. More widely available guidelines for the provision of gastrostomy and advice on the best way to impart information to patients and caregivers about gastrostomy and NIV appear to be needed.
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Affiliation(s)
| | | | - Anna Janssen
- King's College London, Institute of Psychiatry, London, UK
| | - Lokesh Wijesekera
- KHP Centre for Neurodegeneration Research, King's College London, Institute of Psychiatry, London, UK
| | - Catherine Knights
- King's MND Care and Research Centre, King's College London, London, UK
| | - Rachel Burman
- King's College Hospital NHS Foundation Trust, Cicely Saunders Institute, London, UK
| | - David J. Oliver
- Wisdom Hospice, Rochester, and the Centre for Professional Practice, University of Kent, Chatham, UK
| | - Ammar Al-Chalabi
- KHP Centre for Neurodegeneration Research, King's College London, Institute of Psychiatry, and Department of Clinical Neuroscience, King's College London, Institute of Psychiatry, London, UK
| | - Laura H. Goldstein
- LH Goldstein (corresponding author): Department of Psychology, King's College London, Institute of Psychiatry, Box PO77, Henry Wellcome Building, De Crespigny Park, Denmark Hill, London SE5 8AF UK
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52
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Christidi F, Karavasilis E, Rentzos M, Kelekis N, Evdokimidis I, Bede P. Clinical and Radiological Markers of Extra-Motor Deficits in Amyotrophic Lateral Sclerosis. Front Neurol 2018; 9:1005. [PMID: 30524366 PMCID: PMC6262087 DOI: 10.3389/fneur.2018.01005] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 11/06/2018] [Indexed: 12/11/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is now universally recognized as a complex multisystem disorder with considerable extra-motor involvement. The neuropsychological manifestations of frontotemporal, parietal, and basal ganglia involvement in ALS have important implications for compliance with assistive devices, survival, participation in clinical trials, caregiver burden, and the management of individual care needs. Recent advances in neuroimaging have been instrumental in characterizing the biological substrate of heterogeneous cognitive and behavioral deficits in ALS. In this review we discuss the clinical and radiological aspects of cognitive and behavioral impairment in ALS focusing on the recognition, assessment, and monitoring of these symptoms.
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Affiliation(s)
- Foteini Christidi
- First Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstratios Karavasilis
- Second Department of Radiology, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece
| | - Michail Rentzos
- First Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Kelekis
- Second Department of Radiology, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Evdokimidis
- First Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Peter Bede
- Computational Neuroimaging Group, Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
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53
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Cortés-Vicente E, Turon-Sans J, Gelpi E, Clarimón J, Borrego-Écija S, Dols-Icardo O, Illán-Gala I, Lleó A, Illa I, Blesa R, Al-Chalabi A, Rojas-García R. Distinct Clinical Features and Outcomes in Motor Neuron Disease Associated with Behavioural Variant Frontotemporal Dementia. Dement Geriatr Cogn Disord 2018; 45:220-231. [PMID: 29886477 DOI: 10.1159/000488528] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 03/16/2018] [Indexed: 11/19/2022] Open
Abstract
AIM To determine the motor phenotype and outcome in a clinically ascertained group of patients with motor neuron disease (MND) and frontotemporal dementia (FTD). METHODS This is an observational retrospective clinical study of patients fulfilling the clinical criteria for MND-FTD. A contemporary series of patients with amyotrophic lateral sclerosis (ALS) without dementia were included for comparison. Demographic, clinical, genetic, and neuropathological data were collected. A descriptive and comparative data analysis was performed. RESULTS We identified 22 patients with MND-FTD. Selective distal upper limb muscle weakness and atrophy with non-significant lower limb weakness during follow-up was the most frequent motor pattern, present in 18 patients - in 15 of them associated with severe dysphagia. Aspiration pneumonia was the most common cause of death (12/19; 63%) despite gastrostomy. One-third of the patients did not develop upper motor neuron dysfunction. When compared to classic ALS without dementia (n = 162), these features were significantly different. A neuro-pathological examination was performed on 7 patients, and it confirmed the presence of MND with TDP43 protein aggregates in all patients. CONCLUSIONS The MND-FTD patients frequently displayed a distinctive motor pattern characterized by weakness and atrophy in distal upper limb muscles and dysphagia, with no or little spreading to other regions. These features may help to define specific subgroups of patients, which is important with regard to clinical management, outcome, and research.
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Affiliation(s)
- Elena Cortés-Vicente
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Center for Networked Biomedical Research into Rare Diseases (CIBERER), Madrid, Spain
| | - Janina Turon-Sans
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Center for Networked Biomedical Research into Rare Diseases (CIBERER), Madrid, Spain
| | - Ellen Gelpi
- Neurological Tissue Bank of the Biobanc Hospital Clínic IDIBAPS, Barcelona, Spain.,Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Jordi Clarimón
- Institute of Neurology, Medical University of Vienna, Vienna, Austria.,Memory Unit, Department of Neurology, and Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sergi Borrego-Écija
- Alzheimer and Other Cognitive Disorders Unit, Department of Neurology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Oriol Dols-Icardo
- Memory Unit, Department of Neurology, and Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Center for Networked Biomedical Research into Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Ignacio Illán-Gala
- Memory Unit, Department of Neurology, and Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Center for Networked Biomedical Research into Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Alberto Lleó
- Memory Unit, Department of Neurology, and Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Center for Networked Biomedical Research into Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Isabel Illa
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Center for Networked Biomedical Research into Rare Diseases (CIBERER), Madrid, Spain
| | - Rafael Blesa
- Memory Unit, Department of Neurology, and Sant Pau Biomedical Research Institute, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Center for Networked Biomedical Research into Neurodegenerative Diseases (CIBERNED), Madrid, Spain
| | - Ammar Al-Chalabi
- Maurice Wohl Clinical Neuroscience Institute, Department of Basic and Clinical Neuroscience, King's College London, London, United Kingdom
| | - Ricard Rojas-García
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Center for Networked Biomedical Research into Rare Diseases (CIBERER), Madrid, Spain
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54
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Caga J, Hsieh S, Highton-Williamson E, Zoing MC, Ramsey E, Devenney E, Ahmed RM, Hogden A, Kiernan MC. The burden of apathy for caregivers of patients with amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2018; 19:599-605. [PMID: 30369270 DOI: 10.1080/21678421.2018.1497659] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Apathy is the most common behavioral symptom of amyotrophic lateral sclerosis (ALS). Despite its known impact on caregiver wellbeing, apathy is typically considered a unitary construct making assessment and targeting treatment problematic. The aim of this study was to explore the relationship between caregiver burden and the behavioral, cognitive, and emotional symptoms of apathy in ALS. METHODS Fifty-one ALS patient-caregiver dyads from an ALS/frontotemporal dementia Clinic were assessed with the Apathy Evaluation Scale which measured the cognitive, behavioral, emotional, and nonspecific symptoms of apathy as well as the Zarit Burden Interview, a measure of perceived burden among caregivers of cognitively impaired older adults. The relationship between apathy and caregiver burden were analyzed using univariate and multivariate methods. RESULTS Apathy was identified in 18% of ALS patients. Greater behavioral (p = 0.011) and nonspecific (p = 0.010) symptoms of apathy exhibited by patients were reported by caregivers with higher levels of burden compared to caregivers with lower levels of burden. Of the cognitive, behavioral, emotional, and nonspecific symptoms of apathy, only the behavioral symptoms explained a significant amount of variance in caregiver burden (p = 0.031). CONCLUSIONS Apathy, specifically the behavioral symptoms of apathy was associated with higher burden of care among ALS caregivers, highlighting the importance of multidimensional assessment of apathy and provision of behavior management support as part of ALS care.
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Affiliation(s)
- Jashelle Caga
- a Brain & Mind Centre , University of Sydney , Camperdown , NSW , Australia , and.,b Sydney Medical School University of Sydney , Camperdown , NSW , Australia
| | - Sharpley Hsieh
- a Brain & Mind Centre , University of Sydney , Camperdown , NSW , Australia , and
| | | | - Margaret C Zoing
- a Brain & Mind Centre , University of Sydney , Camperdown , NSW , Australia , and
| | - Eleanor Ramsey
- a Brain & Mind Centre , University of Sydney , Camperdown , NSW , Australia , and
| | - Emma Devenney
- a Brain & Mind Centre , University of Sydney , Camperdown , NSW , Australia , and
| | - Rebekah M Ahmed
- a Brain & Mind Centre , University of Sydney , Camperdown , NSW , Australia , and
| | - Anne Hogden
- a Brain & Mind Centre , University of Sydney , Camperdown , NSW , Australia , and
| | - Matthew C Kiernan
- a Brain & Mind Centre , University of Sydney , Camperdown , NSW , Australia , and.,b Sydney Medical School University of Sydney , Camperdown , NSW , Australia
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55
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Tilanus T, Groothuis J, ten Broek-Pastoor J, Doorduin J, van Engelen B, Kampelmacher M, Raaphorst J. Respiratory Assessment of ALS Patients: A Nationwide Survey of Current Dutch Practice. J Neuromuscul Dis 2018; 5:431-438. [DOI: 10.3233/jnd-180302] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- T.B.M. Tilanus
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J.T. Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J.M.C. ten Broek-Pastoor
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J. Doorduin
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - B.G.M. van Engelen
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M.J. Kampelmacher
- Home Ventilation Service, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - J. Raaphorst
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
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56
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Femiano C, Trojsi F, Caiazzo G, Siciliano M, Passaniti C, Russo A, Bisecco A, Cirillo M, Monsurrò MR, Esposito F, Tedeschi G, Santangelo G. Apathy Is Correlated with Widespread Diffusion Tensor Imaging (DTI) Impairment in Amyotrophic Lateral Sclerosis. Behav Neurol 2018; 2018:2635202. [PMID: 30425751 PMCID: PMC6217902 DOI: 10.1155/2018/2635202] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 08/06/2018] [Accepted: 09/12/2018] [Indexed: 01/17/2023] Open
Abstract
Apathy is recognized as the most common behavioral change in several neurodegenerative diseases, including amyotrophic lateral sclerosis (ALS), a multisystem neurodegenerative disorder. Particularly, apathy has been reported to be associated with poor ALS prognosis. However, the brain microstructural correlates of this behavioral symptom, reported as the most common in ALS, have not been completely elucidated. Using diffusion tensor imaging (DTI) and tract-based spatial statistics (TBSS), here we aimed to quantify the correlation between brain microstructural damage and apathy scores in the early stages of ALS. Twenty-one consecutive ALS patients, in King's clinical stage 1 or 2, and 19 age- and sex-matched healthy controls (HCs) underwent magnetic resonance imaging and neuropsychological examination. Between-group comparisons did not show any significant difference on cognitive and behavioral variables. When compared to HCs, ALS patients exhibited a decreased fractional anisotropy (FA) [p < .05, threshold-free cluster enhancement (TFCE) corrected] in the corpus callosum and in bilateral anterior cingulate cortices. Self-rated Apathy Evaluation Scale (AES) scores and self-rated apathy T-scores of the Frontal Systems Behavior (FrSBe) scale were found inversely correlated to FA measures (p < .05, TFCE corrected) in widespread white matter (WM) areas, including several associative fiber tracts in the frontal, temporal, and parietal lobes. These results point towards an early microstructural degeneration of brain areas biologically involved in cognition and behavior regulation in ALS. Moreover, the significant correlations between apathy and DTI measures in several brain areas may suggest that subtle WM changes may be associated with mild behavioral symptoms in ALS even in the absence of overt cognitive and behavioral impairment.
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Affiliation(s)
- Cinzia Femiano
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences; MRI Research Center SUN-FISM, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Francesca Trojsi
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences; MRI Research Center SUN-FISM, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Giuseppina Caiazzo
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences; MRI Research Center SUN-FISM, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Mattia Siciliano
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences; MRI Research Center SUN-FISM, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
- Department of Psychology, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Carla Passaniti
- Department of Psychology, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Antonio Russo
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences; MRI Research Center SUN-FISM, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Alvino Bisecco
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences; MRI Research Center SUN-FISM, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Mario Cirillo
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences; MRI Research Center SUN-FISM, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Maria Rosaria Monsurrò
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences; MRI Research Center SUN-FISM, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Fabrizio Esposito
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Baronissi, Salerno, Italy
| | - Gioacchino Tedeschi
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences; MRI Research Center SUN-FISM, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Gabriella Santangelo
- Department of Psychology, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
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57
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Ishaque A, Mah D, Seres P, Luk C, Eurich D, Johnston W, Yang YH, Kalra S. Evaluating the cerebral correlates of survival in amyotrophic lateral sclerosis. Ann Clin Transl Neurol 2018; 5:1350-1361. [PMID: 30480029 PMCID: PMC6243384 DOI: 10.1002/acn3.655] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 08/20/2018] [Indexed: 01/17/2023] Open
Abstract
Objective To evaluate cerebral degenerative changes in ALS and their correlates with survival using 3D texture analysis. Methods A total of 157 participants were included in this analysis from four neuroimaging studies. Voxel-wise texture analysis on T1-weighted brain magnetic resonance images (MRIs) was conducted between patients and controls. Patients were divided into long- and short-survivors using the median survival of the cohort. Neuroanatomical differences between the two survival groups were also investigated. Results Whole-brain analysis revealed significant changes in image texture (FDR P < 0.05) bilaterally in the motor cortex, corticospinal tract (CST), insula, basal ganglia, hippocampus, and frontal regions including subcortical white matter. The texture of the CST correlated (P < 0.05) with finger- and foot-tapping rate, measures of upper motor neuron function. Patients with a survival below the media of 19.5 months demonstrated texture change (FDR P < 0.05) in the motor cortex, CST, basal ganglia, and the hippocampus, a distribution which corresponds to stage 4 of the distribution TDP-43 pathology in ALS. Patients with longer survival exhibited texture changes restricted to motor regions, including the motor cortex and the CST. Interpretation Widespread gray and white matter pathology is evident in ALS, as revealed by texture analysis of conventional T1-weighted MRI. Length of survival in patients with ALS is associated with the spatial extent of cerebral degeneration.
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Affiliation(s)
- Abdullah Ishaque
- Faculty of Medicine and Dentistry University of Alberta Edmonton Canada.,Neuroscience and Mental Health Institute University of Alberta Edmonton Canada
| | - Dennell Mah
- Division of Neurology Department of Medicine University of Alberta Edmonton Canada
| | - Peter Seres
- Department of Biomedical Engineering University of Alberta Edmonton Canada
| | - Collin Luk
- Faculty of Medicine and Dentistry University of Alberta Edmonton Canada
| | - Dean Eurich
- School of Public Health University of Alberta Edmonton Canada
| | - Wendy Johnston
- Division of Neurology Department of Medicine University of Alberta Edmonton Canada
| | - Yee-Hong Yang
- Department of Computing Sciences University of Alberta Edmonton Canada
| | - Sanjay Kalra
- Neuroscience and Mental Health Institute University of Alberta Edmonton Canada.,Division of Neurology Department of Medicine University of Alberta Edmonton Canada.,Department of Biomedical Engineering University of Alberta Edmonton Canada.,Department of Computing Sciences University of Alberta Edmonton Canada
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58
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Crockford C, Newton J, Lonergan K, Chiwera T, Booth T, Chandran S, Colville S, Heverin M, Mays I, Pal S, Pender N, Pinto-Grau M, Radakovic R, Shaw CE, Stephenson L, Swingler R, Vajda A, Al-Chalabi A, Hardiman O, Abrahams S. ALS-specific cognitive and behavior changes associated with advancing disease stage in ALS. Neurology 2018; 91:e1370-e1380. [PMID: 30209236 PMCID: PMC6177274 DOI: 10.1212/wnl.0000000000006317] [Citation(s) in RCA: 137] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 06/28/2018] [Indexed: 11/25/2022] Open
Abstract
Objective To elucidate the relationship between disease stage in amyotrophic lateral sclerosis (ALS), as measured with the King's Clinical Staging System, and cognitive and behavioral change, measured with the Edinburgh Cognitive and Behavioural ALS Screen (ECAS). Methods A large multicenter observational cohort of 161 cross-sectional patients with ALS and 80 healthy matched controls were recruited across 3 research sites (Dublin, Edinburgh, and London). Participants were administered the ECAS and categorized into independent groups based on their King's clinical disease stage at time of testing. Results Significant differences were observed between patients and controls on all subtests of the ECAS except for visuospatial functioning. A significant cross-sectional effect was observed across disease stages for ALS-specific functions (executive, language, letter fluency) and ECAS total score but not for ALS-nonspecific functions (memory, visuospatial). Rates of ALS-specific impairment and behavioral change were also related to disease stage. The relationship between cognitive function and disease stage may be due to letter fluency impairment, whereas higher rates of all behavioral domains were seen in later King's stage. The presence of bulbar signs, but not site of onset, was significantly related to ALS-specific, ECAS total, and behavioral scores. Conclusion ALS-specific cognitive deficits and behavioral impairment are more frequent with more severe disease stage. By end-stage disease, only a small percentage of patients are free of neuropsychological impairment. The presence of bulbar symptoms exaggerates the differences observed between disease stages. These findings suggest that cognitive and behavioral change should be incorporated into ALS diagnostic criteria and should be included in future staging systems.
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Affiliation(s)
- Christopher Crockford
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK
| | - Judith Newton
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK
| | - Katie Lonergan
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK
| | - Theresa Chiwera
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK
| | - Tom Booth
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK
| | - Siddharthan Chandran
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK
| | - Shuna Colville
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK
| | - Mark Heverin
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK
| | - Iain Mays
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK
| | - Suvankar Pal
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK
| | - Niall Pender
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK
| | - Marta Pinto-Grau
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK
| | - Ratko Radakovic
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK
| | - Christopher E Shaw
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK
| | - Laura Stephenson
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK
| | - Robert Swingler
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK
| | - Alice Vajda
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK
| | - Ammar Al-Chalabi
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK
| | - Orla Hardiman
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK
| | - Sharon Abrahams
- From Human Cognitive Neuroscience (C.C., J.N., T.B., R.R., S.A.), Psychology, Philosophy, Psychology and Language Sciences, Euan MacDonald Centre for Motor Neurone Disease Research (C.C., S.A.), and Alzheimer Scotland Dementia Research Centre (R.R.), University of Edinburgh; Anne Rowling Regenerative Neurology Clinic (J.N., S.C., S.P., R.R., L.S., R.S., S.A.), Royal Infirmary of Edinburgh, UK; Academic Unit of Neurology (K.L., M.H., I.M., M.P.-G., A.V., O.H.), Trinity College Dublin; Departments of Psychology (K.L., I.M., N.P., M.P.-G.) and Neurology (O.H.), Beaumont Hospital, Dublin, Ireland; and Maurice Wohl Clinical Neuroscience Institute (T.C., C.E.S., A.A.-C.), Department of Basic and Clinical Neuroscience, King's College London, UK.
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Abstract
OBJECTIVE Disease progression varies widely among patients with motor neuron disease (MND). Patients with MND and coexisting dementia have shorter survival. However, implications of mild cognitive and behavioral difficulties are unclear. The present study examined the relative contribution of executive functioning and self-regulation difficulties on survival over a 6-year period among patients with MND, who scored largely within normal limits on cognitive and behavioral indices. METHODS Patients with MND (N = 37, age = 59.97 ± 11.57, 46% female) completed the Wisconsin Card Sorting Task as an executive functioning perseveration index. The Behavior Rating Inventory of Executive Functions (BRIEF-A) was used as a behavioral measure of self-regulation in two subdomains self-regulatory behavior (Behavioral Regulation) and self-regulatory problem-solving (Metacognition). Cox proportional hazard regression analyses were used. RESULTS In total, 23 patients died during follow-up. In Cox proportional hazard regressions adjusted for a priori covariates, each 10-point t-score increment in patient-reported BRIEF-A self-regulatory behavior and problem-solving difficulties increased mortality risk by 94% and 103%, respectively (adjusted HR = 1.94, 95% CI = 1.07-3.52; adjusted HR = 2.03, 95% CI = 1.19-3.48). In sensitivity analyses, patient-reported self-regulatory problem-solving remained significant independent of disease severity and a priori covariates (adjusted HR = 1.68, 95% CI = 1.01-2.78), though the predictive value of self-regulatory behavior was attenuated in adjusted models (HR = 1.67, 95% CI = 0.85-3.27). Caregiver-reported BRIEF-A ratings of patients and Wisconsin Card Sorting Task perseverative errors did not significantly predict survival. CONCLUSIONS Preliminary evidence suggests patient-reported self-regulatory problem-solving difficulties indicate poorer prognosis in MND. Further research is needed to uncover mechanisms that negatively impact patient survival.
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60
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Tilanus TBM, Groothuis JT, Ten Broek-Pastoor JMC, Doorduin J, van Engelen BGM, Kampelmacher MJ, Raaphorst J. Respiratory Assessment of ALS Patients: A Nationwide Survey of Current Dutch Practice. J Neuromuscul Dis 2018:JND18302. [PMID: 30175982 DOI: 10.3233/jnd-18302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Non-invasive ventilation (NIV) is an established treatment for respiratory failure in patients with amyotrophic lateral sclerosis (ALS). Several studies have shown room for improvement with regard to respiratory care for ALS patients, including latency of referral. These studies focused on the time period starting at the moment of referral to a home ventilation service (HVS) onwards. In the current study we performed a nationwide survey to gain insight in the trajectory before referral. We questioned the assessment of respiratory impairment by ALS physicians/care teams, including criteria for referral to an HVS. METHODS We requested 40 ALS care teams in the Netherlands to fill in an online questionnaire on respiratory management in ALS patients. RESULTS Thirty-two ALS care teams (80%) responded. Forced vital capacity was the most frequently used test at each outpatient visit (72%) and often served as a criterion (78%) for referral to an HVS. Other respiratory function measurements that were performed less often included peak cough flow (50%), maximum inspiratory/expiratory pressure (31% /28%) and sniff nasal inspiratory pressure (13%). Morning headache was the most frequently questioned complaint (94%), followed by daytime sleepiness (91%). Dyspnoea and orthopnoea were reported by 38% and 59% as important complaints. Out of all patients under the care of the ALS care teams, the mean estimated proportion of patients that was referred to an HVS was 69% (range 20-100%). When physicians refrained from referral, the most often cited reasons were patient's decision to withhold NIV (94%) and cognitive impairment (50%). Sixteen percent of the respondents stated bulbar impairment as a reason to refrain from referral. CONCLUSION Despite findings in previous studies on the superiority of SNIP and PCF as compared to FVC, our study shows that a majority of ALS care teams still prefers to use FVC for the assessment of respiratory dysfunction and for the timing of referral to an HVS. Another finding is that bulbar impairment is not an obstacle for referral for NIV.
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Affiliation(s)
- T B M Tilanus
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J T Groothuis
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J M C Ten Broek-Pastoor
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Doorduin
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - B G M van Engelen
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M J Kampelmacher
- Home Ventilation Service, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - J Raaphorst
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
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61
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Bello-Haas VD. Physical therapy for individuals with amyotrophic lateral sclerosis: current insights. Degener Neurol Neuromuscul Dis 2018; 8:45-54. [PMID: 30890895 PMCID: PMC6065609 DOI: 10.2147/dnnd.s146949] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive, neurodegenerative, and inevitably fatal disease. There is no cure for ALS and life expectancy is typically 2–5 years after symptom onset. Despite the lack of a cure and the rapidly progressive nature of the disease, ALS is considered a “treatable disease” and rehabilitation is integral to optimal, comprehensive care. In addition to the other health care professions making up the health care team, physical therapy provides a critical role in the overall management in individuals with ALS. Physical therapy that is tailored to the individual’s needs and goals and focused on addressing symptoms and maximizing function and participation enables people with ALS to live their lives to the fullest and with quality. The purpose of this paper is to review some of the recent ALS research findings that have implications for physical therapy practice.
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Affiliation(s)
- Vanina Dal Bello-Haas
- Physiotherapy Program, School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada,
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62
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Extrapyramidal deficits in ALS: a combined biomechanical and neuroimaging study. J Neurol 2018; 265:2125-2136. [DOI: 10.1007/s00415-018-8964-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/23/2018] [Accepted: 07/04/2018] [Indexed: 12/25/2022]
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Christidi F, Karavasilis E, Velonakis G, Ferentinos P, Rentzos M, Kelekis N, Evdokimidis I, Bede P. The Clinical and Radiological Spectrum of Hippocampal Pathology in Amyotrophic Lateral Sclerosis. Front Neurol 2018; 9:523. [PMID: 30018591 PMCID: PMC6037820 DOI: 10.3389/fneur.2018.00523] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 06/13/2018] [Indexed: 12/29/2022] Open
Abstract
Hippocampal pathology in Amyotrophic Lateral Sclerosis (ALS) remains surprisingly under recognized despite compelling evidence from neuropsychology, neuroimaging and neuropathology studies. Hippocampal dysfunction contributes significantly to the clinical heterogeneity of ALS and requires structure-specific cognitive and neuroimaging tools for accurate in vivo evaluation. Recent imaging studies have generated unprecedented insights into the presymptomatic and longitudinal processes affecting this structure and have contributed to the characterisation of both focal and network-level changes. Emerging neuropsychology data suggest that memory deficits in ALS may be independent from executive dysfunction. In the era of precision medicine, where the development of individualized care strategies and patient stratification for clinical trials are key priorities, the comprehensive review of hippocampal dysfunction in ALS is particularly timely.
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Affiliation(s)
- Foteini Christidi
- First Department of Neurology, Aeginition Hospital National and Kapodistrian University of Athens, Athens, Greece
| | - Efstratios Karavasilis
- Second Department of Radiology, General University Hospital “Attikon”, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Velonakis
- Second Department of Radiology, General University Hospital “Attikon”, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Ferentinos
- Second Department of Psychiatry, General University Hospital “Attikon”, National and Kapodistrian University of Athens, Athens, Greece
| | - Michail Rentzos
- First Department of Neurology, Aeginition Hospital National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Kelekis
- Second Department of Radiology, General University Hospital “Attikon”, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Evdokimidis
- First Department of Neurology, Aeginition Hospital National and Kapodistrian University of Athens, Athens, Greece
| | - Peter Bede
- Computational Neuroimaging Group, Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
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Poletti B, Solca F, Carelli L, Faini A, Madotto F, Lafronza A, Monti A, Zago S, Ciammola A, Ratti A, Ticozzi N, Abrahams S, Silani V. Cognitive-behavioral longitudinal assessment in ALS: the Italian Edinburgh Cognitive and Behavioral ALS screen (ECAS). Amyotroph Lateral Scler Frontotemporal Degener 2018; 19:387-395. [DOI: 10.1080/21678421.2018.1473443] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Barbara Poletti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy,
| | - Federica Solca
- Department of Pathophysiology and Transplantation, “Dino Ferrari” Center, Università degli Studi di Milano, Milan, Italy,
| | - Laura Carelli
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy,
| | - Andrea Faini
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy,
| | - Fabiana Madotto
- Department of Medicine and Surgery, Research Centre on Public Health, University of Milano-Bicocca, Monza, Italy,
| | - Annalisa Lafronza
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy,
| | - Alessia Monti
- Department of Neurorehabilitation Sciences, Casa Cura Policlinico (CCP), Milan, Italy,
| | - Stefano Zago
- Department of Neuroscience and Mental Health, Università degli Studi di Milano, IRCCS Ospedale Maggiore Policlinico, Milan, Italy and
| | - Andrea Ciammola
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy,
| | - Antonia Ratti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy,
- Department of Pathophysiology and Transplantation, “Dino Ferrari” Center, Università degli Studi di Milano, Milan, Italy,
| | - Nicola Ticozzi
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy,
- Department of Pathophysiology and Transplantation, “Dino Ferrari” Center, Università degli Studi di Milano, Milan, Italy,
| | - Sharon Abrahams
- PPLS, Department of Psychology, Euan MacDonald Centre for Motor Neurone Disease Research, Human Cognitive Neuroscience-Psychology, University of Edinburgh, Edinburgh, UK
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy,
- Department of Pathophysiology and Transplantation, “Dino Ferrari” Center, Università degli Studi di Milano, Milan, Italy,
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Scherz B, Rabl R, Flunkert S, Rohler S, Neddens J, Taub N, Temmel M, Panzenboeck U, Niederkofler V, Zimmermann R, Hutter-Paier B. mTh1 driven expression of hTDP-43 results in typical ALS/FTLD neuropathological symptoms. PLoS One 2018; 13:e0197674. [PMID: 29787578 PMCID: PMC5963763 DOI: 10.1371/journal.pone.0197674] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 05/07/2018] [Indexed: 12/12/2022] Open
Abstract
Transgenic mouse models are indispensable tools to mimic human diseases and analyze the effectiveness of related new drugs. For a long time amyotrophic lateral sclerosis (ALS) research depended on only a few mouse models that exhibit a very strong and early phenotype, e.g. SOD1 mice, resulting in a short treatment time window. By now, several models are available that need to be characterized to highlight characteristics of each model. Here we further characterized the mThy1-hTDP-43 transgenic mouse model TAR6/6 that overexpresses wild type human TARDBP, also called TDP-43, under control of the neuronal Thy-1 promoter presented by Wils and colleagues, 2010, by using biochemical, histological and behavioral readouts. Our results show that TAR6/6 mice exhibit a strong TDP-43 expression in the hippocampus, spinal cord, hypothalamus and medulla oblongata. Apart from prominent protein expression in the nucleus, TDP-43 protein was found at lower levels in the cytosol of transgenic mice. Additionally, we detected insoluble TDP-43 in the cortex, motoneuron loss, and increased neuroinflammation in the central nervous system of TAR6/6 animals. Behavioral analyses revealed early motor deficits in the clasping- and wire suspension test as well as decreased anxiety in the elevated plus maze. Further motor tests showed differences at later time points compared to non-transgenic littermates, thus allowing the observation of onset and severity of such deficits. Together, TAR6/6 mice are a valuable tool to test new ALS/FTLD drugs that target TDP-43 expression and insolubility, neuroinflammation, motoneuron loss or other TDP-43 related downstream signaling pathways since these mice exhibit a later pathology as previously used ALS/FTLD mouse models.
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Affiliation(s)
- Barbara Scherz
- QPS Austria GmbH, Grambach, Austria
- Karl-Franzens University, Institute of Molecular Biosciences, Graz, Austria
| | | | | | - Siegfried Rohler
- Medical University Graz, Institute of Pathophysiology and Immunology, Graz, Austria
| | | | | | | | - Ute Panzenboeck
- Medical University Graz, Institute of Pathophysiology and Immunology, Graz, Austria
| | | | - Robert Zimmermann
- Karl-Franzens University, Institute of Molecular Biosciences, Graz, Austria
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Moszczynski AJ, Hintermayer MA, Strong MJ. Phosphorylation of Threonine 175 Tau in the Induction of Tau Pathology in Amyotrophic Lateral Sclerosis-Frontotemporal Spectrum Disorder (ALS-FTSD). A Review. Front Neurosci 2018; 12:259. [PMID: 29731706 PMCID: PMC5919950 DOI: 10.3389/fnins.2018.00259] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 04/04/2018] [Indexed: 11/17/2022] Open
Abstract
Approximately 50–60% of all patients with amyotrophic lateral sclerosis (ALS) will develop a deficit of frontotemporal function, ranging from frontotemporal dementia (FTD) to one or more deficits of neuropsychological, speech or language function which are collectively known as the frontotemporal spectrum disorders of ALS (ALS-FTSD). While the neuropathology underlying these disorders is most consistent with a widespread alteration in the metabolism of transactive response DNA-binding protein 43 (TDP-43), in both ALS with cognitive impairment (ALSci) and ALS with FTD (ALS-FTD; also known as MND-FTD) there is evidence for alterations in the metabolism of the microtubule associated protein tau. This alteration in tau metabolism is characterized by pathological phosphorylation at residue Thr175 (pThr175 tau) which in vitro is associated with activation of GSK3β (pTyr216GSK3β), phosphorylation of Thr231tau, and the formation of cytoplasmic inclusions with increased rates of cell death. This putative pathway of pThr175 induction of pThr231 and the formation of pathogenic tau inclusions has been recently shown to span a broad range of tauopathies, including chronic traumatic encephalopathy (CTE) and CTE in association with ALS (CTE-ALS). This pathway can be experimentally triggered through a moderate traumatic brain injury, suggesting that it is a primary neuropathological event and not secondary to a more widespread neuronal dysfunction. In this review, we discuss the neuropathological underpinnings of the postulate that ALS is associated with a tauopathy which manifests as a FTSD, and examine possible mechanisms by which phosphorylation at Thr175tau is induced. We hypothesize that this might lead to an unfolding of the hairpin structure of tau, activation of GSK3β and pathological tau fibril formation through the induction of cis-Thr231 tau conformers. A potential role of TDP-43 acting synergistically with pathological tau metabolism is proposed.
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Affiliation(s)
- Alexander J Moszczynski
- Molecular Medicine Research Group, Schulich School of Medicine & Dentistry, Robarts Research Institute, Western University, London, ON, Canada
| | - Matthew A Hintermayer
- Molecular Medicine Research Group, Schulich School of Medicine & Dentistry, Robarts Research Institute, Western University, London, ON, Canada
| | - Michael J Strong
- Molecular Medicine Research Group, Schulich School of Medicine & Dentistry, Robarts Research Institute, Western University, London, ON, Canada.,Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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Erkkinen MG, Kim MO, Geschwind MD. Clinical Neurology and Epidemiology of the Major Neurodegenerative Diseases. Cold Spring Harb Perspect Biol 2018; 10:a033118. [PMID: 28716886 PMCID: PMC5880171 DOI: 10.1101/cshperspect.a033118] [Citation(s) in RCA: 534] [Impact Index Per Article: 89.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Neurodegenerative diseases are a common cause of morbidity and cognitive impairment in older adults. Most clinicians who care for the elderly are not trained to diagnose these conditions, perhaps other than typical Alzheimer's disease (AD). Each of these disorders has varied epidemiology, clinical symptomatology, laboratory and neuroimaging features, neuropathology, and management. Thus, it is important that clinicians be able to differentiate and diagnose these conditions accurately. This review summarizes and highlights clinical aspects of several of the most commonly encountered neurodegenerative diseases, including AD, frontotemporal dementia (FTD) and its variants, progressive supranuclear palsy (PSP), corticobasal degeneration (CBD), Parkinson's disease (PD), dementia with Lewy bodies (DLB), multiple system atrophy (MSA), and Huntington's disease (HD). For each condition, we provide a brief overview of the epidemiology, defining clinical symptoms and diagnostic criteria, relevant imaging and laboratory features, genetics, pathology, treatments, and differential diagnosis.
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Affiliation(s)
- Michael G Erkkinen
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California 94158
| | - Mee-Ohk Kim
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California 94158
| | - Michael D Geschwind
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, California 94158
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Ayers JI, Cashman NR. Prion-like mechanisms in amyotrophic lateral sclerosis. HANDBOOK OF CLINICAL NEUROLOGY 2018; 153:337-354. [PMID: 29887144 DOI: 10.1016/b978-0-444-63945-5.00018-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The prion hypothesis - a protein conformation capable of replicating without a nucleic acid genome - was heretical at the time of its discovery. However, the characteristics of the disease-misfolded prion protein and its ability to transmit disease, replicate, and spread are now widely accepted throughout the scientific community. In fact, in the last decade a wealth of evidence has emerged supporting similar properties observed for many of the misfolded proteins implicated in other neurodegenerative diseases, such as Alzheimer disease, Parkinson disease, tauopathies, and as described in this chapter, amyotrophic lateral sclerosis (ALS). Multiple studies have now demonstrated the ability for superoxide dismutase-1, 43-kDa transactive response (TAR) DNA-binding protein, fused-in sarcoma, and most recently, C9orf72-encoded polypeptides to display properties similar to those of prions. The majority of these are cell-free and in vitro assays, while superoxide dismutase-1 remains the only ALS-linked protein to demonstrate several prion-like properties in vivo. In this chapter, we provide an introduction to ALS and review the recent literature linking several proteins implicated in the familial forms of the disease to properties of the prion protein.
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Affiliation(s)
- Jacob I Ayers
- Department of Neuroscience, Center for Translational Research in Neurodegenerative Disease (CTRND), University of Florida, Gainesville, FL, United States
| | - Neil R Cashman
- Department of Medicine, Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada.
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Crockford C, Newton J, Lonergan K, Madden C, Mays I, O'Sullivan M, Costello E, Pinto-Grau M, Vajda A, Heverin M, Pender N, Al-Chalabi A, Hardiman O, Abrahams S. Measuring reliable change in cognition using the Edinburgh Cognitive and Behavioural ALS Screen (ECAS). Amyotroph Lateral Scler Frontotemporal Degener 2017; 19:65-73. [PMID: 29214872 PMCID: PMC6510059 DOI: 10.1080/21678421.2017.1407794] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: Cognitive impairment affects approximately 50% of people with amyotrophic lateral sclerosis (ALS). Research has indicated that impairment may worsen with disease progression. The Edinburgh Cognitive and Behavioural ALS Screen (ECAS) was designed to measure neuropsychological functioning in ALS, with its alternate forms (ECAS-A, B, and C) allowing for serial assessment over time. Objective: The aim of the present study was to establish reliable change scores for the alternate forms of the ECAS, and to explore practice effects and test-retest reliability of the ECAS’s alternate forms. Method: Eighty healthy participants were recruited, with 57 completing two and 51 completing three assessments. Participants were administered alternate versions of the ECAS serially (A-B-C) at four-month intervals. Intra-class correlation analysis was employed to explore test-retest reliability, while analysis of variance was used to examine the presence of practice effects. Reliable change indices (RCI) and regression-based methods were utilized to establish change scores for the ECAS alternate forms. Results: Test-retest reliability was excellent for ALS Specific, ALS Non-Specific, and ECAS Total scores of the combined ECAS A, B, and C (all > .90). No significant practice effects were observed over the three testing sessions. RCI and regression-based methods produced similar change scores. Conclusion: The alternate forms of the ECAS possess excellent test-retest reliability in a healthy control sample, with no significant practice effects. The use of conservative RCI scores is recommended. Therefore, a change of ≥8, ≥4, and ≥9 for ALS Specific, ALS Non-Specific, and ECAS Total score is required for reliable change.
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Affiliation(s)
- Christopher Crockford
- a Department of Psychology, Human Cognitive Neuroscience , University of Edinburgh , Edinburgh , UK.,b Euan MacDonald Centre for Motor Neurone Disease Research , Royal Infirmary of Edinburgh , Edinburgh , UK
| | - Judith Newton
- a Department of Psychology, Human Cognitive Neuroscience , University of Edinburgh , Edinburgh , UK.,c Anne Rowling Regenerative Neurology Clinic , Royal Infirmary of Edinburgh , Edinburgh , UK
| | - Katie Lonergan
- d Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland.,e Department of Psychology , Beaumont Hospital , Dublin , Ireland
| | - Caoifa Madden
- d Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland.,e Department of Psychology , Beaumont Hospital , Dublin , Ireland
| | - Iain Mays
- d Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland.,e Department of Psychology , Beaumont Hospital , Dublin , Ireland
| | - Meabhdh O'Sullivan
- d Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland
| | - Emmet Costello
- d Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland.,e Department of Psychology , Beaumont Hospital , Dublin , Ireland
| | - Marta Pinto-Grau
- d Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland.,e Department of Psychology , Beaumont Hospital , Dublin , Ireland
| | - Alice Vajda
- d Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland
| | - Mark Heverin
- d Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland
| | - Niall Pender
- e Department of Psychology , Beaumont Hospital , Dublin , Ireland
| | - Ammar Al-Chalabi
- f Department of Basic and Clinical Neuroscience , Maurice Wohl Clinical Neuroscience Institute, King's College London , London , UK , and
| | - Orla Hardiman
- d Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland.,g Department of Neurology , Beaumont Hospital , Dublin , Ireland
| | - Sharon Abrahams
- a Department of Psychology, Human Cognitive Neuroscience , University of Edinburgh , Edinburgh , UK.,b Euan MacDonald Centre for Motor Neurone Disease Research , Royal Infirmary of Edinburgh , Edinburgh , UK.,c Anne Rowling Regenerative Neurology Clinic , Royal Infirmary of Edinburgh , Edinburgh , UK
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Crockford CJ, Kleynhans M, Wilton E, Radakovic R, Newton J, Niven EH, Al-Chalabi A, Hardiman O, Bak TH, Abrahams S. ECAS A-B-C: alternate forms of the Edinburgh Cognitive and Behavioural ALS Screen. Amyotroph Lateral Scler Frontotemporal Degener 2017; 19:57-64. [PMID: 29205065 DOI: 10.1080/21678421.2017.1407793] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The Edinburgh Cognitive and Behavioural ALS Screen (ECAS) is a short assessment by which neuropsychological symptoms can be detected and quantified in people with ALS. To avoid potential practice effects with repeated administration, here we present alternative versions of the ECAS suitable for measuring change over time. OBJECTIVE To develop two alternate versions of the ECAS: ECAS-B and ECAS-C. METHOD One hundred and forty-nine healthy adult participants were recruited. Thirty participants completed a pilot study in developing the alternate versions. Two groups of 40 participants were administered the ECAS-B or ECAS-C and compared to published data of the original ECAS (ECAS-A) to determine equivalence. An additional 39 participants were administered the ECAS consecutively, either repeating the original version (ECAS-A-A-A) serially or the different versions (ECAS-A-B-C) to determine potential practice effects. Recordings of assessments were scored by a second researcher to determine inter-rater reliability. RESULTS No significant differences were found between versions (A, B, C) of the composite performance measures of ALS Specific, ALS Non-Specific, and ECAS Total scores. Repeated serial administration of ECAS-A (A-A-A) produced some practice effects for composite scores, whereas no such effects were found when alternate versions were administered serially (A-B-C). Exceptionally high intra-class correlations were found for all three versions of the ECAS suggesting a high degree of rater agreement. CONCLUSION The newly developed alternate forms of the ECAS are both highly equitable to the original ECAS-A and enable avoidance of practice effects, thus supporting their use in measuring cognition and behaviour over time.
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Affiliation(s)
- Christopher J Crockford
- a Department of Psychology , University of Edinburgh , Edinburgh , UK.,b Euan MacDonald Centre for Motor Neurone Disease Research , Royal Infirmary of Edinburgh , Edinburgh , UK
| | | | - Evelyn Wilton
- a Department of Psychology , University of Edinburgh , Edinburgh , UK
| | - Ratko Radakovic
- a Department of Psychology , University of Edinburgh , Edinburgh , UK.,c Anne Rowling Regenerative Neurology Clinic , Royal Infirmary of Edinburgh , Edinburgh , UK.,d Alzheimer Scotland Dementia Research Centre , University of Edinburgh , Edinburgh , UK
| | - Judith Newton
- a Department of Psychology , University of Edinburgh , Edinburgh , UK.,c Anne Rowling Regenerative Neurology Clinic , Royal Infirmary of Edinburgh , Edinburgh , UK
| | - Elaine H Niven
- a Department of Psychology , University of Edinburgh , Edinburgh , UK
| | - Ammar Al-Chalabi
- e Department of Basic and Clinical Neuroscience , Maurice Wohl Clinical Neuroscience Institute, King's College London , London , UK , and
| | - Orla Hardiman
- f Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland
| | - Thomas H Bak
- a Department of Psychology , University of Edinburgh , Edinburgh , UK.,b Euan MacDonald Centre for Motor Neurone Disease Research , Royal Infirmary of Edinburgh , Edinburgh , UK.,c Anne Rowling Regenerative Neurology Clinic , Royal Infirmary of Edinburgh , Edinburgh , UK
| | - Sharon Abrahams
- a Department of Psychology , University of Edinburgh , Edinburgh , UK.,b Euan MacDonald Centre for Motor Neurone Disease Research , Royal Infirmary of Edinburgh , Edinburgh , UK.,c Anne Rowling Regenerative Neurology Clinic , Royal Infirmary of Edinburgh , Edinburgh , UK
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71
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Bock M, Duong YN, Kim A, Allen I, Murphy J, Lomen-Hoerth C. Progression and effect of cognitive-behavioral changes in patients with amyotrophic lateral sclerosis. Neurol Clin Pract 2017; 7:488-498. [PMID: 29431172 DOI: 10.1212/cpj.0000000000000397] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background To prospectively evaluate the progression of cognitive-behavioral function in amyotrophic lateral sclerosis (ALS) and examine the association of cognitive-behavioral deficits with disease progression, patient quality of life (QOL), and caregiver burden. Methods We evaluated cognitive-behavioral function using the Amyotrophic Lateral Sclerosis Cognitive Behavioral Screen at enrollment and after 7 months in a cohort of patients with ALS. Paired t tests were used to evaluate the change in the 2 assessments. Linear regression and Kruskal-Wallis tests were applied to investigate how initial cognitive or behavioral status related to outcomes. Results The mean test-retest interval was 6.8 months (SD 1.6). Cognitive status of the study population (n = 49) overall did not change over the study period (p = 0.06) despite progression of motor weakness (p < 0.001), though small subsets of the sample demonstrate cognitive change. Patients initially classified as behaviorally normal showed increased behavioral problems over time (t = -2.8, p = 0.009). Decline in cognitive (β = -1.3, p = 0.03) and behavioral (β = -0.76, p = 0.002) status predicted increasing caregiver burden. Behavioral abnormalities predicted decline in forced vital capacity and ALS Functional Rating Scale-Revised score (p = 0.008, 0.012) in the study population and patient QOL in the most severely affected group (t = 4.3, p = 0.003). Conclusions Cognitive-behavioral change is a key aspect of disease heterogeneity in ALS. Executive function in ALS overall remains stable over 7 months as detected by an administered screening tool. However, patients may develop caregiver-reported behavioral symptoms in that time period. Screening for caregiver-reported symptoms has a particular utility in predicting future clinical decline, increased caregiver burden, and worsening patient QOL.
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Affiliation(s)
- Meredith Bock
- Departments of Neurology (MB, Y-ND, AK, JM, CL-H) and Epidemiology and Biostatistics (IA), University of California, San Francisco
| | - Y-Nhy Duong
- Departments of Neurology (MB, Y-ND, AK, JM, CL-H) and Epidemiology and Biostatistics (IA), University of California, San Francisco
| | - Anthony Kim
- Departments of Neurology (MB, Y-ND, AK, JM, CL-H) and Epidemiology and Biostatistics (IA), University of California, San Francisco
| | - Isabel Allen
- Departments of Neurology (MB, Y-ND, AK, JM, CL-H) and Epidemiology and Biostatistics (IA), University of California, San Francisco
| | - Jennifer Murphy
- Departments of Neurology (MB, Y-ND, AK, JM, CL-H) and Epidemiology and Biostatistics (IA), University of California, San Francisco
| | - Catherine Lomen-Hoerth
- Departments of Neurology (MB, Y-ND, AK, JM, CL-H) and Epidemiology and Biostatistics (IA), University of California, San Francisco
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Comorbidity of dementia with amyotrophic lateral sclerosis (ALS): insights from a large multicenter Italian cohort. J Neurol 2017; 264:2224-2231. [PMID: 28914354 DOI: 10.1007/s00415-017-8619-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/02/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
Abstract
To assess the association, at diagnosis, between amyotrophic lateral sclerosis (ALS) and dementia in a large cohort of well-characterized Italian patients. We investigated the phenotypic profile of 1638 incident patients with definite, probable or laboratory-supported probable ALS, diagnosed from January 2009 to December 2013 in 13 Italian Referral Centers, located in 10 Italian Regions, and classified in two independent subsamples accounting for presence or not of dementia. The collected ALS features, including survival and other follow-up data, were compared between the two subgroups using a one-way analysis of variance and Chi-square test, as appropriate, logistic regression models and Kaplan-Meier survival analysis. Between-subgroup comparisons showed an older age at clinical observation (p = .006), at onset and at diagnosis (p = .002) in demented versus non demented ALS patients. After adjustment for these variables, diagnosis of dementia was significantly associated with higher odds of family history of ALS (p = .001) and frontotemporal dementia (p = .003) and of bulbar onset (p = .004), and lower odds of flail leg phenotype (p = .019) and spinal onset (p = .008). The median survival time was shorter in demented versus non-demented patients, especially in case of classical, bulbar and flail limb phenotypes and both bulbar and spinal onset. Our multicenter study emphasized the importance of an early diagnosis of comorbid dementia in ALS patients, which may have clinical impact and prognostic relevance. Moreover, our results may give further inputs to validation of ALS-specific tools for the screening of cognitive impairment in clinical practice.
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Grad LI, Rouleau GA, Ravits J, Cashman NR. Clinical Spectrum of Amyotrophic Lateral Sclerosis (ALS). Cold Spring Harb Perspect Med 2017; 7:cshperspect.a024117. [PMID: 28003278 DOI: 10.1101/cshperspect.a024117] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is primarily characterized by progressive loss of motor neurons, although there is marked phenotypic heterogeneity between cases. Typical, or "classical," ALS is associated with simultaneous upper motor neuron (UMN) and lower motor neuron (LMN) involvement at disease onset, whereas atypical forms, such as primary lateral sclerosis and progressive muscular atrophy, have early and predominant involvement in the UMN and LMN, respectively. The varying phenotypes can be so distinctive that they would seem to have differing biology. Because the same phenotypes can have multiple causes, including different gene mutations, there may be multiple molecular mechanisms causing ALS, implying that the disease is a syndrome. Conversely, multiple phenotypes can be caused by a single gene mutation; thus, a single molecular mechanism could be compatible with clinical heterogeneity. The pathogenic mechanism(s) in ALS remain unknown, but active propagation of the pathology neuroanatomically is likely a primary component.
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Affiliation(s)
- Leslie I Grad
- Djavad Mowafaghian Centre for Brain Health, Department of Medicine (Neurology), University of British Columbia, Vancouver V6T 2B5, Canada
| | - Guy A Rouleau
- Montreal Neurological Institute and Hospital, McGill University, Montréal H3A 2B4, Canada
| | - John Ravits
- Department of Neurosciences, University of California, San Diego, La Jolla, California 92093
| | - Neil R Cashman
- Djavad Mowafaghian Centre for Brain Health, Department of Medicine (Neurology), University of British Columbia, Vancouver V6T 2B5, Canada
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Omer T, Finegan E, Hutchinson S, Doherty M, Vajda A, McLaughlin RL, Pender N, Hardiman O, Bede P. Neuroimaging patterns along the ALS-FTD spectrum: a multiparametric imaging study. Amyotroph Lateral Scler Frontotemporal Degener 2017; 18:611-623. [DOI: 10.1080/21678421.2017.1332077] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Taha Omer
- Quantitative Neuroimaging Group, Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Eoin Finegan
- Quantitative Neuroimaging Group, Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | | | - Mark Doherty
- Population Genetics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Ireland
| | - Alice Vajda
- Quantitative Neuroimaging Group, Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Russell L. McLaughlin
- Population Genetics Laboratory, Smurfit Institute of Genetics, Trinity College Dublin, Dublin, Ireland
| | - Niall Pender
- Quantitative Neuroimaging Group, Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Orla Hardiman
- Quantitative Neuroimaging Group, Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Peter Bede
- Quantitative Neuroimaging Group, Academic Unit of Neurology, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
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Abstract
Frontotemporal dementia (FTD) is a heterogeneous disorder with distinct clinical phenotypes associated with multiple neuropathologic entities. Presently, the term FTD encompasses clinical disorders that include changes in behavior, language, executive control, and often motor symptoms. The core FTD spectrum disorders include behavioral variant FTD, nonfluent/agrammatic variant primary progressive aphasia, and semantic variant PPA. Related FTD disorders include frontotemporal dementia with motor neuron disease, progressive supranuclear palsy syndrome, and corticobasal syndrome. In this article, the authors discuss the clinical presentation, diagnostic criteria, neuropathology, genetics, and treatments of these disorders.
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Affiliation(s)
- Nicholas T Olney
- Department of Neurology, UCSF Memory and Aging Center, San Francisco, CA, USA.
| | - Salvatore Spina
- Department of Neurology, UCSF Memory and Aging Center, San Francisco, CA, USA
| | - Bruce L Miller
- Department of Neurology, UCSF Memory and Aging Center, San Francisco, CA, USA; UCSF School of Medicine, San Francisco, CA, USA
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Ceriana P, Surbone S, Segagni D, Schreiber A, Carlucci A. Decision-making for tracheostomy in amyotrophic lateral sclerosis (ALS): a retrospective study. Amyotroph Lateral Scler Frontotemporal Degener 2017; 18:492-497. [PMID: 28457142 DOI: 10.1080/21678421.2017.1317812] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND ALS patients should discuss the issue of tracheostomy before the onset of terminal respiratory failure. While the process of shared decision-making is desirable, there are few data on the practical application of this real-life situation. AIM OF THE STUDY To determine how a decision-making process is actually carried out, we analysed the episodes of acute respiratory failure preceding tracheostomy. METHODS We studied the charts of a group of ALS patients after tracheostomy. An interview focusing on the existence of anticipated directives was carried out. Tracheostomies were classified as planned or unplanned according to the presence of a decision plan. RESULTS A total of 209 ALS patients were cared for during a three-year period. Of these patients, 34 (16%) were tracheotomised. In 38% of cases, tracheostomy was planned, 41% were unplanned, and 21% remained undiagnosed. CONCLUSIONS A minority of ALS patients make a voluntary decision for tracheostomy before the procedure is conducted. The advising process of care still presents limits that have been thus far poorly addressed. In the future, we will need to develop guidelines for the timing and content of the shared-decision making process.
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Affiliation(s)
- Piero Ceriana
- a Pulmonary Rehabilitation Unit, IRCCS Istituti Clinici Scientifici Maugeri , Pavia , Italy
| | - Sara Surbone
- b Respiratory Disease Department , ASST , Pavia , Italy , and
| | - Daniele Segagni
- c Laboratory of System Engineering for Clinical Research , IRCCS Istituti Clinici Scientifici Maugeri , Pavia , Italy
| | - Annia Schreiber
- a Pulmonary Rehabilitation Unit, IRCCS Istituti Clinici Scientifici Maugeri , Pavia , Italy
| | - Annalisa Carlucci
- a Pulmonary Rehabilitation Unit, IRCCS Istituti Clinici Scientifici Maugeri , Pavia , Italy
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Schuster C, Hardiman O, Bede P. Survival prediction in Amyotrophic lateral sclerosis based on MRI measures and clinical characteristics. BMC Neurol 2017; 17:73. [PMID: 28412941 PMCID: PMC5393027 DOI: 10.1186/s12883-017-0854-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 04/01/2017] [Indexed: 11/20/2022] Open
Abstract
Background Amyotrophic lateral sclerosis (ALS) a highly heterogeneous neurodegenerative condition. Accurate diagnostic, monitoring and prognostic biomarkers are urgently needed both for individualised patient care and clinical trials. A multimodal magnetic resonance imaging study is presented, where MRI measures of ALS-associated brain regions are utilised to predict 18-month survival. Methods A total of 60 ALS patients and 69 healthy controls were included in this study. 20% of the patient sample was utilised as an independent validation sample. Surface-based morphometry and diffusion tensor white matter parameters were used to identify anatomical patterns of neurodegeneration in 80% of the patient sample compared to healthy controls. Binary logistic ridge regressions were carried out to predict 18-month survival based on clinical measures alone, MRI features, and a combination of clinical and MRI data. Clinical indices included age at symptoms onset, site of disease onset, diagnostic delay from first symptom to diagnosis, and physical disability (ALSFRS-r). MRI features included the average cortical thickness of the precentral and paracentral gyri, the average fractional anisotropy, radial-, medial-, and axial diffusivity of the superior and inferior corona radiata, internal capsule, cerebral peduncles and the genu, body and splenium of the corpus callosum. Results Clinical data alone had a survival prediction accuracy of 66.67%, with 62.50% sensitivity and 70.84% specificity. MRI data alone resulted in a prediction accuracy of 77.08%, with 79.16% sensitivity and 75% specificity. The combination of clinical and MRI measures led to a survival prediction accuracy of 79.17%, with 75% sensitivity and 83.34% specificity. Conclusion Quantitative MRI measures of ALS-specific brain regions enhance survival prediction in ALS and should be incorporated in future clinical trial designs. Electronic supplementary material The online version of this article (doi:10.1186/s12883-017-0854-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christina Schuster
- Quantitative Neuroimaging Group, Academic Unit of Neurology, Room 5.43, Biomedical Sciences Institute, Trinity College Dublin, Pearse Street, Dublin 2, Ireland
| | - Orla Hardiman
- Quantitative Neuroimaging Group, Academic Unit of Neurology, Room 5.43, Biomedical Sciences Institute, Trinity College Dublin, Pearse Street, Dublin 2, Ireland
| | - Peter Bede
- Quantitative Neuroimaging Group, Academic Unit of Neurology, Room 5.43, Biomedical Sciences Institute, Trinity College Dublin, Pearse Street, Dublin 2, Ireland.
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Burkhardt C, Neuwirth C, Weber M. Longitudinal assessment of the Edinburgh Cognitive and Behavioural Amyotrophic Lateral Sclerosis Screen (ECAS): lack of practice effect in ALS patients? Amyotroph Lateral Scler Frontotemporal Degener 2017; 18:202-209. [PMID: 28165766 DOI: 10.1080/21678421.2017.1283418] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The study objective was to assess whether controls and ALS patients show a practice effect in the Edinburgh Cognitive and Behavioural ALS Screen (ECAS) on repeated longitudinal testing and if the ECAS detects progression of cognitive or behavioural changes over time. METHODS The ECAS was administered serially to ALS patients (n = 24 after six months, n = 10 after 12-18 months) and controls (n = 21 after six months). The ECAS was fully performed by all participants. For comparison purposes the Frontal Assessment Battery (FAB) was administered to a subgroup of 14 patients and 14 controls. RESULTS After six months controls showed a significantly higher overall score (p < 0.001) and significantly higher scores in all subdomains of the ECAS, except for visuospatial function and fluency. ALS patients showed no significant difference in any score of the ECAS after six months and up to18 months. Behavioural changes were increasingly, but not statistically, significant, noted by patient carers. The FAB was no longer applicable due to progressive motor deficits in 20% of ALS patients. CONCLUSIONS In conclusion, in contrast to healthy controls, ALS patients show no practice effects. This could reflect 'pre-symptomatic' cognitive decline and progressive behavioural symptoms.
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Affiliation(s)
- Christian Burkhardt
- a ALS Clinic/Neuromuscular Diseases Unit , Kantonsspital St. Gallen , St Gallen , Switzerland
| | - Christoph Neuwirth
- a ALS Clinic/Neuromuscular Diseases Unit , Kantonsspital St. Gallen , St Gallen , Switzerland
| | - Markus Weber
- a ALS Clinic/Neuromuscular Diseases Unit , Kantonsspital St. Gallen , St Gallen , Switzerland
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Knibb JA, Keren N, Kulka A, Leigh PN, Martin S, Shaw CE, Tsuda M, Al-Chalabi A. A clinical tool for predicting survival in ALS. J Neurol Neurosurg Psychiatry 2016; 87:1361-1367. [PMID: 27378085 PMCID: PMC5136716 DOI: 10.1136/jnnp-2015-312908] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 03/24/2016] [Accepted: 04/06/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a progressive and usually fatal neurodegenerative disease. Survival from diagnosis varies considerably. Several prognostic factors are known, including site of onset (bulbar or limb), age at symptom onset, delay from onset to diagnosis and the use of riluzole and non-invasive ventilation (NIV). Clinicians and patients would benefit from a practical way of using these factors to provide an individualised prognosis. METHODS 575 consecutive patients with incident ALS from a population-based registry in South-East England register for ALS (SEALS) were studied. Their survival was modelled as a two-step process: the time from diagnosis to respiratory muscle involvement, followed by the time from respiratory involvement to death. The effects of predictor variables were assessed separately for each time interval. FINDINGS Younger age at symptom onset, longer delay from onset to diagnosis and riluzole use were associated with slower progression to respiratory involvement, and NIV use was associated with lower mortality after respiratory involvement, each with a clinically significant effect size. Riluzole may have a greater effect in younger patients and those with longer delay to diagnosis. A patient's survival time has a roughly 50% chance of falling between half and twice the predicted median. INTERPRETATION A simple and clinically applicable graphical method of predicting an individual patient's survival from diagnosis is presented. The model should be validated in an independent cohort, and extended to include other important prognostic factors.
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Affiliation(s)
- Jonathan A Knibb
- Brighton and Sussex University Hospitals NHS Trust, Royal Sussex County Hospital, Brighton, UK
| | - Noa Keren
- Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anna Kulka
- Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - P Nigel Leigh
- Trafford Centre for Biomedical Research, Brighton and Sussex Medical School, Falmer, UK
| | - Sarah Martin
- Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Christopher E Shaw
- Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Miho Tsuda
- Macclesfield District General Hospital, Macclesfield, Cheshire, UK
| | - Ammar Al-Chalabi
- Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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80
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Neural correlates of cognitive set shifting in amyotrophic lateral sclerosis. Clin Neurophysiol 2016; 127:3537-3545. [DOI: 10.1016/j.clinph.2016.09.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 08/30/2016] [Accepted: 09/26/2016] [Indexed: 12/11/2022]
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81
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Keller J, Gorges M, Aho-Özhan HEA, Uttner I, Schneider E, Kassubek J, Pinkhardt EH, Ludolph AC, Lulé D. Eye-Tracking Control to Assess Cognitive Functions in Patients with Amyotrophic Lateral Sclerosis. J Vis Exp 2016. [PMID: 27768047 DOI: 10.3791/54634] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder with pathological involvement of upper and lower motoneurons, subsequently leading to progressive loss of motor and speech abilities. In addition, cognitive functions are impaired in a subset of patients. To evaluate these potential deficits in severely physically impaired ALS patients, eye-tracking is a promising means to conduct cognitive tests. The present article focuses on how eye movements, an indirect means of communication for physically disabled patients, can be utilized to allow for detailed neuropsychological assessment. The requirements, in terms of oculomotor parameters that have to be met for sufficient eye-tracking in ALS patients are presented. The properties of stimuli, including type of neuropsychological tests and style of presentation, best suited to successfully assess cognitive functioning, are also described. Furthermore, recommendations regarding procedural requirements are provided. Overall, this methodology provides a reliable, easy to administer and fast approach for assessing cognitive deficits in patients who are unable to speak or write such as patients with severe ALS. The only confounding factor might be deficits in voluntary eye movement control in a subset of ALS patients.
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Affiliation(s)
| | | | | | | | - Erich Schneider
- Institute of Medical Technology, Brandenburg University of Technology Cottbus-Senftenberg
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82
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Govaarts R, Beeldman E, Kampelmacher MJ, van Tol MJ, van den Berg LH, van der Kooi AJ, Wijkstra PJ, Zijnen-Suyker M, Cobben NAM, Schmand BA, de Haan RJ, de Visser M, Raaphorst J. The frontotemporal syndrome of ALS is associated with poor survival. J Neurol 2016; 263:2476-2483. [PMID: 27671483 PMCID: PMC5110703 DOI: 10.1007/s00415-016-8290-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/19/2016] [Accepted: 09/16/2016] [Indexed: 01/22/2023]
Abstract
Thirty percent of ALS patients have a frontotemporal syndrome (FS), defined as behavioral changes or cognitive impairment. Despite previous studies, there are no firm conclusions on the effect of the FS on survival and the use of non-invasive ventilation (NIV) in ALS. We examined the effect of the FS on survival and the start and duration of NIV in ALS. Behavioral changes were defined as >22 points on the ALS-Frontotemporal-Dementia-Questionnaire or ≥3 points on ≥2 items of the Neuropsychiatric Inventory. Cognitive impairment was defined as below the fifth percentile on ≥2 tests of executive function, memory or language. Classic ALS was defined as ALS without the frontotemporal syndrome. We performed survival analyses from symptom onset and time from NIV initiation, respectively, to death. The impact of the explanatory variables on survival and NIV initiation were examined using Cox proportional hazards models. We included 110 ALS patients (76 men) with a mean age of 62 years. Median survival time was 4.3 years (95 % CI 3.53–5.13). Forty-seven patients (43 %) had an FS. Factors associated with shorter survival were FS, bulbar onset, older age at onset, short time to diagnosis and a C9orf72 repeat expansion. The adjusted hazard ratio (HR) for the FS was 2.29 (95 % CI 1.44–3.65, p < 0.001) in a multivariate model. Patients with an FS had a shorter survival after NIV initiation (adjusted HR 2.70, 95 % CI 1.04–4.67, p = 0.04). In conclusion, there is an association between the frontotemporal syndrome and poor survival in ALS, which remains present after initiation of NIV.
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Affiliation(s)
- Rosanne Govaarts
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Emma Beeldman
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Mike J Kampelmacher
- Center for Home Mechanical Ventilation, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marie-Jose van Tol
- Neuroimaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Leonard H van den Berg
- Department of Neurology, Brain Center Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anneke J van der Kooi
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter J Wijkstra
- Department of Home Mechanical Ventilation/Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marianne Zijnen-Suyker
- Department of Intensive Care/Center for Home Mechanical Ventilation, University Medical Center, Erasmus MC, Rotterdam, The Netherlands
| | - Nicolle A M Cobben
- Department of Respiratory Medicine/Center of Home Mechanical Ventilation Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ben A Schmand
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Medical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Rob J de Haan
- Clinical Research Unit, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marianne de Visser
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Joost Raaphorst
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Neurology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
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83
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Nolan M, Talbot K, Ansorge O. Pathogenesis of FUS-associated ALS and FTD: insights from rodent models. Acta Neuropathol Commun 2016; 4:99. [PMID: 27600654 PMCID: PMC5011941 DOI: 10.1186/s40478-016-0358-8] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 07/31/2016] [Indexed: 12/29/2022] Open
Abstract
Disruptions to genes linked to RNA processing and homeostasis are implicated in the pathogenesis of two pathologically related but clinically heterogeneous neurodegenerative diseases, amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD). Mutations in the Fused-in-Sarcoma (FUS) gene encoding a 526 amino-acid RNA-binding protein are found in a small subset of ALS cases, but FUS mutations do not appear to be a direct cause of FTD. Structural and functional similarities between FUS and another ALS-related RNA-binding protein, TDP-43, highlight the potential importance of aberrant RNA processing in ALS/FTD, and this pathway is now a major focus of interest. Recently, several research groups have reported transgenic vertebrate models of FUSopathy, with varying results. Here, we discuss the evidence for FUS pathogenicity in ALS/FTD, review the experimental approaches used and phenotypic features of FUS rodent models reported to date, and outline their contribution to our understanding of pathogenic mechanisms. Further refinement of vertebrate models will likely aid our understanding of the role of FUS in both diseases.
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84
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Branco LMT, Zanao T, De Rezende TJ, Casseb RF, Balthazar MF, Woolley SC, França MC. Transcultural validation of the ALS-CBS Cognitive Section for the Brazilian population. Amyotroph Lateral Scler Frontotemporal Degener 2016; 18:60-67. [DOI: 10.1080/21678421.2016.1211147] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Lucas M. T. Branco
- Departments of Neurology and Neuroimaging Laboratory, School of Medicine, University of Campinas – UNICAMP, Campinas, SP, Brazil and
| | - Tamires Zanao
- Departments of Neurology and Neuroimaging Laboratory, School of Medicine, University of Campinas – UNICAMP, Campinas, SP, Brazil and
| | - Thiago J. De Rezende
- Departments of Neurology and Neuroimaging Laboratory, School of Medicine, University of Campinas – UNICAMP, Campinas, SP, Brazil and
| | - Raphael F. Casseb
- Departments of Neurology and Neuroimaging Laboratory, School of Medicine, University of Campinas – UNICAMP, Campinas, SP, Brazil and
| | - Marcio F. Balthazar
- Departments of Neurology and Neuroimaging Laboratory, School of Medicine, University of Campinas – UNICAMP, Campinas, SP, Brazil and
| | - Susan C. Woolley
- Forbes Norris ALS Research Center, California Pacific Medical Center, San Francisco, California, USA
| | - Marcondes C. França
- Departments of Neurology and Neuroimaging Laboratory, School of Medicine, University of Campinas – UNICAMP, Campinas, SP, Brazil and
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85
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Stojkovic T, Stefanova E, Pekmezovic T, Peric S, Stevic Z. Executive dysfunction and survival in patients with amyotrophic lateral sclerosis: Preliminary report from a Serbian centre for motor neuron disease. Amyotroph Lateral Scler Frontotemporal Degener 2016; 17:543-547. [PMID: 27494074 DOI: 10.1080/21678421.2016.1211148] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Our objective was to determine whether the presence of executive dysfunction in non-demented amyotrophic lateral sclerosis (ALS) patients might affect the longevity of survival. Forty-eight consecutive non-demented ALS patients (mean age = 52.93 ± 12.37) were followed for five years. All patients underwent clinical and neuropsychological assessments at baseline visit. Further, a yearly follow-up check for associated dementia (ALS-Dem) was completed and the time of death was recorded, when applicable. Executive deficits were shown in 49.5% of ALS patients, with the most striking differences found on the tests of verbal fluency (both phonemic and category, p < 0.01); as well as inefficient strategy on a working memory test (p < 0.05); as on the more demanding levels of the planning and problem solving task (p < 0.01). It appears that the baseline executive status might predict survival in ALS (p = 0.075), and the patients presenting executive dysfunction could have up to three times greater risk of death, after adjustment by several potential confounding factors. In conclusion, this study suggests that executive dysfunction could potentially influence survival in ALS patients. The cognitive testing might give us important clues about the prognosis of the disease. Further studies with larger sample size are necessary.
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Affiliation(s)
- Tanja Stojkovic
- a Neurology Clinic, Clinical Centre of Serbia and.,b Medical Faculty , University of Belgrade , Serbia
| | - Elka Stefanova
- a Neurology Clinic, Clinical Centre of Serbia and.,b Medical Faculty , University of Belgrade , Serbia
| | - Tatjana Pekmezovic
- a Neurology Clinic, Clinical Centre of Serbia and.,b Medical Faculty , University of Belgrade , Serbia
| | - Stojan Peric
- a Neurology Clinic, Clinical Centre of Serbia and
| | - Zorica Stevic
- a Neurology Clinic, Clinical Centre of Serbia and.,b Medical Faculty , University of Belgrade , Serbia
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86
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Beeldman E, Raaphorst J, Klein Twennaar M, de Visser M, Schmand BA, de Haan RJ. The cognitive profile of ALS: a systematic review and meta-analysis update. J Neurol Neurosurg Psychiatry 2016; 87:611-9. [PMID: 26283685 DOI: 10.1136/jnnp-2015-310734] [Citation(s) in RCA: 205] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 07/19/2015] [Indexed: 11/04/2022]
Abstract
Cognitive impairment is present in approximately 30% of patients with amyotrophic lateral sclerosis (ALS) and, especially when severe, has a negative impact on survival and caregiver burden. Our 2010 meta-analysis of the cognitive profile of ALS showed impairment of fluency, executive function, language and memory. However, the limited number of studies resulted in large confidence intervals. To obtain a more valid assessment, we updated the meta-analysis and included methodological improvements (controlled data extraction, risk of bias analysis and effect size calculation of individual neuropsychological tests). Embase, Medline and PsycInfo were searched for neuropsychological studies of non-demented patients with ALS and age-matched and education-matched healthy controls. Neuropsychological tests were categorised in 13 cognitive domains and effect sizes (Hedges' g) were calculated for each domain and for individual tests administered in ≥5 studies. Subgroup analyses were performed to assess the influence of clinical and demographic variables. Forty-four studies were included comprising 1287 patients and 1130 healthy controls. All cognitive domains, except visuoperceptive functions, showed significant effect sizes compared to controls. Cognitive domains without bias due to motor impairment showed medium effect sizes (95% CI): fluency (0.56 (0.43 to 0.70)), language (0.56 (0.40 to 0.72)), social cognition (0.55 (0.34 to 0.76)), or small effect sizes: delayed verbal memory 0.47 (0.27 to 0.68)) and executive functions (0.41 (0.27 to 0.55)). Individual neuropsychological tests showed diverging effect sizes, which could be explained by bias due to motor impairment. Subgroup analyses showed no influence of bulbar disease onset and depression and anxiety on the cognitive outcomes. The cognitive profile of ALS consists of deficits in fluency, language, social cognition, executive functions and verbal memory. Social cognition is a new cognitive domain with a relatively large effect size, highlighting the overlap between ALS and frontotemporal dementia. The diverging effect sizes for individual neuropsychological tests show the importance of correction for motor impairment in patients with ALS. These findings have implications for bedside testing, the design of cognitive screening measures and full neuropsychological examinations.
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Affiliation(s)
- Emma Beeldman
- Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Joost Raaphorst
- Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands Department of Neurology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Michelle Klein Twennaar
- Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Marianne de Visser
- Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Ben A Schmand
- Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Rob J de Haan
- Clinical Research Unit, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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87
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Poletti B, Solca F, Carelli L, Madotto F, Lafronza A, Faini A, Monti A, Zago S, Calini D, Tiloca C, Doretti A, Verde F, Ratti A, Ticozzi N, Abrahams S, Silani V. The validation of the Italian Edinburgh Cognitive and Behavioural ALS Screen (ECAS). Amyotroph Lateral Scler Frontotemporal Degener 2016; 17:489-498. [PMID: 27219526 DOI: 10.1080/21678421.2016.1183679] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study presents the Italian validation of the recently developed Edinburgh Cognitive and Behavioural ALS Screen (ECAS), a short screen for cognitive/behavioural alterations in patients with amyotrophic lateral sclerosis (ALS). We evaluated the psychometric properties of the ECAS Italian version in terms of reliability and convergent validity for both cognitive and behavioural features. Furthermore, we investigated the relationship with affective and clinical variables, in addition to ECAS usability and patients' insight into cognitive/behaviour changes. Finally, correlations between genetic and cognitive/behavioural data were analysed. We recruited 107 patients with ALS. Normative data were collected on 248 healthy subjects. Participants were administered the ECAS and two standard cognitive screening tools (FAB, MoCA), two psychological questionnaires (BDI, STAI/Y) and an ad hoc usability questionnaire. The FBI was also carried out with caregivers. Results showed that the ECAS Italian version discriminated well between patients and controls. The most prevalent deficit occurred in executive functions and fluency. Correlations were observed between the ECAS and standard cognitive screening tools and between the ECAS carer interview and the FBI, supporting its full convergent validity. In conclusion, the ECAS Italian version provides clinicians with a rapid, feasible and sensitive tool, useful to identify different profiles of cognitive-behavioural impairment in ALS.
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Affiliation(s)
- Barbara Poletti
- a Department of Neurology and Laboratory of Neuroscience - IRCCS Istituto Auxologico Italiano , Milan , Italy
| | - Federica Solca
- a Department of Neurology and Laboratory of Neuroscience - IRCCS Istituto Auxologico Italiano , Milan , Italy
| | - Laura Carelli
- a Department of Neurology and Laboratory of Neuroscience - IRCCS Istituto Auxologico Italiano , Milan , Italy
| | - Fabiana Madotto
- b Research Centre on Public Health, Department of Medicine and Surgery , University of Milano-Bicocca , Milan , Italy
| | - Annalisa Lafronza
- a Department of Neurology and Laboratory of Neuroscience - IRCCS Istituto Auxologico Italiano , Milan , Italy
| | - Andrea Faini
- c Department of Cardiovascular, Neural and Metabolic Sciences - IRCCS Istituto Auxologico Italiano , Milan , Italy
| | - Alessia Monti
- d Department of Neurorehabilitation Sciences , Casa Cura Policlinico , Milan , Italy
| | - Stefano Zago
- e Department of Neuroscience and Mental Health , Università degli Studi di Milano, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Daniela Calini
- a Department of Neurology and Laboratory of Neuroscience - IRCCS Istituto Auxologico Italiano , Milan , Italy
| | - Cinzia Tiloca
- a Department of Neurology and Laboratory of Neuroscience - IRCCS Istituto Auxologico Italiano , Milan , Italy
| | - Alberto Doretti
- a Department of Neurology and Laboratory of Neuroscience - IRCCS Istituto Auxologico Italiano , Milan , Italy.,f Department of Pathophysiology and Transplantation , 'Dino Ferrari' Centre, Università degli Studi di Milano , Milan , Italy , and
| | - Federico Verde
- a Department of Neurology and Laboratory of Neuroscience - IRCCS Istituto Auxologico Italiano , Milan , Italy.,f Department of Pathophysiology and Transplantation , 'Dino Ferrari' Centre, Università degli Studi di Milano , Milan , Italy , and
| | - Antonia Ratti
- a Department of Neurology and Laboratory of Neuroscience - IRCCS Istituto Auxologico Italiano , Milan , Italy.,f Department of Pathophysiology and Transplantation , 'Dino Ferrari' Centre, Università degli Studi di Milano , Milan , Italy , and
| | - Nicola Ticozzi
- a Department of Neurology and Laboratory of Neuroscience - IRCCS Istituto Auxologico Italiano , Milan , Italy.,f Department of Pathophysiology and Transplantation , 'Dino Ferrari' Centre, Università degli Studi di Milano , Milan , Italy , and
| | - Sharon Abrahams
- g Euan MacDonald Centre for Motor Neurone Disease Research, Anne Rowling Regenerate Neurology Clinic, Centre for Cognitive Ageing and Cognitive Epidemiology, Human Cognitive Neuroscience-PPLS, University of Edinburgh , Edinburgh , UK
| | - Vincenzo Silani
- a Department of Neurology and Laboratory of Neuroscience - IRCCS Istituto Auxologico Italiano , Milan , Italy.,f Department of Pathophysiology and Transplantation , 'Dino Ferrari' Centre, Università degli Studi di Milano , Milan , Italy , and
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88
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Wei Q, Chen X, Cao B, Ou R, Zhao B, Wu Y, Shang H. Associations between neuropsychiatric symptoms and cognition in Chinese patients with amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2016; 17:358-65. [PMID: 26962892 DOI: 10.3109/21678421.2016.1154574] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Our objective was to explore features of the neuropsychiatric symptoms in Chinese patients with amyotrophic lateral sclerosis (ALS) and the associations between these neuropsychiatric symptoms and cognition. A total of 91 ALS patients were evaluated using three recommended scales including the Neuropsychiatric Inventory (NPI), Addenbrooke's Cognitive Examination Revised (ACE-R), and Frontal Assessment Battery (FAB) tests. The mean age of onset was 52.5 ± 10.8 years. The median NPI score of all patients was 2.0. The most common neuropsychiatric symptom was dysphoria/depression (59.3%), followed by anxiety (41.8%) and irritability/lability (26.4%). There were no significant differences in the frequency of neuropsychiatric symptoms in terms of gender, age of onset, onset form and disease duration. There were no significant differences in NPI total score, ACE-R total score and FAB total score in terms of gender, age of onset, onset form and disease duration, except for a higher ACE-R score observed in patients with a shorter disease duration. The NPI score had a strong correlation with the ACE-R score but not with the FAB score. In conclusion, neuropsychiatric symptoms appear to be quite common in Chinese ALS patients, who were likely to present with the emotional states of depression or anxiety. The neuropsychiatric symptoms in ALS are closely related to global cognition dysfunction.
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Affiliation(s)
- Qianqian Wei
- a Department of Neurology , West China Hospital, Sichuan University , Chengdu Sichuan , China
| | - Xueping Chen
- a Department of Neurology , West China Hospital, Sichuan University , Chengdu Sichuan , China
| | - Bei Cao
- a Department of Neurology , West China Hospital, Sichuan University , Chengdu Sichuan , China
| | - Ruwei Ou
- a Department of Neurology , West China Hospital, Sichuan University , Chengdu Sichuan , China
| | - Bi Zhao
- a Department of Neurology , West China Hospital, Sichuan University , Chengdu Sichuan , China
| | - Ying Wu
- a Department of Neurology , West China Hospital, Sichuan University , Chengdu Sichuan , China
| | - Huifang Shang
- a Department of Neurology , West China Hospital, Sichuan University , Chengdu Sichuan , China
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89
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Murphy J, Factor-Litvak P, Goetz R, Lomen-Hoerth C, Nagy PL, Hupf J, Singleton J, Woolley S, Andrews H, Heitzman D, Bedlack RS, Katz JS, Barohn RJ, Sorenson EJ, Oskarsson B, Fernandes Filho JAM, Kasarskis EJ, Mozaffar T, Rollins YD, Nations SP, Swenson AJ, Koczon-Jaremko BA, Mitsumoto H. Cognitive-behavioral screening reveals prevalent impairment in a large multicenter ALS cohort. Neurology 2016; 86:813-20. [PMID: 26802094 PMCID: PMC4793785 DOI: 10.1212/wnl.0000000000002305] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 11/05/2015] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To characterize the prevalence of cognitive and behavioral symptoms using a cognitive/behavioral screening battery in a large prospective multicenter study of amyotrophic lateral sclerosis (ALS). METHODS Two hundred seventy-four patients with ALS completed 2 validated cognitive screening tests and 2 validated behavioral interviews with accompanying caregivers. We examined the associations between cognitive and behavioral performance, demographic and clinical data, and C9orf72 mutation data. RESULTS Based on the ALS Cognitive Behavioral Screen cognitive score, 6.5% of the sample scored below the cutoff score for frontotemporal lobar dementia, 54.2% scored in a range consistent with ALS with mild cognitive impairment, and 39.2% scored in the normal range. The ALS Cognitive Behavioral Screen behavioral subscale identified 16.5% of the sample scoring below the dementia cutoff score, with an additional 14.1% scoring in the ALS behavioral impairment range, and 69.4% scoring in the normal range. CONCLUSIONS This investigation revealed high levels of cognitive and behavioral impairment in patients with ALS within 18 months of symptom onset, comparable to prior investigations. This investigation illustrates the successful use and scientific value of adding a cognitive-behavioral screening tool in studies of motor neuron diseases, to provide neurologists with an efficient method to measure these common deficits and to understand how they relate to key clinical variables, when extensive neuropsychological examinations are unavailable. These tools, developed specifically for patients with motor impairment, may be particularly useful in patient populations with multiple sclerosis and Parkinson disease, who are known to have comorbid cognitive decline.
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Affiliation(s)
- Jennifer Murphy
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT.
| | - Pam Factor-Litvak
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - Raymond Goetz
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - Catherine Lomen-Hoerth
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - Peter L Nagy
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - Jonathan Hupf
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - Jessica Singleton
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - Susan Woolley
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - Howard Andrews
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - Daragh Heitzman
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - Richard S Bedlack
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - Jonathan S Katz
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - Richard J Barohn
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - Eric J Sorenson
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - Björn Oskarsson
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - J Americo M Fernandes Filho
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - Edward J Kasarskis
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - Tahseen Mozaffar
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - Yvonne D Rollins
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - Sharon P Nations
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - Andrea J Swenson
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
| | - Boguslawa A Koczon-Jaremko
- From the Department of Neurology (J.M., C.L.-H.), UCSF; Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University Medical Center (CUMC); Department of Psychiatry (R.G.), New York State Psychiatric Institute and CUMC; Department of Pathology and Cell Biology (P.L.N), Columbia University; Eleanor and Lou Gehrig MDA/ALS Research Center (J.H., J.S., H.M.), Department of Neurology, CUMC, New York, NY; California Pacific Medical Center (S.W., J.S.K.), San Francisco, CA; Departments of Biostatistics and Psychiatry (H.A.), Mailman School of Medicine, CUMC, New York, NY; Texas Neurology (D.H.), P.A., Dallas, TX; Duke University (R.S.B.), Durham, NC; Department of Neurology (R.J.B.), University of Kansas; Mayo Clinic (E.J.S.), Rochester, MN; University of California, Davis (B.O.), Sacramento, CA; University of Nebraska Medical Center (J.A.M.F.F.), Omaha, NE; University of Kentucky (E.J.K.), Lexington, KY; University of California, Irvine (T.M.), Orange, CA; University of Colorado, Denver (Y.D.R.), Aurora, CO; University of Texas-Southwestern (S.P.N.), Dallas, TX; University of Iowa (A.J.S.), Iowa City, IA; and Hospital for Special Care (B.A.K.-J.), New Britain, CT
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90
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Caga J, Turner MR, Hsieh S, Ahmed RM, Devenney E, Ramsey E, Zoing MC, Mioshi E, Kiernan MC. Apathy is associated with poor prognosis in amyotrophic lateral sclerosis. Eur J Neurol 2016; 23:891-7. [DOI: 10.1111/ene.12959] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 12/04/2015] [Indexed: 11/28/2022]
Affiliation(s)
- J. Caga
- Brain and Mind Centre; University of Sydney; Camperdown NSW Australia
- Sydney Medical School; University of Sydney; Camperdown NSW Australia
| | - M. R. Turner
- Nuffield Department of Clinical Neurosciences; Oxford University; Oxford UK
| | - S. Hsieh
- Brain and Mind Centre; University of Sydney; Camperdown NSW Australia
| | - R. M. Ahmed
- Neuroscience Research Australia; Randwick NSW Australia
| | - E. Devenney
- Neuroscience Research Australia; Randwick NSW Australia
| | - E. Ramsey
- Brain and Mind Centre; University of Sydney; Camperdown NSW Australia
| | - M. C. Zoing
- Brain and Mind Centre; University of Sydney; Camperdown NSW Australia
| | - E. Mioshi
- Faculty of Medicine and Health Sciences; University of East Anglia; Norwich UK
| | - M. C. Kiernan
- Brain and Mind Centre; University of Sydney; Camperdown NSW Australia
- Sydney Medical School; University of Sydney; Camperdown NSW Australia
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91
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Hsieh S, Caga J, Leslie FVC, Shibata M, Daveson N, Foxe D, Ramsey E, Lillo P, Ahmed RM, Devenney E, Burrell JR, Hodges JR, Kiernan MC, Mioshi E. Cognitive and Behavioral Symptoms in ALSFTD: Detection, Differentiation, and Progression. J Geriatr Psychiatry Neurol 2016; 29:3-10. [PMID: 26251110 DOI: 10.1177/0891988715598232] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 04/29/2015] [Indexed: 11/16/2022]
Abstract
Brief screening tools that detect and differentiate patients with amyotrophic lateral sclerosis and frontotemporal dementia (ALSFTD) from those more subtle cognitive or behavioral symptoms (ALS plus) and motor symptoms only (ALS pure) is pertinent in a clinical setting. The utility of 2 validated and data-driven tests (Mini-Addenbrooke's Cognitive Examination [M-ACE] and Motor Neuron Disease Behavioral Scale [MiND-B]) was investigated in 70 ALS patients (24 ALSFTD, 19 ALS plus, and 27 ALS pure). More than 90% of patients with ALSFTD scored at or below the cutoff on the M-ACE, whereas this was seen in only about 20% of ALS patients without dementia. The MiND-B differentiated between ALS pure and ALS plus diagnostic categories. Rasch modeling of M-ACE and MiND-B items revealed early cognitive (fluency, memory recall) and behavioral (apathy) symptoms in ALSFTD. The combined use of the M-ACE and MiND-B detects patients with ALSFTD, differentiates along the ALS continuum, and offers insight into the progression of nonmotor symptomatology in ALSFTD.
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Affiliation(s)
- Sharpley Hsieh
- Brain and Mind Research Institute, Sydney, New South Wales, Australia Neuroscience Research Australia, Sydney, New South Wales, Australia ARC Centre of Excellence in Cognition and its Disorders, University of New South Wales, Sydney, New South Wales, Australia
| | - Jashelle Caga
- Brain and Mind Research Institute, Sydney, New South Wales, Australia
| | | | - Marlene Shibata
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Naomi Daveson
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - David Foxe
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Eleanor Ramsey
- Brain and Mind Research Institute, Sydney, New South Wales, Australia
| | - Patricia Lillo
- Departamento de Neurología Sur, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Rebekah M Ahmed
- Brain and Mind Research Institute, Sydney, New South Wales, Australia Neuroscience Research Australia, Sydney, New South Wales, Australia Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Emma Devenney
- Brain and Mind Research Institute, Sydney, New South Wales, Australia Neuroscience Research Australia, Sydney, New South Wales, Australia Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - James R Burrell
- Neuroscience Research Australia, Sydney, New South Wales, Australia Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - John R Hodges
- Neuroscience Research Australia, Sydney, New South Wales, Australia ARC Centre of Excellence in Cognition and its Disorders, University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew C Kiernan
- Brain and Mind Research Institute, Sydney, New South Wales, Australia
| | - Eneida Mioshi
- Neuroscience Research Australia, Sydney, New South Wales, Australia Department of Psychiatry, Cambridge University, Cambridge, United Kingdom
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92
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Couratier P, Corcia P, Lautrette G, Nicol M, Preux PM, Marin B. Epidemiology of amyotrophic lateral sclerosis: A review of literature. Rev Neurol (Paris) 2015; 172:37-45. [PMID: 26727307 DOI: 10.1016/j.neurol.2015.11.002] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 11/10/2015] [Indexed: 12/11/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease of motor neurons, resulting in worsening weakness of voluntary muscles until death occurs from respiratory failure. The incidence of ALS in European populations is two to three people per year per 100,000 of the general population. In Europe, crude prevalences range from 1.1/100,000 population in Yugoslavia to 8.2/100,000 in the Faroe Islands. Major advances have been made in our understanding of the genetic causes of ALS, whereas the contribution of environmental factors has been more difficult to assess and large-scale studies have not yet revealed a replicable, definitive environmental risk factor. The only established risk factors to date are older age, male gender and a family history of ALS. Median survival time from onset to death is usually 3 years from the first appearance of symptoms. Older age and bulbar onset are consistently reported to have poorer outcomes. However, there are conflicting data regarding gender, diagnostic delay and El Escorial criteria. The rate of symptom progression has been revealed to be an independent prognostic factor. Psychosocial factors and impaired cognitive function are negatively related to ALS outcome, while nutritional status and respiratory function are also related to ALS prognosis. The effect of enteral nutrition on survival is still unclear, although noninvasive positive pressure ventilation (NIPPV) has been found to improve survival. These findings have relevant implications for the design of future trials.
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Affiliation(s)
- P Couratier
- Centre de compétence SLA-fédération Tours-Limoges, CHU de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France; Inserm UMR1094, neuroépidémiologie tropicale, université de Limoges, 2, rue du Dr.-Marcland, 87025 Limoges cedex, France.
| | - P Corcia
- Centre de compétence SLA-fédération Tours-Limoges, CHU de Tours, 37044 Tours cedex 9, France
| | - G Lautrette
- Centre de compétence SLA-fédération Tours-Limoges, CHU de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - M Nicol
- Centre de compétence SLA-fédération Tours-Limoges, CHU de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - P-M Preux
- Inserm UMR1094, neuroépidémiologie tropicale, université de Limoges, 2, rue du Dr.-Marcland, 87025 Limoges cedex, France
| | - B Marin
- Inserm UMR1094, neuroépidémiologie tropicale, université de Limoges, 2, rue du Dr.-Marcland, 87025 Limoges cedex, France
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93
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Seer C, Fürkötter S, Vogts MB, Lange F, Abdulla S, Dengler R, Petri S, Kopp B. Executive Dysfunctions and Event-Related Brain Potentials in Patients with Amyotrophic Lateral Sclerosis. Front Aging Neurosci 2015; 7:225. [PMID: 26733861 PMCID: PMC4683183 DOI: 10.3389/fnagi.2015.00225] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 11/20/2015] [Indexed: 01/12/2023] Open
Abstract
A growing body of evidence implies psychological disturbances in amyotrophic lateral sclerosis (ALS). Specifically, executive dysfunctions occur in up to 50% of ALS patients. The recently shown presence of cytoplasmic aggregates (TDP-43) in ALS patients and in patients with behavioral variants of frontotemporal dementia suggests that these two disease entities form the extremes of a spectrum. The present study aimed at investigating behavioral and electrophysiological indices of conflict processing in patients with ALS. A non-verbal variant of the flanker task demanded two-choice responses to target stimuli that were surrounded by flanker stimuli which either primed the correct response or the alternative response (the latter case representing the conflict situation). Behavioral performance, event-related potentials (ERP), and lateralized readiness potentials (LRP) were analyzed in 21 ALS patients and 20 controls. In addition, relations between these measures and executive dysfunctions were examined. ALS patients performed the flanker task normally, indicating preserved conflict processing. In similar vein, ERP and LRP indices of conflict processing did not differ between groups. However, ALS patients showed enhanced posterior negative ERP waveform deflections, possibly indicating increased modulation of visual processing by frontoparietal networks in ALS. We also found that the presence of executive dysfunctions was associated with more error-prone behavior and enhanced LRP amplitudes in ALS patients, pointing to a prefrontal pathogenesis of executive dysfunctions and to a potential link between prefrontal and motor cortical functional dysregulation in ALS, respectively.
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Affiliation(s)
- Caroline Seer
- Department of Neurology, Hannover Medical School Hannover, Germany
| | | | - Maj-Britt Vogts
- Department of Neurology, Hannover Medical School Hannover, Germany
| | - Florian Lange
- Department of Neurology, Hannover Medical School Hannover, Germany
| | - Susanne Abdulla
- Department of Neurology, Hannover Medical SchoolHannover, Germany; Department of Neurology, Otto-von-Guericke University MagdeburgMagdeburg, Germany; Department of Neurology, German Center for Neurodegenerative DiseasesMagdeburg, Germany
| | - Reinhard Dengler
- Department of Neurology, Hannover Medical School Hannover, Germany
| | - Susanne Petri
- Department of Neurology, Hannover Medical School Hannover, Germany
| | - Bruno Kopp
- Department of Neurology, Hannover Medical School Hannover, Germany
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94
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Nidos A, Kasselimis DS, Simos PG, Rentzos M, Alexakis T, Zalonis I, Zouvelou V, Potagas C, Evdokimidis I, Woolley SC. Frontotemporal Dysfunction in Amyotrophic Lateral Sclerosis: A Discriminant Function Analysis. NEURODEGENER DIS 2015; 16:140-6. [DOI: 10.1159/000381186] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 02/12/2015] [Indexed: 11/19/2022] Open
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Rudnicki S, McVey AL, Jackson CE, Dimachkie MM, Barohn RJ. Symptom Management and End-of-Life Care in Amyotrophic Lateral Sclerosis. Neurol Clin 2015; 33:889-908. [PMID: 26515628 PMCID: PMC5031364 DOI: 10.1016/j.ncl.2015.07.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The number of available symptomatic treatments has markedly enhanced the care of patients with amyotrophic lateral sclerosis (ALS). Once thought to be untreatable, patients with ALS today clearly benefit from multidisciplinary care. The impact of such care on the disease course, including rate of progression and mortality, has surpassed the treatment effects commonly sought in clinical drug trials. Unfortunately, there are few randomized controlled trials of medications or interventions addressing symptom management. In this review, the authors provide the level of evidence, when available, for each intervention that is currently considered standard of care by consensus opinion.
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Affiliation(s)
- Stacy Rudnicki
- University of Arkansas for Medical Sciences, 501 Jackson Stephens Drive, Room 769, Little Rock, Arkansas 72205-7199
| | - April L. McVey
- University of Kansas Medical Center, Dept. of Neurology, 3901 Rainbow Blvd, Mailstop 2012, Kansas City, KS 66160
| | - Carlayne E. Jackson
- University of Texas Health Science Center, 8300 Floyd Curl Drive, Mail Code 7883, San Antonio, TX 78229-3900
| | - Mazen M. Dimachkie
- University of Kansas Medical Center, Dept. of Neurology, 3901 Rainbow Blvd, Mailstop 2012, Kansas City, KS 66160
| | - Richard J. Barohn
- University of Kansas Medical Center, Dept. of Neurology, 3901 Rainbow Blvd, Mailstop 2012, Kansas City, KS 66160
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96
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Hsieh S, Leyton CE, Caga J, Flanagan E, Kaizik C, O’Connor CM, Kiernan MC, Hodges JR, Piguet O, Mioshi E. The Evolution of Caregiver Burden in Frontotemporal Dementia with and without Amyotrophic Lateral Sclerosis. J Alzheimers Dis 2015; 49:875-85. [DOI: 10.3233/jad-150475] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Sharpley Hsieh
- Brain and Mind Research Centre, Sydney, Australia
- Neuroscience Research Australia, Sydney, Australia
- ARC Centre of Excellence in Cognition and its Disorders, University of New South Wales, Australia
| | - Cristian E. Leyton
- Neuroscience Research Australia, Sydney, Australia
- ARC Centre of Excellence in Cognition and its Disorders, University of New South Wales, Australia
- Faculty of Health Sciences, The University of Sydney, Australia
| | | | | | | | | | | | - John R. Hodges
- Neuroscience Research Australia, Sydney, Australia
- ARC Centre of Excellence in Cognition and its Disorders, University of New South Wales, Australia
| | - Olivier Piguet
- Neuroscience Research Australia, Sydney, Australia
- ARC Centre of Excellence in Cognition and its Disorders, University of New South Wales, Australia
| | - Eneida Mioshi
- Brain and Mind Research Centre, Sydney, Australia
- Department of Psychiatry, Cambridge University, Cambridge, UK
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97
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Lee S, Huang EJ. Modeling ALS and FTD with iPSC-derived neurons. Brain Res 2015; 1656:88-97. [PMID: 26462653 DOI: 10.1016/j.brainres.2015.10.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 08/05/2015] [Accepted: 10/02/2015] [Indexed: 12/14/2022]
Abstract
Recent advances in genetics and neuropathology support the idea that amyotrophic lateral sclerosis (ALS) and frontotemporal lobar dementia (FTD) are two ends of a disease spectrum. Although several animal models have been developed to investigate the pathogenesis and disease progression in ALS and FTD, there are significant limitations that hamper our ability to connect these models with the neurodegenerative processes in human diseases. With the technical breakthrough in reprogramming biology, it is now possible to generate patient-specific induced pluripotent stem cells (iPSCs) and disease-relevant neuron subtypes. This review provides a comprehensive summary of studies that use iPSC-derived neurons to model ALS and FTD. We discuss the unique capabilities of iPSC-derived neurons that capture some key features of ALS and FTD, and underscore their potential roles in drug discovery. There are, however, several critical caveats that require improvements before iPSC-derived neurons can become highly effective disease models. This article is part of a Special Issue entitled SI: Exploiting human neurons.
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Affiliation(s)
- Sebum Lee
- Department of Pathology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0502, United States
| | - Eric J Huang
- Department of Pathology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0502, United States; Pathology Service 113B, San Francisco VA Medical Center, 505 Parnassus Avenue, San Francisco, CA 94143-0502, United States.
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98
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Marin B, Logroscino G, Boumédiene F, Labrunie A, Couratier P, Babron MC, Leutenegger AL, Preux PM, Beghi E. Clinical and demographic factors and outcome of amyotrophic lateral sclerosis in relation to population ancestral origin. Eur J Epidemiol 2015; 31:229-45. [DOI: 10.1007/s10654-015-0090-x] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 10/05/2015] [Indexed: 01/08/2023]
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99
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Machts J, Loewe K, Kaufmann J, Jakubiczka S, Abdulla S, Petri S, Dengler R, Heinze HJ, Vielhaber S, Schoenfeld MA, Bede P. Basal ganglia pathology in ALS is associated with neuropsychological deficits. Neurology 2015; 85:1301-9. [DOI: 10.1212/wnl.0000000000002017] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 06/18/2015] [Indexed: 12/12/2022] Open
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100
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Woolley SC, Strong MJ. Frontotemporal Dysfunction and Dementia in Amyotrophic Lateral Sclerosis. Neurol Clin 2015; 33:787-805. [PMID: 26515622 DOI: 10.1016/j.ncl.2015.07.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Although amyotrophic lateral sclerosis (ALS) is classically considered a disorder exclusively affecting motor neurons, there is substantial clinical, neuroimaging, and neuropathologic evidence that more than half of patients have an associated syndrome of frontotemporal dysfunction. These syndromes range from frontotemporal dementia to behavioral or cognitive syndromes. Neuroimaging and neuropathologic findings are consistent with frontotemporal lobar degeneration that underpins alterations in network connectivity. Future clinical trials need to be stratified based on the presence or absence of frontotemporal dysfunction on the disease course of ALS.
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Affiliation(s)
- Susan C Woolley
- Forbes Norris MDA/ALS Research Center, California Pacific Medical Center, 2324 Sacramento Street, Suite 111, San Francisco, CA 94115, USA
| | - Michael J Strong
- Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
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