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Nishiyama M, Koreki A, Isose S, Takeda T, Ishikawa A, Kokubun S, Saito Y, Ito K, Arai K, Takahashi N, Motoda Y, Kuwabara S, Honda K. Factors associated with psychological distress in patients with amyotrophic lateral sclerosis: A retrospective medical records study. J Psychosom Res 2024; 187:111915. [PMID: 39270519 DOI: 10.1016/j.jpsychores.2024.111915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 09/02/2024] [Accepted: 09/02/2024] [Indexed: 09/15/2024]
Abstract
OBJECTIVE Although psychological distress is a prevalent issue among patients with amyotrophic lateral sclerosis (ALS) and can impact survival, the risk factors contributing to this distress remain insufficiently understood. METHODS Patients with ALS who completed the Profile of Mood States (POMS) between June 2017 and March 2022 were included. Participants with moderate to severe cognitive decline were excluded, resulting in the recruitment of 121 patients. The associations between POMS profiles and clinical characteristics were analyzed. Physical motor symptoms were evaluated using the Revised ALS Functional Rating Scale (ALSFRS-R) for objective measurement and the 40-item ALS Assessment Questionnaire (ALSAQ-40) for subjective assessment. RESULTS Our model, employing the ALSFRS-R, revealed significant factors associated with overall psychological distress, as assessed by the POMS, including upper limb symptoms, the presence of sleep apnea syndrome, older age at onset, and male sex, with an inverse association with tracheostomy. The POMS subscale scores revealed that anger and depression were significantly associated with upper limb symptoms. The second model, which employed subjective scales, yielded similar results, reinforcing the robustness of our findings. Moreover, subjective bulbar symptoms on the ALSAQ-40 were significantly associated with psychological distress, particularly in female patients. CONCLUSION This study identified the main clinical characteristics significantly associated with psychological distress in patients with ALS. Our findings may be useful in developing individualized psychological management strategies for these patients.
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Affiliation(s)
- Mami Nishiyama
- Department of Psychology, NHO Chibahigashi National Hospital, Chiba, Japan
| | - Akihiro Koreki
- Department of Psychiatry, NHO Shimofusa Psychiatric Medical Center, Chiba, Japan; Department of Psychiatry, NHO Chibahigashi National Hospital, Chiba, Japan.
| | - Sagiri Isose
- Department of Neurology, NHO Chibahigashi National Hospital, Chiba, Japan
| | - Takahiro Takeda
- Department of Neurology, NHO Chibahigashi National Hospital, Chiba, Japan
| | - Ai Ishikawa
- Department of Neurology, NHO Chibahigashi National Hospital, Chiba, Japan
| | - Sayuri Kokubun
- Department of Neurology, NHO Chibahigashi National Hospital, Chiba, Japan
| | - Yumiko Saito
- Department of Neurology, NHO Chibahigashi National Hospital, Chiba, Japan
| | - Kimiko Ito
- Department of Neurology, NHO Chibahigashi National Hospital, Chiba, Japan
| | - Kimihito Arai
- Department of Neurology, NHO Chibahigashi National Hospital, Chiba, Japan
| | - Nao Takahashi
- Department of Psychology, NHO Chibahigashi National Hospital, Chiba, Japan
| | - Yuka Motoda
- Department of Psychology, NHO Chibahigashi National Hospital, Chiba, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazuhiro Honda
- Department of Neurology, NHO Chibahigashi National Hospital, Chiba, Japan
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Jellinger KA. Understanding depression with amyotrophic lateral sclerosis: a short assessment of facts and perceptions. J Neural Transm (Vienna) 2024; 131:107-115. [PMID: 37922093 DOI: 10.1007/s00702-023-02714-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/19/2023] [Indexed: 11/05/2023]
Abstract
Depression with an average prevalence of 25-40% is a serious condition in amyotrophic lateral sclerosis (ALS) that can impact quality of life and survival of patients and caregiver burden, yet the underlying neurobiology is poorly understood. Preexisting depression has been associated with a higher risk of developing ALS, while people with ALS have a significantly higher risk of developing depression that can cause multiple complications. Depression may be a prodromal or subclinical symptom prior to motor involvement, although its relations with disease progression and impairment of quality of life are under discussion. Unfortunately, there are no studies existing that explore the pathogenic mechanisms of depression associated with the basic neurodegenerative process, and no specific neuroimaging data or postmortem findings for the combination of ALS and depression are currently available. Experience from other neurodegenerative processes suggests that depressive symptoms in ALS may be the consequence of cortical thinning in prefrontal regions and other cortex areas, disruption of mood-related brain networks, dysfunction of neurotransmitter systems, changing cortisol levels and other, hitherto unknown mechanisms. Treatment of both ALS and depression is a multidisciplinary task, depression generally being treated with a combination of antidepressant medication, physiotherapy, psychological and other interventions, while electroconvulsive therapy and deep brain stimulation might not be indicated in the majority of patients in view of their poor prognosis. Since compared to depression in other neurodegenerative diseases, our knowledge of its molecular basis in ALS is missing, multidisciplinary clinicopathological studies to elucidate the pathomechanism of depression in motor system disorders including ALS are urgently warranted.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150, Vienna, Austria.
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Young C, Ealing J, McDermott C, Williams T, Al-Chalabi A, Majeed T, Roberts R, Mills R, Tennant A. Fatigue and anxiety mediate the effect of dyspnea on quality of life in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2021; 23:390-398. [PMID: 34709092 DOI: 10.1080/21678421.2021.1990343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: Dyspnea (or breathlessness) due to progressive neuromuscular respiratory failure is common in amyotrophic lateral sclerosis (ALS). It is associated with anxiety, depression and reduced quality of life (QoL). For effective treatment, it is essential to understand the relationships between dyspnea, anxiety, depression and QoL.Methods: The UK Trajectories of Outcomes in Neurological Conditions-ALS study (TONiC-ALS) collected self-report measures from patients with ALS. Ordinal scales were transformed to interval-scaled estimates by the Rasch Measurement model. They were subsequently included in a series of path models where the focal relationships were dyspnea to QoL and dyspnea to depression.Results: Path analyses using 1022 participants showed that 60.5% of the variance of QoL was explained by fatigue, anxiety, dyspnea and disability. For depression, 54.1% of the variance was explained by a model of these factors. Dyspnea played an important but mostly indirect role in influencing QoL and depressive symptoms. Disability was dominated by all other factors in the model.Discussion: Dyspnea in ALS influences quality of life and depression largely through indirect effects, principally acting via anxiety and fatigue. Recognition of this is essential for clinicians to understand where to intervene for greatest benefit. Researchers must be aware that studies of the effect of dyspnea on QoL and depression require path models, measuring both direct and indirect effects, as the impact of dyspnea is likely to be significantly miscalculated if only direct effects are assessed.
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Affiliation(s)
- Carolyn Young
- Walton Centre NHS Foundation Trust, Lower Lane, Liverpool, UK.,University of Liverpool, Liverpool, UK
| | - John Ealing
- Salford Royal Foundation Trust, Manchester, UK
| | | | - Tim Williams
- Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Ammar Al-Chalabi
- Department of Basic and Clinical Neuroscience, King's College London, Maurice Wohl Clinical Neuroscience Institute, London, UK.,Department of Neurology, King's College Hospital, London, UK
| | | | | | - Roger Mills
- Walton Centre NHS Foundation Trust, Lower Lane, Liverpool, UK.,University of Liverpool, Liverpool, UK
| | - Alan Tennant
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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Quality of Life Structural Equation Model for Patients With Amyotrophic Lateral Sclerosis. Rehabil Nurs 2020; 46:253-261. [PMID: 32991398 DOI: 10.1097/rnj.0000000000000292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of the study was to propose and test a quality of life model among Korean patients with amyotrophic lateral sclerosis (ALS) using structural equation modeling. DESIGN A cross-sectional study was performed. METHODS Data from 184 patients with ALS were collected from two university hospitals in Seoul and Busan, South Korea, between June and December 2018. FINDINGS The modified model indices indicated adequate data fit. Quality of life predictors were social support, physical functional status, depression, and general health perception. CONCLUSION This study improved the understanding of quality of life for Korean patients with ALS, including complex direct and indirect relationships among quality of life factors. CLINICAL RELEVANCE Depression was identified as the most influential factor in this population; hence, early assessment and timely intervention for depression are essential for better quality of life in patients with ALS.
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Predictors of Depression in Caucasian Patients with Amyotrophic Lateral Sclerosis in Romania. Brain Sci 2020; 10:brainsci10080470. [PMID: 32707986 PMCID: PMC7465215 DOI: 10.3390/brainsci10080470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 11/17/2022] Open
Abstract
Depression remains an underdiagnosed comorbidity which significantly decreases the quality of life in amyotrophic lateral sclerosis (ALS) patients. We aimed to investigate the prevalence of depression in a cohort of ALS patients with more than one year of disease evolution. A total of 50 ALS patients were evaluated with the Beck Depression Inventory II (BDI-II) and cognition, using the Mini-Cog Standardized Instrument (MCSI). The clinical disability was evaluated using the ALS Functional Rating Scale (ALSFRS). The prevalence of depression was 42.8%. A lower BDI-II score was significantly correlated with a higher education level, the spouse as a caregiver, spiritual devotion, and employment status (p < 0.05). A multiple linear regression analysis between the BDI-II score as the dependent variable and various independent variables such as spirituality, caregiver status, educational level, and occupational status revealed that only the type of caregiver (spouse or parent/child) significantly affected the BDI-II total score (p = 0.006). The functional disability significantly correlated with loss of appetite and loss of libido (p < 0.001). A high education, spiritual devotion, high ALSFRS, and the presence of the spouse as the caregiver were associated with the absence of depression.
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Carvalho TL, Almeida LMSD, Lorega CMA, Barata MFO, Ferreira MLB, Brito-Marques PRD, Correia CDC. Depression and anxiety in individuals with amyotrophic lateral sclerosis: a systematic review. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2016; 38:1-5. [DOI: 10.1590/2237-6089-2015-0030] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 08/19/2015] [Indexed: 12/11/2022]
Abstract
Introduction Studies assessing symptoms of depression and anxiety in individuals with amyotrophic lateral sclerosis (ALS) have reported contradictory results. The objective of this systematic review is to identify the prevalence of these mood disorders in the literature. Methods We searched the PubMed, HighWire, MEDLINE, SciELO, LILACS and ScienceDirect databases. Literature was selected for review in two stages, according to eligibility criteria. The first stage involved searching databases and checking titles and abstracts. The second step consisted of reading complete articles and excluding those that did not meet the inclusion criteria. The inclusion criteria were articles written in Portuguese, English or Spanish, published in the last five years and involving people with ALS diagnosed according to the El Escorial criteria. Results The database searches returned a total of 1,135 titles and abstracts and then 1,117 of these were excluded. Eighteen articles were selected for review. The 12-item Amyotrophic Lateral Sclerosis Depression Inventory (ADI-12) was the only instrument designed specifically to assess depression in ALS, but it was only used in three studies. No instruments specifically designed for anxiety in ALS were used. A large number of studies found presence and slight increase of anxiety disorders. There was considerable large variation in the results related to depressive disorders, ranging from moderate depression to an absence of symptoms. Conclusions Patients with ALS may exhibit symptoms of depression and anxiety at different levels, but there is a need for studies using specific instruments with larger samples in order to ascertain the prevalence of symptoms in ALS and the factors associated with it.
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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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Wei Q, Zheng Z, Guo X, Ou R, Chen X, Huang R, Yang J, Shang H. Association between depression and survival in Chinese amyotrophic lateral sclerosis patients. Neurol Sci 2016; 37:557-63. [PMID: 26758858 DOI: 10.1007/s10072-015-2472-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 12/28/2015] [Indexed: 02/05/2023]
Abstract
To determine the prevalence of depression, to identify correlated factors for depression, and to explore the impact on the progression or survival of amyotrophic lateral sclerosis (ALS) by depression in a Chinese population. A total of 166 ALS patients were recruited. Diagnosis of depression disorders and the severity of depression were established by using the fourth diagnostic and statistical manual of mental disorders, Hamilton Depression Rating Scale-24 items (HDRS-24) and Beck Depression Inventory (BDI). Major depression was found in 15 patients (9.6 %). The multiple regression analysis showed that a lower ALS Functional Rating Scale-Revised (ALSFRS-R) score was correlated with increasing HDRS scores and BDI scores (P = 0.018 and P = 0.012). No significant difference in the median survival time between ALS patients with and without depression was revealed by Kaplan-Meier analysis (log-rank P = 0.282). Cox hazard model showed that the presence of depression in ALS was unrelated to the survival, while the severity of depression in ALS was correlated with the survival. The presence and severity of depression in ALS did not correlate with the progression of ALS. Major depression in ALS is uncommon. Depression evaluation should be given to ALS patients, especially those with lower ALSFRS-R score. The severity of depression may be associated with the survival; however, depression does not worse the progression of ALS.
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Affiliation(s)
- Qianqian Wei
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Zhenzhen Zheng
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Xiaoyan Guo
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ruwei Ou
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Xueping Chen
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Rui Huang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jing Yang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Huifang Shang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China.
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Körner S, Kollewe K, Abdulla S, Zapf A, Dengler R, Petri S. Interaction of physical function, quality of life and depression in Amyotrophic lateral sclerosis: characterization of a large patient cohort. BMC Neurol 2015; 15:84. [PMID: 25982050 PMCID: PMC4493831 DOI: 10.1186/s12883-015-0340-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 05/06/2015] [Indexed: 11/13/2022] Open
Abstract
Background Due to lack of any curative therapy for ALS, symptomatic treatment and maintenance of quality of life (QoL) is very important. We aimed to characterize the affected domains of QoL in ALS patients and to identify factors which are associated with reduced QoL and increased depression. Methods 159 ALS patients answered standardized questionnaires (Beck Depression Inventory-II, SF-36 Health Survey questionnaire, revised ALS functional rating scale). Multiple regression analysis was used to identify correlations between clinical features of ALS patients and depression/QoL scores. In addition, QoL data from ALS patients were compared to age-matched reference values representing the German normal population. Results QoL of ALS patients was reduced in nearly all SF-36-categories. Progression of physical impairment was positively correlated with depression but reduced QoL scores only in items directly related to physical function. However, QoL was considerably influenced by depression, independently from physical impairment. Regarding distinct patient characteristics one of the most interesting findings was that increasing age was correlated with significantly worse QoL results regarding social functioning. Conclusions Depressive symptoms had a strong influence on QoL, hence their detection and treatment is of particular importance. Different domains of QoL are differently affected in subgroups of ALS patients. Being aware of these differences can be valuable for both ALS professional and family caregivers and physicians. Electronic supplementary material The online version of this article (doi:10.1186/s12883-015-0340-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sonja Körner
- Department of Neurology, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Katja Kollewe
- Department of Neurology, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Susanne Abdulla
- Department of Neurology, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. .,Department of Neurology, Otto von Guericke University, Magdeburg, Germany.
| | - Antonia Zapf
- Department of Medical Statistics, University Göttingen, Göttingen, Germany.
| | - Reinhard Dengler
- Department of Neurology, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. .,Center for Systems Neuroscience (ZSN), Hannover, Germany.
| | - Susanne Petri
- Department of Neurology, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. .,Center for Systems Neuroscience (ZSN), Hannover, Germany.
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Pisa FE, Logroscino G, Casetta A, Cecotti L, Verriello L, Bratina A, Sartori A, Lazzarino de Lorenzo L, Eleopra R, Barbone F. The Use of Antidepressant Medication before and after the Diagnosis of Amyotrophic Lateral Sclerosis: A Population-Based Cohort Study. Neuroepidemiology 2015; 44:91-8. [DOI: 10.1159/000374119] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 01/05/2015] [Indexed: 11/19/2022] Open
Abstract
Background: The prevalent use of antidepressants (ATDs) in patients with Amyotrophic Lateral Sclerosis (ALS) varies across cross-sectional and clinic-based published studies. This population-based cohort study assesses the real-world prevalence of the use of ATDs, its trajectory and the association of incident use with clinical characteristics. Methods: All patients with incident ALS in the Friuli Venezia Giulia region, Italy, from 2002 to 2009, were identified through multiple sources including health databases. Diagnosis was validated through clinical documentation review. ATDs prescriptions from 2000 to 2011 were obtained from regional database. The trajectory was estimated through generalized estimating equations for repeated measures logistic regression and the Hazard ratio (HR) of initiating ATDs through multivariate proportional hazard Cox regression. Results: In this cohort of 261 ALS cases, age-, sex-adjusted prevalence of the use of ATDs was 37.3%, higher than in general population. The trajectory increased by 16% in 1-year period across diagnosis. Age ≤67 years at diagnosis (HR 1.28, 95% CI 0.84-1.95) and bulbar onset (1.43, 95% CI 0.90-2.26) were positively associated with initiating ATDs after diagnosis. Conclusions: More than one-third of patients used ATDs. Depression may occur more frequently than previously reported. Depression may precede motor alterations and be related to both ALS diagnosis and progression.
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Chen D, Guo X, Zheng Z, Wei Q, Song W, Cao B, Huang R, Yang R, Shang H. Depression and anxiety in amyotrophic lateral sclerosis: correlations between the distress of patients and caregivers. Muscle Nerve 2015; 51:353-7. [PMID: 24976369 DOI: 10.1002/mus.24325] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2014] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Depression and anxiety are common in amyotrophic lateral sclerosis (ALS) patients and caregivers. METHODS In this study we investigated 93 ALS patients and their 93 caregivers. Depression and anxiety were quantified by the Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale, respectively. RESULTS Very strong correlations between depression and anxiety were found among patients and their caregivers. The severity of depression and anxiety of patients correlated moderately with that of their caregivers. No correlations were found between the severity of depression and anxiety and ALS Functional Rating Scale-Revised (ALSFRS-R) score or for disease duration among patients and caregivers. However, severity of depression and anxiety in caregivers correlated with their age. CONCLUSIONS Depression and anxiety in ALS patients and their caregivers were associated closely with each other but not with physical disability or disease duration in our Chinese population.
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Affiliation(s)
- Dezhi Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
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Cui F, Zhu W, Zhou Z, Ren Y, Li Y, Li M, Huo Y, Huang X. Frequency and risk factor analysis of cognitive and anxiety-depressive disorders in patients with amyotrophic lateral sclerosis/motor neuron disease. Neuropsychiatr Dis Treat 2015; 11:2847-54. [PMID: 26604769 PMCID: PMC4639547 DOI: 10.2147/ndt.s90520] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES To examine the frequency and risk factors of cognitive and anxiety-depressive disorders in patients with amyotrophic lateral sclerosis/motor neuron disease (ALS/MND). METHODS This was an observational study of 100 ALS/MND patients treated at our hospital outpatient and inpatient departments between January 2009 and April 2010 and 100 matched healthy controls. Subjects were surveyed using Mini Mental State Examination (MMSE), Zung Self-Rating Anxiety Scale (SAS), and Zung Self-Rating Depression Scale (SDS). Patient neurological status was graded by the ALS Functional Rating Scale (ALSFRS). Multivariate linear regression was used to identify factors associated with the MMSE, SAS, SDS, and ALSFRS scores. RESULTS Patients had significantly lower MMSE scores than controls (P<0.05). MMSE score did not differ by sex or age (<50/≥50 years) (P>0.05). Patients with higher educational level (college and above), shorter disease course (<2 years), and lower ALSFRS score (<20) had significantly higher MMSE scores (all P<0.05). Multivariate analysis revealed that higher education, shorter disease course, and lower ALSFRS score were independent predictors of better cognitive function (higher MMSE score). Patients had significantly higher mean SAS and SDS total scores than controls (both P<0.05), indicating higher subjective anxiety and depression. Female patients, patients with higher education, and those with higher ALSFRS scores had significantly higher SAS and SDS scores (all P<0.05). Age, occupation, diagnostic classification, disease duration, and disease awareness did not influence SAS or SDS scores. Multivariate analysis indicated that lower education and lower ALSFRS were protective factors against anxiety and depression. CONCLUSION The frequency of anxiety-depressive disorders was high among patients with ALS/MND. High educational level, short course of disease, and lower ALSFRS were associated with preserved cognitive function. Female sex, higher education, and lower ALSFRS score conferred a greater risk of anxiety and depression. Tailored pharmacotherapy and psychological interventions may help in reducing anxiety and depression in these patients.
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Affiliation(s)
- Fang Cui
- Department of Neurology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Wenjia Zhu
- Department of Neurology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Zhibin Zhou
- Department of Neurology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yuting Ren
- Department of Neurology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yifan Li
- Department of Neurology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Mao Li
- Department of Neurology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yunyun Huo
- Department of Neurology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xusheng Huang
- Department of Neurology, Chinese PLA General Hospital, Beijing, People's Republic of China
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A longer diagnostic interval is a risk for depression in amyotrophic lateral sclerosis. Palliat Support Care 2014; 13:1019-24. [DOI: 10.1017/s1478951514000881] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
AbstractObjective:Recognizing depressive symptoms in patients with amyotrophic lateral sclerosis (ALS) remains problematic given the potential overlap with the normal psychological responses to a terminal illness. Understanding mental health and disease-related risk factors for depression is key to identifying psychological morbidity. The present study aimed to determine the prevalence of depressive symptoms in ALS and to explore mental health and disease-related risk factors for depression.Method:Structured medical and psychiatric history questionnaires and a validated depression scale (Depression, Anxiety, Stress Scale–21) were completed by 27 ALS patients (60% female; 59% limb onset; age 65.11 ± SE 2.21) prior to their initial review at a multidisciplinary clinic. Physical function was assessed with the Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS–R).Results:At the time of initial assessment, 44% of patients had a previous psychiatric history, although the majority (62%) reported no symptoms of depression. The mean ALSFRS–R score was 37.78 ± SE 1.22, with an average diagnostic interval of 16.04 ± SE 2.39 months. Logistic regression analysis revealed that the length of the diagnostic interval alone predicted depressive symptoms (χ2(3, n = 26) = 9.21, Odds Ratio (OR) = 1.12, p < 0.05.Significance of Results:The illness experiences of ALS patients rather than established mental health risk factors influence the manifestation of depressive symptoms in the early stages of the disease, with clinical implications for the assessment and treatment of psychological morbidity. Patients with lengthy diagnostic intervals may be prime targets for psychological assessment and intervention, especially in the absence of ALS-specific tests and biomarkers.
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Jones AR, Jivraj N, Balendra R, Murphy C, Kelly J, Thornhill M, Young C, Shaw PJ, Leigh PN, Turner MR, Steen IN, McCrone P, Al-Chalabi A. Health utility decreases with increasing clinical stage in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2014; 15:285-91. [PMID: 24641613 DOI: 10.3109/21678421.2013.872149] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease typically causing death within three years. Understanding the impact of disease on patients using health utility at different stages of ALS would allow meaningful cost-benefit analysis of new potential therapies. A common health-related quality of life measurement, developed and validated for the UK, is the EQ-5D. Using clinical trial data from the LiCALS study, we calculated health utility using the EQ-5D for each King's ALS clinical stage from 214 patients. We analysed whether health utility, and other health-related measures, significantly changed between each of the clinical stages. Results showed that mean health utility decreased by 0.487 (the scale runs from 1 to - 0.594) between clinical stages 2A and 4. Emotional states, measured using the Hospital Anxiety and Depression Scale (HADS), showed worsening depression and anxiety scores as ALS progressed. Age of onset, disease onset, gender and treatment group were not predictors of EQ-5D, depression or anxiety. In conclusion, increasing severity of King's ALS Clinical Stage is associated with a progressive decrease in EQ-5D health utility. This is useful for cost-benefit analysis of new therapies and validates this ALS clinical staging system.
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Affiliation(s)
- Ashley R Jones
- Department of Clinical Neuroscience, Institute of Psychiatry , King's College London, London
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Jelsone-Swain L, Persad C, Votruba KL, Weisenbach SL, Johnson T, Gruis KL, Welsh RC. The Relationship between Depressive Symptoms, Disease State, and Cognition in Amyotrophic Lateral Sclerosis. Front Psychol 2012; 3:542. [PMID: 23411492 PMCID: PMC3571885 DOI: 10.3389/fpsyg.2012.00542] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 11/14/2012] [Indexed: 12/12/2022] Open
Abstract
Cognitive impairment (CI) in amyotrophic lateral sclerosis (ALS) may present a serious barrier to a patient's wellbeing and significantly decrease quality of life. Although reports of CI in ALS without frank dementia are becoming quite common, questions remain regarding the specific cognitive domains affected, as well as how other psychological and medical factors may impact cognitive functioning in these patients. Additionally, the influence of depressive symptoms on disease processes is not known. We aimed to address these questions by completing extensive neuropsychological tests with 22 patients with ALS and 17 healthy volunteers. A subgroup of these patients also completed questionnaires to measure depressive and vegetative symptoms. We tested for overall cognitive differences between groups, the influence of physical (e.g., bulbar and limb), vegetative (e.g., fatigue), and depressive symptoms on cognitive performance, and the relationship between depressive symptoms and disease severity in ALS. Overall, patients performed more poorly than healthy controls (HCs), most notably on tests of executive functioning and learning and memory. Results suggest that true cognitive performance differences exist between patients with ALS and HCs, as these differences were not changed by the presence of vegetative or depressive symptoms. There was no effect of limb or bulbar symptoms on cognitive functioning. Also, patients were not any more depressed than HCs, however increased depressive scores correlated with faster disease progression and decreased limb function. Collectively, it is suggested that translational advances in psychological intervention for those with CI and depression become emphasized in future research.
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Affiliation(s)
| | - Carol Persad
- Department of Psychiatry, University of MichiganAnn Arbor, MI, USA
| | | | | | - Timothy Johnson
- Department of Biostatistics, University of MichiganAnn Arbor, MI, USA
| | - Kirsten L. Gruis
- Department of Neurology, The State University of New York Upstate Medical UniversitySyracuse, NY, USA
| | - Robert C. Welsh
- Department of Radiology, University of MichiganAnn Arbor, MI, USA
- Department of Psychiatry, University of MichiganAnn Arbor, MI, USA
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