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Didcote L, Vitoratou S, Al-Chalabi A, Goldstein LH. Comparison of in-person vs. remote administration of cognitive screening tools for people with ALS. Neurol Sci 2024:10.1007/s10072-024-07661-y. [PMID: 38951432 DOI: 10.1007/s10072-024-07661-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/15/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVE This study investigated whether cognitive screening tools used for people with amyotrophic lateral sclerosis (pwALS) are affected by the screen being administered face-to-face or remotely online. It also investigated whether demographic variables predicted total cognitive screen scores. METHODS The cognitive component of the Edinburgh Cognitive and Behavioural ALS Screen (ECASc), the cognitive component of the ALS Cognitive Behavioural Screen (ALS-CBSc), and the Mini Addenbrooke's Cognitive Examination (Mini-ACE) were administered to 41 pwALS and 41 controls face-to-face. Versions of the cognitive screens designed to be administered remotely were administered to 57 pwALS and 44 controls via videoconferencing methods. Backwards stepwise linear regressions were conducted to assess whether total scores on the ECASc, ALS-CBSc, and Mini-ACE scores were predicted by administration mode (face-to-face or remote) or demographic variables. RESULTS Mode of administration significantly affected scores on the ECASc and ALS-CBSc; remote administration was associated with better total scores. Administration mode did not significantly affect Mini-ACE scores. All cognitive screens were significantly affected by IQ scores; higher IQ scores predicted better screening tool scores. Only ECASc scores were significantly affected by age, with older age predicting poorer scores. Being female was associated with better Mini-ACE scores; sex did not predict ECASc and ALS-CBSc scores. CONCLUSIONS Our results suggest that videoconferencing versions of the ECASc and ALS-CBSc may function differently to the original, face-to-face versions. There are advantages to using remote versions of cognitive screening tools but clinicians and researchers who use them should consider that they may not yield equivalent scores.
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Affiliation(s)
- Lyndsay Didcote
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Silia Vitoratou
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ammar Al-Chalabi
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
| | - Laura H Goldstein
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
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2
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Barker MS, Ceslis A, Argall R, McCombe P, Henderson RD, Robinson GA. Verbal and nonverbal fluency in amyotrophic lateral sclerosis. J Neuropsychol 2024; 18:265-285. [PMID: 37997256 DOI: 10.1111/jnp.12354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/25/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is a multi-system disorder that commonly affects cognition and behaviour. Verbal fluency impairments are consistently reported in ALS patients, and we aimed to investigate whether this deficit extends beyond the verbal domain. We further aimed to determine whether deficits are underpinned by a primary intrinsic response generation impairment (i.e., a global reduction across tasks), potentially related to apathy, or an inability to maintain responding over time (i.e., a 'drop off' pattern). Twenty-two ALS patients and 21 demographically-matched controls completed verbal and nonverbal fluency tasks (phonemic/semantic word fluency, design fluency, gesture fluency and ideational fluency), requiring the generation of responses over a specified time period. Fluency performance was analysed in terms of the overall number of novel items produced, as well as the number of items produced in the first 'initiation' and the remaining 'maintenance' time periods. ALS patients' overall performance was not globally reduced across tasks. Patients were impaired only on meaningful gesture fluency, which requires the generation of gestures that communicate meaning (e.g., waving). On phonemic fluency, ALS patients showed a 'drop off' pattern of performance, where they had difficulty maintaining responding over time, but this pattern was not evident on the other fluency tasks. Apathy did not appear to be related to fluency performance. The selective meaningful gesture fluency deficit, in the context of preserved meaningless gesture fluency, highlights that the retrieval of action knowledge may be weakened in early ALS.
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Affiliation(s)
- Megan S Barker
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Amelia Ceslis
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
- Neuropsychology and Neurology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Rosemary Argall
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
- Neuropsychology and Neurology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Pamela McCombe
- Neuropsychology and Neurology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Robert D Henderson
- Neuropsychology and Neurology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
- Wesley Medical Research, The Wesley Hospital, Brisbane, Queensland, Australia
| | - Gail A Robinson
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
- Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
- Neuropsychology and Neurology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
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Kasper E, Temp AGM, Köckritz V, Meier L, Machts J, Vielhaber S, Hermann A, Prudlo J. Verbal expressive language minimally affected in non-demented people living with amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2024; 25:308-316. [PMID: 38306019 DOI: 10.1080/21678421.2024.2307512] [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: 06/22/2023] [Accepted: 01/08/2024] [Indexed: 02/03/2024]
Abstract
Objective: Language dysfunction is one of the most common cognitive impairments in amyotrophic lateral sclerosis (ALS). Although discourse capacities are essential for daily functioning, verbal expressive language has not been widely investigated in ALS. The existing research available suggests that discourse impairments are prevalent. This study investigates verbal expressive language in people living with ALS (plwALS) in contrast to healthy controls (HC).Methods: 64 plwALS and 49 age, gender and education-matched healthy controls were ask to describe the Cookie Theft Picture Task. The recordings were analyzed for discourse productivity, discourse content, syntactic complexity, speech fluency and verb processing. We applied the Bayesian hypothesis-testing framework, incorporating the effects of dysarthria, cognitive impairment status (CIS), and premorbid crystalline verbal IQ.Results: Compared to HC, plwALS only showed a single impairment: speech dysfluency. Discourse productivity, discourse content, syntactic complexity and verb processing were not impaired. Cognition and dysarthria exceeded the influence of verbal IQ for total words spoken and content density. Cognition alone seemed to explain dysfluency. Body-agent verbs were produced at even higher rates than other verb types. For the remaining outcomes, verbal IQ was the most decisive factor.Conclusions: In contrast to existing research, our data demonstrates no discernible impairment in verbal expressive language in ALS. What our findings show to be decisive is accounting for the influence of dysarthria, cognitive impairment status, and verbal IQ as variables on spontaneous verbal expressive language. Minor impairments in verbal expressive language appear to be influenced to a greater degree by executive dysfunctioning and dysarthria than by language impairment.
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Affiliation(s)
- Elisabeth Kasper
- Department of Neurology, University Medical Centre, Rostock, Germany
- DZNE site Rostock, German Centre for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Anna G M Temp
- DZNE site Rostock, German Centre for Neurodegenerative Diseases (DZNE), Rostock, Germany
- Neurozentrum, Berufsgenossenschaftliches Klinikum Hamburg, Germany
| | - Verena Köckritz
- DZNE site Rostock, German Centre for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Lisa Meier
- Department of Neurology, University Medical Centre, Rostock, Germany
| | - Judith Machts
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Magdeburg, Germany, and
| | - Stefan Vielhaber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Magdeburg, Germany, and
| | - Andreas Hermann
- Department of Neurology, University Medical Centre, Rostock, Germany
- Translational Neurodegeneration Section "Albrecht Kossel", University Medical Centre, Rostock
| | - Johannes Prudlo
- Department of Neurology, University Medical Centre, Rostock, Germany
- DZNE site Rostock, German Centre for Neurodegenerative Diseases (DZNE), Rostock, Germany
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Jellinger KA. The Spectrum of Cognitive Dysfunction in Amyotrophic Lateral Sclerosis: An Update. Int J Mol Sci 2023; 24:14647. [PMID: 37834094 PMCID: PMC10572320 DOI: 10.3390/ijms241914647] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/21/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
Cognitive dysfunction is an important non-motor symptom in amyotrophic lateral sclerosis (ALS) that has a negative impact on survival and caregiver burden. It shows a wide spectrum ranging from subjective cognitive decline to frontotemporal dementia (FTD) and covers various cognitive domains, mainly executive/attention, language and verbal memory deficits. The frequency of cognitive impairment across the different ALS phenotypes ranges from 30% to 75%, with up to 45% fulfilling the criteria of FTD. Significant genetic, clinical, and pathological heterogeneity reflects deficits in various cognitive domains. Modern neuroimaging studies revealed frontotemporal degeneration and widespread involvement of limbic and white matter systems, with hypometabolism of the relevant areas. Morphological substrates are frontotemporal and hippocampal atrophy with synaptic loss, associated with TDP-43 and other co-pathologies, including tau deposition. Widespread functional disruptions of motor and extramotor networks, as well as of frontoparietal, frontostriatal and other connectivities, are markers for cognitive deficits in ALS. Cognitive reserve may moderate the effect of brain damage but is not protective against cognitive decline. The natural history of cognitive dysfunction in ALS and its relationship to FTD are not fully understood, although there is an overlap between the ALS variants and ALS-related frontotemporal syndromes, suggesting a differential vulnerability of motor and non-motor networks. An assessment of risks or the early detection of brain connectivity signatures before structural changes may be helpful in investigating the pathophysiological mechanisms of cognitive impairment in ALS, which might even serve as novel targets for effective disease-modifying therapies.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, A-1150 Vienna, Austria
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Milella G, Sciancalepore D, Cavallaro G, Piccirilli G, Nanni AG, Fraddosio A, D’Errico E, Paolicelli D, Fiorella ML, Simone IL. Acoustic Voice Analysis as a Useful Tool to Discriminate Different ALS Phenotypes. Biomedicines 2023; 11:2439. [PMID: 37760880 PMCID: PMC10525613 DOI: 10.3390/biomedicines11092439] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/24/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
Approximately 80-96% of people with amyotrophic lateral sclerosis (ALS) become unable to speak during the disease progression. Assessing upper and lower motor neuron impairment in bulbar regions of ALS patients remains challenging, particularly in distinguishing spastic and flaccid dysarthria. This study aimed to evaluate acoustic voice parameters as useful biomarkers to discriminate ALS clinical phenotypes. Triangular vowel space area (tVSA), alternating motion rates (AMRs), and sequential motion rates (SMRs) were analyzed in 36 ALS patients and 20 sex/age-matched healthy controls (HCs). tVSA, AMR, and SMR values significantly differed between ALS and HCs, and between ALS with prevalent upper (pUMN) and lower motor neuron (pLMN) impairment. tVSA showed higher accuracy in discriminating pUMN from pLMN patients. AMR and SMR were significantly lower in patients with bulbar onset than those with spinal onset, both with and without bulbar symptoms. Furthermore, these values were also lower in patients with spinal onset associated with bulbar symptoms than in those with spinal onset alone. Additionally, AMR and SMR values correlated with the degree of dysphagia. Acoustic voice analysis may be considered a useful prognostic tool to differentiate spastic and flaccid dysarthria and to assess the degree of bulbar involvement in ALS.
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Affiliation(s)
- Giammarco Milella
- Neurology Unit, Department of Translational Biomedicine and Neurosciences, 70121 Bari, Italy; (G.M.); (G.P.); (A.G.N.); (A.F.); (E.D.); (D.P.)
| | - Diletta Sciancalepore
- Otolaryngology Unit, Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, 70121 Bari, Italy; (D.S.); (G.C.); (M.L.F.)
| | - Giada Cavallaro
- Otolaryngology Unit, Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, 70121 Bari, Italy; (D.S.); (G.C.); (M.L.F.)
| | - Glauco Piccirilli
- Neurology Unit, Department of Translational Biomedicine and Neurosciences, 70121 Bari, Italy; (G.M.); (G.P.); (A.G.N.); (A.F.); (E.D.); (D.P.)
| | - Alfredo Gabriele Nanni
- Neurology Unit, Department of Translational Biomedicine and Neurosciences, 70121 Bari, Italy; (G.M.); (G.P.); (A.G.N.); (A.F.); (E.D.); (D.P.)
| | - Angela Fraddosio
- Neurology Unit, Department of Translational Biomedicine and Neurosciences, 70121 Bari, Italy; (G.M.); (G.P.); (A.G.N.); (A.F.); (E.D.); (D.P.)
| | - Eustachio D’Errico
- Neurology Unit, Department of Translational Biomedicine and Neurosciences, 70121 Bari, Italy; (G.M.); (G.P.); (A.G.N.); (A.F.); (E.D.); (D.P.)
| | - Damiano Paolicelli
- Neurology Unit, Department of Translational Biomedicine and Neurosciences, 70121 Bari, Italy; (G.M.); (G.P.); (A.G.N.); (A.F.); (E.D.); (D.P.)
| | - Maria Luisa Fiorella
- Otolaryngology Unit, Department of Translational Biomedicine and Neurosciences (DiBraiN), University of Bari Aldo Moro, 70121 Bari, Italy; (D.S.); (G.C.); (M.L.F.)
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Nash Y, Sitty M. Non-Motor Symptoms of Amyotrophic Lateral Sclerosis: A Multi-Faceted Disorder. J Neuromuscul Dis 2021; 8:699-713. [PMID: 34024773 DOI: 10.3233/jnd-210632] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Amyotrophic Lateral Sclerosis (ALS) is a fatal neurodegenerative disease characterized by progressive degeneration of motor pathways. A growing body of evidence from recent years suggests that ALS results in a wide range of non-motor symptoms as well, which can have a significant impact on patients' quality of life. These symptoms could also, in turn, provide useful information as biomarkers for disease progression, and can shed insight on ALS mechanisms. Here we aim to review a wide range of non-motor symptoms of ALS, with emphasis on their importance to research and clinical treatment of patients.
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Affiliation(s)
- Yuval Nash
- Tel Aviv Youth University, The Jaime and Joan Constantiner School of Education, Tel Aviv University, Tel Aviv, Israel
| | - Michal Sitty
- Clalit Health Services, Kiryat Ono, Israel.,Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Robinson GA, Campbell L, Ceslis A. A Goal Intervention Improves Language Fluency: Evidence from Parkinson's Disease and Healthy Aging. MEDICINES 2021; 8:medicines8030015. [PMID: 33810201 PMCID: PMC8004843 DOI: 10.3390/medicines8030015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/19/2021] [Accepted: 03/20/2021] [Indexed: 12/04/2022]
Abstract
Background: Parkinson’s disease [PD] is associated with reduced motor and cognitive initiation, and decreased goal-directed behavior including language generation. The current study investigated a novel goal intervention for language generation impairments in PD patients. Methods: Twenty-one PD patients and 22 healthy controls, matched for gender, age, and education, completed a cognitive baseline and language generation tasks (complex scene descriptions and phonemic/semantic word fluency) with standard and adapted instructions, which implements a target ‘goal’. In addition, participants completed self-report questionnaires for apathy and mood. Results: PD patients performed more poorly on two of three language generation tasks. The goal intervention was effective in increasing both the PD patient and healthy control groups’ language generation. However, there was no differential benefit of increased goal specificity and difficulty for PD patients. As a group, PD patients reported higher levels of apathy and depression than healthy controls. Specifically, PD patients with executive apathy were more likely to have language generation impairments than PD patients without executive apathy and controls. Apathy subscales and goal benefit were unrelated. Conclusions: The goal intervention was effective for PD patients and older adults, suggesting that enhanced goal specificity and difficulty may benefit individuals with PD or those aging naturally.
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Affiliation(s)
- Gail A. Robinson
- Queensland Brain Institute, The University of Queensland, Brisbane 4072, Australia
- Neuropsychology Research Unit, School of Psychology, The University of Queensland, Brisbane 4072, Australia; (L.C.); (A.C.)
- Correspondence: ; Tel.: +61-(0)7-3365-6401
| | - Lara Campbell
- Neuropsychology Research Unit, School of Psychology, The University of Queensland, Brisbane 4072, Australia; (L.C.); (A.C.)
| | - Amelia Ceslis
- Neuropsychology Research Unit, School of Psychology, The University of Queensland, Brisbane 4072, Australia; (L.C.); (A.C.)
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A Brief Executive Language Screen for Frontal Aphasia. Brain Sci 2021; 11:brainsci11030353. [PMID: 33802073 PMCID: PMC7998395 DOI: 10.3390/brainsci11030353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/02/2021] [Accepted: 03/08/2021] [Indexed: 11/16/2022] Open
Abstract
Aphasia assessment tools have primarily focused on classical aphasia type and severity, with minimal incorporation of recent findings that suggest a significant role of executive control operations in language generation. Assessment of the interface between language and executive functions is needed to improve detection of spontaneous speech difficulties. In this study we develop a new Brief Executive Language Screen (BELS), a brief tool specifically designed to assess core language and executive functions shown to be involved in spontaneous generation of language. Similar to other measures of aphasia, the BELS assesses articulation and core language skills (repetition, naming and comprehension). Unique additions to the BELS include assessments of spontaneous connected speech, word fluency (phonemic/semantic) and sentence completion (verbal initiation, inhibition and selection). One-hundred and eight healthy controls and 136 stroke patients were recruited. Confirmatory factor analysis was used to determine construct validity and logistic regression was used to evaluate the discriminative validity, informing the final version of the BELS. The results showed that the BELS is sensitive for articulation and nominal language deficits, and it measures executive aspects of spontaneous language generation, which is a hallmark of frontal dynamic aphasia. The results have encouraging theoretical and practical implications.
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