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Keetharuth AD, Gould RL, McDermott CJ, Thompson BJ, Rawlinson C, Bradburn M, Bursnall M, Kumar P, Turton EJ, Tappenden P, White D, Howard RJ, Serfaty MA, McCracken LM, Graham CD, Al‐Chalabi A, Goldstein LH, Lawrence V, Cooper C, Young T. Cost-effectiveness of acceptance and commitment therapy for people living with motor neuron disease, and their health-related quality of life. Eur J Neurol 2024; 31:e16317. [PMID: 38660985 PMCID: PMC11235598 DOI: 10.1111/ene.16317] [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: 11/28/2023] [Revised: 03/27/2024] [Accepted: 04/10/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Given the degenerative nature of the condition, people living with motor neuron disease (MND) experience high levels of psychological distress. The purpose of this research was to investigate the cost-effectiveness of acceptance and commitment therapy (ACT), adapted for the specific needs of this population, for improving quality of life. METHODS A trial-based cost-utility analysis over a 9-month period was conducted comparing ACT plus usual care (n = 97) versus usual care alone (n = 94) from the perspective of the National Health Service. In the primary analysis, quality-adjusted life years (QALYs) were computed using health utilities generated from the EQ-5D-5L questionnaire. Sensitivity analyses and subgroup analyses were also carried out. RESULTS Difference in costs was statistically significant between the two arms, driven mainly by the intervention costs. Effects measured by EQ-5D-5L were not statistically significantly different between the two arms. The incremental cost-effectiveness was above the £20,000 to £30,000 per QALY gained threshold used in the UK. However, the difference in effects was statistically significant when measured by the McGill Quality of Life-Revised (MQOL-R) questionnaire. The intervention was cost-effective in a subgroup experiencing medium deterioration in motor neuron symptoms. CONCLUSIONS Despite the intervention being cost-ineffective in the primary analysis, the significant difference in the effects measured by MQOL-R, the low costs of the intervention, the results in the subgroup analysis, and the fact that ACT was shown to improve the quality of life for people living with MND, suggest that ACT could be incorporated into MND clinical services.
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Affiliation(s)
- Anju D. Keetharuth
- School of Medicine and Population Health, Sheffield Centre for Health and Related ResearchUniversity of SheffieldSheffieldUK
| | | | | | - Benjamin J. Thompson
- Clinical Trials Research Unit, Sheffield Centre for Health and Related ResearchUniversity of SheffieldSheffieldUK
| | | | - Mike Bradburn
- Clinical Trials Research Unit, Sheffield Centre for Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - Matt Bursnall
- Clinical Trials Research Unit, Sheffield Centre for Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - Pavithra Kumar
- Clinical Trials Research Unit, Sheffield Centre for Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - Emily J. Turton
- Clinical Trials Research Unit, Sheffield Centre for Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - Paul Tappenden
- School of Medicine and Population Health, Sheffield Centre for Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - David White
- School of Medicine and Population Health, Sheffield Centre for Health and Related ResearchUniversity of SheffieldSheffieldUK
| | | | - Marc A. Serfaty
- Division of PsychiatryUniversity College LondonLondonUK
- Priory Hospital North LondonLondonUK
| | | | | | - Ammar Al‐Chalabi
- Maurice Wohl Clinical Neuroscience InstituteKing's College LondonLondonUK
| | - Laura H. Goldstein
- Department of Psychology, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Vanessa Lawrence
- Health Service & Population Research Department, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Cindy Cooper
- Clinical Trials Research Unit, Sheffield Centre for Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - Tracey Young
- School of Medicine and Population Health, Sheffield Centre for Health and Related ResearchUniversity of SheffieldSheffieldUK
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Watt CL, Smith IC, Rice J, Murphy R, Breiner A, Duff MLV, Nogo D, Bush SH, McNeely S, Buenger U, Zehrt B, Zwicker J. Qualitative Analysis of Initial Palliative Care Consultations in Amyotrophic Lateral Sclerosis. J Pain Symptom Manage 2024; 68:43-52.e2. [PMID: 38574876 DOI: 10.1016/j.jpainsymman.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/27/2024] [Accepted: 03/25/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Palliative care (PC) benefits patients with amyotrophic lateral sclerosis (ALS), however the needs of patients and caregivers and the optimal timing of PC discussions remains unclear. This study reports the analysis of PC consult notes from a larger feasibility trial. The specific aims of this analysis were to i) identify the PC needs of patients with ALS via qualitative analysis and ii) identify characteristics of patients and caregivers that could predict specific PC needs. METHODS This study was nested within a nonrandomized, prospective study of patients with ALS (and their caregivers) being treated at a multidisciplinary ALS clinic. Exclusion criteria of the main study were age <18 years, inability to complete questionnaires, and prior receipt of PC. All patients were offered a PC consultation (PCC); those who accepted were included in this nested study. Consultation notes were reviewed and thematic and content analyses were conducted. The occurrence of themes across patient and caregiver contextual variables were examined. RESULTS Thirty-two PCCs were completed between October 2020 and April 2022. Six major themes were identified: PC roles (with subthemes encompassing the spectrum of specialist PC practice including symptom management and advance care planning), engagement with PC, patients' concerns for their caregivers, caregiver-specific concerns, finances, and COVID-19. An average of 12 topics were discussed per PCC (range = 3-22). Discussion of advance care planning, care coordination, and symptom management was common, and these topics were not discussed more frequently in PCCs with patients with lower functional status, more bulbar symptoms, or lower quality of life. Time from diagnosis did not impact topics of discussion. Patients reporting more symptoms of depression more frequently required psychological support, particularly regarding loss of independence, employment, and leisure activities. DISCUSSION Patients with ALS and their caregivers have a wide range of PC needs. These needs vary irrespective of time from diagnosis, functional status, or quality of life, therefore PCC is recommended for all patients with ALS. PCC should be individualized based on patient and caregiver preferences. TRIAL REGISTRATION INFORMATION The study was registered with ClinicalTrials.gov (NCT04257760; https://clinicaltrials.gov/ct2/show/NCT04257760) on February 6, 2020. The first enrollment occurred on October 20, 2020.
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Affiliation(s)
- Christine L Watt
- Department of Medicine, Division of Palliative Care (C.L.W., J.R., R.M., S.H.B.), University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H 8M5, Canada; The Ottawa Hospital (C.L.W., J.R., R.M., A.B., S.M., B.Z., J.Z.), 501 Smyth Rd, Ottawa, Ontario K1H 8L6, Canada; Bruyère Continuing Care (C.L.W., J.R., R.M., S.H.B.), 60 Cambridge St. N., Ottawa, Ontario K1R 7A5, Canada; Bruyère Research Institute (C.L.W., J.R., S.H.B.), 43 Bruyère St., Ottawa, Ontario K1N 5C8, Canada; Ottawa Hospital Research Institute (C.L.W., I.C.S., J.R., A.B., M.D., D.N., S.H.B., J.Z.), 1053 Carling Ave, Ottawa, Ontario K1Y 4E9, Canada.
| | - Ian C Smith
- Ottawa Hospital Research Institute (C.L.W., I.C.S., J.R., A.B., M.D., D.N., S.H.B., J.Z.), 1053 Carling Ave, Ottawa, Ontario K1Y 4E9, Canada
| | - Jill Rice
- Department of Medicine, Division of Palliative Care (C.L.W., J.R., R.M., S.H.B.), University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H 8M5, Canada; The Ottawa Hospital (C.L.W., J.R., R.M., A.B., S.M., B.Z., J.Z.), 501 Smyth Rd, Ottawa, Ontario K1H 8L6, Canada; Bruyère Continuing Care (C.L.W., J.R., R.M., S.H.B.), 60 Cambridge St. N., Ottawa, Ontario K1R 7A5, Canada; Bruyère Research Institute (C.L.W., J.R., S.H.B.), 43 Bruyère St., Ottawa, Ontario K1N 5C8, Canada; Ottawa Hospital Research Institute (C.L.W., I.C.S., J.R., A.B., M.D., D.N., S.H.B., J.Z.), 1053 Carling Ave, Ottawa, Ontario K1Y 4E9, Canada
| | - Rebekah Murphy
- Department of Medicine, Division of Palliative Care (C.L.W., J.R., R.M., S.H.B.), University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H 8M5, Canada; The Ottawa Hospital (C.L.W., J.R., R.M., A.B., S.M., B.Z., J.Z.), 501 Smyth Rd, Ottawa, Ontario K1H 8L6, Canada; Bruyère Continuing Care (C.L.W., J.R., R.M., S.H.B.), 60 Cambridge St. N., Ottawa, Ontario K1R 7A5, Canada; Queensway Carleton Hospital (R.M.), 3045 Baseline Road, Ottawa, Ontario K2H 8P4, Canada
| | - Ari Breiner
- The Ottawa Hospital (C.L.W., J.R., R.M., A.B., S.M., B.Z., J.Z.), 501 Smyth Rd, Ottawa, Ontario K1H 8L6, Canada; Ottawa Hospital Research Institute (C.L.W., I.C.S., J.R., A.B., M.D., D.N., S.H.B., J.Z.), 1053 Carling Ave, Ottawa, Ontario K1Y 4E9, Canada; Department of Medicine (A.B.), Department of Neurology, University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H 8M5, Canada
| | - Maria L V Duff
- Ottawa Hospital Research Institute (C.L.W., I.C.S., J.R., A.B., M.D., D.N., S.H.B., J.Z.), 1053 Carling Ave, Ottawa, Ontario K1Y 4E9, Canada
| | - Danica Nogo
- Ottawa Hospital Research Institute (C.L.W., I.C.S., J.R., A.B., M.D., D.N., S.H.B., J.Z.), 1053 Carling Ave, Ottawa, Ontario K1Y 4E9, Canada
| | - Shirley H Bush
- Department of Medicine, Division of Palliative Care (C.L.W., J.R., R.M., S.H.B.), University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H 8M5, Canada; Bruyère Continuing Care (C.L.W., J.R., R.M., S.H.B.), 60 Cambridge St. N., Ottawa, Ontario K1R 7A5, Canada; Bruyère Research Institute (C.L.W., J.R., S.H.B.), 43 Bruyère St., Ottawa, Ontario K1N 5C8, Canada; Ottawa Hospital Research Institute (C.L.W., I.C.S., J.R., A.B., M.D., D.N., S.H.B., J.Z.), 1053 Carling Ave, Ottawa, Ontario K1Y 4E9, Canada
| | - Susan McNeely
- The Ottawa Hospital (C.L.W., J.R., R.M., A.B., S.M., B.Z., J.Z.), 501 Smyth Rd, Ottawa, Ontario K1H 8L6, Canada
| | - Usha Buenger
- Faculty of Medicine (U.B.), Division of Physical Medicine and Rehabilitation, The Ottawa Hospital Rehabilitation Centre 505 Smyth Road, Ottawa, Ontario K1H 8M2, Canada
| | - Belinda Zehrt
- The Ottawa Hospital (C.L.W., J.R., R.M., A.B., S.M., B.Z., J.Z.), 501 Smyth Rd, Ottawa, Ontario K1H 8L6, Canada
| | - Jocelyn Zwicker
- The Ottawa Hospital (C.L.W., J.R., R.M., A.B., S.M., B.Z., J.Z.), 501 Smyth Rd, Ottawa, Ontario K1H 8L6, Canada; Ottawa Hospital Research Institute (C.L.W., I.C.S., J.R., A.B., M.D., D.N., S.H.B., J.Z.), 1053 Carling Ave, Ottawa, Ontario K1Y 4E9, Canada; Department of Medicine (A.B.), Department of Neurology, University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H 8M5, Canada
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Bjelica B, Bartels MB, Hesebeck-Brinckmann J, Petri S. Non-motor symptoms in patients with amyotrophic lateral sclerosis: current state and future directions. J Neurol 2024; 271:3953-3977. [PMID: 38805053 PMCID: PMC11233299 DOI: 10.1007/s00415-024-12455-5] [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: 04/17/2024] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 05/29/2024]
Abstract
Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease characterized by the progressive degeneration of both upper and lower motor neurons. A defining histopathological feature in approximately 97% of all ALS cases is the accumulation of phosphorylated trans-activation response (TAR) DNA-binding protein 43 protein (pTDP-43) aggregates in the cytoplasm of neurons and glial cells within the central nervous system. Traditionally, it was believed that the accumulation of TDP-43 aggregates and subsequent neurodegeneration primarily occurs in motor neurons. However, contemporary evidence suggests that as the disease progresses, other systems and brain regions are also affected. Despite this, there has been a limited number of clinical studies assessing the non-motor symptoms in ALS patients. These studies often employ various outcome measures, resulting in a wide range of reported frequencies of non-motor symptoms in ALS patients. The importance of assessing the non-motor symptoms reflects in a fact that they have a significant impact on patients' quality of life, yet they frequently go underdiagnosed and unreported during clinical evaluations. This review aims to provide an up-to-date overview of the current knowledge concerning non-motor symptoms in ALS. Furthermore, we address their diagnosis and treatment in everyday clinical practice.
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Affiliation(s)
- Bogdan Bjelica
- Department of Neurology, Hannover Medical School, 1, Carl-Neuberg-Strasse, 30625, Hannover, Germany.
| | - Maj-Britt Bartels
- Precision Neurology of Neuromuscular and Motoneuron Diseases, University of Luebeck, Lübeck, Germany
| | - Jasper Hesebeck-Brinckmann
- Neurology Department, Division for Neurodegenerative Diseases, University Medicine Mannheim, Heidelberg University, Mannheim Center for Translational Medicine, Mannheim, Germany
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, 1, Carl-Neuberg-Strasse, 30625, Hannover, Germany
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Sun S, Chen Y, Zhao B, Zhu J, Wen T, Peng B, Ren Q, Sun X, Lin P, Zhang D, Liu S. Abnormal brain functional network dynamics in amyotrophic lateral sclerosis patients with depression. Brain Imaging Behav 2024:10.1007/s11682-024-00896-5. [PMID: 38814545 DOI: 10.1007/s11682-024-00896-5] [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] [Accepted: 05/11/2024] [Indexed: 05/31/2024]
Abstract
Since depression is common in amyotrophic lateral sclerosis (ALS) patients, we aimed to explore the specific brain functional network dynamics in ALS patients with depression (ALS-D) compared with healthy controls (HCs) and ALS patients without depressive symptoms (ALS-ND). According to the DSM-V, 32 ALS-D patients were selected from a large and newly diagnosed ALS cohort. Then, 32 demographic- and cognitive-matched ALS-ND patients were also selected, and 64 HCs were recruited. These participants underwent resting-state fMRI scans, and functional connectivity state analysis and dynamic graph theory were applied to evaluate brain functional network dynamics. Moreover, the Hamilton Depression Rating Scale (HDRS) was used to quantify depressive symptoms in the ALS-D patients. Four distinct states were identified in the ALS-D patients and controls. Compared with that in HCs, the fraction rate (FR) in state 2 was significantly decreased in ALS-D patients, and the FR in state 4 was significantly increased in ALS-D patients. Compared with that of HCs, the dwell time in state 4 was significantly increased in the ALS-D patients. Moreover, compared with that in the ALS-D patients, the FR in state 3 was significantly decreased in the ALS-ND patients. Among the ALS-D patients, there was the suggestion of a positive association between HDRS scores and dwell time of state 4, but this association did not reach statistical significance (r = 0.354; p = 0.055). Depression is an important feature of ALS patients, and we found a special pattern of brain functional network dynamics in ALS-D patients. Our findings may play an important role in understanding the mechanism underlying depression in ALS patients and help develop therapeutic interventions for depressed ALS patients.
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Affiliation(s)
- Sujuan Sun
- Research Institute of Neuromuscular and Neurodegenerative Disease, Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, West Wenhua Street No. 107, Jinan, 250012, China
| | - Yujing Chen
- Research Institute of Neuromuscular and Neurodegenerative Disease, Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, West Wenhua Street No. 107, Jinan, 250012, China
| | - Bing Zhao
- Department of Neurology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Jun Zhu
- Research Institute of Neuromuscular and Neurodegenerative Disease, Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, West Wenhua Street No. 107, Jinan, 250012, China
| | - Tianrui Wen
- Research Institute of Neuromuscular and Neurodegenerative Disease, Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, West Wenhua Street No. 107, Jinan, 250012, China
| | - Bingnan Peng
- Research Institute of Neuromuscular and Neurodegenerative Disease, Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, West Wenhua Street No. 107, Jinan, 250012, China
| | - Qingguo Ren
- Department of Radiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Xiaohan Sun
- Research Institute of Neuromuscular and Neurodegenerative Disease, Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, West Wenhua Street No. 107, Jinan, 250012, China
| | - Pengfei Lin
- Research Institute of Neuromuscular and Neurodegenerative Disease, Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, West Wenhua Street No. 107, Jinan, 250012, China
| | - Dong Zhang
- Research Institute of Neuromuscular and Neurodegenerative Disease, Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, West Wenhua Street No. 107, Jinan, 250012, China.
| | - Shuangwu Liu
- Research Institute of Neuromuscular and Neurodegenerative Disease, Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, West Wenhua Street No. 107, Jinan, 250012, China.
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China.
- Department of Neurology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China.
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Hamad AA, Amer BE, Abbas NB, Alnajjar AZ, Meshref M. Prevalence and correlates of fatigue in amyotrophic lateral sclerosis: A systematic review and meta-analysis. Neurol Sci 2024; 45:485-493. [PMID: 37837507 PMCID: PMC10791750 DOI: 10.1007/s10072-023-07119-7] [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: 09/22/2023] [Accepted: 10/04/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVES This systematic review and meta-analysis aimed to determine the frequency and correlates of fatigue in patients with amyotrophic lateral sclerosis (ALS). METHODS Three databases were searched up to 2nd May 2023 to identify studies reporting fatigue frequency in ALS. Studies included had to identify ALS patients through one of ALS diagnostic criteria and measure fatigue by a validated tool with a specific cut-off value. Meta-analysis was conducted using RStudio's "meta" package with a random-effects model. Subgroup analyses and meta-regression explored the relationship between fatigue frequency in ALS and different covariates. RESULTS Eleven studies, compromising 1072 patients, met the inclusion criteria and were included in our analysis. The pooled frequency of fatigue across all studies was 48% (95% CI = 40% to 57%). Our subgroup analysis based on the ALSFRS-R revealed a higher frequency of fatigue in studies with lower scores (< 30) compared to those with higher scores (≥ 30), with a pooled frequency of 62% (95% CI = 43% to 79%) and 43% (95% CI = 37% to 49%), respectively. Also, the meta-regression analysis showed a significant negative association between fatigue and ALSFRS-R mean (P = 0.02). The included studies reported an association between fatigue and lower functional status and poorer quality of life in patients with ALS. CONCLUSION Our findings suggest that fatigue is prevalent in almost half of ALS patients and is associated with lower functional status and poorer quality of life, highlighting the importance of assessing and managing fatigue in ALS patients.
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Affiliation(s)
| | | | | | - Asmaa Zakria Alnajjar
- Faculty of Medicine, Al-Azhar University, Gaza, Palestine
- Medical Research Group of Egypt, Negida Academy, Arlington, MA, USA
| | - Mostafa Meshref
- Department of Neurology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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6
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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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Heidari ME, Irvani SSN, Pourhoseingholi MA, Takhtegahi MM, Beyranvand R, Mardanparvar H, Hesami H, Ghavampour N, Hatami H. Prevalence of depressive symptoms and suicidal behaviors among Iranian high school students: A systematic review and meta-analysis. J Affect Disord 2024; 346:9-20. [PMID: 37858733 DOI: 10.1016/j.jad.2023.10.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 09/29/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023]
Abstract
AIM The objective of this meta-analysis was to determine the prevalence of depressive symptoms and suicidal behaviors among high-school students in Iran. MATERIALS AND METHODS A comprehensive search strategy was conducted in the following original databases: PubMed, Web of Science (ISI), Scopus, Psycinfo, and national databases, including the Scientific Information Database (SID) and MagIran, from January 1988 through January 2023. Studies that reported the prevalence of depressive symptoms and suicidal behaviors among high school students in Iran were included. Two investigators extracted all relevant data independently. For deriving mean prevalence rates, random-effects meta-analyses were used. We assessed the quality of studies by the Joanna Briggs Institute (JBI). RESULTS Total of 67 studies (45,798 participants) were included in the syntheses on depressive symptoms and suicidal ideation. For depressive symptoms, the mean prevalence rate was 48 % (40 %, 55 %). 2804 participants were enrolled for assessing of the prevalence of suicide ideation, and the mean prevalence rate was 21 % (6 %, 36 %). The meta-analysis pooling of the prevalence estimates of suicide attempts was 18 % (15 %, 20 %). CONCLUSIONS Approximately half of the high school students experience depressive symptoms and, astonishingly, one in five high school students experiences suicidal ideation, so to identify strategies for preventing and treating depressive symptoms and suicidal behaviors in this special population, further research and policymaking are urgently needed.
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Affiliation(s)
| | - Seyed Sina Naghibi Irvani
- Department of Public Health, School of Health & Environmental and Occupational Hazards Control Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mohamad Amin Pourhoseingholi
- Department of Health System Research, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | - Hossein Mardanparvar
- Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Hesami
- Medical Researcher, Pediatric Gastroenterology, Hepatology and Nutrition Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Neda Ghavampour
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Hatami
- Department of Public Health, School of Health & Environmental and Occupational Hazards Control Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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8
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Cassereau J, Bernard E, Genestet S, Chebbah M, Le Clanche S, Verschueren A, Couratier P. Management of amyotrophic lateral sclerosis in clinical practice: Results of the expert consensus using the Delphi methodology. Rev Neurol (Paris) 2023; 179:1134-1144. [PMID: 37827930 DOI: 10.1016/j.neurol.2023.07.011] [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: 04/24/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 10/14/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is a rare disease characterized by a progressive and irreversible degeneration of upper and lower motor neurons leading to death. In France, limited data exist describing the criteria used in clinical practice for diagnosis and follow-up, and how novel therapies may fit in. The objective of this Delphi panel was to obtain an overview of current French practices in ALS diagnosis, management, and follow-up by determining the scales and criteria used in clinical practice outside of clinical trials, as well as the place of a future treatment like AMX0035, acting on endoplasmic reticulum (ER) stress and mitochondrial dysfunction, in the current therapeutic strategies. A questionnaire was administered to 24 ALS healthcare providers practicing in ALS centers in France. Two rounds of remote voting were organized, before proposition of final consensus statements. Consensus was considered reached when at least 66% of the voters agreed. Consensus were obtained to define the new Gold Coast criteria as the ones used in clinical practice to establish the diagnosis of ALS, thus replacing the revised El Escorial criteria, considered too complex and now mainly used to characterize the patient populations to be included in clinical trials. The clinical factors considered to establish ALS diagnosis are mainly the demonstration of progression of the motor deficit and elimination of differential diagnoses. The ALSFRS-R scale is used in daily clinical practice to assess patient's functional impairment in terms of number of points lost, with the bulbar, respiratory, and fine motor subscores being the most important to evaluate independently. A critical medical need was identified regarding the provision of new therapeutic alternatives in ALS. The panel members would support the earliest management of patients. In this landscape, based on data from a very encouraging phase II (Centaur trial), AMX0035 represents a new tool of choice in current treatment strategies for all patients for whom experts are confident in the diagnosis of ALS, in combination with riluzole. These results will need to be confirmed by the ongoing phase III trial (Phoenix trial).
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Affiliation(s)
- J Cassereau
- Service de neurologie, CRC-SLA d'Angers, CHU d'Angers, 4, rue Larrey, 49933 Angers, France.
| | - E Bernard
- Centre SLA de Lyon, hôpital neurologique P. Wertheimer, hospices civils de Lyon, université de Lyon, 59, boulevard Pinel, 69677 Bron cedex, France; Institut NeuroMyoGène, faculté de médecine Rockefeller, CNRS UMR5310, INSERM U1217, université Claude-Bernard Lyon I, 8, avenue Rockefeller, 69373 Lyon cedex 08, France
| | - S Genestet
- Explorations fonctionnelles neurologiques, CRC SLA et maladies du motoneurone, hôpital Cavale-Blanche, CHRU de Brest, boulevard Tanguy-Prigent, 29609 Brest, France
| | - M Chebbah
- Public Health Expertise, département affaires médicales, 10, boulevard de Sébastopol, 75004 Paris, France
| | - S Le Clanche
- Public Health Expertise, département affaires médicales, 10, boulevard de Sébastopol, 75004 Paris, France
| | - A Verschueren
- Centre de référence pour les maladies neuromusculaires et la SLA, hôpital de la Timone, CHU de Marseille, Marseille, France
| | - P Couratier
- Neurosciences tête, cou et os, service de neurologie, centre référence maladies rares SLA & autres maladies du neurone moteur, hôpital Dupuytren 1, CHU de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France
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Spörndly-Nees S, Jakobsson Larsson B, Zetterberg L, Åkerblom Y, Nyholm D, Åsenlöf P. Pain in patients with motor neuron disease: Variation of pain and association with disease severity, health-related quality of life and depression - A longitudinal study. Palliat Support Care 2023:1-8. [PMID: 37955056 DOI: 10.1017/s1478951523001347] [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: 11/14/2023]
Abstract
OBJECTIVES To describe levels of pain over time during disease progression in individual patients and for a total sample of patients with motor neuron disease (MND), respectively, and to examine associations between pain, disease severity, health-related quality of life (HRQOL), and depression. METHODS A prospective cohort study was conducted on 68 patients with MND, including data collected on five occasions over a period of 2 years. Pain was assessed using the Brief Pain Inventory - Short Form. Depression was assessed using the Amyotrophic Lateral Sclerosis (ALS)-Depression-Inventory (ADI-12). Disability progression was measured using the Amyotrophic Lateral Sclerosis Functional Rating Scale - Revised Version (ALSFRS-R). HRQOL was assessed using the Amyotrophic Lateral Sclerosis Assessment Questionnaire (ALSAQ-5). RESULTS Participants reported great individual variation over time. The median level of pain was 4 (min 0 and max 10). Higher levels of pain during the last 24 h were associated with higher depression scores (ADI-12), poorer quality of life (ALSAQ-5), and lower reporting of fine and gross motor skills (ALSFRS-R). Baseline pain levels did not predict future values of depression and function. Individuals reporting average pain >3 experienced more hopelessness toward the future and reported higher depression scores compared with participants reporting average pain <3. SIGNIFICANCE OF RESULTS Great within-individual variation of pain intensity was reported. Pain intensity was associated with depression, function and HRQOL cross-sectionally, but it did not have a strong prognostic value for future depression, function, or HRQOL. Patients with MND should be offered frequent assessment of pain and depressive symptoms in person-centered care, allowing for individualization of treatment.
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Affiliation(s)
- Sören Spörndly-Nees
- Department of Women's and Children's Health, Physiotherapy and Behavioral Medicine, Uppsala University, Uppsala, Sweden
| | | | - Lena Zetterberg
- Department of Women's and Children's Health, Physiotherapy and Behavioral Medicine, Uppsala University, Uppsala, Sweden
| | - Ylva Åkerblom
- Department of Women's and Children's Health, Physiotherapy and Behavioral Medicine, Uppsala University, Uppsala, Sweden
| | - Dag Nyholm
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden
| | - Pernilla Åsenlöf
- Department of Women's and Children's Health, Physiotherapy and Behavioral Medicine, Uppsala University, Uppsala, Sweden
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10
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Theme 11 - Cognitive and Psychological Assessment and Support. Amyotroph Lateral Scler Frontotemporal Degener 2023; 24:245-257. [PMID: 37966328 DOI: 10.1080/21678421.2023.2260203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
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11
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Runacres F, Mathers S, Lee SC, Hearn R, Gregory S, Bear N, Aoun S. Motor neurone disease: A point-prevalence study of patient reported symptom prevalence, severity and palliative care needs. Palliat Med 2023; 37:1402-1412. [PMID: 37553906 DOI: 10.1177/02692163231191545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
BACKGROUND Motor neurone disease is a rare but debilitating illness with incomplete evidence regarding patients' symptom burden. Palliative care and generalist clinicians are often in-experienced in caring for these patients and assessing their needs. AIM To identify the symptom prevalence and severity experienced by patients with motor neurone disease. Secondary objectives were to examine differences in symptom burden and clusters according to phenotype, functional status, palliative care provision and those in their last months of life. DESIGN A point prevalence study assessing patient-reported symptoms using a modified IPOS-Neuro assessment tool, incorporating 41 symptom items. SETTING/PARTICIPANTS Patients with motor neurone disease attending the State-wide Progressive Neurological Disease Service or inpatient unit at Calvary Health Care Bethlehem, Melbourne Australia, from March to December 2021. RESULTS A total of 102 patients participated, the majority diagnosed with lumber-onset (30.4%), bulbar-onset (28.4%) and cervical-onset (25.5%) phenotypes. Patients experienced a median of 17 symptoms (range 2-32) with a median of 3 symptoms rated as severe/overwhelming (range 0-13). Motor and functional symptoms predominated, with differences in symptom clusters present according to phenotype. Patients had a higher number of severe/overwhelming symptoms if they were accessing palliative care services (p = 0.005), in their last 6 months of life (p = 0.003) and experiencing moderate or severe functional impairment (p < 0.001). CONCLUSIONS Patients with motor neurone disease report high symptom burden. A validated motor neurone disease-specific symptom assessment tool is needed to accurately assess patients, including important variations in symptom clusters according to phenotype. Further research must focus on evidence-based treatment guidelines for symptoms experienced commonly and severely.
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Affiliation(s)
- Fiona Runacres
- Calvary Health Care Bethlehem, Caulfield South, VIC, Australia
- Monash Health, Supportive & Palliative Care Department, Clayton, VIC, Australia
- Monash University, School of Clinical Sciences, Clayton, VIC, Australia
- The University of Notre Dame, Darlinghurst, NSW, Australia
| | - Susan Mathers
- Calvary Health Care Bethlehem, Caulfield South, VIC, Australia
- Monash Health, Department of Neurology, Clayton, VIC, Australia
| | - Sarah Cm Lee
- Calvary Health Care Bethlehem, Caulfield South, VIC, Australia
- Monash University, School of Clinical Sciences, Clayton, VIC, Australia
| | - Rowan Hearn
- Calvary Health Care Bethlehem, Caulfield South, VIC, Australia
| | | | - Natasha Bear
- Bear Statistics, Perth, WA, Australia
- The University of Notre Dame, Institute for Health Research, Perth, WA, Australia
| | - Samar Aoun
- Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia
- The University of Western Australia, Perth, WA, Australia
- La Trobe University, Melbourne, VIC, Australia
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12
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Fu H, Fu Z, Mao M, Si L, Bai J, Wang Q, Guo R. Prevalence and prognostic role of PD-L1 in patients with gynecological cancers: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2023; 189:104084. [PMID: 37536446 DOI: 10.1016/j.critrevonc.2023.104084] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/19/2023] [Accepted: 07/30/2023] [Indexed: 08/05/2023] Open
Abstract
OBJECTIVE Our study aims to evaluate programmed cell death ligand-1 (PD-L1) expression and its prognostic significance in cervical cancer (CC), endometrial cancer (EC) and ovarian cancer (OC). METHODS Several electronic databases were searched. Fixed effects models or random effects models were employed to calculate the pooled prevalence of PD-L1 positivity and pooled hazard ratios (HRs) as appropriate. Heterogeneity and publication bias were also assessed. RESULTS The pooled prevalence of PD-L1 positivity was 58.1%, 33.8% and 37.5% for CC, EC and OC patients, respectively. There were significant differences in the pooled estimates after stratification by PD-L1-positive assessment criteria and antibody clones. PD-L1 positivity was associated with worse OS in CC and EC patients and poorer progression-free survival (PFS) in CC patients. CONCLUSIONS The prevalence of PD-L1-positive expression was considerably high in CC and modestly high in EC and OC patients. PD-L1 expression has the potential to be a prognostic biomarker for predicting the clinical outcomes of patients with CC and EC but not OC.
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Affiliation(s)
- Hanlin Fu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Zhihui Fu
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Meng Mao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Lulu Si
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Jing Bai
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Qian Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Ruixia Guo
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
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Villa NAE, Fiore GMP, Espiridion ED. Insights Into the Association Between Myasthenia Gravis and Depression: A Clinical Case Study. Cureus 2023; 15:e43682. [PMID: 37724206 PMCID: PMC10505266 DOI: 10.7759/cureus.43682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 09/20/2023] Open
Abstract
Myasthenia gravis (MG) is a serious and debilitating autoimmune disease characterized by muscle weakness, shortness of breath, and issues affecting the eyes, limbs, throat, and speech. Given the intense physical toll of the disease, it is unsurprising that higher rates of depression are observed among MG patients. We present a case involving a 30-year-old female patient who was admitted to the hospital for MG exacerbation and had a psychiatric consultation for worsening depression symptoms. The patient acknowledged symptoms of sad mood, crying spells, anhedonia, fatigue, insomnia, and inappropriate guilt. She admits to psychosocial stressors of her declining health, recent job loss, and low self-esteem due to weight gain. Past medical history includes a thymectomy and a total thyroidectomy that caused postsurgical-acquired hypothyroidism. She is currently on prednisone and pyridostigmine for her MG. The patient has many potential causes of her increased depressive symptoms, including her medications, psychosocial stressors, and her past medical history, in addition to her MG. However, the literature shows higher incidence rates of depression in MG patients compared to both healthy controls and controls with other comparable chronic conditions, as well as shows a positive association between increased depressive symptoms and MG severity. Thus, these findings prompt the consideration of possible physiological interplay between the two diseases and encourage further research into the association between MG and depression.
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Affiliation(s)
| | | | - Eduardo D Espiridion
- Psychiatry, West Virginia School of Osteopathic Medicine, Lewisburg, USA
- Psychiatry, Drexel University College of Medicine, Philadelphia, USA
- Psychiatry, Philadelphia College of Osteopathic Medicine, Philadelphia, USA
- Psychiatry, Reading Hospital, Tower Health Systems, West Reading, USA
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14
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Hu N, Wang X. The level of homocysteine in amyotrophic lateral sclerosis: a systematic review and meta-analysis. Neurol Sci 2023; 44:1185-1192. [PMID: 36422727 DOI: 10.1007/s10072-022-06518-6] [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: 10/06/2022] [Accepted: 11/17/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the differences of the level of homocysteine (Hcy) between ALS patients and controls. METHODS PubMed, EMBASE, OVID, and other databases were searched systematically up to October 2022 for relevant reports about the level of Hcy, folic acid, and vitamin B12 (VB12) among ALS patients. Two reviewers screened and selected the titles and abstracts of the studies independently during the database searches and performed full-text reviews and extracted available data. The MD (mean difference) and 95%CI (credibility interval) of the level of Hcy, folic acid, and VB12 between ALS group and control group were calculated. RESULTS Pooled results of nine studies including 812 ALS patients and 2632 controls showed that the MD in plasma levels of HCY between ALS patients and controls was 1.56 (95%CI: - 0.07, 3.19) μmol/L with remarkable heterogeneity (I2 = 94%). The mean CSF levels of Hcy among ALS patients were significantly higher than that of controls (MD: 0.23, 95%CI: 0.21, 0.24 μmol/L) with no significant heterogeneity (I2 = 0%). No significant difference in the plasma level of folic acid (MD: - 0.52, 95%CI: - 1.89, 0.84 ng/mL) or VB12 (MD: - 9.76, 95%CI: - 83.41, 63.89) was found between ALS patients and controls. CONCLUSION There was no significant difference in the plasma level of Hcy, folic acid, or VB12 between ALS patients and controls. The CSF level of Hcy among ALS population was remarkably higher than that among controls. Vitamin supplements including folate and VB12 might be recommended to ALS patients with the complication of deficiencies.
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Affiliation(s)
- Nan Hu
- Department of Neurology, Peking Union Medical College Hospital, Beijing, 100730, China.
| | - Xubiao Wang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
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15
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Chen C, Zhou Y, Wang D, Li G, Yin K, Tao H, Wang CY, Li ZS, Wei C, Hu LH. Anxiety, depression, and coping styles among patients with chronic pancreatitis in East China. BMC Psychiatry 2023; 23:212. [PMID: 36991480 PMCID: PMC10061863 DOI: 10.1186/s12888-023-04691-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 03/15/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Anxiety and depression are common psychological comorbidities in patients with chronic pancreatitis (CP). There is still a lack of epidemiological studies on anxiety and depression in Chinese CP patients. This study aimed to identify the incidence and related factor of anxiety and depression among East Chinese CP patients and explore the relationship between anxiety, depression, and coping styles. METHODS This prospective observational study was conducted from June 1, 2019 to March 31, 2021 in Shanghai, China. Patient diagnosed with CP were interviewed using the sociodemographic and clinical characteristics questionnaire, Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and Coping Style Questionnaire (CSQ). Multivariate logistic regression analysis was conducted to identify the related factors of anxiety and depression. Correlation test was preformed to analyze the correlation between anxiety, depression, and coping styles. RESULTS The incidence of anxiety and depression in East Chinese CP patients was 22.64% and 38.61%, respectively. Patients' previous health status, level of disease coping, frequency of abdominal pain episodes, and pain severity were significantly associated with anxiety and depression. Mature coping styles (Problem solving, Seeking for help) had a positive impact on anxiety and depression, while immature coping styles (Self-blame, Fantasy, Repression, Rationalization) had negative effects on anxiety and depression. CONCLUSION Anxiety and depression were common in patients with CP in China. The factors identified in this study may provide references for the management of anxiety and depression in CP patients.
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Affiliation(s)
- Cui Chen
- Department of Gastroenterology, First Affiliated Hospital of Naval Medical University, No. 168 Changhai Road, Yangpu District, Shanghai, China
| | - You Zhou
- Department of Gastroenterology, First Affiliated Hospital of Naval Medical University, No. 168 Changhai Road, Yangpu District, Shanghai, China
- Department of Nursing, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Dan Wang
- Department of Gastroenterology, First Affiliated Hospital of Naval Medical University, No. 168 Changhai Road, Yangpu District, Shanghai, China
| | - Ge Li
- Department of Gastroenterology, First Affiliated Hospital of Naval Medical University, No. 168 Changhai Road, Yangpu District, Shanghai, China
| | - Kun Yin
- Department of Gastroenterology, First Affiliated Hospital of Naval Medical University, No. 168 Changhai Road, Yangpu District, Shanghai, China
| | - Hong Tao
- Department of Gastroenterology, First Affiliated Hospital of Naval Medical University, No. 168 Changhai Road, Yangpu District, Shanghai, China
| | - Chun-Yan Wang
- Department of Gastroenterology, First Affiliated Hospital of Naval Medical University, No. 168 Changhai Road, Yangpu District, Shanghai, China
| | - Zhao-Shen Li
- Department of Gastroenterology, First Affiliated Hospital of Naval Medical University, No. 168 Changhai Road, Yangpu District, Shanghai, China.
| | - Cun Wei
- Department of Naval Psychology, Faculty of Psychology, Naval Medical University, No. 800 Xiangyin Road, Yangpu District, Shanghai, China.
| | - Liang-Hao Hu
- Department of Gastroenterology, First Affiliated Hospital of Naval Medical University, No. 168 Changhai Road, Yangpu District, Shanghai, China.
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Schreiber S, Bernal J, Arndt P, Schreiber F, Müller P, Morton L, Braun-Dullaeus RC, Valdés-Hernández MDC, Duarte R, Wardlaw JM, Meuth SG, Mietzner G, Vielhaber S, Dunay IR, Dityatev A, Jandke S, Mattern H. Brain Vascular Health in ALS Is Mediated through Motor Cortex Microvascular Integrity. Cells 2023; 12:957. [PMID: 36980297 PMCID: PMC10047140 DOI: 10.3390/cells12060957] [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: 02/10/2023] [Revised: 03/07/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
Brain vascular health appears to be critical for preventing the development of amyotrophic lateral sclerosis (ALS) and slowing its progression. ALS patients often demonstrate cardiovascular risk factors and commonly suffer from cerebrovascular disease, with evidence of pathological alterations in their small cerebral blood vessels. Impaired vascular brain health has detrimental effects on motor neurons: vascular endothelial growth factor levels are lowered in ALS, which can compromise endothelial cell formation and the integrity of the blood-brain barrier. Increased turnover of neurovascular unit cells precedes their senescence, which, together with pericyte alterations, further fosters the failure of toxic metabolite removal. We here provide a comprehensive overview of the pathogenesis of impaired brain vascular health in ALS and how novel magnetic resonance imaging techniques can aid its detection. In particular, we discuss vascular patterns of blood supply to the motor cortex with the number of branches from the anterior and middle cerebral arteries acting as a novel marker of resistance and resilience against downstream effects of vascular risk and events in ALS. We outline how certain interventions adapted to patient needs and capabilities have the potential to mechanistically target the brain microvasculature towards favorable motor cortex blood supply patterns. Through this strategy, we aim to guide novel approaches to ALS management and a better understanding of ALS pathophysiology.
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Affiliation(s)
- Stefanie Schreiber
- Department of Neurology, Otto von Guericke University Magdeburg, Medical Faculty, 39120 Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 39120 Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), 39106 Magdeburg, Germany
| | - Jose Bernal
- Department of Neurology, Otto von Guericke University Magdeburg, Medical Faculty, 39120 Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 39120 Magdeburg, Germany
| | - Philipp Arndt
- Department of Neurology, Otto von Guericke University Magdeburg, Medical Faculty, 39120 Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 39120 Magdeburg, Germany
| | - Frank Schreiber
- Department of Neurology, Otto von Guericke University Magdeburg, Medical Faculty, 39120 Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 39120 Magdeburg, Germany
| | - Patrick Müller
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 39120 Magdeburg, Germany
- Department of Internal Medicine/Cardiology and Angiology, Otto von Guericke University Magdeburg, 39120 Magdeburg, Germany
| | - Lorena Morton
- Institute of Inflammation and Neurodegeneration, Otto von Guericke University Magdeburg, 39120 Magdeburg, Germany
| | | | | | - Roberto Duarte
- Centre for Clinical Brain Sciences, The University of Edinburgh, UK Dementia Research Institute Centre, Edinburgh EH16 4UX, UK
| | - Joanna Marguerite Wardlaw
- Centre for Clinical Brain Sciences, The University of Edinburgh, UK Dementia Research Institute Centre, Edinburgh EH16 4UX, UK
| | - Sven Günther Meuth
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Grazia Mietzner
- Department of Neurology, Otto von Guericke University Magdeburg, Medical Faculty, 39120 Magdeburg, Germany
| | - Stefan Vielhaber
- Department of Neurology, Otto von Guericke University Magdeburg, Medical Faculty, 39120 Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), 39106 Magdeburg, Germany
| | - Ildiko Rita Dunay
- Center for Behavioral Brain Sciences (CBBS), 39106 Magdeburg, Germany
- Institute of Inflammation and Neurodegeneration, Otto von Guericke University Magdeburg, 39120 Magdeburg, Germany
| | - Alexander Dityatev
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 39120 Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), 39106 Magdeburg, Germany
- Medical Faculty, Otto von Guericke University, 39120 Magdeburg, Germany
| | - Solveig Jandke
- Department of Neurology, Otto von Guericke University Magdeburg, Medical Faculty, 39120 Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 39120 Magdeburg, Germany
| | - Hendrik Mattern
- German Center for Neurodegenerative Diseases (DZNE) within the Helmholtz Association, 39120 Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), 39106 Magdeburg, Germany
- Department of Biomedical Magnetic Resonance, Faculty of Natural Sciences, Otto von Guericke University Magdeburg, 39120 Magdeburg, Germany
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17
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Kiper V, Gary A, Geist R. Navigating ALS: An overlooked disease. Nursing 2023; 53:24-30. [PMID: 36700810 DOI: 10.1097/01.nurse.0000905700.44849.f4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
ABSTRACT Amyotrophic lateral sclerosis (ALS) is a rare and serious disease affecting approximately 20,000 people in the US. This article details the signs, symptoms, and diagnosis of ALS and important management considerations.
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Affiliation(s)
- Valerie Kiper
- Valerie Kiper , Annette Gary , and Rebecca Geist are associate professors at the Texas Tech University Health Science Center (TTUHSC) School of Nursing. Kiper is also the School of Nursing's Regional Dean
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18
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Young CA, Ealing J, McDermott CJ, Williams TL, Al-Chalabi A, Majeed T, Talbot K, Harrower T, Faull C, Malaspina A, Annadale J, Mills RJ, Tennant A. Prevalence of depression in amyotrophic lateral sclerosis/motor neuron disease: multi-attribute ascertainment and trajectories over 30 months. Amyotroph Lateral Scler Frontotemporal Degener 2023; 24:82-90. [PMID: 36066075 DOI: 10.1080/21678421.2022.2096410] [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: 01/26/2023]
Abstract
Objective: Evidence is equivocal about the prevalence of depression in amyotrophic lateral sclerosis (ALS). This study uses a multi-attribute ascertainment of the prevalence of depression and examines this prevalence over time. Methods: Patients with ALS were recruited into the Trajectories of Outcome in Neurological Conditions (TONiC-ALS) study. Caseness was identified by the Modified-Hospital Anxiety and Depression Scale (M-HADS). In addition, participants provided data on co-morbidities and medication use. A combination of the three was used to derive the estimate for the prevalence of depression, treated or untreated. Longitudinal data were analyzed by trajectory analysis of interval level M-HADS-Depression data. Results: Among 1120 participants, the mean age was 65.0 years (SD 10.7), 60.4% male, and the median duration since diagnosis was 9 months (IQR 4-24). Caseness of probable depression at baseline, defined by M-HADS-Depression, was 6.45% (95%CI: 5.1-8.0). Taken together with antidepressant medication and co-morbidity data, the prevalence of depression was 23.1% (95%CI: 20.7-25.6). Of those with depression, 17.8% were untreated. Trajectory analysis identified three groups, one of which contained the most cases; the level of depression for each group remained almost constant over time. Conclusion: Depression affects almost a quarter of those with ALS, largely confined to a single trajectory group. Prevalence estimates based on screening for current depressive symptoms substantially under-estimate the population experiencing depression. Future prevalence studies should differentiate data based on current symptoms from those including treated patients. Both have their place in assessing depression and the response by the health care system, including medication, depending upon the hypothesis under test.
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Affiliation(s)
- C A Young
- Walton Centre NHS Foundation Trust, Lower Lane, Liverpool, UK.,Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - J Ealing
- Greater Manchester Centre for Clinical Neurosciences, Salford, UK
| | - C J McDermott
- Sheffield Institute for Translational Neuroscience, Sheffield, UK
| | - T L Williams
- Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - A 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
| | - T Majeed
- Lancashire Teaching Hospital, Preston, UK
| | - K Talbot
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - T Harrower
- University of Exeter, Exeter Medical School, Exeter, UK
| | - C Faull
- LOROS Hospice, Leicester, UK
| | - A Malaspina
- UCL Queen Square Institute of Neurology, London, UK
| | - J Annadale
- Hywel Dda University Health Board, Wales, UK, and
| | - R J Mills
- Walton Centre NHS Foundation Trust, Lower Lane, Liverpool, UK.,Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - A Tennant
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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19
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Nadali J, Ghavampour N, Beiranvand F, Maleki Takhtegahi M, Heidari ME, Salarvand S, Arabzadeh T, Narimani Charan O. Prevalence of depression and anxiety among myasthenia gravis (MG) patients: A systematic review and meta-analysis. Brain Behav 2023; 13:e2840. [PMID: 36495116 PMCID: PMC9847616 DOI: 10.1002/brb3.2840] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 11/03/2022] [Accepted: 11/16/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Myasthenia gravis (MG) people experience adverse psychiatric outcomes, which may impact on their life and disturb their daily activity. Depression and anxiety are identified as significant psychiatric problems that MG people face. However, there is no sufficient epidemiological information about depression and anxiety-based publication. Due to this limitation, the aim of this study was to review the prevalence of depression and anxiety in MG patients. METHODS Original and international databases were searched to find papers about the estimation of anxiety and depression. Random-effects analysis was used for calculating the proportions of anxiety and depression. For estimating anxiety and depression based the severity, instruments, type of studies, and study regions, subgroup analysis was performed. RESULTS 38 studies met inclusion criteria and entered study. The pooling of the prevalence of depression was found at 36%, (95% CI 28% to 45%). Also, prevalence of anxiety was found at 33%, (95% CI 25% to 42%). Prevalence of depression based on mild, moderate, and severe level was 27%, 14%, and 9%, respectively. CONCLUSIONS Anxiety and depression are a major concern among MG individuals. The estimation of both anxiety and depression are high even when compared to other autoimmune diseases. It seems depression and anxiety are important issues and more attention needs to be paid to these psychiatric disorders.
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Affiliation(s)
- Javad Nadali
- School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Neda Ghavampour
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzaneh Beiranvand
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Eghbal Heidari
- Student's Scientific Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahin Salarvand
- Hepatitis Research Center, Nursing and midwifery faculty, Lorestan University of Medical Sciences, Lorestan, Iran
| | - Tina Arabzadeh
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Omid Narimani Charan
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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20
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Korupolu R, Malik A, Ratcliff C, Robinson-Whelen S, Taylor HB. Feasibility, Acceptability, and Efficacy of Mindfulness Training in People With Upper Motor Neuron Disorders: A Systematic Review. Arch Phys Med Rehabil 2022; 103:2410-2428. [PMID: 35760105 DOI: 10.1016/j.apmr.2022.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 05/03/2022] [Accepted: 05/12/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES This systematic review aims to gain a comprehensive understanding of the feasibility, acceptability, and efficacy of mindfulness-based interventions (MBIs) on depression, anxiety, fatigue, and health-related quality of life among individuals with upper motor neuron disorders (UMNDs). DATA SOURCES PubMed, PsycINFO, Excerpta Medica Database, and Cumulative Index to Nursing and Allied Health Literature were searched for relevant studies published between January 2001 and June 2021. STUDY SELECTION Clinical trials published in English evaluating MBIs in adults with the 4 most common UMNDs (multiple sclerosis, brain injury including stroke, spinal cord injury, amyotrophic lateral sclerosis) were included. DATA EXTRACTION Two reviewers independently performed the risk of bias assessment using standardized tools and extracted desired data electronically. DATA SYNTHESIS A total of 44 studies were included: 26 randomized controlled trials, 10 nonrandomized controlled trials, and 8 pre-post intervention studies. The average ± SD duration of MBIs was 8±2 weeks. On average, 85%±14% of participants completed the MBI, and the retention rate at follow-up was 80%±16%. Only 14% of the studies delivered MBIs virtually, and feasibility metrics were similar to in-person studies. Among studies reporting acceptability data, most participants reported satisfaction with the MBI. Randomized controlled trials that evaluated the effects of MBI on depression, anxiety, fatigue, and quality of life revealed greater relative improvement in these outcomes among MBI participants compared with controls, with differences greater when compared with passive control than active control participants. None of the studies included in this review studied dose response. CONCLUSIONS Based on current data, MBIs are feasible and offer a promising approach to address the biopsychosocial needs of individuals with UMNDs. MBIs are associated with a high acceptance rate among participants, with notable improvements in depression, anxiety, fatigue, and quality of life post intervention. Future studies are needed to evaluate alternate models of delivery of MBIs and the dose-response relationship.
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Affiliation(s)
- Radha Korupolu
- Department of Physical Medicine and Rehabilitation, University of Texas Health Sciences Center at Houston, Houston, Texas; TIRR Memorial Hermann, Houston, Texas.
| | - Aila Malik
- Department of Physical Medicine and Rehabilitation, University of Texas Health Sciences Center at Houston, Houston, Texas
| | - Chelsea Ratcliff
- Department of Psychology, Sam Houston State University, Huntsville, Texas
| | - Susan Robinson-Whelen
- TIRR Memorial Hermann, Houston, Texas; Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Heather B Taylor
- Department of Physical Medicine and Rehabilitation, University of Texas Health Sciences Center at Houston, Houston, Texas; TIRR Memorial Hermann, Houston, Texas
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21
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Liu S, Zhao Y, Ren Q, Zhang D, Shao K, Lin P, Yuan Y, Dai T, Zhang Y, Li L, Li W, Shan P, Meng X, Wang Q, Yan C. Amygdala abnormalities across disease stages in patients with sporadic amyotrophic lateral sclerosis. Hum Brain Mapp 2022; 43:5421-5431. [PMID: 35866384 PMCID: PMC9704775 DOI: 10.1002/hbm.26016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 06/14/2022] [Accepted: 06/26/2022] [Indexed: 01/15/2023] Open
Abstract
To examine selective atrophy patterns and resting-state functional connectivity (FC) alterations in the amygdala at different stages of amyotrophic lateral sclerosis (ALS), and to explore any correlations between amygdala abnormalities and neuropsychiatric symptoms. We used the King's clinical staging system for ALS to divide 83 consecutive patients with ALS into comparable subgroups at different disease stages. We explored the pattern of selective amygdala subnucleus atrophy and amygdala-based whole-brain FC alteration in these patients and 94 healthy controls (HCs). Cognitive and emotional functions were also evaluated using a neuropsychological test battery. There were no significant differences between ALS patients at King's stage 1 and HCs for any amygdala subnucleus volumes. Compared with HCs, ALS patients at King's stage 2 had significantly lower left accessory basal nucleus and cortico-amygdaloid transition volumes. Furthermore, ALS patients at King's stage 3 demonstrated significant reductions in most amygdala subnucleus volumes and global amygdala volumes compared with HCs. Notably, amygdala-cuneus FC was increased in ALS patients at King's stage 3. Specific subnucleus volumes were significantly associated with Mini-Mental State Examination scores and Hamilton Anxiety Rating Scale scores in ALS patients. In conclusions, our study provides a comprehensive profile of amygdala abnormalities in ALS patients. The pattern of amygdala abnormalities in ALS patients differed greatly across King's clinical disease stages, and amygdala abnormalities are an important feature of patients with ALS at relatively advanced stages. Moreover, our findings suggest that amygdala volume may play an important role in anxiety and cognitive dysfunction in ALS patients.
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Affiliation(s)
- Shuangwu Liu
- School of Medicine, Cheeloo College of MedicineShandong UniversityJinanChina,Department of NeurologyResearch Institute of Neuromuscular and Neurodegenerative Disease, Qilu Hospital, Cheeloo College of Medicine, Shandong UniversityJinanChina,School of Nursing and Rehabilitation, Cheeloo College of MedicineShandong UniversityJinanChina
| | - Yuying Zhao
- Department of NeurologyResearch Institute of Neuromuscular and Neurodegenerative Disease, Qilu Hospital, Cheeloo College of Medicine, Shandong UniversityJinanChina
| | - Qingguo Ren
- Department of RadiologyQilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong UniversityQingdaoChina
| | - Dong Zhang
- Department of NeurologyResearch Institute of Neuromuscular and Neurodegenerative Disease, Qilu Hospital, Cheeloo College of Medicine, Shandong UniversityJinanChina
| | - Kai Shao
- Mitochondrial Medicine LaboratoryQilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong UniversityQingdaoShandongChina,Department of Clinical LaboratoryQilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong UniversityQingdaoChina
| | - Pengfei Lin
- Department of NeurologyResearch Institute of Neuromuscular and Neurodegenerative Disease, Qilu Hospital, Cheeloo College of Medicine, Shandong UniversityJinanChina
| | - Ying Yuan
- Sleep Medicine CenterQilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong UniversityQingdaoChina
| | - Tingjun Dai
- Department of NeurologyResearch Institute of Neuromuscular and Neurodegenerative Disease, Qilu Hospital, Cheeloo College of Medicine, Shandong UniversityJinanChina
| | - Yongqing Zhang
- Department of NeurologyQilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong UniversityQingdaoChina
| | - Ling Li
- Department of NeurologyQilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong UniversityQingdaoChina
| | - Wei Li
- Department of NeurologyResearch Institute of Neuromuscular and Neurodegenerative Disease, Qilu Hospital, Cheeloo College of Medicine, Shandong UniversityJinanChina
| | - Peiyan Shan
- Department of GerontologyQilu Hospital of Shandong UniversityJinanChina
| | - Xiangshui Meng
- Department of RadiologyQilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong UniversityQingdaoChina
| | - Qian Wang
- Department of RadiologyQilu Hospital of Shandong UniversityJinanChina
| | - Chuanzhu Yan
- Department of NeurologyResearch Institute of Neuromuscular and Neurodegenerative Disease, Qilu Hospital, Cheeloo College of Medicine, Shandong UniversityJinanChina,Mitochondrial Medicine LaboratoryQilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong UniversityQingdaoShandongChina
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22
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Glutamate Efflux across the Blood–Brain Barrier: New Perspectives on the Relationship between Depression and the Glutamatergic System. Metabolites 2022; 12:metabo12050459. [PMID: 35629963 PMCID: PMC9143347 DOI: 10.3390/metabo12050459] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/11/2022] [Accepted: 05/17/2022] [Indexed: 02/04/2023] Open
Abstract
Depression is a significant cause of disability and affects millions worldwide; however, antidepressant therapies often fail or are inadequate. Current medications for treating major depressive disorder can take weeks or months to reach efficacy, have troubling side effects, and are limited in their long-term capabilities. Recent studies have identified a new set of glutamate-based approaches, such as blood glutamate scavengers, which have the potential to provide alternatives to traditional antidepressants. In this review, we hypothesize as to the involvement of the glutamate system in the development of depression. We identify the mechanisms underlying glutamate dysregulation, offering new perspectives on the therapeutic modalities of depression with a focus on its relationship to blood–brain barrier (BBB) permeability. Ultimately, we conclude that in diseases with impaired BBB permeability, such as depression following stroke or traumatic brain injury, or in neurogenerative diseases, the glutamate system should be considered as a pathway to treatment. We propose that drugs such as blood glutamate scavengers should be further studied for treatment of these conditions.
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23
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Wang Y, Yang X, Han Q, Liu M, Zhou C. Prevalence of Sialorrhea Among Amyotrophic Lateral Sclerosis Patients: A Systematic Review and Meta-Analysis. J Pain Symptom Manage 2022; 63:e387-e396. [PMID: 34920148 DOI: 10.1016/j.jpainsymman.2021.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative motor neuron disease (MND), and sialorrhea is a known symptom in patients with ALS, which may cause a social embarrassment and discomfort. However, people do not pay attention to sialorrhea up to now. This study is aimed at conducting a systematic review and meta-analysis of the pooled prevalence of sialorrhea in ALS patients all around the world and raising awareness of salivation. METHODS We searched PubMed and EMBASE databases to obtain the comprehensive literatures which reported the prevalence of sialorrhea. We used AHRQ and NOS to evaluate the literature quality. Subgroup analyses were performed based on screening instruments and severity of sialorrhea. At the meantime, sensitivity analyses was also conducted to identify the source of heterogeneity. RESULTS A total of 17 eligible studies which included 21 groups of data reported prevalence of sialorrhea. The pooled prevalence of sialorrhea among ALS patients was 30.8% (95% CI: 20.0%-44.2%). For studies using ALSFRS-R, direct questioning, postal survey, and ALSSoL average and ALSFRS-R, the pooled prevalence of sialorrhea was 22.7%, 25.8%, 29.8% and 52.0% respectively. According to the severity of sialorrhea, the prevalence of mild, moderate, and severe sialorrhea were 25.1%, 11.2%, and 10.5%, respectively. And none of the studies alone had a significant effect on the overall prevalence of sialorrhea after we eliminated each study separately in sensitivity analyses. CONCLUSIONS Sialorrhea is a relatively common symptom in ALS patients with a comparatively high prevalence. In our study, we found that the prevalence of sialorrhea in ALS patients is relatively higher than the results based on direct questioning or postal survey. Therefore, we deduced that sialorrhea should be evaluated by more complex professional assessment scales to improve the quality of life and improve early prognosis of disease.
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Affiliation(s)
- Yao Wang
- Department of Neurology, (Y.W., X.Y., M.L.) The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China.
| | - Xiaoyu Yang
- Department of Neurology, (Y.W., X.Y., M.L.) The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Qun Han
- Department of Orthopedics, (Q.H.) Xianggong Central Health Center, Linyi, Shandong Province, China
| | - Min Liu
- Department of Neurology, (Y.W., X.Y., M.L.) The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China
| | - Chang Zhou
- Department of Neurology, (Y.W., X.Y., M.L.) The Affiliated Hospital of Qingdao University, Qingdao, Shandong Province, China.
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24
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Zago S, Lorusso L, Aiello EN, Ugolini M, Poletti B, Ticozzi N, Silani V. Cognitive and behavioral involvement in ALS has been known for more than a century. Neurol Sci 2022; 43:6741-6760. [PMID: 36053340 PMCID: PMC9663353 DOI: 10.1007/s10072-022-06340-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/10/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Among clinicians and researchers, it is common knowledge that, in ALS, cognitive and behavioral involvement within the spectrum of frontotemporal degenerations (FTDs) begun to be regarded as a fact in the late 1990s of the twentieth century. By contrast, a considerable body of evidence on cognitive/behavioral changes in ALS can be traced in the literature dating from the late nineteenth century. METHODS Worldwide reports on cognitive/behavioral involvement in ALS dating from 1886 to 1981 were retrieved thanks to Biblioteca di Area Medica "Adolfo Ferrate," Sistema Bibliotecario di Ateneo, University of Pavia, Pavia, Italy and qualitatively synthetized. RESULTS One-hundred and seventy-four cases of ALS with co-occurring FTD-like cognitive/behavioral changes, described in Europe, America, and Asia, were detected. Neuropsychological phenotypes were consistent with the revised Strong et al.'s consensus criteria. Clinical observations were not infrequently supported by histopathological, post-mortem verifications of extra-motor, cortical/sub-cortical alterations, as well as by in vivo instrumental exams-i.e., assessments of brain morphology/physiology and psychometric testing. In this regard, as earlier as 1907, the notion of motor and cognitive/behavioral features in ALS yielding from the same underlying pathology was acknowledged. Hereditary occurrences of ALS with cognitive/behavioral dysfunctions were reported, as well as familial associations with ALS-unrelated brain disorders. Neuropsychological symptoms often occurred before motor ones. Bulbar involvement was at times acknowledged as a risk factor for cognitive/behavioral changes in ALS. DISCUSSION Historical observations herewith delivered can be regarded as the antecedents of current knowledge on cognitive/behavioral impairment in the ALS-FTD spectrum.
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Affiliation(s)
- Stefano Zago
- grid.4708.b0000 0004 1757 2822U.O.C. Neurologia, Fondazione IRCCS Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Lorenzo Lorusso
- U.O.C., Neurologia & Stroke Unit, A.S.S.T. Lecco, Merate, LC Italy
| | - Edoardo N. Aiello
- grid.7563.70000 0001 2174 1754PhD Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy ,grid.418224.90000 0004 1757 9530IRCCS Istituto Auxologico Italiano, Department of Neurology and Laboratory of Neuroscience, Milan, Italy
| | - Martino Ugolini
- grid.9851.50000 0001 2165 4204Center for Integrative Genomics, University of Lausanne, Lausanne, Switzerland
| | - Barbara Poletti
- grid.418224.90000 0004 1757 9530IRCCS Istituto Auxologico Italiano, Department of Neurology and Laboratory of Neuroscience, Milan, Italy
| | - Nicola Ticozzi
- grid.418224.90000 0004 1757 9530IRCCS Istituto Auxologico Italiano, Department of Neurology and Laboratory of Neuroscience, Milan, Italy ,grid.4708.b0000 0004 1757 2822Department of Pathophysiology and Transplantation, “Dino Ferrari Center”, Università degli Studi di Milano, Milan, Italy
| | - Vincenzo Silani
- grid.418224.90000 0004 1757 9530IRCCS Istituto Auxologico Italiano, Department of Neurology and Laboratory of Neuroscience, Milan, Italy ,grid.4708.b0000 0004 1757 2822Department of Pathophysiology and Transplantation, “Dino Ferrari Center”, Università degli Studi di Milano, Milan, Italy
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25
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Sharbafshaaer M, Buonanno D, Passaniti C, De Stefano M, Esposito S, Canale F, D'Alvano G, Silvestro M, Russo A, Tedeschi G, Siciliano M, Trojsi F. Psychological Support for Family Caregivers of Patients With Amyotrophic Lateral Sclerosis at the Time of the Coronavirus Disease 2019 Pandemic: A Pilot Study Using a Telemedicine Approach. Front Psychiatry 2022; 13:904841. [PMID: 35782440 PMCID: PMC9243390 DOI: 10.3389/fpsyt.2022.904841] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/20/2022] [Indexed: 11/23/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic confined most of the population to homes worldwide, and then, a lot of amyotrophic lateral sclerosis (ALS) centers moved to telemedicine services to continue to assist both patients with ALS and their caregivers. This pilot, randomized, controlled study aimed to explore the potential role of psychological support interventions for family caregivers of patients with ALS through resilience-oriented sessions of group therapy during the COVID-19 pandemic. In total, 12 caregivers agreed to be remotely monitored by our center since March 2020 and underwent scales for global burden (i.e., Caregiver Burden Inventory, CBI), resilience (i.e., Connor Davidson Resilience Scale, CD-RISC), and perceived stress (i.e., Perceived Stress Scale, PSS) at two-time points (i.e., at pre-treatment assessment and after 9 months or at post-treatment assessment). They were randomized into two groups: the former group underwent resilience-oriented sessions of group therapy two times a month for 3 months, while the latter one was only remotely monitored. No significant differences were found in CBI, CD-RISC, and PSS during the 9-month observation period in the treated group compared with the control group, suggesting a trend toward stability of caregiver burden together with resilience and perceived stress scores in all the subjects monitored. The lack of differences in caregivers' burden, resilience, and perceived stress scores by comparing the two groups monitored during 9 months could be due to the co-occurrence of the COVID-19 pandemic with the stressful events related to caring for patients with ALS that might have hindered the detection of significant benefits from short-lasting psychological support.
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Affiliation(s)
- Minoo Sharbafshaaer
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Daniela Buonanno
- First Division of Neurology, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Carla Passaniti
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Manuela De Stefano
- First Division of Neurology, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Sabrina Esposito
- First Division of Neurology, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Fabrizio Canale
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy.,First Division of Neurology, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Giulia D'Alvano
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy.,First Division of Neurology, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Marcello Silvestro
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Russo
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy.,First Division of Neurology, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Gioacchino Tedeschi
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy.,First Division of Neurology, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Mattia Siciliano
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesca Trojsi
- Department of Advanced Medical and Surgical Sciences, MRI Research Center SUN-FISM, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy.,First Division of Neurology, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
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26
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Pain D, Aiello EN, Gallucci M, Miglioretti M, Mora G. The Italian Version of the ALS Depression Inventory-12. Front Neurol 2021; 12:723776. [PMID: 34630298 PMCID: PMC8497880 DOI: 10.3389/fneur.2021.723776] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/27/2021] [Indexed: 01/20/2023] Open
Abstract
Introduction: Depression is a comorbidity in patients with amyotrophic lateral sclerosis (ALS). However, its diagnosis is challenged by the co-occurrence of a similar frontotemporal (FT) behavioral symptom—i.e., apathy. Moreover, its psychometric evaluation is confounded by motor disabilities. This study aimed at investigating psychometric properties and feasibility of the ALS Depression Inventory (ADI-12), a self-report questionnaire set up for this issue—as measuring mood changes without referring to movement. Methods: Eighty-five ALS patients were administered the ADI-12 and underwent cognitive (Mini-Mental State Examination, MMSE), quality of life (McGill Quality of Life Questionnaire, MQoL) and further anxiety/mood (Hospital Anxiety and Depression Scale, HADS) assessments. Reliability, validity, sensitivity, and specificity of the ADI-12 were explored. Results: Principal component analyses revealed two related components—“Negative Mood and Lack of Energy” (ME) and “Anhedonia” (A). Both components and the inventory as a whole were internally consistent and highly related to HADS-D. ADI-12-total score was also associated with HADS-A. ADI-12 measures were inversely related to MQoL. ADI-12-total/sub-scales were not related to either MMSE or disease-related outcomes. Estimates of depression yielded by HADS-D and ADI-12 were 11.1 and 35.3%. Discussion: The ADI-12 is a valid, reliable and usable feasibile tool to assess depression in Italian ALS patients independently from motor disabilities. Its interplay with psycho-social outcomes is in agreement with previous studies. The lack of association with cognition suggests that the ADI-12 is partially independent from FT spectrum disorders. The disagreement in depression rates between the ADI-12 and HADS-D suggests the need to ALS-specific mood scales.
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Affiliation(s)
- Debora Pain
- Istituti Clinici Scientifici Maugeri, IRCCS, Neurorehabilitation Department of Milano Institute, Milan, Italy
| | - Edoardo Nicolò Aiello
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,PhD Program in Neuroscience, University of Milano-Bicocca, Monza, Italy
| | - Marcello Gallucci
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | | | - Gabriele Mora
- Istituti Clinici Scientifici Maugeri, IRCCS, Neurorehabilitation Department of Milano Institute, Milan, Italy
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