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Francis R, Attrill S, Radakovic R, Doeltgen S. Exploring clinical management of cognitive and behavioural deficits in MND. A scoping review. PATIENT EDUCATION AND COUNSELING 2023; 116:107942. [PMID: 37597466 DOI: 10.1016/j.pec.2023.107942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/11/2023] [Accepted: 08/13/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVES Little is known about how cognitive and behavioural decline in MND is managed clinically. This review aimed to summarise clinical management approaches of cognitive and behavioural decline in MND reported in peer-reviewed and grey literature. METHODS A scoping review was conducted across Embase, Medline, Psychinfo and Emcare in October 2022. Grey literature was also searched across Google Scholar and Google in October 2022. RESULTS A total of N = 26 studies and 8 documents were included. Thematic analysis revealed six key areas of clinical management: i. Assessment, ii. Education, iii. Advance Care Planning, iv. Adaptation of Care Plan, v. Communication and vi. Carer Support. CONCLUSIONS The literature on management of cognitive and behavioural decline in MND is sparse. Most peer-reviewed literature consists of expert commentary and there is a lack of primary data to guide practitioners and families on how to manage cognitive and behavioural change in MND. PRACTICE IMPLICATIONS Determining as early as practicable the presence of cognitive and behavioural changes in pwMND will enable practitioners to make adaptations to communication, provide education and supported decision-making for forward planning. This will enable individualised care, planned in partnership with families with MND, which incorporates personal needs and wishes.
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Affiliation(s)
- Rebecca Francis
- Speech Pathology, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, Australia; Swallowing Neurorehabilitation Research Laboratory, Caring Futures Institute, Flinders University, Adelaide, Australia.
| | - Stacie Attrill
- Speech Pathology, School of Allied Health Science and Practice, Faculty of Health and Medicine, The University of Adelaide, Adelaide, Australia
| | - Ratko Radakovic
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK; Euan MacDonald Centre for Motor Neuron Disease Research, University of Edinburgh, Edinburgh, UK; Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Sebastian Doeltgen
- Speech Pathology, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, Australia; Swallowing Neurorehabilitation Research Laboratory, Caring Futures Institute, Flinders University, Adelaide, Australia
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Sung W, Nahm M, Lim SM, Noh MY, Lee S, Hwang SM, Kim YH, Park J, Oh KW, Ki CS, Kim YE, Kim SH. Clinical and genetic characteristics of amyotrophic lateral sclerosis patients with ANXA11 variants. Brain Commun 2022; 4:fcac299. [PMID: 36458208 PMCID: PMC9707645 DOI: 10.1093/braincomms/fcac299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/26/2022] [Accepted: 11/16/2022] [Indexed: 08/12/2023] Open
Abstract
Increasing genetic evidence supports the hypothesis that variants in the annexin A11 gene (ANXA11 ) contribute to amyotrophic lateral sclerosis pathogenesis. Therefore, we studied the clinical aspects of sporadic amyotrophic lateral sclerosis patients carrying ANXA11 variants. We also implemented functional experiments to verify the pathogenicity of the hotspot variants associated with amyotrophic lateral sclerosis-frontotemporal dementia. Korean patients diagnosed with amyotrophic lateral sclerosis (n = 882) underwent genetic evaluations through next-generation sequencing, which identified 16 ANXA11 variants in 26 patients. We analysed their clinical features, such as the age of onset, progression rate, initial symptoms and cognitive status. To evaluate the functional significance of the ANXA11 variants in amyotrophic lateral sclerosis-frontotemporal dementia pathology, we additionally utilized patient fibroblasts carrying frontotemporal dementia-linked ANXA11 variants (p.P36R and p.D40G ) to perform a series of in vitro studies, including calcium imaging, stress granule dynamics and protein translation. The frequency of the pathogenic or likely pathogenic variants of ANXA11 was 0.3% and the frequency of variants classified as variants of unknown significance was 2.6%. The patients with variants in the low-complexity domain presented unique clinical features, including late-onset, a high prevalence of amyotrophic lateral sclerosis-frontotemporal dementia, a fast initial progression rate and a high tendency for bulbar-onset compared with patients carrying variants in the C-terminal repeated annexin homology domains. In addition, functional studies using amyotrophic lateral sclerosis-frontotemporal dementia patient fibroblasts revealed that the ANXA11 variants p.P36R and p.D40G impaired intracellular calcium homeostasis, stress granule disassembly and protein translation. This study suggests that the clinical manifestations of amyotrophic lateral sclerosis and amyotrophic lateral sclerosis-frontotemporal dementia spectrum patients with ANXA11 variants could be distinctively characterized depending upon the location of the variant.
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Affiliation(s)
- Wonjae Sung
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Minyeop Nahm
- Dementia Research Group, Korea Brain Research Institute, Daegu, Republic of Korea
| | - Su Min Lim
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Min-Young Noh
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Sanggon Lee
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Sung-Min Hwang
- Gachon Pain Center and Department of Physiology, College of Medicine, Gachon University, Incheon, Republic of Korea
| | - Yong Ho Kim
- Gachon Pain Center and Department of Physiology, College of Medicine, Gachon University, Incheon, Republic of Korea
| | - Jinseok Park
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Ki-Wook Oh
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | | | - Young-Eun Kim
- Department of Laboratory Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Seung Hyun Kim
- Department of Neurology, College of Medicine, Hanyang University, Seoul, Republic of Korea
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Foley G, Neely F. Cognitive Impairment in Amyotrophic Lateral Sclerosis: A Consideration for Occupational Performance. Br J Occup Ther 2016. [DOI: 10.1177/030802260306600906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Traditionally, amyotrophic lateral sclerosis (ALS) has been viewed as a degenerative disease, selective to the motor system. Until recently, research into cognitive impairment in ALS was confined primarily to a small proportion of patients with overt and clinically evident frontotemporal dementia (ALS/FTD). However, evidence from contemporary neuropsychological analysis and functional imaging studies, as identified in this review, indicates that a significantly higher percentage of patients with ALS presents with milder cognitive impairment in frontotemporal function. These deficits are considered progressive in nature, with increasing disability. Disturbances within the supervisory attentional system or central executive are thought to be responsible. It would appear that patients diagnosed with ALS may not be equally susceptible to developing cognitive deficits. The relationship between bulbar-onset ALS and increased cognitive decline is noteworthy. In ALS, the impact of cognitive disturbance on occupational performance must be considered in addition to physical disability.
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Stojkovic T, Stefanova E, Pekmezovic T, Peric S, Stevic Z. Executive dysfunction and survival in patients with amyotrophic lateral sclerosis: Preliminary report from a Serbian centre for motor neuron disease. Amyotroph Lateral Scler Frontotemporal Degener 2016; 17:543-547. [PMID: 27494074 DOI: 10.1080/21678421.2016.1211148] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Our objective was to determine whether the presence of executive dysfunction in non-demented amyotrophic lateral sclerosis (ALS) patients might affect the longevity of survival. Forty-eight consecutive non-demented ALS patients (mean age = 52.93 ± 12.37) were followed for five years. All patients underwent clinical and neuropsychological assessments at baseline visit. Further, a yearly follow-up check for associated dementia (ALS-Dem) was completed and the time of death was recorded, when applicable. Executive deficits were shown in 49.5% of ALS patients, with the most striking differences found on the tests of verbal fluency (both phonemic and category, p < 0.01); as well as inefficient strategy on a working memory test (p < 0.05); as on the more demanding levels of the planning and problem solving task (p < 0.01). It appears that the baseline executive status might predict survival in ALS (p = 0.075), and the patients presenting executive dysfunction could have up to three times greater risk of death, after adjustment by several potential confounding factors. In conclusion, this study suggests that executive dysfunction could potentially influence survival in ALS patients. The cognitive testing might give us important clues about the prognosis of the disease. Further studies with larger sample size are necessary.
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Affiliation(s)
- Tanja Stojkovic
- a Neurology Clinic, Clinical Centre of Serbia and.,b Medical Faculty , University of Belgrade , Serbia
| | - Elka Stefanova
- a Neurology Clinic, Clinical Centre of Serbia and.,b Medical Faculty , University of Belgrade , Serbia
| | - Tatjana Pekmezovic
- a Neurology Clinic, Clinical Centre of Serbia and.,b Medical Faculty , University of Belgrade , Serbia
| | - Stojan Peric
- a Neurology Clinic, Clinical Centre of Serbia and
| | - Zorica Stevic
- a Neurology Clinic, Clinical Centre of Serbia and.,b Medical Faculty , University of Belgrade , Serbia
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Radakovic R, Stephenson L, Colville S, Swingler R, Chandran S, Abrahams S. Multidimensional apathy in ALS: validation of the Dimensional Apathy Scale. J Neurol Neurosurg Psychiatry 2016. [PMID: 26203157 DOI: 10.1136/jnnp-2015-310772] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM Apathy is a prominent symptom of amyotrophic lateral sclerosis (ALS), but measurement is confounded by physical disability. Furthermore, it has been traditionally measured as a unidimensional symptom despite research demonstrating a multifaceted construct. The new Dimensional Apathy Scale (DAS) has been specifically designed for patients with motor disability to measure 3 neurologically based subtypes of apathy: Executive, Emotional and Initiation. We aimed to explore this behavioural symptom by examining the substructure of apathy in ALS and to determine the reliability and validity of the DAS in patients and their carers. METHOD Patients and carers were recruited through the national Scottish Motor Neurone Disease Register and were asked to complete the DAS, the standardised Apathy Evaluation Scale, and the Geriatric Depression Scale-Short Form. 83 patients with ALS, 75 carers and 83 sex-matched, age-matched and education-matched controls participated. RESULTS When compared with healthy controls, patients showed a significant increase in apathy on the Initiation subscale, and were significantly less apathetic on the Emotional subscale. Scores on the DAS patient and carer versions did not significantly differ. Internal consistency reliability, convergent and discriminant validity were found to be good for the DAS subscales. There was no association between the DAS and functional disability using the ALS Functional Rating Scale. CONCLUSIONS Apathy in ALS is characterised by a specific profile of increased initiation apathy and reduced emotional apathy. The DAS is a reliable and valid measure for the assessment of multidimensional apathy in ALS.
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Affiliation(s)
- Ratko Radakovic
- Department of Psychology, School of Philosophy, Psychology & Language Sciences, University of Edinburgh, Edinburgh, UK Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK Euan MacDonald Centre for MND Research, University of Edinburgh, Edinburgh, UK
| | - Laura Stephenson
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK
| | - Shuna Colville
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK
| | - Robert Swingler
- Euan MacDonald Centre for MND Research, University of Edinburgh, Edinburgh, UK Department of Neurology, Ninewells Hospital and Medical School, Dundee, UK
| | - Siddharthan Chandran
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK
| | - Sharon Abrahams
- Department of Psychology, School of Philosophy, Psychology & Language Sciences, University of Edinburgh, Edinburgh, UK Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK Euan MacDonald Centre for MND Research, University of Edinburgh, Edinburgh, UK
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Barnett JH, Blackwell AD, Sahakian BJ, Robbins TW. The Paired Associates Learning (PAL) Test: 30 Years of CANTAB Translational Neuroscience from Laboratory to Bedside in Dementia Research. Curr Top Behav Neurosci 2016; 28:449-74. [PMID: 27646012 DOI: 10.1007/7854_2015_5001] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
The origins and rationale of the Cambridge Neuropsychological Test Automated Battery (CANTAB) as a cross-species translational instrument suitable for use in human neuropsychopharmacological studies are reviewed. We focus on its use for the early assessment and detection of Alzheimer's disease, in particular the Paired Associates Learning (PAL) test. We consider its psychometric properties, neural validation, and utility, including studies on large samples of healthy volunteers, patients with mild cognitive impairment (MCI), and Alzheimer's disease. We demonstrate how it can be applied in cross-species studies using experimental animals to bridge the cross-species translational 'gap'. We also show how the CANTAB PAL has bridged a second translational 'gap' through its application to the early detection of memory problems in primary care clinics, using iPad technology.
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Affiliation(s)
- Jennifer H Barnett
- Department of Psychiatry, University of Cambridge, Cambridge, UK.
- Cambridge Cognition, Cambridge, UK.
| | - Andrew D Blackwell
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridge Cognition, Cambridge, UK
| | - Barbara J Sahakian
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Medical Research Council/Wellcome Trust Behavioural and Clinical Neuroscience Institute, Cambridge, UK
| | - Trevor W Robbins
- Medical Research Council/Wellcome Trust Behavioural and Clinical Neuroscience Institute, Cambridge, UK
- Department of Psychology, University of Cambridge, Cambridge, UK
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Personality disturbances in amyotrophic lateral sclerosis: a case study demonstrating changes in personality without cognitive deficits. J Int Neuropsychol Soc 2014; 20:764-71. [PMID: 24854881 PMCID: PMC4429900 DOI: 10.1017/s1355617714000459] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Patients with amyotrophic lateral sclerosis (ALS) often show deficits on neuropsychological tests that tap functions related to the integrity of the prefrontal lobes. Various aspects of personality are also known to be mediated by prefrontal regions, particularly ventromedial prefrontal cortex (vmPFC). Other than apathy, personality changes have not been widely reported in patients with ALS, although clinical observations indicate such changes might be relatively common. Here, we report on a middle-aged woman with bulbar onset ALS (diagnosed 06/2011, examined in Spring, 2012) whose neuropsychological exam did not reveal cognitive deficits. She performed normally on tests of executive functioning. Self-report measures of mood and personality were unremarkable. However, significant personality changes subsequent to disease onset were reported by her husband and two daughters, and these changes were quantified with the Iowa Scales of Personality Change. Results show that personality disturbance may manifest in the absence of notable cognitive changes in ALS, and careful assessment of personality may be important for documenting early neurobehavioral changes in some ALS patients. Findings also show that patients with ALS may not have good insight into personality changes, underscoring the importance of acquiring collateral information. More generally, the results provide further evidence that ALS may compromise the integrity of ventromedial prefrontal regions.
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Pagnini F, Manzoni GM, Tagliaferri A, Gibbons CJ. Depression and disease progression in amyotrophic lateral sclerosis: A comprehensive meta-regression analysis. J Health Psychol 2014; 20:1107-28. [PMID: 24764286 DOI: 10.1177/1359105314530453] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Depression in people with amyotrophic lateral sclerosis, a fatal and progressive neurodegenerative disorder, is a serious issue with important clinical consequences. However, physical impairment may confound the diagnosis when using generic questionnaires. We conducted a comprehensive review of literature. Mean scores from depression questionnaires were meta-regressed on study-level mean time since onset of symptoms. Data from 103 studies (3190 subjects) indicate that the Beck Depression Inventory and, to a lesser degree, the Hospital Anxiety and Depression Scale are influenced by the time since symptom onset, strongly related to physical impairment. Our results suggest that widely used depression scales overestimate depression due to confounding with physical symptoms.
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Affiliation(s)
- Francesco Pagnini
- Department of Psychology, Catholic University of Milan, Italy Azienda Ospedaliera Niguarda Ca' Granda, Italy
| | - Gian Mauro Manzoni
- Department of Psychology, Catholic University of Milan, Italy San Giuseppe Hospital, Istituto Auxologico Italiano, Italy
| | | | - Chris J Gibbons
- NIHR Collaboration for Applied Health Research and Care (CLAHRC-GM), University of Manchester, Manchester, UK Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, UK
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Spectrum of cognitive impairment in Korean ALS patients without known genetic mutations. PLoS One 2014; 9:e87163. [PMID: 24498297 PMCID: PMC3911969 DOI: 10.1371/journal.pone.0087163] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 12/18/2013] [Indexed: 11/29/2022] Open
Abstract
Background Cognitive impairment is associated with a negative prognosis in amyotrophic lateral sclerosis (ALS), as well as with clinical specificity. We investigate neuropsychological function in ALS patients without known genetic mutations in a Korean tertiary clinic. Methods Three hundred and eighteen patients were enrolled in a prospective longitudinal cohort from September 2008 to February 2012. At the time of diagnosis of sporadic ALS, we carried out genetic and comprehensive neuropsychological tests on all patients, and collected demographic and clinical characteristics. Six cognitive domains, namely executive function, attention, language, calculation, visuospatial function and memory were evaluated. ANOVA and t-tests were used to assess differences in clinical characteristics and neuropsychological parameters between sporadic ALS patients. The Kaplan-Meier method and Cox proportional hazard model were used for survival analysis. Results One hundred and sixty-six patients were categorized into five subtypes: normal cognition (ALS pure), cognitive impairment (ALSci), behavioral impairment (ALSbi), frontotemporal dementia (ALS-FTD), and other types of dementia. Seventy patients (70/166, 42.2%) were cognitively or behaviorally impaired. Among the impaired patients, eight (8/166, 4.8%) had FTD-type dementia and one (1/166, 0.6%) was Alzheimer's disease-type. The ALS patients with cognitive impairment (ALSci) and with FTD (ALS-FTD) were more severely impaired in executive function, attention, language and memory than the cognitively intact ALS patients (ALS pure). In a survival analysis, ALSci (β = 1.925, p = 0.025) and ALS-FTD groups (β = 4.150, p = 0.019) tended to have shorter survival than the ALS pure group. Conclusions About half of ALS patients without known genetic variation have cognitive or behavioral impairment. ALS patients with cognitive abnormalities, especially FTD, have a poorer prognosis than those without cognitive impairment. In neuropsychological profiling, executive tasks were effective in identifying cognitive impairment in the ALS patients. It would be useful for clinicians to classify ALS according to neuropsychological profiles, and screen for subtle cognitive impairment.
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Thorns J, Jansma H, Peschel T, Grosskreutz J, Mohammadi B, Dengler R, Münte TF. Extent of cortical involvement in amyotrophic lateral sclerosis--an analysis based on cortical thickness. BMC Neurol 2013; 13:148. [PMID: 24138960 PMCID: PMC3853794 DOI: 10.1186/1471-2377-13-148] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Accepted: 10/14/2013] [Indexed: 11/21/2022] Open
Abstract
Background Besides the defining involvement of upper and lower motor neurons, the involvement of extramotor structures has been increasingly acknowledged in amyotrophic lateral sclerosis (ALS). Methods Here we investigated a group of 14 mildly to moderately affected ALS patients and 14 age-matched healthy control participants using cortical thickness analysis. Cortical thickness was determined from high resolution 3D T1 magnetic resonance images and involved semiautomatic segmentation in grey and white matter, cortical alignment and determination of thickness using the Laplace method. In addition to a whole-cortex analysis a region of interest approach was applied. Results ALS patients showed regions of significant cortical thinning in the pre- and postcentral gyri bilaterally. Further regions of cortical thinning included superior and inferior parietal lobule, angular and supramarginal gyrus, insula, superior frontal, temporal and occipital regions, thus further substantiating extramotor involvement in ALS. A relationship between cortical thickness of the right superior frontal cortex and clinical severity (assessed by the ALS functional rating scale) was also demonstrated. Conclusions Cortical thickness is reduced in ALS not only in motor areas but in widespread non-motor cortical areas. Cortical thickness is related to clinical severity.
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Affiliation(s)
| | | | | | | | | | | | - Thomas F Münte
- Department of Neurology, University of Lübeck, Ratzeburger Allee 160, Lübeck, 23538, Germany.
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Vengoechea J, David MP, Yaghi SR, Carpenter L, Rudnicki SA. Clinical variability and female penetrance in X-linked familial FTD/ALS caused by a P506S mutation in UBQLN2. Amyotroph Lateral Scler Frontotemporal Degener 2013; 14:615-9. [DOI: 10.3109/21678421.2013.824001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Achi EY, Rudnicki SA. ALS and Frontotemporal Dysfunction: A Review. Neurol Res Int 2012; 2012:806306. [PMID: 22919484 PMCID: PMC3423946 DOI: 10.1155/2012/806306] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 06/19/2012] [Indexed: 12/11/2022] Open
Abstract
Though once believed to be a disease that was limited to the motor system, it is now apparent that amyotrophic lateral sclerosis (ALS) may be associated with cognitive changes in some patients. Changes are consistent with frontotemporal dysfunction, and may range from mild abnormalities only recognized with formal neuropsychological testing, to profound frontotemporal dementia (FTD). Executive function, behavior, and language are the most likely areas to be involved. Screening helpful in detecting abnormalities includes verbal or categorical fluency, behavioral inventories filled out by the caregiver, and evaluation for the presence of depression and pseudobulbar affect. Patients with cognitive dysfunction have shortened survival and may be less compliant with recommendations regarding use of feeding tubes and noninvasive ventilation. Evolving knowledge of genetic and pathological links between ALS and FTD has allowed us to better understand the overlapping spectrum of ALS and FTD.
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Affiliation(s)
| | - Stacy A. Rudnicki
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
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Morimoto N, Kurata T, Sato K, Ikeda Y, Sato S, Abe K. Frontal dysfunctions of ALS-PBP patients in relation to their bulbar symptoms and rCBF decline. J Neurol Sci 2012; 319:96-101. [DOI: 10.1016/j.jns.2012.04.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 04/03/2012] [Accepted: 04/30/2012] [Indexed: 12/12/2022]
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Hogden A, Greenfield D, Nugus P, Kiernan MC. Engaging in patient decision-making in multidisciplinary care for amyotrophic lateral sclerosis: the views of health professionals. Patient Prefer Adherence 2012; 6:691-701. [PMID: 23055703 PMCID: PMC3468167 DOI: 10.2147/ppa.s36759] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The aim of this study was to explore clinician perspectives on patient decision-making in multidisciplinary care for amyotrophic lateral sclerosis (ALS), in an attempt to identify factors influencing decision-making. METHODS Thirty-two health professionals from two specialized multidisciplinary ALS clinics participated in individual and group interviews. Participants came from allied health, medical, and nursing backgrounds. Interviews were audio recorded, and the transcripts were analyzed thematically. RESULTS Respondents identified barriers and facilitators to optimal timing and quality of decision-making. Barriers related to the patient and the health system. Patient barriers included difficulties accepting the diagnosis, information sources, and the patient-carer relationship. System barriers were timing of diagnosis and symptom management services, access to ALS-specific resources, and interprofessional communication. Facilitators were teamwork approaches, supported by effective communication and evidence-based information. CONCLUSION Patient-centered and collaborative decision-making is influenced by a range of factors that inhibit the delivery of optimal care. Decision-making relies on a fine balance between timing of information and service provision, and the readiness of patients to receive them. Health system restrictions impacted on optimal timing, and patients coming to terms with their condition. Clinicians valued proactive decision-making to prepare patients and families for inevitable change. The findings indicate disparity between patient choices and clinician perceptions of evidence, knowledge, and experience. To improve multidisciplinary ALS practice, and ultimately patient care, further work is required to bridge this gap in perspectives.
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Affiliation(s)
- Anne Hogden
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, New South Wales, Australia
- Correspondence: Anne Vaughan Hogden, Centre for Clinical Governance Research, Australian Institute of Health Innovation, Faculty of Medicine, Level 1, AGSM, Building, University of New South Wales, Sydney, NSW 2052, Australia, Tel +612 9385 3071, Fax +612 9663 4926, Email
| | - David Greenfield
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, New South Wales, Australia
| | - Peter Nugus
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, New South Wales, Australia
| | - Matthew C Kiernan
- Prince of Wales Clinical School, University of New South Wales, and Neuroscience Research Australia, Sydney, New South Wales, Australia
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Abstract
SUMMARY There is an overlap between amyotrophic lateral sclerosis and frontotemporal dementia. Approximately 15% of amyotrophic lateral sclerosis patients suffer from frontotemporal dementia characterized by behavioral change while a further third experience subtle executive dysfunction (typically letter fluency deficits) and corresponding prefrontal changes. Behavior change appears prevalent with apathy being the most prominent feature. Reports of social and emotional cognition deficits are increasing. Deficits have been described on theory of mind tasks including interpretation of stories and cartoons, faux pas detection and in the judgment of preference based on direction of eye-gaze. Impairments in emotional face and prosody perception and emotional enhancement of memory have been reported, and decision making (with and without risk) appears affected. The role of executive dysfunction in this social cognition deficit remains unresolved and more direct evidence of oribitofrontal involvement has yet to be found. Implications for healthcare provision are discussed with deterioration of social interaction with carers predicted.
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Affiliation(s)
- Sharon Abrahams
- Centre for Cognitive Aging & Epidemiology, Euan MacDonald Centre, University of Edinburgh, UK
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Usman U, Choi C, Camicioli R, Seres P, Lynch M, Sekhon R, Johnston W, Kalra S. Mesial prefrontal cortex degeneration in amyotrophic lateral sclerosis: a high-field proton MR spectroscopy study. AJNR Am J Neuroradiol 2011; 32:1677-80. [PMID: 21778247 DOI: 10.3174/ajnr.a2590] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Frontotemporal lobar degeneration is responsible for the cognitive abnormalities seen in patients with ALS. We sought to evaluate the in vivo neurochemical changes associated with this pathology indicative of neuronal loss and gliosis. MATERIALS AND METHODS Twenty-four patients with ALS (2 with ALS-FTD) and 15 healthy controls were studied. High-field proton MR spectroscopy of the mesial prefrontal cortex was used to determine concentrations of NAA and mIns, markers of neuronal integrity and gliosis, respectively. Metabolite concentrations were correlated with cognitive tests (verbal fluency, ACE). RESULTS NAA/mIns was decreased 17% (P =.002). Abnormalities were present to a lesser degree in the individual metabolites NAA (decreased 9%; P =.08) and mIns (increased 11%; P =.06) than the ratio of the 2 metabolites. These measures did not correlate significantly with verbal fluency or the ACE. CONCLUSIONS Prefrontal lobe degeneration exists in patients with ALS as indicated by an abnormal mesial prefrontal cortex neurochemical profile. Further study is necessary to determine the potential utility of the NAA/mIns ratio as a biomarker for frontal lobe degeneration in ALS.
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Affiliation(s)
- U Usman
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Yuan Q, Jia J. Reduced cognitive function in Chinese patients with early amyotrophic lateral sclerosis and associated factors. Int J Neurosci 2010; 120:641-6. [PMID: 20942578 DOI: 10.3109/00207454.2010.506585] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aims of this study were to investigate the cognitive function of Chinese amyotrophic lateral sclerosis (ALS) patients. Twenty-two patients with ALS were enrolled and a group of 60 healthy individuals were enrolled as a control group. The Extended Scale for Dementia (ESD) was used to evaluate cognitive function and the Hamilton Depression Scale was used for the assessment of depression. In addition, the Modified Norris Scale was used to assess medulla oblongata and limb function. The overall ESD scores were significantly lower in the ALS patients; however, no correlation was found between individual scores of cognitive function and the overall Modified Norris Scale scores. A majority of ALS patients had significantly reduced cognitive function, suggesting the pathological involvement of areas in the brain outside the motor area. This study shows that through the assessment of cognitive function, abnormalities in cognitive function in ALS patients can be identified.
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Affiliation(s)
- Quan Yuan
- Department of Neurology, Xuan Wu Hospital of the Capital Medical University, Beijing, PR China
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King SJ, Duke MM, O'Connor BA. Living with amyotrophic lateral sclerosis/motor neurone disease (ALS/MND): decision-making about 'ongoing change and adaptation'. J Clin Nurs 2010; 18:745-54. [PMID: 19239541 DOI: 10.1111/j.1365-2702.2008.02671.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIMS AND OBJECTIVES To present a model that explicates the dimensions of change and adaptation as revealed by people who are diagnosed and live with amyotrophic lateral sclerosis/motor neurone disease. BACKGROUND Most research about amyotrophic lateral sclerosis/motor neurone disease is medically focused on cause and cure for the illness. Although psychological studies have sought to understand the illness experience through questionnaires, little is known about the experience of living with amyotrophic lateral sclerosis/motor neurone disease as described by people with the disease. DESIGN A grounded theory method of simultaneous data collection and constant comparative analysis was chosen for the conduct of this study. METHODS Data collection involved in-depth interviews, electronic correspondence, field notes, as well as stories, prose, songs and photographs important to participants. QSR NVivo 2 software was used to manage the data and modelling used to illustrate concepts. FINDINGS Participants used a cyclic, decision-making pattern about 'ongoing change and adaptation' as they lived with the disease. This pattern formed the basis of the model that is presented in this paper. CONCLUSION The lives of people living with amyotrophic lateral sclerosis/motor neurone disease revolve around the need to make decisions about how to live with the disease progression and their deteriorating abilities. Life decisions were negotiated by participants to maintain a sense of self and well-being in the face of change. RELEVANCE TO CLINICAL PRACTICE The 'ongoing change and adaptation' model is a framework that can guide practitioners to understand the decision-making processes of people living with amyotrophic lateral sclerosis/motor neurone disease. Such understanding will enhance caring and promote models of care that are person-centred. The model may also have relevance for people with other life limiting diseases and their care.
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Affiliation(s)
- Susan J King
- Faculty of Health, Medicine, Nursing and Behavioural Sciences, School of Nursing, Deakin University, Burwood, Vic, Australia.
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Raggi A, Iannaccone S, Cappa SF. Event-related brain potentials in amyotrophic lateral sclerosis: A review of the international literature. ACTA ACUST UNITED AC 2010; 11:16-26. [DOI: 10.3109/17482960902912399] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Maekawa S, Leigh PN, King A, Jones E, Steele JC, Bodi I, Shaw CE, Hortobagyi T, Al-Sarraj S. TDP-43 is consistently co-localized with ubiquitinated inclusions in sporadic and Guam amyotrophic lateral sclerosis but not in familial amyotrophic lateral sclerosis with and without SOD1 mutations. Neuropathology 2009; 29:672-83. [DOI: 10.1111/j.1440-1789.2009.01029.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Gibbons ZC, Richardson A, Neary D, Snowden JS. Behaviour in amyotrophic lateral sclerosis. ACTA ACUST UNITED AC 2009; 9:67-74. [DOI: 10.1080/17482960701642437] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Strong MJ. The syndromes of frontotemporal dysfunction in amyotrophic lateral sclerosis. ACTA ACUST UNITED AC 2009; 9:323-38. [PMID: 18752088 DOI: 10.1080/17482960802372371] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Rusina R, Ridzon P, Kulist'ák P, Keller O, Bartos A, Buncová M, Fialová L, Koukolík F, Matej R. Relationship between ALS and the degree of cognitive impairment, markers of neurodegeneration and predictors for poor outcome. A prospective study. Eur J Neurol 2009; 17:23-30. [PMID: 19572947 DOI: 10.1111/j.1468-1331.2009.02717.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Amyotrophic lateral sclerosis (ALS) is a common neurodegenerative disease affecting motor neurons and may be associated with impaired cognition. Reliable prognostic factors for ALS patients are still missing. METHODS We prospectively included 67 patients, 42 women and 25 men, with clinically defined ALS. The disease severity was assessed and the patients underwent SPECT, lumbar puncture with determination of tau, hyperphosporylated tau (p-tau) and beta-amyloid and a detailed neuropsychological assessment using a standardized test battery. In patients who died, a detailed neuropathologic evaluation was performed. RESULTS The mean survival duration was 26.8 months. The delay between the first signs and confirmation of the diagnosis was 12.75 months. Cognitive impairment did not have an impact on the evolution of the disease. There was no correlation between neuropsychological and SPECT findings. Higher age at onset, more pronounced handicap and elevated beta-amyloid in the CSF were associated with shorter survival times. In brain tissue from nine of the deceased patients with ALS and dementia, all showed signs of comorbidity, six had hallmarks of frontotemporal lobar degeneration (FTLD) and three showed Alzheimer disease pathology. Brain tissues form 11 deceased ALS patients who did not show signs of dementia, had only changes compatible with a diagnosis of motor neuron disease. CONCLUSION In our prospective study, age, disease severity and CSF beta-amyloid levels taken together were a risk factor suggesting shorter survival times. Dementia is relatively frequent in ALS and may be a consequence of either FTLD or result from co-existing Alzheimer disease.
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Affiliation(s)
- R Rusina
- Department of Neurology, Thomayer Teaching Hospital and Institute for Postgraduate Education in Medicine, Prague, Czech Republic.
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Mohammadi B, Kollewe K, Samii A, Krampfl K, Dengler R, Münte TF. Changes of resting state brain networks in amyotrophic lateral sclerosis. Exp Neurol 2009; 217:147-53. [DOI: 10.1016/j.expneurol.2009.01.025] [Citation(s) in RCA: 180] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Revised: 01/28/2009] [Accepted: 01/29/2009] [Indexed: 11/29/2022]
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Palmieri A, Abrahams S, Sorarù G, Mattiuzzi L, D'Ascenzo C, Pegoraro E, Angelini C. Emotional Lability in MND: Relationship to cognition and psychopathology and impact on caregivers. J Neurol Sci 2009; 278:16-20. [DOI: 10.1016/j.jns.2008.10.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Revised: 10/23/2008] [Accepted: 10/30/2008] [Indexed: 12/13/2022]
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Phukan J, Hardiman O. The management of amyotrophic lateral sclerosis. J Neurol 2009; 256:176-86. [PMID: 19224316 DOI: 10.1007/s00415-009-0142-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Revised: 09/03/2008] [Accepted: 09/22/2008] [Indexed: 12/11/2022]
Abstract
The terms amyotrophic lateral sclerosis (ALS) or motor neuron disease (MND) refer to a condition characterized by motor system degeneration with relative preservation of other pathways. Although there have been advances in symptomatic treatment, ALS remains an incurable condition. Advances in ALS management prolong survival but simultaneously raise challenging ethical dilemmas for physicians, patients and their families. Here, we review current practice in the management of ALS including pharmacological treatment, nutritional management, respiratory care, and evolving strategies in the management of cognitive impairment.
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Affiliation(s)
- Julie Phukan
- Dept. of Neurology, Beaumont Hospital, and Trinity College Institute of Neuroscience, Dublin 9, Ireland
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Phukan J, Pender NP, Hardiman O. Cognitive impairment in amyotrophic lateral sclerosis. Lancet Neurol 2007; 6:994-1003. [DOI: 10.1016/s1474-4422(07)70265-x] [Citation(s) in RCA: 337] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
This study presents a new theory to explain the neural origins of human mind. This is the psychomotor theory. The author briefly analyzed the historical development of the mind-brain theories. The close relations between psychological and motor systems were subjected to a rather detailed analysis, using psychiatric and neurological examples. The feedback circuits between mind, brain, and body were shown to occur within the mind-brain-body triad, in normal states, and psycho-neural diseases. It was stated that psychiatric signs and symptoms are coupled with motor disturbances; neurological diseases are coupled with psychological disturbances; changes in cortico-spinal motor-system activity may influence mind-brain-body triad, and vice versa. Accordingly, a psychomotor theory was created to explain the psychomotor coupling in health and disease, stating that, not the mind-brain duality or unity, but the mind-brain-body triad as a functional unit may be essential in health and disease, because mind does not end in the brain, but further controls movements, in a reciprocal manner; mental and motor events share the same neural substrate, cortical, and spinal motoneurons; mental events emerging from the motoneuronal system expressed by the human language may be closely coupled with the unity of the mind-brain-body triad. So, the psychomotor theory rejects the mind-brain duality and instead advances the unity of the psychomotor system, which will have important consequences in understanding and improving the human mind, brain, and body in health and disease.
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Affiliation(s)
- Uner Tan
- Department of Physics, Cukurova University, Adana, Turkey.
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Quels sont les signes cliniques, classiques et inhabituels, devant faire évoquer une sclérose latérale amyotrophique ? Rev Neurol (Paris) 2006. [DOI: 10.1016/s0035-3787(06)75160-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Papps B, Abrahams S, Wicks P, Leigh PN, Goldstein LH. Changes in memory for emotional material in amyotrophic lateral sclerosis (ALS). Neuropsychologia 2005; 43:1107-14. [PMID: 15817168 DOI: 10.1016/j.neuropsychologia.2004.11.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2004] [Revised: 11/05/2004] [Accepted: 11/16/2004] [Indexed: 12/11/2022]
Abstract
The current study sought to examine the performance of non-demented ALS patients on neuropsychological tests involving emotional perception and memory. Nineteen non-demented patients with ALS were compared with 20 healthy controls on assessments of facial expression recognition, social judgement ratings of faces and recognition memory for emotional words. Patients and controls were well matched to exclude a range of potentially confounding variables. The patients and controls demonstrated significant differences on only one test of cognitive functioning. The ALS group demonstrated a failure to show the normative pattern of enhanced recognition memory for emotional words compared to neutral words and produced higher scores than controls on recognition memory for neutral words. These findings suggest that patients with ALS show a different pattern of cognitive performance with respect to memory for emotional material when compared to healthy adults.
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Affiliation(s)
- B Papps
- Department of Psychology, Box P077, Henry Wellcome Building, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK.
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Chiò A, Gauthier A, Montuschi A, Calvo A, Di Vito N, Ghiglione P, Mutani R. A cross sectional study on determinants of quality of life in ALS. J Neurol Neurosurg Psychiatry 2004; 75:1597-601. [PMID: 15489393 PMCID: PMC1738825 DOI: 10.1136/jnnp.2003.033100] [Citation(s) in RCA: 131] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Understanding the determinants of quality of life (QoL) in amyotrophic lateral sclerosis (ALS) has become increasingly important with the recent emphasis on the comprehensive management of patients. OBJECTIVE To evaluate the determinants of QoL in ALS using two scales with different theoretical constructs: the Schedule for the Evaluation of QoL-Direct Weighting (SEIQoL-DW), which evaluates subjective aspects of QoL, and the McGill QoL Questionnaire (MQOL), which evaluates both health related and non-health related factors of QoL. METHODS Eighty consecutive patients with ALS underwent a battery of tests evaluating QoL and a series of physical, emotional, psychological, and socioeconomic predictor variables. A stepwise linear regression model was used to compare QoL scores and explicatory variables. RESULTS SEIQoL-DW score was related to social support, depression, religiosity, and socioeconomic status. Total MQOL score was related to social support, socioeconomic status, and clinical status. MQOL single item score (MQOL-SIS) was related to social support, depression, social withdrawal, and socioeconomic status. SEIQoL-DW score was not related to total MQOL score. Conversely, a significant correlation was found between SEIQoL-DW and MQOL-SIS. CONCLUSIONS With both QoL scales, the most important explicatory variable of QoL was the self perceived quality of social support. Physical status was not relevant in determining QoL. This study indicates that health related QoL measures are not adequate to assess QoL in patients with ALS, because their appreciation of QoL mainly relies on psychological, supportive, and spiritual factors. Therapeutic interventions should consider the psychological needs of patients and pay greater attention to caregivers' issues.
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Affiliation(s)
- A Chiò
- Department of Neuroscience, University of Turin, Via Cherasco 15, 10126 Torino, Italy.
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