1
|
Peters B, O'Brien K, Fried-Oken M. A recent survey of augmentative and alternative communication use and service delivery experiences of people with amyotrophic lateral sclerosis in the United States. Disabil Rehabil Assist Technol 2024; 19:1121-1134. [PMID: 36448513 DOI: 10.1080/17483107.2022.2149866] [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: 08/17/2022] [Revised: 11/10/2022] [Accepted: 11/15/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE The objective of this study was to explore and describe current trends in the augmentative and alternative communication (AAC) use and service delivery experiences of people with amyotrophic lateral sclerosis (PALS) in the U.S. METHODS Cross-sectional data were collected from 216 PALS via an anonymous online questionnaire in 2021. RESULTS Over 70% of participants reported at least some detectable speech disturbance, and approximately half used aided communication during face-to-face interactions. Among respondents with severe speech impairment, over 90% reported using speech-generating devices, and just over half reported using low-tech AAC. Most participants had met with an SLP to discuss speech and communication, but varied in both timing of the initial intervention and frequency of ongoing intervention. Fewer than half reported that their family members or other important people had received education or support related to communication for PALS. Participants also shared their use of and experiences with telephone and video calls, access methods, mounting systems, word prediction and stored phrases, and message and voice banking. CONCLUSIONS Results highlight the importance of early referral for AAC intervention, ongoing re-evaluation and treatment, involvement of communication partners and support for multimodal communication and adaptation to changing needs.
Collapse
Affiliation(s)
- Betts Peters
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
- Systems Science Program, Portland State University, Portland, OR, USA
| | - Kerth O'Brien
- Department of Psychology, Portland State University, Portland, OR, USA
| | - Melanie Fried-Oken
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
| |
Collapse
|
2
|
Talbott EO, Malek AM, Arena VC, Wu F, Steffes K, Sharma RK, Buchanich J, Rager JR, Bear T, Hoffman CA, Lacomis D, Donnelly C, Mauna J, Vena JE. Case-control study of environmental toxins and risk of amyotrophic lateral sclerosis involving the national ALS registry. Amyotroph Lateral Scler Frontotemporal Degener 2024:1-10. [PMID: 38591179 DOI: 10.1080/21678421.2024.2336108] [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: 12/26/2023] [Accepted: 03/18/2024] [Indexed: 04/10/2024]
Abstract
Objective: Neurotoxic chemicals are suggested in the etiology of amyotrophic lateral sclerosis (ALS). We examined the association of environmental and occupational risk factors including persistent organochlorine pesticides (OCPs) and ALS risk among cases from the Centers for Disease Control and Prevention National ALS Registry and age, sex, and county-matched controls. Methods: Participants completed a risk factor survey and provided a blood sample for OCP measurement. ALS cases were confirmed through the Registry. Conditional logistic regression assessed associations between ALS and risk factors including OCP levels. Results: 243 matched case-control pairs (61.7% male, mean [SD] age = 62.9 [10.1]) were included. Fifteen of the 29 OCPs examined had sufficient detectable levels for analysis. Modest correlations of self-reported years of exposure to residential pesticide mixtures and OCP serum levels were found (p<.001). Moreover, occupational exposure to lead including soldering and welding with lead/metal dust and use of lead paint/gasoline were significantly related to ALS risk (OR = 1.77, 95% CI: 1.11-2.83). Avocational gardening was a significant risk factor for ALS (OR = 1.57, 95% CI: 1.04-2.37). ALS risk increased for each 10 ng/g of α-Endosulfan (OR = 1.42, 95% CI: 1.14-1.77) and oxychlordane (OR = 1.24, 95% CI: 1.01-1.53). Heptachlor (detectable vs. nondetectable) was also associated with ALS risk (OR = 3.57, 95% CI: 1.50-8.52). Conclusion: This national case-control study revealed both survey and serum levels of OCPs as risk factors for ALS. Despite the United States banning many OCPs in the 1970s and 1980s, their use abroad and long half-lives continue to exert possible neurotoxic health effects.
Collapse
Affiliation(s)
- Evelyn O Talbott
- Department of Epidemiology, University of Pittsburgh, School of Public Health, Pittsburgh, PA, USA
| | - Angela M Malek
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Vincent C Arena
- Department of Biostatistics, University of Pittsburgh, School of Public Health, Pittsburgh, PA, USA
| | - Fan Wu
- Department of Epidemiology, University of Pittsburgh, School of Public Health, Pittsburgh, PA, USA
| | - Kristen Steffes
- Department of Epidemiology, University of Pittsburgh, School of Public Health, Pittsburgh, PA, USA
| | - Ravi K Sharma
- Department of Epidemiology, University of Pittsburgh, School of Public Health, Pittsburgh, PA, USA
| | - Jeanine Buchanich
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, School of Public Health, Pittsburgh, PA, USA
| | - Judith R Rager
- Department of Epidemiology, University of Pittsburgh, School of Public Health, Pittsburgh, PA, USA
| | - Todd Bear
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, School of Public Health, Pittsburgh, PA, USA
| | - Caroline A Hoffman
- Department of Epidemiology, University of Pittsburgh, School of Public Health, Pittsburgh, PA, USA
| | - David Lacomis
- Departments of Neurology and Pathology, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA, and
| | - Chris Donnelly
- Department of Neurobiology, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | - Jocelyn Mauna
- Department of Neurobiology, University of Pittsburgh, School of Medicine, Pittsburgh, PA, USA
| | - John E Vena
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
3
|
Peters B, Wiedrick J, Baylor C. Effects of Aided Communication on Communicative Participation for People With Amyotrophic Lateral Sclerosis. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:1450-1465. [PMID: 37335771 PMCID: PMC10473367 DOI: 10.1044/2023_ajslp-22-00346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/07/2023] [Accepted: 02/23/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE Many people with amyotrophic lateral sclerosis (PALS) experience speech changes, which may interfere with participation in communication situations. This study was designed to investigate the effects of aided communication on self-rated communicative participation among PALS and the relationship between speech function and communicative participation for PALS at various stages of speech impairment and communication aid use. METHOD Participants with amyotrophic lateral sclerosis completed an online questionnaire in which they identified their current communication methods, rated their speech function, and rated their communicative participation in various situations on a modified version of the Communicative Participation Item Bank short form. PALS who reported using aided communication rated their communicative participation under two conditions: with unaided communication only and with access to all of their communication methods. RESULTS Communication aids appeared to support communicative participation for many participants with dysarthria. Across all levels of speech function, PALS who use aided communication reported better participation under the all-methods condition than the unaided-only condition, with the largest benefits for participants with anarthria (Revised ALS Functional Rating Scale [ALSFRS-R] speech rating = 0). Communicative participation ratings worsened with more severe speech impairment under both conditions for most levels of speech function, but PALS with anarthria (ALSFRS-R speech rating = 0) reported better participation under the all-methods condition than those who used residual speech in combination with non speech methods (ALSFRS-R speech rating = 1). CONCLUSIONS Aided communication can help PALS continue to participate in various communication situations as their speech function deteriorates. Variability in self-rated communicative participation, even for PALS at the same level of speech function, highlights the need for an individualized approach and consideration of personal and environmental factors in augmentative and alternative communication intervention. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.22782986.
Collapse
Affiliation(s)
- Betts Peters
- Institute on Development and Disability, Department of Pediatrics, Oregon Health & Science University, Portland
- Systems Science Program, Portland State University, OR
| | - Jack Wiedrick
- Biostatistics & Design Program, Oregon Health & Science University, Portland
| | - Carolyn Baylor
- Department of Rehabilitation Medicine, University of Washington, Seattle
| |
Collapse
|
4
|
Pattee GL, Genge A, Couratier P, Lunetta C, Sobue G, Aoki M, Yoshino H, Jackson CE, Wymer J, Salah A, Nelson S. Oral Edaravone - Introducing a Flexible Treatment Option for Amyotrophic Lateral Sclerosis. Expert Rev Neurother 2023; 23:859-866. [PMID: 37646130 DOI: 10.1080/14737175.2023.2251687] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION Amyotrophic lateral sclerosis (ALS) is a progressive and incurable neurodegenerative disease. While pharmacotherapy options remain limited, the Food and Drug Administration (FDA) approved intravenous (IV) and oral edaravone for the treatment of ALS in 2017 and 2022, respectively. With the addition of oral edaravone, patients with ALS may exclusively use oral medications. AREAS COVERED The authors performed a review of the published literature using the United States (US) National Library of Medicine's PubMed.gov resource to describe the pharmacokinetics, pharmacodynamics, safety, and efficacy of oral edaravone, as well as pertinent completed and ongoing clinical trials, including the oral edaravone clinical trial development program. The clinical profile of oral edaravone is also discussed. EXPERT OPINION Edaravone has been shown to slow the rate of motor function deterioration experienced by patients with ALS. As the oral formulation has been approved, patients with ALS may use it alone or in combination with other approved therapeutics. Additional clinical trials and real-world evidence are ongoing to gain further understanding of the clinical profile of oral edaravone.
Collapse
Affiliation(s)
- Gary L Pattee
- Neurological Sciences Department, University of Nebraska Medical Center/Neurology Associates, Lincoln, Nebraska, USA
| | - Angela Genge
- Clinical Research and ALS Clinic, Montreal Neurological Institute and Hospital, Montreal, Canada
| | - Philippe Couratier
- Department of Neurology, University Hospital of Limoges, Limoges, France
| | - Christian Lunetta
- ALS Medical Rehabilitation Department, Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit of Milano, Milan, Italy
| | - Gen Sobue
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Neurology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Hiide Yoshino
- Department of Neurology, Yoshino Neurology Clinic, Chiba, Japan
| | - Carlayne E Jackson
- Department of Neurology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - James Wymer
- Department of Neuromuscular Neurology, University of Florida, Gainesville, Florida, USA
| | | | - Sally Nelson
- Mitsubishi Tanabe Pharma America, Inc, New Jersey, USA
| |
Collapse
|
5
|
MEHTA PAUL, RAYMOND JAIME, PUNJANI RESHMA, HAN MOON, LARSON THEODORE, KAYE WENDY, NELSON LORENEM, TOPOL BARBARA, MURAVOV OLEG, GENSON CORINA, HORTON DKEVIN. Prevalence of amyotrophic lateral sclerosis in the United States using established and novel methodologies, 2017. Amyotroph Lateral Scler Frontotemporal Degener 2023; 24:108-116. [PMID: 35422180 PMCID: PMC9568617 DOI: 10.1080/21678421.2022.2059380] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Objective:To estimate the prevalence of amyotrophic lateral sclerosis (ALS) in the United States for 2017 using data from the National ALS Registry (Registry) as well as capture-recapture methodology to account for under-ascertainment. Established in 2010, the Registry collects and examines data on ALS patients in the US to better describe the epidemiology of ALS (i.e. risk factor exposures, demographics).Methods: The Registry compiled data from national administrative databases (from the Centers for Medicare and Medicaid Services, the Veterans Health Administration, and the Veterans Benefits Administration) and a voluntary enrollment data through a web portal (www.cdc.gov/als). To estimate the number of missing cases, capture-recapture methodology was utilized.Results: The Registry conservatively identified 17,800 adult persons (lower-bound estimate) who met the Registry definition of ALS for an age-adjusted prevalence of 5.5 per 100,000 US population. Using capture-recapture methodology, we obtained a "mean case count" of 24,821 ALS cases (prevalence of 7.7 per 100,000 U.S. population) and estimated the upper-bound estimate to be 31,843 cases (prevalence of 9.9 per 100,000 U.S. population). The pattern of patient characteristics (e.g. age, sex, and race/ethnicity) remained unchanged from previous Registry reports. Overall, ALS was most common among whites, males, and persons aged 60-69 years. The age groups with the lowest number of cases were persons aged 18-39 years. Males had a higher prevalence than females overall and across all data sources.Conclusions: Existing Registry methodology, along with capture-recapture methodology, are being used to better describe the epidemiology and demographics of ALS in the US.
Collapse
Affiliation(s)
- PAUL MEHTA
- Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry, National ALS Registry (CDC/ATSDR), Atlanta, GA, USA
| | - JAIME RAYMOND
- Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry, National ALS Registry (CDC/ATSDR), Atlanta, GA, USA
| | - RESHMA PUNJANI
- Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry, National ALS Registry (CDC/ATSDR), Atlanta, GA, USA
| | - MOON HAN
- Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry, National ALS Registry (CDC/ATSDR), Atlanta, GA, USA
| | - THEODORE LARSON
- Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry, National ALS Registry (CDC/ATSDR), Atlanta, GA, USA
| | - WENDY KAYE
- McKing Consulting Corporation, Atlanta, GA, USA
| | - LORENE M. NELSON
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - BARBARA TOPOL
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - OLEG MURAVOV
- Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry, National ALS Registry (CDC/ATSDR), Atlanta, GA, USA
| | - CORINA GENSON
- Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry, National ALS Registry (CDC/ATSDR), Atlanta, GA, USA
| | - D. KEVIN HORTON
- Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry, National ALS Registry (CDC/ATSDR), Atlanta, GA, USA
| |
Collapse
|
6
|
A new method for estimating under-recruitment of a patient registry: a case study with the Ohio Registry of Amyotrophic Lateral Sclerosis. Sci Rep 2022; 12:14721. [PMID: 36042373 PMCID: PMC9428141 DOI: 10.1038/s41598-022-18944-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/22/2022] [Indexed: 12/04/2022] Open
Abstract
We developed a disease registry to collect all incident amyotrophic lateral sclerosis (ALS) cases diagnosed during 2016–2018 in Ohio. Due to incomplete case ascertainment and limitations of the traditional capture-recapture method, we proposed a new method to estimate the number of cases not recruited by the Registry and their spatial distribution. Specifically, we employed three statistical methods to identify reference counties with normal case-population relationships to build a Poisson regression model for estimating case counts in target counties that potentially have unrecruited cases. Then, we conducted spatial smoothing to adjust outliers locally. We validated the estimates with ALS mortality data. We estimated that 119 total cases (95% CI [109, 130]) were not recruited, including 36 females (95% CI [31, 41]) and 83 males (95% CI [74, 99]), and were distributed unevenly across the state. For target counties, including estimated unrecruited cases increased the correlation between the case count and mortality count from r = 0.8494 to 0.9585 for the total, from 0.7573 to 0.8270 for females, and from 0.6862 to 0.9292 for males. The advantage of this method in the spatial perspective makes it an alternative to capture-recapture for estimating cases missed by disease registries.
Collapse
|
7
|
Nelson LM, Topol B, Kaye W, Raymond J, Horton DK, Mehta P, Wagner T. Evaluation of the Completeness of ALS Case Ascertainment in the U.S. National ALS Registry: Application of the Capture-Recapture Method. Neuroepidemiology 2021; 56:104-114. [PMID: 34929703 DOI: 10.1159/000521591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 12/06/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The Centers for Disease Control and Prevention (CDC) National Amyotrophic Lateral Sclerosis (ALS) Registry is the first national registry for a chronic neurologic disease in the U.S. and uses a combination of case-finding methods including administrative healthcare data and patient self-registration. METHODS We applied capture-recapture methodology to estimate the completeness of the Registry for ascertaining patients with ALS for the first full year and the fourth years of the Registry (2011, 2014). The Registry uses the combination of two national administrative claims databases (Medicare and Veterans Affairs) with a self-register option at the registry portal. We conducted descriptive analyses of the demographic and clinical characteristics of the ALS cases identified by each of the sources and estimated the completeness of case ascertainment for each of the three ALS Registry sources individually, pairwise, and in all combinations. RESULTS Case-finding completeness was 54% in 2011 and improved to 56% in 2014. A smaller proportion of ALS patients under age 65 were ascertained than those 65 or older and ascertainment was also lower for non-White than White patients. The uncorrected ALS prevalence was 4.3/100,000 in 2011 (in 2014 5.0/100,000), but after correction for under-ascertainment, annual prevalence in 2011 was 7.9/100,000 (95% CI 7.6-8.2) (in 2014 was 8.9/100,000 (95% CI 8.7-9.2)). DISCUSSION/CONCLUSION Our findings indicate that administrative healthcare databases are a very efficient method for identifying the majority of ALS prevalent cases in the National ALS Registry and that the inclusion of a web registry portal for patients to self-register is important to ensure a more representative population for estimating ALS prevalence. Nonetheless, more than 40% of ALS cases were not ascertained by the Registry, with individuals younger than age 65 and people of color underrepresented. Recommendations are provided for additional methods that can be considered to improve the completeness of case ascertainment.
Collapse
Affiliation(s)
- Lorene M Nelson
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Barbara Topol
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Wendy Kaye
- McKing Consulting Corporation, Atlanta, Georgia, USA
| | - Jaime Raymond
- Division of Toxicology and Human Health Sciences, Agency for Toxic Substances and Disease Registry/Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - D Kevin Horton
- Division of Toxicology and Human Health Sciences, Agency for Toxic Substances and Disease Registry/Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Paul Mehta
- Division of Toxicology and Human Health Sciences, Agency for Toxic Substances and Disease Registry/Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Todd Wagner
- Department of Surgery, Stanford University School of Medicine, Stanford University School of Medicine, Stanford, California, USA
- Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Menlo Park, California, USA
| |
Collapse
|
8
|
Cook SF, Rhodes T, Schlusser C, Han S, Chen C, Zach N, Murthy V, Davé S. A Descriptive Review of Global Real World Evidence Efforts to Advance Drug Discovery and Clinical Development in Amyotrophic Lateral Sclerosis. Front Neurol 2021; 12:770001. [PMID: 34819914 PMCID: PMC8606522 DOI: 10.3389/fneur.2021.770001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/15/2021] [Indexed: 11/22/2022] Open
Abstract
Understanding patient clinical progression is a key gateway to planning effective clinical trials and ultimately enabling bringing treatments to patients in need. In a rare disease like amyotrophic lateral sclerosis (ALS), studies of disease natural history critically depend on collaboration between clinical centers, regions, and countries to enable creation of platforms to allow patients, caregivers, clinicians, and researchers to come together and more fully understand the condition. Rare disease registries and collaborative platforms such as those developed in ALS collect real-world data (RWD) in standardized formats, including clinical and biological specimen data used to evaluate risk factors and natural history of disease, treatment patterns and clinical (ClinROs) and patient- reported outcomes (PROs) and validate novel endpoints. Importantly, these data support the development of new therapeutics by supporting the evaluation of feasibility and design of clinical trials and offer valuable information on real-world disease trajectory and outcomes outside of the clinical trial setting for comparative purposes. RWD may help to accelerate therapy development by identifying and validating outcome measures and disease subpopulations. RWD can also make potential contributions to the evaluation of the safety and effectiveness of new indications for approved products and to satisfy post-approval regulatory and market access requirements. There is a lack of amalgamated information on available registries, databases, and other sources of real-world data on ALS; thus, a global review of all available resources was warranted. This targeted review identifies and describes ALS registries, biobanks and collaborative research networks that are collecting and synthesizing RWD for the purposes of increasing patient awareness and advancing scientific knowledge with the hope of expediting future development of new therapies.
Collapse
Affiliation(s)
- Suzanne F Cook
- CERobs Consulting, LLC, Wrightsville Beach, NC, United States
| | - Thomas Rhodes
- CERobs Consulting, LLC, Wrightsville Beach, NC, United States
| | - Courtney Schlusser
- Gillings School of Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, United States
| | - Steve Han
- Takeda Development Center Americas, Inc., Cambridge, MA, United States
| | - Chao Chen
- Takeda Development Center Americas, Inc., Cambridge, MA, United States
| | - Neta Zach
- Takeda Development Center Americas, Inc., Cambridge, MA, United States
| | - Venkatesha Murthy
- Takeda Development Center Americas, Inc., Cambridge, MA, United States
| | - Shreya Davé
- Takeda Development Center Americas, Inc., Cambridge, MA, United States
| |
Collapse
|
9
|
Raymond J, Mehta P, Larson T, Pioro EP, Horton DK. Reproductive History and Age of Onset for Women Diagnosed with Amyotrophic Lateral Sclerosis: Data from the National ALS Registry: 2010-2018. Neuroepidemiology 2021; 55:416-424. [PMID: 34218222 DOI: 10.1159/000516344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/05/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a neurological disease of largely unknown etiology with no cure. The National ALS Registry is a voluntary online system that collects demographic and reproductive history (females only) data from patients with ALS. We will examine the association between demographic and reproductive history among female patients aged >18 years and various ages of onset for ALS. METHODS Data from a cross-sectional study were collected and examined for 1,018 female ALS patients. Patient characteristics examined were demographics including race, BMI, and familial history of ALS. Among patients, information on reproductive history, including age at menopause, ever pregnant, and age at first pregnancy was collected. Unadjusted and adjusted logistic regression models were used to estimate OR and 95% CI in this study. RESULTS Women were more likely to be diagnosed with ALS before age 60 if they were nonwhite (p = 0.015), had attended college (p = 0.0012), had a normal BMI at age 40 (p < 0.0001), completed menopause before age 50 (p < 0.0001), and had never been pregnant (p = 0.046) in the univariate analysis. Women diagnosed with ALS before age 60 were also more likely to have limb site of onset (p < 0.0001). In the multivariate analysis, those who completed menopause before age 50 were more likely to be diagnosed with ALS before age 60 (OR = 1.8, 95% CI: 1.4-2.3) compared with women who completed menopause at or after age 50, after controlling for race, ever pregnant, age at first pregnancy, family history of ALS, education status, smoking history, and BMI at age 40. For women who were diagnosed with ALS before age 50, the odds of them entering menopause before age 50 climb to 48.7 (95% CI: 11.8, 200.9). The mean age of ALS diagnosis for women who completed menopause before age 50 was 58 years and 64 years for women who entered menopause after age 50 (p < 0.0001). CONCLUSION Women who reported completing menopause before age 50 were significantly more likely to be diagnosed with ALS before age 60 compared with those who reported entering menopause after age 50. More research is needed to determine the relationship between female reproductive history, especially regarding endogenous estrogen exposure and early-onset ALS.
Collapse
Affiliation(s)
- Jaime Raymond
- Office of Innovation and Analytics, Agency for Toxic Substances and Disease Registry/Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Paul Mehta
- Office of Innovation and Analytics, Agency for Toxic Substances and Disease Registry/Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ted Larson
- Office of Innovation and Analytics, Agency for Toxic Substances and Disease Registry/Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Erik P Pioro
- Section of ALS and Related Disorders, The Cleveland Clinic, Cleveland, Ohio, USA
| | - D Kevin Horton
- Office of Innovation and Analytics, Agency for Toxic Substances and Disease Registry/Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
10
|
Raymond J, Mehta P, Larson T, Factor-Litvak P, Davis B, Horton K. History of vigorous leisure-time physical activity and early onset amyotrophic lateral sclerosis (ALS), data from the national ALS registry: 2010-2018. Amyotroph Lateral Scler Frontotemporal Degener 2021; 22:535-544. [PMID: 33896281 DOI: 10.1080/21678421.2021.1910308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Previous research has suggested that vigorous physical activity (VPA) during adolescence and early adulthood is associated with ALS. The National ALS Registry (Registry) collects physical activity data from persons with ALS. Objective: To examine the association between vigorous VPA and early onset ALS, defined as a diagnosis before age 60, among patients enrolled in the Registry. VPA was defined as engaging in dynamic exercise for at least 10 minutes in a session that caused heavy sweating or large increases in breathing or heart rate. Methods: A cross-sectional study was conducted of 5463 ALS patients with VPA history and 956 ALS patients who never engaged in VPA. Patient characteristics were collected via online surveys in the following areas: demographic, lifetime VPA history, and initial onset of symptoms. General linear modeling was used to estimate mean age of diagnosis and to compute 95% confidence intervals. Results: Patients who reported engaging in VPA at least moderately (three times a week) during early adulthood were more likely to have an ALS diagnosis earlier compared to patients who did not (p < 0.0001). After controlling for year of birth, statistically significant associations between those reporting VPA at age 15-24 and 25-34 and diagnosis of ALS earlier (p = 0.0009, p = 0.0144 respectively). Conclusion: Patients with ALS who had a history of VPA before age 35, were significantly more likely to be diagnosed with ALS before age 60 compared to patients with ALS who never engaged vigorously. More research is needed in the relationship between VPA and early onset ALS.
Collapse
Affiliation(s)
- Jaime Raymond
- Agency for Toxic Substances and Disease Registry/Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Paul Mehta
- Agency for Toxic Substances and Disease Registry/Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ted Larson
- Agency for Toxic Substances and Disease Registry/Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Pam Factor-Litvak
- Mailman School of Public Health, Columbia University, New York City, NY, USA
| | - Bryn Davis
- Agency for Toxic Substances and Disease Registry/Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kevin Horton
- Agency for Toxic Substances and Disease Registry/Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
11
|
Opie-Martin S, Ossher L, Bredin A, Kulka A, Pearce N, Talbot K, Al-Chalabi A. Motor Neuron Disease Register for England, Wales and Northern Ireland-an analysis of incidence in England. Amyotroph Lateral Scler Frontotemporal Degener 2020; 22:86-93. [PMID: 32940088 DOI: 10.1080/21678421.2020.1812661] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Amyotrophic lateral sclerosis (ALS) has a reported incidence of 1-2/100,000 person-years. It is estimated that there are 5000 people with ALS in the UK at any one time; however, the true figure and geographical distribution, are unknown. In this study, we describe the establishment of a population register for England, Wales, and Northern Ireland and report-estimated incidence. Methods: People with a diagnosis of ALS given by a consultant neurologist and whose postcode of residence is within England, Wales, or Northern Ireland were eligible. The catchment area was based on six data contributors that had been participating since 2016. All centres included in this analysis were in England, and therefore Wales and Northern Ireland are not included in this report. Crude age- and sex-specific incidence rates were estimated using population census records for the relevant postcodes from Office of National Statistics census data. These rates were standardized to the UK population structure using direct standardization. Results: There were 232 people in the database with a date of diagnosis between 2017 and 2018, when missing data were imputed there were an estimated 287-301 people. The denominator population of the catchment area is 7,251,845 according to 2011 UK census data. Age- and sex-adjusted incidence for complete cases was 1.61/100,000 person-years (95% confidence interval 1.58, 1.63), and for imputed datasets was 2.072/100,000 person-years (95% CI 2.072, 2.073). Discussion: We found incidence in this previously unreported area of the UK to be similar to other published estimates. As the MND Register for England, Wales, and Northern Ireland grows we will update incidence estimates and report on further analyses.
Collapse
Affiliation(s)
- Sarah Opie-Martin
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
| | - Lynn Ossher
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK, and
| | - Andrea Bredin
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
| | - Anna Kulka
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
| | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Kevin Talbot
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK, and
| | - Ammar Al-Chalabi
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
| |
Collapse
|
12
|
Rechtman L, Jordan H, Kaye W, Ritsick M, Mehta P. Increasing Patient Self-Enrollment in the National Amyotrophic Lateral Sclerosis Registry: Lessons Learned From a Direct to Provider Campaign. J Patient Exp 2020; 7:71-82. [PMID: 32128374 PMCID: PMC7036692 DOI: 10.1177/2374373518811935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To conduct educational and promotional outreach activities to general neurologists and
to increase self-enrollment of persons with amyotrophic lateral sclerosis (ALS) in the
National ALS Registry (Registry). Methods: A multicomponent project to educate neurologists and increase Registry self-enrollment
was delivered. Project components consisted of phone calls, mailings, train-the-trainer
presentations, and key informant interviews. Project-specific metrics, continuing
education enrollment, and Registry self-enrollment data were analyzed to measure project
efficacy. Results: Mailings were sent to 1561 neurologists in 6 states during 2015 to 2016. Sixty-five
percent of responding neurologists remembered the mailing 3 months after receipt. Of
providers who saw patients with ALS in the 3-month period, 60% read the provider guide,
22% distributed a patient guide, and 15% advised a patient to self-enroll. No changes in
self-enrollment rates were observed. Conclusion: Targeted mailings to providers can be used to educate them about the Registry; however,
most providers did not distribute materials to patients with ALS. Increases in providers
receiving Registry material did not lead to increases in patient self-enrollment. Practice Implications: General neurologists have competing priorities, and they see patients with ALS
infrequently. Neurologists could be the appropriate channel to distribute Registry
information to patients, but they are not the appropriate resource to assist patients
with self-enrollment. Engaging the support staff of busy specialists can help increase
research response rates and information distribution. The lessons learned from this
project can be applied to other rare conditions and disease specialists.
Collapse
Affiliation(s)
| | - Heather Jordan
- Department of Social and Behavioral Health Sciences, School of Public Health, Rutgers, the State University of New Jersey, Piscataway, NY, USA
| | - Wendy Kaye
- McKing Consulting Corporation, Atlanta, GA, USA
| | | | - Paul Mehta
- Agency for Toxic Substances and Disease Registry, Atlanta, GA, USA
| |
Collapse
|
13
|
Carrera-Juliá S, Moreno ML, Barrios C, de la Rubia Ortí JE, Drehmer E. Antioxidant Alternatives in the Treatment of Amyotrophic Lateral Sclerosis: A Comprehensive Review. Front Physiol 2020; 11:63. [PMID: 32116773 PMCID: PMC7016185 DOI: 10.3389/fphys.2020.00063] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 01/21/2020] [Indexed: 12/11/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that produces a selective loss of the motor neurons of the spinal cord, brain stem and motor cortex. Oxidative stress (OS) associated with mitochondrial dysfunction and the deterioration of the electron transport chain has been shown to be a factor that contributes to neurodegeneration and plays a potential role in the pathogenesis of ALS. The regions of the central nervous system affected have high levels of reactive oxygen species (ROS) and reduced antioxidant defenses. Scientific studies propose treatment with antioxidants to combat the characteristic OS and the regeneration of nicotinamide adenine dinucleotide (NAD+) levels by the use of precursors. This review examines the possible roles of nicotinamide riboside and pterostilbene as therapeutic strategies in ALS.
Collapse
Affiliation(s)
- Sandra Carrera-Juliá
- Doctoral Degree’s School, Catholic University of Valencia “San Vicente Mártir”, Valencia, Spain
- Department of Nutrition and Dietetics, Catholic University of Valencia “San Vicente Mártir”, Valencia, Spain
| | - Mari Luz Moreno
- Department of Basic Sciences, Catholic University of Valencia “San Vicente Mártir”, Valencia, Spain
| | - Carlos Barrios
- Institute for Research on Musculoskeletal Disorders, Catholic University of Valencia “San Vicente Mártir”, Valencia, Spain
| | | | - Eraci Drehmer
- Department of Basic Sciences, Catholic University of Valencia “San Vicente Mártir”, Valencia, Spain
| |
Collapse
|
14
|
Raymond J, Oskarsson B, Mehta P, Horton K. Clinical characteristics of a large cohort of US participants enrolled in the National Amyotrophic Lateral Sclerosis (ALS) Registry, 2010-2015. Amyotroph Lateral Scler Frontotemporal Degener 2019; 20:413-420. [PMID: 31131638 PMCID: PMC6946020 DOI: 10.1080/21678421.2019.1612435] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 04/11/2019] [Accepted: 04/14/2019] [Indexed: 12/03/2022]
Abstract
Background: Amyotrophic lateral sclerosis (ALS) is a progressive fatal disease with a varying range of clinical characteristics. Objective: To describe the clinical characteristics in a large cohort of ALS participants enrolled in the National ALS Registry. Methods: Data from ALS participants who completed the Registry's online clinical survey module during 2010-2015 were analyzed to determine characteristics, such as site of onset, associated symptoms, time of symptom onset to diagnosis, time of diagnosis to hospice referral, and pharmacological and non-pharmacological interventions. Results: Of the 1758 participants who completed the survey, 60.9% were male, 62.1% were 50-69 years old, and 95.5% white. Approximately, 72.0% reported initial limb weakness onset of disease, followed by bulbar (22.1%), and trunk/global onset (6.1%). Other symptoms ever experienced included cramps (56.7%), fasciculations (56.3%), and dysarthria (33.0%). The median time between an increase of muscle cramps until an ALS diagnosis was 12 months; limb onset participants had cramps longer preceding diagnosis versus those with bulbar onset. The most frequent interventions used included riluzole (48.3% currently using), wheelchairs/scooters (32.8%), and noninvasive breathing equipment (30.0%). Participants with trunk/global onset were referred to hospice almost four times earlier than others. Conclusions: These data show how ALS clinical characteristics differ widely in a large cohort of participants preceding diagnosis and reflect variations in disease onset, progression, and prognosis. Better characterization of symptom onset may assist clinicians in diagnosing ALS sooner, which could lead to earlier therapeutic interventions.
Collapse
Affiliation(s)
- Jaime Raymond
- a Agency for Toxic Substances and Disease Registry/Centers for Disease Control and Prevention , Atlanta , GA , USA and
| | | | - Paul Mehta
- a Agency for Toxic Substances and Disease Registry/Centers for Disease Control and Prevention , Atlanta , GA , USA and
| | - Kevin Horton
- a Agency for Toxic Substances and Disease Registry/Centers for Disease Control and Prevention , Atlanta , GA , USA and
| |
Collapse
|
15
|
Bhattacharya R, Harvey RA, Abraham K, Rosen J, Mehta P. Amyotrophic lateral sclerosis among patients with a Medicare Advantage prescription drug plan; prevalence, survival and patient characteristics. Amyotroph Lateral Scler Frontotemporal Degener 2019; 20:251-259. [PMID: 30892090 DOI: 10.1080/21678421.2019.1582674] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective: To estimate amyotrophic lateral sclerosis (ALS) prevalence, 5-year survival, and explore factors associated with survival in a Medicare population. Methods: A validated administrative claims algorithm was used to classify individual's ages 18-89 years at index date (first claim with a diagnosis of motor neuron disease or ALS between 1 January 2007 and 31 December 2011) with Medicare Advantage prescription drug coverage into mutually exclusive categories: ALS, no ALS, and possible ALS. Crude prevalence and cumulative survival from index date to the date of death, disenrollment or end of the study were calculated. Cox-proportional hazards were used to estimate and explore factors associated with survival. Results: Of 2631 eligible individuals, the algorithm identified 1271 (48 %), 1157 (44 %), 203 (8 %) as ALS, no ALS and possible ALS, respectively. The 5-year period prevalence and the 2011 point prevalence of ALS were 20.5 and 11.8 per 100,000, respectively. Evidence of death was documented in 81%, 35%, and 1.6% of the ALS, no ALS or possible ALS groups, respectively. Unadjusted median survival time was 388, 542 and 1473 days for the ALS, no ALS and possible ALS groups, respectively. Seeing a psychiatrist or neurologist at the index visit, having respiratory or genitourinary comorbidities, and the number of pre-index acute inpatient admissions were associated with shorter survival. Conclusions: Surveillance data from a Medicare population demonstrated a higher prevalence of ALS. Results highlight the need for effective ALS treatment options and resources for patients with ALS who will likely face limited therapeutic choices and care options at the end of life.
Collapse
Affiliation(s)
| | | | | | - Jon Rosen
- a Humana Inc , Louisville , KY , USA and
| | - Paul Mehta
- b Division of Toxicology and Human Health Sciences , Agency for Toxic Substances and Disease Registry/Centers for Disease Control and Prevention , Atlanta , GA , USA
| |
Collapse
|
16
|
Mehta P, Kaye W, Raymond J, Punjani R, Larson T, Cohen J, Muravov O, Horton K. Prevalence of Amyotrophic Lateral Sclerosis - United States, 2015. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2018; 67:1285-1289. [PMID: 30462626 PMCID: PMC6289079 DOI: 10.15585/mmwr.mm6746a1] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Paul Mehta
- Division of Toxicology and Human Health Sciences, Agency for Toxic Substances and Disease Registry, CDC
| | - Wendy Kaye
- Division of Toxicology and Human Health Sciences, Agency for Toxic Substances and Disease Registry, CDC
| | - Jaime Raymond
- Division of Toxicology and Human Health Sciences, Agency for Toxic Substances and Disease Registry, CDC
| | - Reshma Punjani
- Division of Toxicology and Human Health Sciences, Agency for Toxic Substances and Disease Registry, CDC
| | - Theodore Larson
- Division of Toxicology and Human Health Sciences, Agency for Toxic Substances and Disease Registry, CDC
| | - Jessica Cohen
- Division of Toxicology and Human Health Sciences, Agency for Toxic Substances and Disease Registry, CDC
| | - Oleg Muravov
- Division of Toxicology and Human Health Sciences, Agency for Toxic Substances and Disease Registry, CDC
| | - Kevin Horton
- Division of Toxicology and Human Health Sciences, Agency for Toxic Substances and Disease Registry, CDC
| |
Collapse
|