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Poletti B, Aiello EN, Consonni M, Iazzolino B, Torre S, Solca F, Faltracco V, Telesca A, Palumbo F, Dalla Bella E, Bersano E, Riva N, Verde F, Messina S, Doretti A, Maranzano A, Morelli C, Calvo A, Silani V, Lauria G, Chiò A, Ticozzi N. Prevalence and motor-functional correlates of frontotemporal-spectrum disorders in a large cohort of non-demented ALS patients. J Neurol 2024:10.1007/s00415-024-12658-w. [PMID: 39235524 DOI: 10.1007/s00415-024-12658-w] [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: 07/28/2024] [Revised: 08/20/2024] [Accepted: 08/20/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND This study aimed at (1) delivering generalizable estimates of the prevalence of frontotemporal-spectrum disorders (FTSDs) in non-demented ALS patients and (2) exploring their motor-functional correlates. METHODS N = 808 ALS patients without FTD were assessed for motor-functional outcomes-i.e., disease duration, severity (ALSFRS-R), progression rate (ΔFS), and stage (King's and Milano-Torino-MiToS-systems)-cognition-via the cognitive section of the Edinburgh Cognitive and Behavioural ALS Screen (ECAS)-and behaviour-via the ECAS-Carer Interview. Neuropsychological phenotypes were retrieved via Strong's revised criteria-i.e., ALS cognitively and behaviourally normal (ALScbn) or cognitively and/or behaviourally impaired (ALSci/bi/cbi). RESULTS Defective ECAS-Total performances were detected in ~ 29% of patients, with the ECAS-Executive being failed by the highest number of patients (~ 30%), followed by the ECAS-Language, -Fluency, and -Memory (~ 15-17%) and -Visuospatial (~ %8). Apathy was the most frequent behavioural change (~ 28%), followed by loss of sympathy/empathy (~ 13%); remaining symptoms were reported in < 4% of patients. The distribution of Strong's classifications was as follows: ALScbn: 46.7%; ALSci/bi/cbi: 22.9%/20.0%/10.4%. Multinomial regressions on Strong's classifications revealed that lower ALSFRS-R scores were associated with a higher probability of ALSbi and ALScbi classifications (p ≤ .008). Higher King's and MiToS stages were associated with a higher probability of ALSbi classification (p ≤ .031). CONCLUSIONS FTSDs affect ~ 50% of non-demented ALS patients, with cognitive deficits being as frequent as behavioural changes. A higher degree of motor-functional involvement is associated with worse behavioural outcomes-with this link being weaker for cognitive deficits.
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Affiliation(s)
- Barbara Poletti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy.
- Department of Oncology and Hemato-Oncology, Università Degli Studi Di Milano, Milan, Italy.
| | - Edoardo Nicolò Aiello
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Monica Consonni
- 3rd Neurology Unit and Motor Neuron Disease Centre, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Barbara Iazzolino
- "Rita Levi Montalcini" Department of Neuroscience, Amyotrophic Lateral Sclerosis Center, University of Turin, Turin, Italy
| | - Silvia Torre
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Federica Solca
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Veronica Faltracco
- 3rd Neurology Unit and Motor Neuron Disease Centre, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Alessandra Telesca
- Neuroalgology Unit, Department of Clinical Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Neurointensive Care Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesca Palumbo
- "Rita Levi Montalcini" Department of Neuroscience, Amyotrophic Lateral Sclerosis Center, University of Turin, Turin, Italy
| | - Eleonora Dalla Bella
- 3rd Neurology Unit and Motor Neuron Disease Centre, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Enrica Bersano
- 3rd Neurology Unit and Motor Neuron Disease Centre, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milan, Italy
| | - Nilo Riva
- 3rd Neurology Unit and Motor Neuron Disease Centre, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Federico Verde
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milan, Italy
| | - Stefano Messina
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Alberto Doretti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Alessio Maranzano
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Claudia Morelli
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Andrea Calvo
- "Rita Levi Montalcini" Department of Neuroscience, Amyotrophic Lateral Sclerosis Center, University of Turin, Turin, Italy
- Neurology 1, City of Health and Science University Hospital of Turin, Turin, Italy
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milan, Italy
| | - Giuseppe Lauria
- 3rd Neurology Unit and Motor Neuron Disease Centre, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, Milan, Italy
| | - Adriano Chiò
- "Rita Levi Montalcini" Department of Neuroscience, Amyotrophic Lateral Sclerosis Center, University of Turin, Turin, Italy
- Neurology 1, City of Health and Science University Hospital of Turin, Turin, Italy
- Institute of Cognitive Science and Technologies, National Research Council, Rome, Italy
| | - Nicola Ticozzi
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milan, Italy
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Manera U, Torrieri MC, Moglia C, Canosa A, Vasta R, Palumbo F, Matteoni E, Cabras S, Grassano M, Bombaci A, Mattei A, Bellocchia M, Tabbia G, Ribolla F, Chiò A, Calvo A. Calculated Maximal Volume Ventilation (cMVV) as a Marker of Early Respiratory Failure in Amyotrophic Lateral Sclerosis (ALS). Brain Sci 2024; 14:157. [PMID: 38391731 PMCID: PMC10887238 DOI: 10.3390/brainsci14020157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/28/2024] [Accepted: 01/31/2024] [Indexed: 02/24/2024] Open
Abstract
Respiratory failure assessment is among the most debatable research topics in amyotrophic lateral sclerosis (ALS) clinical research due to the wide heterogeneity of its presentation. Among the different pulmonary function tests (PFTs), maximal voluntary ventilation (MVV) has shown potential utility as a diagnostic and monitoring marker, able to capture early respiratory modification in neuromuscular disorders. In the present study, we explored calculated MVV (cMVV) as a prognostic biomarker in a center-based, retrospective ALS population belonging to the Piemonte and Valle d'Aosta registry for ALS (PARALS). A Spearman's correlation analysis with clinical data and PFTs showed a good correlation of cMVV with forced vital capacity (FVC) and a moderate correlation with some other features such as bulbar involvement, ALSFRS-R total score, blood oxygen (pO2), carbonate (HCO3-), and base excess (BE), measured with arterial blood gas analysis. Both the Cox proportional hazard models for survival and the time to non-invasive ventilation (NIV) measurement highlighted that cMVV at diagnosis (considering cMVV(40) ≥ 80) is able to stratify patients across different risk levels for death/tracheostomy and NIV indication, especially considering patients with FVC% ≥ 80. In conclusion, cMVV is a useful marker of early respiratory failure in ALS, and is easily derivable from standard PFTs, especially in asymptomatic ALS patients with normal FVC measures.
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Affiliation(s)
- Umberto Manera
- Umberto Manera, ALS Centre, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Via Cherasco 15, 10126 Turin, Italy
- SC Neurologia 1U, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | | | - Cristina Moglia
- Umberto Manera, ALS Centre, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Via Cherasco 15, 10126 Turin, Italy
| | - Antonio Canosa
- Umberto Manera, ALS Centre, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Via Cherasco 15, 10126 Turin, Italy
- SC Neurologia 1U, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
- Institute of Cognitive Sciences and Technologies, Consiglio Nazionale delle Ricerche C.N.R., 00185 Rome, Italy
| | - Rosario Vasta
- Umberto Manera, ALS Centre, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Via Cherasco 15, 10126 Turin, Italy
| | - Francesca Palumbo
- Umberto Manera, ALS Centre, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Via Cherasco 15, 10126 Turin, Italy
| | - Enrico Matteoni
- Umberto Manera, ALS Centre, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Via Cherasco 15, 10126 Turin, Italy
| | - Sara Cabras
- Umberto Manera, ALS Centre, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Via Cherasco 15, 10126 Turin, Italy
| | - Maurizio Grassano
- Umberto Manera, ALS Centre, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Via Cherasco 15, 10126 Turin, Italy
| | - Alessandro Bombaci
- Umberto Manera, ALS Centre, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Via Cherasco 15, 10126 Turin, Italy
| | - Alessio Mattei
- S.C. Pneumologia, S. Croce and Carle Hospital, 12100 Cuneo, Italy
| | - Michela Bellocchia
- S.C. Pneumologia U, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Giuseppe Tabbia
- S.C. Pneumologia U, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Fulvia Ribolla
- S.C. Pneumologia U, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Adriano Chiò
- Umberto Manera, ALS Centre, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Via Cherasco 15, 10126 Turin, Italy
- SC Neurologia 1U, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
- Institute of Cognitive Sciences and Technologies, Consiglio Nazionale delle Ricerche C.N.R., 00185 Rome, Italy
| | - Andrea Calvo
- Umberto Manera, ALS Centre, 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Via Cherasco 15, 10126 Turin, Italy
- SC Neurologia 1U, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
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Aiello EN, Solca F, Torre S, Patisso V, De Lorenzo A, Treddenti M, Colombo E, Maranzano A, Morelli C, Doretti A, Verde F, Silani V, Ticozzi N, Poletti B. Bulbar involvement and cognitive features in amyotrophic lateral sclerosis: a retrospective study on 347 patients. Front Aging Neurosci 2023; 15:1217080. [PMID: 37547740 PMCID: PMC10399238 DOI: 10.3389/fnagi.2023.1217080] [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: 05/04/2023] [Accepted: 06/26/2023] [Indexed: 08/08/2023] Open
Abstract
Background This study aimed at clarifying the role of bulbar involvement (BI) as a risk factor for cognitive impairment (CI) in non-demented amyotrophic lateral sclerosis (ALS) patients. Methods Data on N = 347 patients were retrospectively collected. Cognition was assessed via the Edinburgh Cognitive and Behavioral ALS Screen (ECAS). On the basis of clinical records and ALS Functional Rating Scale-Revised (ALSFRS-R) scores, BI was characterized as follows: (1) BI at onset-from medical history; (2) BI at testing (an ALSFRS-R-Bulbar score ≤11); (3) dysarthria (a score ≤3 on item 1 of the ALSFRS-R); (4) severity of BI (the total score on the ALSFRS-R-Bulbar); and (5) progression rate of BI (computed as 12-ALSFRS-R-Bulbar/disease duration in months). Logistic regressions were run to predict a below- vs. above-cutoff performance on each ECAS measure based on BI-related features while accounting for sex, disease duration, severity and progression rate of respiratory and spinal involvement and ECAS response modality. Results No predictors yielded significance either on the ECAS-Total and -ALS-non-specific or on ECAS-Language/-Fluency or -Visuospatial subscales. BI at testing predicted a higher probability of an abnormal performance on the ECAS-ALS-specific (p = 0.035) and ECAS-Executive Functioning (p = 0.018). Lower ALSFRS-R-Bulbar scores were associated with a defective performance on the ECAS-Memory (p = 0.025). No other BI-related features affected other ECAS performances. Discussion In ALS, the occurrence of BI itself, while neither its specific features nor its presence at onset, might selectively represent a risk factor for executive impairment, whilst its severity might be associated with memory deficits.
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Affiliation(s)
- Edoardo Nicolò Aiello
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Federica Solca
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Silvia Torre
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Valerio Patisso
- Neurology Residency Program, Università Degli Studi di Milano, Milan, Italy
| | - Alberto De Lorenzo
- Neurology Residency Program, Università Degli Studi di Milano, Milan, Italy
| | - Mauro Treddenti
- Neurology Residency Program, Università Degli Studi di Milano, Milan, Italy
| | - Eleonora Colombo
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Alessio Maranzano
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Claudia Morelli
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Alberto Doretti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Federico Verde
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, “Dino Ferrari” Center, Università Degli Studi di Milano, Milan, Italy
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, “Dino Ferrari” Center, Università Degli Studi di Milano, Milan, Italy
| | - Nicola Ticozzi
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, “Dino Ferrari” Center, Università Degli Studi di Milano, Milan, Italy
| | - Barbara Poletti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milan, Italy
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