A Brazilian multicentre study on the clinical and epidemiological profiles of 1116 patients with amyotrophic lateral sclerosis and its phenotypic variants

Clinical profile and survival analysis of Alzheimer's disease patients in a Brazilian cohort

OBJECTIVE

To investigate the clinical and epidemiological characteristics of a large sample of patients with dementia due to Alzheimer's disease (AD) who were followed up at a cognitive neurology outpatient clinic.

METHODS

Retrospective, longitudinal, and descriptive design. We collected data from patients with dementia due to AD who visited the outpatient clinic of the SARAH Network of Rehabilitation Hospitals in Rio de Janeiro, Brazil, between May 2009 and June 2019. The evaluated characteristics included age of onset, sex, education, family history, comorbidities, time until diagnosis, and survival rates.

RESULTS

Overall, 1434 patients were evaluated, 74% of whom were women, with a mean age at symptom onset of 72.7 years and 75.8 at diagnosis. A positive family history was reported in 602 patients, with a first-degree relative in 86.3% of them. Hypertension was the most prevalent comorbidity, affecting 61.2% of the sample, and 16.2% were classified as having early-onset AD. The mean survival rate for the sample population was 112.8 months (9.4 years). The sample population was positively affected by dyslipidaemia.

CONCLUSIONS

This study presents a clinical and epidemiological analysis of a large and diverse group of patients with AD. The study confirms previous observations such as a higher prevalence of AD in women, low education among sufferers, and the presence of a family history. The study also found that comorbidities significantly affected patient survival and provides new data on the survival rates of patients with early and late AD in the Brazilian population.

Demographic changes in a large motor neuron disease cohort in Portugal: a 27 year experience

Objective: Motor Neuron Diseases (MND) have a large clinical spectrum, being the most common amyotrophic lateral sclerosis (ALS) but there is significant clinical heterogeneity. Our goal was to investigate this heterogeneity and any potential changes during a long period. Methods: We performed a retrospective cohort study among a large Portuguese cohort of MND patients (n = 1550) and investigated changing patterns in clinical and demographic characteristics over the 27-year period of our database. With that aim, patients were divided into three 9-year groups according to the date of their first visit to our unit: P1, 1994-2002; P2, 2003-2011; P3, 2012-2020. Results: The overall cohort's clinical and demographic characteristics are consistent with clinical experience, but our findings point to gradual changes over time. Time pattern analysis revealed statistically significant differences in the distribution of clinical phenotypes, the average age of onset, diagnostic delay, the proportin of patients using respiratory support with noninvasive ventilation (NIV), time to NIV, and survival. Across time, in the overall cohort, we found an increasing age at onset (p = 0.029), a decrease of two months in diagnostic delay (p < 0.001) and a higher relative frequency of progressive muscular atrophy patients. For ALS patients with spinal onset, from P1 to P2, there was a more widespread (54.8% vs 69.4%, p = 0.005) and earlier (36.9 vs 27.2 months, p = 0.05) use of NIV and a noteworthy 13-month increase in median survival (p = 0.041). Conclusions: Our results probably reflect better comprehensive care, and they are relevant for future studies exploring the impact of new treatments on ALS patients.

A geographical study on amyotrophic lateral sclerosis in Rio Grande Do Norte, Brazil, from 2005 to 2018

OBJECTIVE

amyotrophic lateral sclerosis (ALS) is a rare and fatal neurodegenerative disorder with variable incidence and prevalence worldwide. However, clinical-epidemiological studies on ALS are scarce in Brazil. Thus, this study investigated whether ALS incidence had uniform spatial distribution in population-based cluster analysis in Rio Grande do Norte state (Brazil), from 2005 to 2018.

METHODS

new cases of ALS were identified in a database of the ALS multidisciplinary care center of the Onofre Lopes University Hospital in Natal (Rio Grande do Norte, Brazil). Approaches were based on incidence (empirical Bayes estimator and Moran's I analysis) and cluster analyses (Moran scatter plot and spatial correlogram).

RESULTS

a total of 177 patients (59% males) participated in the study; the mean age of ALS onset was 57 years. Mean annual incidence of ALS was 0.3769 per 100,000 inhabitants (95% confidence interval of 0.0889), higher in males than in females (0.4516 per 100,000 vs. 0.3044 per 100,000). According to spatial statistics, patients were homogeneously distributed throughout the studied area.

CONCLUSION

a low estimate was observed compared with other populations. Results did not indicate areas of increased risk or significant spatial geographic dependence, suggesting a random ALS incidence in Rio Grande do Norte.