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Nicoletti A, Baschi R, Cicero CE, Iacono S, Re VL, Luca A, Schirò G, Monastero R. Sex and gender differences in Alzheimer's disease, Parkinson's disease, and Amyotrophic Lateral Sclerosis: a narrative review. Mech Ageing Dev 2023; 212:111821. [PMID: 37127082 DOI: 10.1016/j.mad.2023.111821] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 05/03/2023]
Abstract
Neurodegenerative diseases (NDs), including Alzheimer's disease (AD), Parkinson's disease (PD), and amyotrophic lateral sclerosis (ALS), exhibit high phenotypic variability and they are very common in the general population. These diseases are associated with poor prognosis and a significant burden on patients and their caregivers. Although increasing evidence suggests that biological sex is an important factor for the development and phenotypical expression of some NDs, the role of sex and gender in the diagnosis and prognosis of NDs has been poorly explored. Current knowledge relating to sex- and gender-related differences in the epidemiology, clinical features, biomarkers, and treatment of AD, PD, and ALS will be summarized in this narrative review. The cumulative evidence hitherto collected suggests that sex and gender are factors to be considered in explaining the heterogeneity of these NDs. Clarifying the role of sex and gender in AD, PD, and ALS is a key topic in precision medicine, which will facilitate sex-specific prevention and treatment strategies to be implemented in the near future.
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Affiliation(s)
- Alessandra Nicoletti
- Department of Medical, Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Via Santa Sofia 78, 95123, Catania, Italy.
| | - Roberta Baschi
- Department of Biomedicine, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Via La Loggia 1, 90129 Palermo, Italy
| | - Calogero Edoardo Cicero
- Department of Medical, Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Salvatore Iacono
- Department of Biomedicine, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Via La Loggia 1, 90129 Palermo, Italy
| | - Vincenzina Lo Re
- Neurology Service, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Via Ernesto Tricomi 5, 90127 Palermo, Italy; Women's Brain Project, Guntershausen, Switzerland
| | - Antonina Luca
- Department of Medical, Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Giuseppe Schirò
- Department of Biomedicine, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Via La Loggia 1, 90129 Palermo, Italy
| | - Roberto Monastero
- Department of Biomedicine, Neurosciences and Advanced Diagnostics (BiND), University of Palermo, Via La Loggia 1, 90129 Palermo, Italy.
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Peng S, Chang W, Tian Y, Yang Y, Li S, Ni J, Zhu W. Herbal medicine and acupuncture relieved progressive bulbar palsy for more than 3 years: A case report. Medicine (Baltimore) 2022; 101:e31446. [PMID: 36397351 PMCID: PMC9666122 DOI: 10.1097/md.0000000000031446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/03/2022] [Indexed: 11/19/2022] Open
Abstract
RATIONALE Progressive bulbar palsy (PBP) is a type of motor neuron disease (MND). The main symptoms include dysarthria, dysphagia, tongue muscle atrophy and fasciculations. This disease is generally severe and develops rapidly. Due to the lack of effective treatment, many patients with MND in China turn to traditional Chinese medicine treatment for help. We successfully relieved dysphagia and sialorrhea in a patient with PBP for 3 years with herbal medicine and acupuncture. PATIENT CONCERNS The patient was a 68-years-old woman with PBP and suffered from severe dysphagia and sialorrhea. DIAGNOSES Progressive bulbar palsy. INTERVENTIONS Chinese herbal medicine and acupuncture. OUTCOMES After 4 months of herbal medicine and acupuncture treatment, dysphagia and sialorrhea were relieved considerably. The patient's condition has been stable for more than 3 years and continues to be treated with Chinese herbal medicine and acupuncture. LESSONS Our case suggests that alternative therapies such as herbal medicine and acupuncture may be effective in alleviating the symptoms of MND/PBP. However, standardized clinical studies are still required to verify the effectiveness and safety.
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Affiliation(s)
- Siyang Peng
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Xicheng District, Beijing, China
| | - Weiqian Chang
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Xicheng District, Beijing, China
| | - Yukun Tian
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Xicheng District, Beijing, China
| | - Yajing Yang
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Xicheng District, Beijing, China
| | - Shaohong Li
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Xicheng District, Beijing, China
| | - Jinxia Ni
- Dongzhimen Hospital of Beijing University of Chinese Medicine, Dongcheng District, Beijing, China
| | - Wenzeng Zhu
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Xicheng District, Beijing, China
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3
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Sun Q, Huo Y, Bai J, Wang H, Cui F, Wang H, Yang F, Huang X. Characteristics of Late-Onset Amyotrophic Lateral Sclerosis in a Chinese Cohort. NEURODEGENER DIS 2021; 21:24-29. [PMID: 34419946 DOI: 10.1159/000519002] [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: 06/09/2021] [Accepted: 08/10/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This retrospective study analyzed the clinical characteristics and prognosis of the elderly amyotrophic lateral sclerosis (ALS) population in a large sample. METHODS The study included 1,005 patients with sporadic ALS admitted to Chinese PLA General Hospital between March 2011 and March 2021. We stratified the ALS patients into young and old groups using 2 cutoffs for the age at disease onset (≥65 or ≥70 years old) and compared their demographic, clinical, and survival data. RESULTS The mean onset age of all patients was 52.79 ± 10.55 years, with 123 (12.24%) having a disease onset ≥65 years and 44 (4.38%) having an onset ≥70 years. There were 624 (62.1%) male patients. More bulbar-onset cases were in the late-onset group (p = 0.001). The sex distribution, time from onset to diagnosis, and the time of symptom spread from spinal or bulbar localization to a generalized localization did not differ between groups. Late-onset patients progressed more rapidly and had a significantly shorter survival. CONCLUSIONS Chinese ALS patients have an earlier age at onset and a relatively smaller proportion of old onset than European and Japanese patients. Elderly patients are more likely to have bulbar onset, which is related to rapid progression and a shorter survival.
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Affiliation(s)
- Qionghua Sun
- College of Medicine, Nankai University, Tianjin, China.,Department of Neurology of the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yunyun Huo
- Department of Neurology of the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jiongming Bai
- College of Medicine, Nankai University, Tianjin, China.,Department of Neurology of the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Haoran Wang
- College of Medicine, Nankai University, Tianjin, China.,Department of Neurology of the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Fang Cui
- Neurological Department of Hainan Hospital, Chinese PLA General Hospital, Sanya, China
| | - Hongfen Wang
- Department of Neurology of the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Fei Yang
- Department of Neurology of the First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xusheng Huang
- College of Medicine, Nankai University, Tianjin, China.,Department of Neurology of the First Medical Center, Chinese PLA General Hospital, Beijing, China
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Milano-Torino Staging and Long-Term Survival in Chinese Patients with Amyotrophic Lateral Sclerosis. Cells 2021; 10:cells10051220. [PMID: 34067647 PMCID: PMC8156970 DOI: 10.3390/cells10051220] [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] [Received: 03/26/2021] [Revised: 04/25/2021] [Accepted: 05/13/2021] [Indexed: 12/03/2022] Open
Abstract
(1) Background: The aim of this longitudinal study was to evaluate the association between disease progression according to the Milano–Torino staging (MITOS) system and long-term survival in Chinese patients with amyotrophic lateral sclerosis (ALS). We also examined factors affecting MITOS progression. (2) Methods: Patients were enrolled and underwent follow-up at 6, 12, 18, and 24 months, and their demographic and clinical data, including the Milano–Torino stage, Amyotrophic Lateral Sclerosis Functional Rating Scale—Revised (ALSFRS-R) score and neuropsychiatric data, were evaluated. The sensitivity and specificity of predicting survival outcomes based on MITOS progression and ALSFRS-R score decline from baseline to 6 months were compared. The associations between MITOS progression from baseline to 6 months and survival outcome at 12, 18 and 24 months were examined, and factors associated with disease progression were evaluated with subgroup analyses. (3) Results: Among the 100 patients included, 74% were in stage 0 at baseline, and approximately 95% progressed to a higher stage of the MITOS system at 24 months. MITOS progression from baseline to 6 months and ALSFRS-R decline showed comparable value for predicting survival at 12, 18, and 24 months. MITOS progression from baseline to 6 months is strongly associated with death outcomes. Older age at onset and increased depression and anxiety scores may be related to disease progression. (4) Conclusions: MITOS progression during the early disease course could serve as a prognostic marker of long-term survival and may have utility in clinical trials. Age at onset and diagnosis and neuropsychiatric factors might be associated with disease progression.
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Chen L, Chen Y, Zhao M, Zheng L, Fan D. Changes in the concentrations of trimethylamine N-oxide (TMAO) and its precursors in patients with amyotrophic lateral sclerosis. Sci Rep 2020; 10:15198. [PMID: 32938991 PMCID: PMC7495434 DOI: 10.1038/s41598-020-72184-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 08/26/2020] [Indexed: 12/29/2022] Open
Abstract
To compare the plasma concentrations of trimethylamine N-oxide (TMAO) and its precursors in amyotrophic lateral sclerosis (ALS) patients, their spouses and healthy controls and to find associations between gut microbiota metabolites and ALS. ALS patients were recruited at Peking University Third Hospital from January 2015 to December 2018. Information was collected from their spouses at the same time. Age and gender matched healthy controls were recruited from individuals who visited the physical examination center for health checkups. Blood samples were collected after at least 4 h of fasting. Concentrations of the metabolites were quantified using stable isotope dilution liquid chromatography–tandem mass spectrometry. Group differences were analyzed using parametric and nonparametric tests, as appropriate. In this study, 160 patients with ALS were recruited. In these patients, 63 were compared with their spouses, 148 were compared with age and gender matched controls, and 60 were compared with both their spouses and heathy controls in the same time. The carnitine concentration was significantly higher in patients than in their spouses, while there were no significant differences in the concentrations of other metabolites. The carnitine and betaine concentrations were higher, while the choline, TMAO and butyrobetaine concentrations were lower in ALS than in healthy controls. The concentrations of the metabolites in the spouses were more similar to the ALS patients rather than to the healthy controls. In the ALS group, the plasma concentrations of carnitine, betaine, choline and TMAO were inversely related to the severity of upper motor neuron impairment. The TMAO metabolic pathway of the gut microbiota is disturbed in both ALS patients and their spouses, which might suggest that the changes in the gut microbiota occurred before disease onset. The negative correlations between the involvement of UMNs and the concentrations of the metabolites might suggest that the inhibition of this metabolic pathway might lead to a better prognosis in ALS patients.
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Affiliation(s)
- Lu Chen
- Department of Neurology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, China
| | - Yong Chen
- Department of Neurology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, China
| | - Mingming Zhao
- School of Basic Medical Sciences, Institute of Cardiovascular Sciences and Institute of Systems Biomedicine, Peking University Health Science Center, Beijing, China.,Key Laboratory of Molecular Cardiovascular Sciences of Ministry of Education, Peking University Health Science Center, Beijing, China
| | - Lemin Zheng
- School of Basic Medical Sciences, Institute of Cardiovascular Sciences and Institute of Systems Biomedicine, Peking University Health Science Center, Beijing, China.,Key Laboratory of Molecular Cardiovascular Sciences of Ministry of Education, Peking University Health Science Center, Beijing, China
| | - Dongsheng Fan
- Department of Neurology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, China. .,Key Laboratory for Neuroscience, National Health Commission/Ministry of Education, Peking University, Beijing, China.
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Xu L, Chen L, Fan DS, Feng JN, Liu LL, Zhan SY, Wang SF. [Calculation of the prevalence of progressive muscular atrophy among adults in China based on urban medical insurance data from 15 provinces]. JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2020; 52:521-526. [PMID: 32541987 DOI: 10.19723/j.issn.1671-167x.2020.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To analyze the characteristics of patients with progressive muscular atrophy (PMA) and calculate the prevalence of PMA in China in 2016. METHODS A retrospective analysis based on China's urban employee basic medical insurance data and the urban residence basic medical insu-rance data from January 1, 2016 to December 31, 2016 was carried out. Children under 18 years old were excluded. Patients with progressive muscular atrophy were identified by disease names and codes. Subgroup analyses by gender, region and age were carried out to calculate the gender-specific, region-specific and age-specific prevalences. Age-adjusted national prevalence was estimated based on 2010 Chinese census data. Sensitivity analyses were done by only considering the observed cases and by excluding the top 10% provinces regarding the missing rate of diagnostic information, respectively. RESULTS A total of 996.09 million person-years were included in this study, with 518.41 million person-years in males and 477.67 million person-years in females. The age and gender distribution of the study population was similar to that of the 2010 Chinese census data, therefore the study population was nationally representative. The prevalence of PMA in China in 2016 was 0.28 per 100 000 person-years (95%CI: 0.24-0.33), with 0.21 per 100 000 person-years (95%CI: 0.16-0.26) and 0.35 per 100 000 person-years (95%CI: 0.28-0.42) for females and males, respectively. Regional disparity existed in the Chinese PMA prevalence, with the lowest prevalence in Southwest region (0.11 per 100 000 person-years, 95%CI: 0.07-0.15) and the highest prevalence in Northwest region (3.47 per 100 000 person-years, 95%CI: 0.80-7.99). Age trend in the PMA prevalence was not obvious, but the prevalence among those aged 70 years and older was relatively higher. The age-adjusted prevalence based on 2010 Chinese census data was 0.29 per 100 000 person-years (95%CI: 0.27-0.31). The national prevalences calculated by only considering the observed cases and by excluding the top 10% provinces regar-ding the missing rate of diagnostic information were 0.17 per 100 000 person-years (95%CI: 0.14-0.20) and 0.24 per 100 000 person-years (95%CI: 0.20-0.28), respectively. CONCLUSION This study is to calculate the prevalence of PMA among adults in urban China, which can provide basic statistics for the enactment of PMA related medical policies, and clues for the studies on the mechanisms of PMA.
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Affiliation(s)
- L Xu
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - L Chen
- Department of Neurology, Peking University Third Hospital, Beijing 100191, China
| | - D S Fan
- Department of Neurology, Peking University Third Hospital, Beijing 100191, China
| | - J N Feng
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - L L Liu
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - S Y Zhan
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China.,Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China
| | - S F Wang
- Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
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7
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Chen W, Xie Y, Zheng M, Lin J, Huang P, Pei Z, Yao X. Clinical and genetic features of patients with amyotrophic lateral sclerosis in southern China. Eur J Neurol 2020; 27:1017-1022. [DOI: 10.1111/ene.14213] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 03/09/2020] [Indexed: 12/11/2022]
Affiliation(s)
- W. Chen
- Department of Neurology The First Affiliated Hospital Sun Yat‐Sen University Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases National Key Clinical Department and Key Discipline of Neurology No.58 Zhongshan Road 2, Guangzhou 510080 China
| | - Y. Xie
- Department of Neurology The First Affiliated Hospital Sun Yat‐Sen University Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases National Key Clinical Department and Key Discipline of Neurology No.58 Zhongshan Road 2, Guangzhou 510080 China
| | - M. Zheng
- Department of Neurology The First Affiliated Hospital Sun Yat‐Sen University Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases National Key Clinical Department and Key Discipline of Neurology No.58 Zhongshan Road 2, Guangzhou 510080 China
| | - J. Lin
- Department of Neurology The First Affiliated Hospital Sun Yat‐Sen University Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases National Key Clinical Department and Key Discipline of Neurology No.58 Zhongshan Road 2, Guangzhou 510080 China
| | - P. Huang
- Department of Neurology The First Affiliated Hospital Sun Yat‐Sen University Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases National Key Clinical Department and Key Discipline of Neurology No.58 Zhongshan Road 2, Guangzhou 510080 China
| | - Z. Pei
- Department of Neurology The First Affiliated Hospital Sun Yat‐Sen University Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases National Key Clinical Department and Key Discipline of Neurology No.58 Zhongshan Road 2, Guangzhou 510080 China
| | - X. Yao
- Department of Neurology The First Affiliated Hospital Sun Yat‐Sen University Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases National Key Clinical Department and Key Discipline of Neurology No.58 Zhongshan Road 2, Guangzhou 510080 China
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8
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Prognostic factors in ALS: a comparison between Germany and China. J Neurol 2019; 266:1516-1525. [DOI: 10.1007/s00415-019-09290-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 03/15/2019] [Accepted: 03/19/2019] [Indexed: 01/08/2023]
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9
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Yedavalli VS, Patil A, Shah P. Amyotrophic Lateral Sclerosis and its Mimics/Variants: A Comprehensive Review. J Clin Imaging Sci 2018; 8:53. [PMID: 30652056 PMCID: PMC6302559 DOI: 10.4103/jcis.jcis_40_18] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 08/12/2018] [Indexed: 12/16/2022] Open
Abstract
Motor neuron diseases (MNDs) are a debilitating subset of diseases, which result in progressive neuronal destruction and eventual loss of voluntary muscular function. These entities are often challenging to distinguish and accurately diagnose given overlapping clinical pictures and overall rarity. This group of diseases has a high morbidity and mortality rate overall and delineating each type of disease can help guide appropriate clinical management and improve quality of life for patients. Of all MNDs, amyotrophic lateral sclerosis (ALS) is by far the most common comprising 80%-90% of cases. However, other mimics and variants of ALS can appear similar both clinically and radiographically. In this review, we delve into the epidemiological, physiological, neuroimaging, and prognostic characteristics and management of ALS and its most common MND mimics/variants. In doing so, we hope to improve accuracy in diagnosis and potential management for this rare group of diseases.
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Affiliation(s)
- Vivek S Yedavalli
- Department of Neuroradiology and Neurointervention, Stanford University, Palo Alto, California, USA
| | - Abhijit Patil
- Department of Radiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Parinda Shah
- Department of Radiology, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
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10
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Liu X, He J, Gao FB, Gitler AD, Fan D. The epidemiology and genetics of Amyotrophic lateral sclerosis in China. Brain Res 2018; 1693:121-126. [PMID: 29501653 PMCID: PMC6486791 DOI: 10.1016/j.brainres.2018.02.035] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 02/20/2018] [Accepted: 02/22/2018] [Indexed: 12/11/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder associated with loss of motor neurons. Previous knowledge of the disease has been mainly based on studies from Caucasian ALS patients of European descent. Here we review the epidemiological characteristics of ALS among the Chinese population in order to compare the similarities and differences between Chinese ALS cases and those from other countries. We describe a potential lower incidence and prevalence of ALS, a younger age of onset and a lower proportion of familial ALS cases in the Chinese population. Additionally, we highlight potential genetic differences between Chinese and Caucasian ALS patients. Most notably, the frequency of GGGGCC repeat expansions in C9ORF72 in Chinese ALS is significantly lower than in Caucasians. Since some conclusions might not be consistent across all of the studies around China to date, we suggest that it is necessary to carry out a prospective population-based study and large-scale gene sequencing around to better define epidemiological and genetic features of Chinese ALS patients.
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Affiliation(s)
- Xiaolu Liu
- Department of Neurology, Peking University Third Hospital, Beijing 100191, PR China
| | - Ji He
- Department of Neurology, Peking University Third Hospital, Beijing 100191, PR China
| | - Fen-Biao Gao
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA 01605, USA
| | - Aaron D Gitler
- Department of Genetics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Dongsheng Fan
- Department of Neurology, Peking University Third Hospital, Beijing 100191, PR China.
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11
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Phenotypic differences of amyotrophic lateral sclerosis (ALS) in China and Germany. J Neurol 2018; 265:774-782. [DOI: 10.1007/s00415-018-8735-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 12/24/2017] [Accepted: 01/04/2018] [Indexed: 10/18/2022]
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12
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Hu F, Jin J, Jia R, Xiang L, Qi H, Zhao X, Dang J. Measuring the validation of assessing the non-dominant-hand function by ALSFRS-r in Chinese ALS patients. J Clin Neurosci 2017; 46:17-20. [PMID: 28887079 DOI: 10.1016/j.jocn.2017.08.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 08/07/2017] [Accepted: 08/14/2017] [Indexed: 12/11/2022]
Abstract
ALSFRS-r is a widely accepted rating scale for measuring the global function of Amyotrophic Lateral Sclerosis (ALS) patients, but we found some limitations of ALSFRS-r in assessing the function of non-dominant hand in Chinese ALS patients. We reviewed 95 ALS patients who expressed upper-limb symptoms at first visit and analyzed the ALSFRS-r score and subscale. In both upper limb involved patients, the ALSFRS-r had no difference between dominant-hand and non-dominant-hand onset groups (39.15±5.55 vs 38.0±5.91, p=0.477). But in only one upper limb involved patients, the ALSFRS-r score in non-dominant-hand onset patients was higher than dominant-hand onset patients (43.94±3.44 vs 40.87±4.42, p<0.05), especially in item of handwriting, cutting food and handing utensils (3.56±0.89 vs 2.2±1.27 p=0.001, 3.44±1.03 vs 1.8±1.21 p=0.000). When the item of cutting food and handing utensils was replaced by using food bowl and chopsticks to assess the function of non-dominant-hand, the modified ALSFRS-r score was significantly lower than original ALSFRS-r (43.94±3.44 vs 42.88±3.07 p=0.001), the progression rate was slower (0.81±0.63 vs 0.64±0.63, p=0.001). So, for Chinese ALS patients, using food bowl and chopsticks should replace the item of cutting food and handling utensils to assess the non-dominant-hand function, especially in non-dominant-hand onset patients.
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Affiliation(s)
- Fangfang Hu
- Department of Neurology, The First Affiliated Hospital, Medical College, Xi'an Jiaotong University, PR China
| | - Jiaoting Jin
- Department of Neurology, The First Affiliated Hospital, Medical College, Xi'an Jiaotong University, PR China
| | - Rui Jia
- Department of Neurology, The First Affiliated Hospital, Medical College, Xi'an Jiaotong University, PR China
| | - Li Xiang
- Department of Neurology, The Second Affiliated Hospital, Medical College, Xi'an Jiaotong University, PR China
| | | | - Xing Zhao
- Department of Neurology, The First Affiliated Hospital, Medical College, Xi'an Jiaotong University, PR China
| | - Jingxia Dang
- Department of Neurology, The First Affiliated Hospital, Medical College, Xi'an Jiaotong University, PR China.
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13
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Yang X, Zheng J, Tian S, Chen Y, An R, Zhao Q, Xu Y. HLA-DRA/HLA-DRB5 polymorphism affects risk of sporadic ALS and survival in a southwest Chinese cohort. J Neurol Sci 2017; 373:124-128. [DOI: 10.1016/j.jns.2016.12.055] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 12/20/2016] [Accepted: 12/26/2016] [Indexed: 12/11/2022]
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14
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Shahrizaila N, Sobue G, Kuwabara S, Kim SH, Birks C, Fan DS, Bae JS, Hu CJ, Gourie-Devi M, Noto Y, Shibuya K, Goh KJ, Kaji R, Tsai CP, Cui L, Talman P, Henderson RD, Vucic S, Kiernan MC. Amyotrophic lateral sclerosis and motor neuron syndromes in Asia. J Neurol Neurosurg Psychiatry 2016; 87:821-30. [PMID: 27093948 DOI: 10.1136/jnnp-2015-312751] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 03/23/2016] [Indexed: 12/11/2022]
Abstract
While the past 2 decades have witnessed an increasing understanding of amyotrophic lateral sclerosis (ALS) arising from East Asia, particularly Japan, South Korea, Taiwan and China, knowledge of ALS throughout the whole of Asia remains limited. Asia represents >50% of the world population, making it host to the largest patient cohort of ALS. Furthermore, Asia represents a diverse population in terms of ethnic, social and cultural backgrounds. In this review, an overview is presented that covers what is currently known of ALS in Asia from basic epidemiology and genetic influences, through to disease characteristics including atypical phenotypes which manifest a predilection for Asians. With the recent establishment of the Pan-Asian Consortium for Treatment and Research in ALS to facilitate collaborations between clinicians and researchers across the region, it is anticipated that Asia and the Pacific will contribute to unravelling the uncertainties in ALS.
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Affiliation(s)
- N Shahrizaila
- Faculty of Medicine, Neurology Unit, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia Brain and Mind Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - G Sobue
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - S Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - S H Kim
- Department of Neurology, Hanyang University Medical Center, Seoul, South Korea
| | - Carol Birks
- International Alliance of ALS/MND Associations, Sydney, New South Wales, Australia
| | - D S Fan
- Department of Neurology, Peking University Third Hospital, Beijing, China
| | - J S Bae
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - C J Hu
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - M Gourie-Devi
- Department of Neurology, Institute of Human Behaviour and Allied Sciences (IHBAS), New Delhi, Delhi, India
| | - Y Noto
- Brain and Mind Centre, University of Sydney, Camperdown, New South Wales, Australia Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - K Shibuya
- Brain and Mind Centre, University of Sydney, Camperdown, New South Wales, Australia Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - K J Goh
- Faculty of Medicine, Neurology Unit, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - R Kaji
- Department of Clinical Neuroscience, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Japan
| | - C P Tsai
- Department of Neurology, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan
| | - L Cui
- Department of Neurology, Peking Union Medical College Hospital, Beijing, China
| | - P Talman
- Neurology Unit, Calvary Health Care, Bethlehem Hospital, Caulfield, Victoria, Australia
| | - R D Henderson
- Department of Neurology, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - S Vucic
- The Brain Dynamics Centre, Westmead Millennium Institute, Westmead, NSW and Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - M C Kiernan
- Brain and Mind Centre, University of Sydney, Camperdown, New South Wales, Australia
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15
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Cui B, Cui LY, Liu MS, Li XG, Ma JF, Fang J, Ding QY. Behavioral Symptoms in Motor Neuron Disease and Their Negative Impact on Caregiver Burden. Chin Med J (Engl) 2016; 128:2295-300. [PMID: 26315075 PMCID: PMC4733792 DOI: 10.4103/0366-6999.163393] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background: The spectrum of abnormal behaviors in amyotrophic lateral sclerosis/motor neuron disease (ALS/MND) has been described, but its practical meaning, namely its impact on caregiver burden, has not been clearly documented in Chinese population. This study aimed to assess the distribution of abnormal behaviors in Chinese population, and to analyze the relationship between behavior changes and caregiver burden. Methods: Sixty-five patients with ALS/MND have been consecutively enrolled into registry platform of Peking Union Medical College Hospital. An investigation was performed to these patients and their caregivers using the revised ALS function rating scale, Frontal Behavioral Inventory-ALS version, the Frontal Assessment Battery, and the Caregiver Burden Inventory. Results: Twenty-eight (43.1%) patients displayed abnormal behaviors of varying degrees, with one fulfilling the diagnostic criteria of frontotemporal lobe degeneration. Irritability, logopenia, and inflexibility ranked top 3 of abnormal behavior list. Correlation analysis revealed that the degree of behavioral change and frontal cognitive status were significantly associated with caregiver burden, with more extensive impact from disinhibitive behaviors. Analysis of covariance analysis showed that after associated factors were corrected, caregivers of patients with moderate to severe behavior change reported significantly heavier developmental burden, physical burden, and total burden than those with no behavioral change. Conclusions: Neurobehavioral symptoms could present in around 40% of Chinese patients with ALS/MND, and the distribution of these behaviors was also unique. Besides, abnormal behaviors were highly related to caregivers’ burden.
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Affiliation(s)
| | - Li-Ying Cui
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences; Neurosciences Center, Chinese Academy of Medical Sciences, Beijing 100730, China
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16
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Tan RH, Kril JJ, McGinley C, Hassani M, Masuda-Suzukake M, Hasegawa M, Mito R, Kiernan MC, Halliday GM. Cerebellar neuronal loss in amyotrophic lateral sclerosis cases with ATXN2 intermediate repeat expansions. Ann Neurol 2016; 79:295-305. [DOI: 10.1002/ana.24565] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 11/03/2015] [Accepted: 11/15/2015] [Indexed: 02/05/2023]
Affiliation(s)
- Rachel H Tan
- Neuroscience Research Australia; Sydney Australia
- School of Medical Sciences; University of New South Wales; Sydney Australia
| | - Jillian J Kril
- Discipline of Pathology, Sydney Medical School; The University of Sydney; Sydney Australia
| | - Ciara McGinley
- Discipline of Pathology, Sydney Medical School; The University of Sydney; Sydney Australia
| | | | - Masami Masuda-Suzukake
- Department of Neuropathology and Cell Biology; Tokyo Metropolitan Institute of Medical Science; Tokyo Japan
| | - Masato Hasegawa
- Department of Neuropathology and Cell Biology; Tokyo Metropolitan Institute of Medical Science; Tokyo Japan
| | - Remika Mito
- Discipline of Pathology, Sydney Medical School; The University of Sydney; Sydney Australia
| | - Matthew C Kiernan
- Brain and Mind Center, Sydney Medical School; The University of Sydney; Sydney Australia
| | - Glenda M Halliday
- Neuroscience Research Australia; Sydney Australia
- School of Medical Sciences; University of New South Wales; Sydney Australia
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17
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Cui B, Cui L, Gao J, Liu M, Li X, Liu C, Ma J, Fang J. Cognitive Impairment in Chinese Patients with Sporadic Amyotrophic Lateral Sclerosis. PLoS One 2015; 10:e0137921. [PMID: 26367133 PMCID: PMC4569418 DOI: 10.1371/journal.pone.0137921] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 08/23/2015] [Indexed: 12/20/2022] Open
Abstract
Background It has reached a consensus that patients with amyotrophic lateral sclerosis (ALS) could display cognitive impairment characterized by executive dysfunction or even dementia, but cognitive spectrum of Chinese patients with ALS still waits to be documented. Methods A total of 106 incident patients with sporadic ALS were enrolled and comprehensive neuropsychological tests covering memory, executive function, attention, language, and visuospatial function were administered to them. Neuropsychological performances of 76 age- and education- matched healthy controls were used for the purpose of classification and comparison. Results 106 patients were categorized into 4 subtypes:84 (79.2%) ALS with normal cognition (ALS-NC), 12 (11.3%) ALS with executive cognitive impairment (ALS-ECI), 5 (4.7%) ALS with non-executive cognitive impairment (ALS-NECI), and 5 (4.7%) ALS with frontotemporal lobe degeneration (ALS-FTLD). Under the same criteria, 2 (2.6%) and 1 (1.3%) healthy controls were diagnosed as ECI and NECI, respectively. The proportion of ECI was significantly higher in non-demented ALS than that in healthy controls, but it was not for NECI. Patients with ALS-FTLD had significantly severer bulbar function and older age than those with ALS-NC. Conclusion Comorbid FTLD occurred in around 5% of Chinese sporadic ALS cases. Different genetic background and unique age distribution of Chinese ALS patients might be the reasons for the relatively low rate of comorbid FTLD. Cognitive dysfunction, predominant but not exclusive in executive area, was present in around 16% of non-demented ALS patients.
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Affiliation(s)
- Bo Cui
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Liying Cui
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
- Neurosciences Center, Chinese Academy of Medical Sciences, Beijing, China
- * E-mail:
| | - Jing Gao
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Mingsheng Liu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoguang Li
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Caiyan Liu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Junfang Ma
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jia Fang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
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18
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Yang X, Zhao Q, An R, Zheng J, Tian S, Xu Y. Association of the functional SNP rs2275294 in ZNF512B with risk of amyotrophic lateral sclerosis and Parkinson's disease in Han Chinese. Amyotroph Lateral Scler Frontotemporal Degener 2015; 17:142-7. [DOI: 10.3109/21678421.2015.1054291] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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19
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Wei Q, Chen X, Zheng Z, Huang R, Guo X, Cao B, Zhao B, Shang H. Clinical features of amyotrophic lateral sclerosis in south-west China. Amyotroph Lateral Scler Frontotemporal Degener 2015. [PMID: 26203659 DOI: 10.3109/21678421.2015.1069849] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Our objective was to profile clinical features of amyotrophic lateral sclerosis (ALS); we performed a large sample, cross-sectional study based on a hospital registry of ALS in south-west China. Patients were coded in our tertiary referral centre from May 2006 to September 2014. Demographic data and disease-related parameters were collected. A total of 1131 patients were included. Mean age of onset was 54.3 ± 11.6 years and the highest proportion of onset age (30.6%) was between 51 and 60 years. Male:female ratio was 1.45:1. Nearly 30% of the patients were young onset, and 20.3% of the patients were bulbar onset; only 35% received riluzole treatment. The young-onset patients had a higher educational level with a higher proportion performing manual labour and living in rural areas, and a lower proportion with bulbar onset than those who were older at onset. The bulbar-onset patients were older at age of onset, with a lower proportion of males than spinal-onset patients. In conclusion, Chinese ALS patients may be younger at age of onset than Caucasian patients. Environmental and geographical factors are related to the occurrence of ALS. The large treatment gap indicated a pressing need for medical and financial support for Chinese ALS patients.
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Affiliation(s)
- Qianqian Wei
- a Department of Neurology , West China Hospital, Sichuan University , Chengdu , Sichuan , China
| | - Xueping Chen
- a Department of Neurology , West China Hospital, Sichuan University , Chengdu , Sichuan , China
| | - Zhenzhen Zheng
- a Department of Neurology , West China Hospital, Sichuan University , Chengdu , Sichuan , China
| | - Rui Huang
- a Department of Neurology , West China Hospital, Sichuan University , Chengdu , Sichuan , China
| | - Xiaoyan Guo
- a Department of Neurology , West China Hospital, Sichuan University , Chengdu , Sichuan , China
| | - Bei Cao
- a Department of Neurology , West China Hospital, Sichuan University , Chengdu , Sichuan , China
| | - Bi Zhao
- a Department of Neurology , West China Hospital, Sichuan University , Chengdu , Sichuan , China
| | - Huifang Shang
- a Department of Neurology , West China Hospital, Sichuan University , Chengdu , Sichuan , China
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20
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Neuropsychological investigation in Chinese patients with progressive muscular atrophy. PLoS One 2015; 10:e0128883. [PMID: 26042930 PMCID: PMC4456153 DOI: 10.1371/journal.pone.0128883] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 05/02/2015] [Indexed: 11/19/2022] Open
Abstract
Background Progressive muscular atrophy (PMA) is a rare type of degenerative motor neuron disease (MND) of which the onset happens in adult period. Despite its well-defined clinical characteristics, its neuropsychological profile has remained poorly understood, considering the consensus of cognitive and behavioral impairment reached in amyotrophic lateral sclerosis (ALS). Methods We conducted a cross-sectional evaluation of Chinese PMA patients with a series of comprehensive batteries emphasizing the executive and attention function, and covering other domains of memory, language, visuospatial function, calculation and behavior as well. Their performances were compared with those of age- and education-matched ALS and healthy controls (HC). Results 21 patients newly diagnosed with PMA were consecutively enrolled into our ALS and other MND registry platform, accounting for 14.7% of all the incident MND cases registered during the same period. 20 patients who completed the neuropsychological batteries were included into analysis. Compared with HC, PMA performed significantly worse in maintenance function of attention, while they exhibited quantitative similarity to ALS in all behavioral inventories and neuropsychological tests except the time for Stroop interference effect. Conclusion PMA could display mild cognitive dysfunction in the same frontal-mediated territory of ALS but in a lesser degree, whereas they did not differ from ALS behaviorally.
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21
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Wei Q, Chen X, Zheng Z, Guo X, Huang R, Cao B, Zeng Y, Shang H. The predictors of survival in Chinese amyotrophic lateral sclerosis patients. Amyotroph Lateral Scler Frontotemporal Degener 2015; 16:237-44. [PMID: 25581512 DOI: 10.3109/21678421.2014.993650] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is a rapidly progressive neurodegenerative disease, so it is important to explore the survival factors for ALS. Our aim was to evaluate the predictors of survival in Chinese ALS patients. A total of 1049 sporadic ALS patients were enrolled. Kaplan-Meier curves were used to compare survival time. Cox proportional hazards function and the hazard ratio were used to identify adjusted prognostic predictors. Results showed that the mean age of onset was 52.6 ± 12.0 years. During follow-up, 155 patients (14.8%) were lost and 378 patients were deceased. Median survival was 33 months for the deceased patients. In the adjusted Cox proportional hazard model, age of onset, diagnosis delay, rate of disease progression, and non-invasive positive pressure ventilation (NIPPV) treatment had an effect on survival in ALS. In conclusion, our study provides information on survival factors for Chinese ALS patients. Although the onset age of Chinese ALS patients is earlier than that of Caucasian patients, survival factors, including the age of onset, diagnostic delay, rate of disease progression, and NIPPV treatment, are similar.
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Affiliation(s)
- Qianqian Wei
- Department of Neurology, West China Hospital, Sichuan University , Chengdu Sichuan , China
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