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López Gómez JJ, Díaz Marín C, Castillo-García T, Larrad-Sainz A, Gastaldo-Simeón R, Juarros-Martínez S, Leunda-Eizmendi L, Civera Andrés M, Matía Martín P. [Medical nutrition therapy in amyotrophic lateral sclerosis - Do we act or react? A case report and multidisciplinary review]. NUTR HOSP 2024; 41:712-723. [PMID: 38726604 DOI: 10.20960/nh.05189] [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] [Indexed: 06/28/2024] Open
Abstract
Introduction Background: amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with a progressive course. The current prevalence is between 3 and 6 cases/100,000. Malnutrition is closely related to patient prognosis in ALS. The implications of this conditions have been that we should recommend patient care in a multidisciplinary unit. Case report: the case presented shows the evolution of a patient with ALS. The patient was referred to different clinical departments after neurological evaluation and her nutritional, functional and respiratory status were assessed. There was no nutritional deterioration at diagnosis; however, intake was below energy-protein requirements. The clinical evolution of the patient showed a decrease in muscle mass with preservation of weight and fat mass. "Aggressive" measures to control nutritional status such as gastrostomy were rejected in the initial stages of the disease, but had to be carried out after development of dysphagia and associated malnutrition. This situation of progressive morphofunctional deterioration and the development of disease-related complications made essential the participation of different health services and professionals in its control. Dicussion: the management of ALS in a multidisciplinary manner allows to improve the course of the disease and the quality of life of both the patients and their families. Patient follow-up is based on the adjustment and management of complications. The basis of the relationship with these patients includes maintaining an adequate communication with them and their families, and ensuring joint decision-making about their condition.
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Affiliation(s)
- Juan José López Gómez
- Servicio de Endocrinología y Nutrición. Hospital Clínico Universitario de Valladolid. Centro de Investigación Endocrinología y Nutrición. Universidad de Valladolid
| | | | | | - Angélica Larrad-Sainz
- Servicio de Endocrinología y Nutrición. Hospital Clínico San Carlos. Instituto de Investigación Sanitaria San Carlos (IdISSC)
| | | | | | | | - Miguel Civera Andrés
- Servicio de Endocrinología y Nutrición. Hospital Clínico Universitario de Valencia
| | - Pilar Matía Martín
- Servicio de Endocrinología y Nutrición. Hospital Clínico San Carlos. Facultad de Medicina. Universidad Complutense de Madrid. Instituto de Investigación Sanitaria San Carlos (IdISSC)
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Ludolph A, Dupuis L, Kasarskis E, Steyn F, Ngo S, McDermott C. Nutritional and metabolic factors in amyotrophic lateral sclerosis. Nat Rev Neurol 2023; 19:511-524. [PMID: 37500993 DOI: 10.1038/s41582-023-00845-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 07/29/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is a complex neurodegenerative disease that is classically thought to impact the motor system. Over the past 20 years, research has started to consider the contribution of non-motor symptoms and features of the disease, and how they might affect ALS prognosis. Of the non-motor features of the disease, nutritional status (for example, malnutrition) and metabolic balance (for example, weight loss and hypermetabolism) have been consistently shown to contribute to more rapid disease progression and/or earlier death. Several complex cellular changes observed in ALS, including mitochondrial dysfunction, are also starting to be shown to contribute to bioenergetic failure. The resulting energy depletion in high energy demanding neurons makes them sensitive to apoptosis. Given that nutritional and metabolic stressors at the whole-body and cellular level can impact the capacity to maintain optimal function, these factors present avenues through which we can identify novel targets for treatment in ALS. Several clinical trials are now underway evaluating the effectiveness of modifying energy balance in ALS, making this article timely in reviewing the evidence base for metabolic and nutritional interventions.
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Affiliation(s)
- Albert Ludolph
- Department of Neurology, University of Ulm, Ulm, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Site Ulm, Ulm, Germany
| | - Luc Dupuis
- Université de Strasbourg, Inserm, Mécanismes Centraux et Périphériques de la Neurodégénérescence, UMR-S1118, Centre de Recherches en Biomédecine, Strasbourg, France
| | - Edward Kasarskis
- Department of Neurology, University of Kentucky, Lexington, KY, USA
| | - Frederik Steyn
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Shyuan Ngo
- Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, QLD, Australia
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Gomes de Souza e Silva EM, Tomaz da Silva S, Januário de Holanda L, Tezoni Borges D, Mendonça Fernandes AP, Evangelista Rodrigues da Silva K, Souza Ribeiro T, Protásio de Melo L, de Medeiros Valentim RA, Alves Pinto Nagem D, Rodrigues Lindquist AR. Effects of a self-care educational program via telerehabilitation on quality of life and caregiver burden in amyotrophic lateral sclerosis: a single-blinded randomized clinical trial protocol. Front Psychol 2023; 14:1164370. [PMID: 37663359 PMCID: PMC10472276 DOI: 10.3389/fpsyg.2023.1164370] [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: 02/16/2023] [Accepted: 07/25/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction The implementation of a telerehabilitation protocol for self-care in the routine of caregivers of individuals with amyotrophic lateral sclerosis (ALS) has been associated with reduced levels of stress and improved quality of life. Moreover, it may reduce the difficulty of traveling to perform physical or other self-care activities. Thus, this study designed a clinical trial protocol to investigate the effects of a self-care education program via telerehabilitation on the burden and quality of life of caregivers of individuals with ALS. Methods This single-blinded randomized clinical trial will recruit 26 caregivers and randomly allocate them to the experimental (EG = 13) or control group (CG = 13). The EG will receive an informative booklet and participate in a 6-week synchronous telerehabilitation program with a neuropsychologist, nutritionist, and physiotherapist to discuss physical and mental health. The CG will receive an informative booklet on self-care and physical activity and weekly phone calls for 6 weeks to solve questions about the booklet. Outcomes will include the caregiver burden (Zarit scale), quality of life (World Health Organization Quality of Life BREF), pain (McGill Pain Questionnaire), stress (Perceived Stress Scale), and depression (Beck Depression Inventory), which will be evaluated at the baseline after the six-week program and 30 days after the program. Additionally, we will assess daily the nocturnal awakenings, sleep patterns, level of physical activity, and heart rate variability. Discussion This study aimed to investigate the effectiveness of telerehabilitation for caregivers of individuals with ALS. If effective, this program could be disseminated among health professionals, increasing the possibility of remotely monitoring individuals with difficulty performing physical activities. Trial registration number NCT05884034 (clinicaltrials.gov).
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Affiliation(s)
- Emília Márcia Gomes de Souza e Silva
- Laboratory of Intervention and Analysis of Movement, Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Stephano Tomaz da Silva
- Laboratory of Intervention and Analysis of Movement, Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Ledycnarf Januário de Holanda
- Laboratory of Intervention and Analysis of Movement, Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Daniel Tezoni Borges
- Laboratory of Intervention and Analysis of Movement, Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Ana Paula Mendonça Fernandes
- Laboratory of Intervention and Analysis of Movement, Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | - Tatiana Souza Ribeiro
- Laboratory of Intervention and Analysis of Movement, Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Luciana Protásio de Melo
- Laboratory of Intervention and Analysis of Movement, Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Ricardo Alexsandro de Medeiros Valentim
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Brazil
- Department of Biomedical Engineering, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Danilo Alves Pinto Nagem
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Brazil
- Department of Biomedical Engineering, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Ana Raquel Rodrigues Lindquist
- Laboratory of Intervention and Analysis of Movement, Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Brazil
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Sarmet M, Kabani A, Maragakis NJ, Mehta AK. Appetite and quality of life in amyotrophic lateral sclerosis: A scoping review. Muscle Nerve 2022; 66:653-660. [PMID: 35986916 DOI: 10.1002/mus.27694] [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: 05/12/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 12/14/2022]
Abstract
Loss of appetite is related to undesirable loss of weight in amyotrophic lateral sclerosis (ALS) and affects up to two thirds of people with this disease. Little is known about the instruments used to measure appetite loss, its impact on quality of life (QoL), or strategies used to improve loss of appetite. In this study we aim to characterize the existing literature on the symptom of appetite loss in ALS through a systematic scoping review following the framework by Arksey and O'Malley and PRISMA guidelines. Studies assessing appetite in people with ALS (pALS) published in English and indexed on Web of Science, PubMed, and Scopus databases were included. A total of 156 full references were identified, of which 10 articles met the inclusion criteria and were eligible for data synthesis after screening. Seven unique instruments were used to assess appetite across the included studies, most commonly the Council of Nutrition Appetite Questionnaire. No studies included a subjective assessment of appetite loss. A total of 12 unique potential associated factors across five studies were identified. QoL was measured in seven studies using nine different QoL measurement tools. Few studies measure appetite in pALS and there is no consensus on the assessment tool used. Few studies evaluated the impact of appetite as a symptom on QoL. Furthermore, the heterogeneity of outcomes and risk factors of the existing data limit the clinical application of these findings. Future studies are needed to guide clinical management and interventions for people with ALS and appetite loss.
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Affiliation(s)
- Max Sarmet
- Tertiary Referral Center of Neuromuscular Diseases, Hospital de Apoio de Brasília, Brasília, Brazil.,Graduate Department of Health Science and Technology, University of Brasília, Brasília, Brazil
| | - Aamna Kabani
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Ambereen K Mehta
- Palliative Care Program, Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Zarotti N, Hudson C, Human H, Muratori G, Fisher P. 'It's working together with what you've got': Healthcare professionals' experiences of working with people with combined intellectual disability and personality disorder diagnoses. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 35:1317-1326. [PMID: 35725900 PMCID: PMC9796244 DOI: 10.1111/jar.13020] [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: 02/07/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND People with intellectual disability often receive diagnoses which may complicate their clinical care. Among these, personality disorder diagnoses are still considered contentious. Little is also known on the perspectives of staff caring for people with intellectual disability who have received a personality disorder diagnosis. METHODS Three focus groups were carried out to explore 15 healthcare professionals' subjective experiences of working with people with intellectual disability who also have a recorded additional diagnosis of personality disorder. Data were analysed through thematic analysis. FINDINGS Four overarching themes were identified: (a) diagnostic issues and the need for person-centred approaches; (b) challenges and adjustments to working with combined intellectual disability and PD diagnoses; (c) the importance of multidisciplinary team training, support, and cohesion; (d) provision issues and barriers to service access. CONCLUSIONS The themes are outlined in depth and a number of implications for clinical management and service improvement are discussed.
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Affiliation(s)
- Nicolò Zarotti
- Department of Clinical Psychology and Psychological TherapiesNorwich Medical School, University of East AngliaNorwichUK
| | - Clive Hudson
- Adult Community Learning Disability Service, SuffolkNorfolk and Suffolk NHS Foundation TrustLowestoftUK
| | - Hannah‐Rose Human
- Adult Community Learning Disability Service, SuffolkNorfolk and Suffolk NHS Foundation TrustLowestoftUK
| | - Greco Muratori
- Adult Community Mental Health ServiceNorfolk and Suffolk NHS Foundation TrustNorwichUK
| | - Paul Fisher
- Department of Clinical Psychology and Psychological TherapiesNorwich Medical School, University of East AngliaNorwichUK
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