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Borghero G, Pierri V, Pili F, Muroni A, Ercoli T, Pateri MI, Pilotto S, Maccabeo A, Chiò A, Defazio G. Percutaneous gastrostomy, mechanical ventilation and survival in amyotrophic lateral sclerosis: an observational study in an incident cohort. Amyotroph Lateral Scler Frontotemporal Degener 2024; 25:563-569. [PMID: 38747354 DOI: 10.1080/21678421.2024.2351185] [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: 01/16/2024] [Revised: 04/24/2024] [Accepted: 04/29/2024] [Indexed: 07/25/2024]
Abstract
OBJECTIVE To analyze disease-modifying effects of percutaneous endoscopic gastrostomy (PEG) insertion for supporting nutrition, noninvasive ventilation (NIV), and tracheostomy-assisted ('invasive') ventilation (TIV) in amyotrophic lateral sclerosis (ALS). METHODS We retrospectively analyzed survival in a large population-based incident cohort that was prospectively followed up in our center. Analysis considered several known ALS-related prognostic variables. RESULTS In this population, PEG and NIV in multivariable analysis significantly correlated to survival as computed by disease onset to death/tracheostomy. NIV was associated with better survival while PEG was associated with reduced survival. Other independent prognostic factors were age at ALS onset, diagnostic delay, and flail arm/leg and pure upper motor neuron (PUMN) phenotypes. The length of survival after TIV was significantly associated with age at ALS onset (inverse correlation) whereas other variables did not. The length of survival after TIV correlated to age at ALS onset in such a way that each additional year of age at ALS onset decreased survival by about 0.7 months. Patients who underwent both TIV and NIV did not experience a better survival than those who underwent TIV alone. CONCLUSION The lack of effect of enteral nutrition on ALS survival probably reflected the timing of PEG insertion in patients with more severe disease. By contrast, patients who used mechanical ventilation had an increased overall survival compared with non-ventilated ones. The study also provided new information showing that the combined use of NIV and TIV did not may prolong ALS survival as compared to TIV alone.
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Affiliation(s)
- Giuseppe Borghero
- Institute of Neurology, Azienda Ospedaliero Universitaria di Cagliari, Italy
| | - Vincenzo Pierri
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - Francesca Pili
- Institute of Neurology, Azienda Ospedaliero Universitaria di Cagliari, Italy
| | - Antonella Muroni
- Institute of Neurology, Azienda Ospedaliero Universitaria di Cagliari, Italy
| | - Tommaso Ercoli
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - Maria Ida Pateri
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - Silvy Pilotto
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - Alessandra Maccabeo
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - Adriano Chiò
- Rita Levi Montalcini Department of Neurosciences, ALS Center, University of Turin, Turin, Italy, and
| | - Giovanni Defazio
- Institute of Neurology, Azienda Ospedaliero Universitaria di Cagliari, Italy
- Department of Translational Biomedicine and Neurosciences, University of Bari "Aldo Moro", Italy
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Mangal AL, Mücke M, Rolke R, Appelmann I. Advance directives in amyotrophic lateral sclerosis - a systematic review and meta-analysis. BMC Palliat Care 2024; 23:191. [PMID: 39075493 PMCID: PMC11285133 DOI: 10.1186/s12904-024-01524-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 07/16/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease of the upper and lower motoneuron. It is associated with a life expectancy of 2-4 years after diagnosis. Individuals experience paralysis, dysphagia, respiratory failure and loss of communicative function, rendering advance care planning (ACP) critically important. This systematic review primarily aimed to internationally compare the application of advance directives (AD) and ACP in ALS. Its secondary aim was to identify ACP preferences, identify fields for future research and to generate recommendations for improving patient care through ACP. METHODS We conducted a systematic literature review and meta-analysis. Five electronic databases (Embase, Medline, Scopus, PsycInfo and CENTRAL) were searched for qualitative and quantitative primary literature from 1999 to 2024. Cross-references were used to identify additional publications. Study selection was performed based on inclusion criteria. Number and content of AD were extracted systematically. After statistical analysis consecutive meta-analysis was performed for international differences and changes over time. Quality assessment of studies was performed using the MMAT (Mixed Methods Appraisal Tool). PROSPERO Registration (June 07, 2021) : CRD42021248040. RESULTS A total of 998 records was screened of which 26 were included in the synthesis. An increase in publication numbers of 88.9% was observed from 1999 to 2024. Results regarding use and content of AD were heterogeneous and international differences were detected. AD were signed in 60.4% of records (1,629 / 2,696 patients). The number of AD decreased over time when separating the review period in two decades (1st 1999-2011: 78% vs. 2nd 2012-2024: 42%). Study quality was superior in qualitative and mixed method designs compared to quantitative studies. CONCLUSION Further prospective studies should include detailed analyses on preferences regarding ventilation and artificial nutrition in ALS and should encompass countries of the global south. Despite the complexity of ACP with regard to individual patient needs, ACP should be part of each individual support plan for ALS patients and should specifically comprise a discussion on the preferred place of death. The available disease-specific AD documents should be preferred.
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Affiliation(s)
- Anne Lisa Mangal
- Department of Palliative Medicine, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, Aachen, 52074, Germany
| | - Martin Mücke
- Department of Digitalization and General Practice, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Roman Rolke
- Department of Palliative Medicine, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, Aachen, 52074, Germany
| | - Iris Appelmann
- Department of Palliative Medicine, Medical Faculty, RWTH Aachen University, Pauwelsstraße 30, Aachen, 52074, Germany.
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Wilson E, Palmer J, Armstrong A, Messer B, Presswood E, Faull C. End of life decision making when home mechanical ventilation is used to sustain breathing in Motor Neurone Disease: patient and family perspectives. BMC Palliat Care 2024; 23:115. [PMID: 38698397 PMCID: PMC11064348 DOI: 10.1186/s12904-024-01443-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/24/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Motor Neurone Disease (MND) leads to muscle weakening, affecting movement, speech, and breathing. Home mechanical ventilation, particularly non-invasive ventilation (NIV), is used to alleviate symptoms and support breathing in people living with MND. While home mechanical ventilation can alleviate symptoms and improve survival, it does not slow the progression of MND. This study addresses gaps in understanding end-of-life decision-making in those dependent on home mechanical ventilation, considering the perspectives of patients, family members, and bereaved families. METHODS A UK-wide qualitative study using flexible interviews to explore the experiences of people living with MND (n = 16), their family members (n = 10), and bereaved family members (n = 36) about the use of home mechanical ventilation at the end of life. RESULTS Some participants expressed a reluctance to discuss end-of-life decisions, often framed as a desire to "live for the day" due to the considerable uncertainty faced by those with MND. Participants who avoided end-of-life discussions often engaged in 'selective decision-making' related to personal planning, involving practical and emotional preparations. Many faced challenges in hypothesising about future decisions given the unpredictability of the disease, opting to make 'timely decisions' as and when needed. For those who became dependent on ventilation and did not want to discuss end of life, decisions were often 'defaulted' to others, especially once capacity was lost. 'Proactive decisions', including advance care planning and withdrawal of treatment, were found to empower some patients, providing a sense of control over the timing of their death. A significant proportion lacked a clear understanding of the dying process and available options. CONCLUSIONS The study highlights the complexity and evolution of decision-making, often influenced by the dynamic and uncertain nature of MND. The study emphasises the need for a nuanced understanding of decision-making in the context of MND.
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Affiliation(s)
- Eleanor Wilson
- School of Health Sciences, University of Nottingham, Nottingham, UK.
| | - Jonathan Palmer
- University Hospitals, University Hospitals NHS Trust Plymouth, Plymouth, UK
| | - Alison Armstrong
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ben Messer
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Jang MS, Yoo SH, Kim MS, Cho B, Kim KH, Shin J, Hwang I, Choi SJ, Sung JJ, Lee SY. Healthcare Utilization and Supportive Care Timing in South Korean People Living With Amyotrophic Lateral Sclerosis: A Single-Center Retrospective Study. J Clin Neurol 2024; 20:166-174. [PMID: 38212665 PMCID: PMC10921051 DOI: 10.3988/jcn.2023.0211] [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: 06/09/2023] [Revised: 08/19/2023] [Accepted: 09/18/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND AND PURPOSE Despite the growing demands and challenges faced by patients with amyotrophic lateral sclerosis (ALS) in accessing healthcare services, our understanding of this access remains poor. This study aimed to investigate the healthcare utilization patterns and timing of nutritional and respiration support in patients with ALS in South Korea. METHODS A retrospective cohort study was conducted on patients diagnosed with ALS at a single tertiary hospital between 2016 and 2019 and followed up for 2 years. We evaluated patient characteristics, healthcare utilization (hospital admissions, outpatient visits, and emergency department [ED] visits), and the timing of nutritional and respiration support (noninvasive positive pressure ventilation [NIPPV], tracheostomy, gastrostomy, and nasogastric tube) at 6-month intervals from the first outpatient visit. RESULTS Among the 143 included patients, 73.4% were admitted at least once, 18.9% experienced unplanned admissions, and 30.1% visited the ED at least once during the study period. The most-common reason for ED visits was neurological symptoms during the first 6 months (59.1%), followed by respiratory symptoms. One fifth of patients who visited the ED underwent tracheostomy (20.9%) or NIPPV (20.9%). Two years after the first visit, 32.2% used a ventilator, and 13.3%, 26.6%, and 6.3% had undergone tracheostomy, gastrostomy, and nasogastric tube insertion, respectively. CONCLUSIONS During the 2 years following their first outpatient visit, 20% of patients with ALS experienced unplanned admissions and 30% visited the ED. An active and prompt supportive-care program should be implemented to ensure timely functional support in order to reduce these risks of unplanned admissions.
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Affiliation(s)
- Min Seol Jang
- Seoul National University Graduate School of Public Health, Seoul, Korea
| | - Shin Hye Yoo
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Korea
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Min Sun Kim
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Belong Cho
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Korea
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
- Institute on Aging, Seoul National University College of Medicine, Seoul, Korea
| | - Kyae Hyung Kim
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Jeongmi Shin
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Inyoung Hwang
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Seok-Jin Choi
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Sun Young Lee
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Korea
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea.
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Francis R, Attrill S, Radakovic R, Doeltgen S. Exploring clinical management of cognitive and behavioural deficits in MND. A scoping review. PATIENT EDUCATION AND COUNSELING 2023; 116:107942. [PMID: 37597466 DOI: 10.1016/j.pec.2023.107942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/11/2023] [Accepted: 08/13/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVES Little is known about how cognitive and behavioural decline in MND is managed clinically. This review aimed to summarise clinical management approaches of cognitive and behavioural decline in MND reported in peer-reviewed and grey literature. METHODS A scoping review was conducted across Embase, Medline, Psychinfo and Emcare in October 2022. Grey literature was also searched across Google Scholar and Google in October 2022. RESULTS A total of N = 26 studies and 8 documents were included. Thematic analysis revealed six key areas of clinical management: i. Assessment, ii. Education, iii. Advance Care Planning, iv. Adaptation of Care Plan, v. Communication and vi. Carer Support. CONCLUSIONS The literature on management of cognitive and behavioural decline in MND is sparse. Most peer-reviewed literature consists of expert commentary and there is a lack of primary data to guide practitioners and families on how to manage cognitive and behavioural change in MND. PRACTICE IMPLICATIONS Determining as early as practicable the presence of cognitive and behavioural changes in pwMND will enable practitioners to make adaptations to communication, provide education and supported decision-making for forward planning. This will enable individualised care, planned in partnership with families with MND, which incorporates personal needs and wishes.
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Affiliation(s)
- Rebecca Francis
- Speech Pathology, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, Australia; Swallowing Neurorehabilitation Research Laboratory, Caring Futures Institute, Flinders University, Adelaide, Australia.
| | - Stacie Attrill
- Speech Pathology, School of Allied Health Science and Practice, Faculty of Health and Medicine, The University of Adelaide, Adelaide, Australia
| | - Ratko Radakovic
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK; Euan MacDonald Centre for Motor Neuron Disease Research, University of Edinburgh, Edinburgh, UK; Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Sebastian Doeltgen
- Speech Pathology, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, Australia; Swallowing Neurorehabilitation Research Laboratory, Caring Futures Institute, Flinders University, Adelaide, Australia
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Mercadante S, Al-Husinat L. Palliative Care in Amyotrophic Lateral Sclerosis. J Pain Symptom Manage 2023; 66:e485-e499. [PMID: 37380145 DOI: 10.1016/j.jpainsymman.2023.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/25/2023] [Accepted: 06/21/2023] [Indexed: 06/30/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is an incurable neurodegenerative disease of the motor neurons. Given the evolutive characteristics of this disease, palliative care principles should be a foundation of ALS care. A multidisciplinary medical intervention is of paramount importance in the different phases of disease. The involvement of the palliative care team improves quality of life and symptoms, and prognosis. Early initiation is of paramount importance to ensuring patient-centered care, when the patient has still the capability to communicate effectively and participate in his medical care. Advance care planning supports patients and family members in understanding and sharing their preferences according to their personal values and life goals regarding future medical treatment. The principal problems which require intensive supportive care include cognitive disturbances, psychological distress, pain, sialorrhrea, nutrition, and ventilatory support. Communication skills of health-care professionals are mandatory to manage the inevitability of death. Palliative sedation has peculiar aspects in this population, particularly with the decision of withdrawing ventilatory support.
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Affiliation(s)
- Sebastiano Mercadante
- Main Regional Center of Pain Relief and Supportive/Palliative Care (S.M.), La Maddalena Cancer Center, Palermo, Italy; Regional Home Care Program, SAMOT (S.M.), Palermo, Italy.
| | - Lou'i Al-Husinat
- Department of Clinical Medical Sciences (L.A.H.), Yarmouk University, Irbid, Jordan
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Annunziata A, Calabrese C, Simioli F, Coppola A, Pierucci P, Mariniello DF, Fiorentino G. Psychological Factors Influencing Adherence to NIV in Neuromuscular Patients Dependent on Non Invasive Mechanical Ventilation: Preliminary Results. J Clin Med 2023; 12:5866. [PMID: 37762807 PMCID: PMC10531532 DOI: 10.3390/jcm12185866] [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: 07/30/2023] [Revised: 09/03/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Non-invasive ventilation (NIV) is associated with improvement of both morbility and mortality in patients affected by neuromuscular diseases with chronic respiratory failure. Several studies have also shown that long-term NIV positively impacts the patient's quality of life and perception of disease status. Its effectiveness is likely related to the adherence to NIV. Several factors, patient- and not patient-related, may compromise adherence to NIV, such as physical, behavioral, familiar, and social issues. Few data are currently available on the role of psychological factors in influencing NIV adherence. MATERIALS AND METHODS In this pilot study, we evaluated the adherence to NIV in a group of 15 adult patients with neuromuscular diseases (Duchenne muscular dystrophy, myotonic dystrophy, and amyotrophic lateral sclerosis) in relation to their grade of depression assessed by the Beck Depression Inventory (BDI) questionnaire. Other data were collected, such as clinical features (age and sex), use of anxiolytic drugs, the presence of a family or professional caregiver, the quality of patient-physician relationship, the beginning of psychological support after BDI screening, and the family acceptance of NIV. NIV adherence was definied as the use of NIV for at least 4 h per night on 70% of nights in a month. RESULTS The overall rate of NIV adherence was 60%. Based on the BDI questionnaire, patients who were non-adherent to NIV had a higher rate of depression, mainly observed in the oldest patients. The acceptance of NIV by the family and positive physician-patient interaction seem to favor NIV adherence. CONCLUSION Depression can interfere with NIV adherence in patients with neuromuscolar diseases.
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Affiliation(s)
- Anna Annunziata
- Unit of Respiratory Pathophysiology, Critic Area Department, Monaldi—Cotugno Hospital, 80131 Naples, Italy; (A.A.); (F.S.); (G.F.)
| | - Cecilia Calabrese
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (C.C.); (D.F.M.)
| | - Francesca Simioli
- Unit of Respiratory Pathophysiology, Critic Area Department, Monaldi—Cotugno Hospital, 80131 Naples, Italy; (A.A.); (F.S.); (G.F.)
| | - Antonietta Coppola
- Unit of Respiratory Pathophysiology, Critic Area Department, Monaldi—Cotugno Hospital, 80131 Naples, Italy; (A.A.); (F.S.); (G.F.)
| | - Paola Pierucci
- Cardiothoracic Department, Respiratory and Critical Care Unit, Bari Policlinic University Hospital, 70121 Bari, Italy;
- Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari ‘Aldo Moro’, 70122 Bari, Italy
| | - Domenica Francesca Mariniello
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (C.C.); (D.F.M.)
| | - Giuseppe Fiorentino
- Unit of Respiratory Pathophysiology, Critic Area Department, Monaldi—Cotugno Hospital, 80131 Naples, Italy; (A.A.); (F.S.); (G.F.)
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Berlowitz DJ, Mathers S, Hutchinson K, Hogden A, Carey KA, Graco M, Whelan BM, Charania S, Steyn F, Allcroft P, Crook A, Sheers NL. The complexity of multidisciplinary respiratory care in amyotrophic lateral sclerosis. Breathe (Sheff) 2023; 19:220269. [PMID: 37830099 PMCID: PMC10567075 DOI: 10.1183/20734735.0269-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/20/2023] [Indexed: 10/14/2023] Open
Abstract
Motor neurone disease/amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder with no known cure, where death is usually secondary to progressive respiratory failure. Assisting people with ALS through their disease journey is complex and supported by clinics that provide comprehensive multidisciplinary care (MDC). This review aims to apply both a respiratory and a complexity lens to the key roles and areas of practice within the MDC model in ALS. Models of noninvasive ventilation care, and considerations in the provision of palliative therapy, respiratory support, and speech and language therapy are discussed. The impact on people living with ALS of both inequitable funding models and the complexity of clinical care decisions are illustrated using case vignettes. Considerations of the impact of emerging antisense and gene modifying therapies on MDC challenges are also highlighted. The review seeks to illustrate how MDC members contribute to collective decision-making in ALS, how the sum of the parts is greater than any individual care component or health professional, and that the MDC per se adds value to the person living with ALS. Through this approach we hope to support clinicians to navigate the space between what are minimum, guideline-driven, standards of care and what excellent, person-centred ALS care that fully embraces complexity could be. Educational aims To highlight the complexities surrounding respiratory care in ALS.To alert clinicians to the risk that complexity of ALS care may modify the effectiveness of any specific, evidence-based therapy for ALS.To describe the importance of person-centred care and shared decision-making in optimising care in ALS.
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Affiliation(s)
- David J. Berlowitz
- The University of Melbourne, Parkville, Australia
- Institute for Breathing and Sleep, Heidelberg, Australia
- Department of Physiotherapy, Austin Health, Heidelberg, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Australia
| | - Susan Mathers
- Calvary Health Care Bethlehem, Caulfield South, Australia
- School of Clinical Sciences, Monash University, Clayton, Australia
| | - Karen Hutchinson
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Central Coast Local Health District, Gosford, Australia
| | - Anne Hogden
- School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Kate A. Carey
- The University of Melbourne, Parkville, Australia
- Institute for Breathing and Sleep, Heidelberg, Australia
| | - Marnie Graco
- The University of Melbourne, Parkville, Australia
- Institute for Breathing and Sleep, Heidelberg, Australia
| | - Brooke-Mai Whelan
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Salma Charania
- Motor Neurone Disease Association of Queensland, Oxley, Australia
| | - Frederik Steyn
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Peter Allcroft
- Southern Adelaide Palliative Services, Flinders Medical Centre, Bedford Park, Australia
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Ashley Crook
- Graduate School of Health, University of Technology Sydney, Chippendale, Australia
- Centre for MND Research and Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Nicole L. Sheers
- The University of Melbourne, Parkville, Australia
- Institute for Breathing and Sleep, Heidelberg, Australia
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Essat M, Coates E, Clowes M, Beever D, Hackney G, White S, Stavroulakis T, Halliday V, McDermott C. Understanding the current nutritional management for people with amyotrophic lateral sclerosis - A mapping review. Clin Nutr ESPEN 2022; 49:328-340. [DOI: 10.1016/j.clnesp.2022.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 02/17/2022] [Accepted: 03/13/2022] [Indexed: 11/16/2022]
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Francis R, Attrill S, Doeltgen S. The impact of cognitive decline in amyotrophic lateral sclerosis on swallowing. A scoping review. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 23:604-613. [PMID: 33779439 DOI: 10.1080/17549507.2021.1894235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose: Impaired swallowing is a serious symptom of amyotrophic lateral sclerosis (ALS) impacting on health and wellbeing. Little is known about how cognitive impairment in amyotrophic lateral sclerosis impacts on oropharyngeal swallowing. A scoping review was undertaken to explore how cognitive impairment impacts on a person living with ALS's (plwALS) ability to understand and manage oropharyngeal swallowing function.Method: Subject headings and keywords were searched across MEDLINE, SCOPUS, CINAHL, PsychINFO, Emcare and Google Scholar in May 2019. Articles containing information on amyotrophic lateral sclerosis and cognition and swallowing were reviewed. A secondary search was conducted in July 2020 with broadened search terms.Result: The primary search identified 1055 articles, and 47 were included for full-text review. Of these, no articles directly met the inclusion criteria of both cognitive impairment and swallowing. The secondary search with broadened terms identified an additional 762 studies, and 9 were included for full-text review, but none met the inclusion criteria. Consequently, thematic analysis was completed on articles from the full-text review to identify themes that related to both cognition and swallowing. The themes identified were: (i) early specialised multidisciplinary management of ALS achieves better outcomes; (ii) cognitive impairment impacts on management; and (iii) impaired swallowing occurs in nearly all people living with ALS and is a serious symptom of the disease.Conclusion: The interaction between cognitive impairment and oropharyngeal swallowing function in ALS has not been investigated. This is important, as cognitive impairment impacts insight and decision-making and may have implications for oropharyngeal swallowing management.
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Affiliation(s)
- Rebecca Francis
- Speech Pathology, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Swallowing Neurorehabilitation Research Laboratory, Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Stacie Attrill
- Speech Pathology, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Sebastian Doeltgen
- Speech Pathology, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Swallowing Neurorehabilitation Research Laboratory, Caring Futures Institute, Flinders University, Adelaide, Australia
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Erdmann A, Spoden C, Hirschberg I, Neitzke G. The wish to die and hastening death in amyotrophic lateral sclerosis: A scoping review. BMJ Support Palliat Care 2021; 11:271-287. [PMID: 33397660 PMCID: PMC8380909 DOI: 10.1136/bmjspcare-2020-002640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/05/2020] [Accepted: 11/18/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) develops into a life-threatening condition 2 to 4 years after the onset of symptoms. Although many people with the disease decide in favour of life-sustaining measures, thoughts about hastening death are not uncommon. OBJECTIVES Our aim was to examine the scope of literature on the wish to die in ALS and provide an insight into determinants and motives for different end-of-life options. METHODS We searched eight databases for English and German publications on death wishes in ALS for the period from 2008 to 2018 and updated the search up to May 2020. After the screening process, 213 full texts were included for the final analysis. We analysed the texts in MAXQDA, using deductively and inductively generated codes. RESULTS We identified end-of-life considerations, ranging from wishes to die without hastening death, to options with the possibility or intention of hastening death. Besides physical impairment, especially psychosocial factors, socio-demographic status and socio-cultural context have a great impact on decisions for life-shortening options. There is huge variation in the motives and determinants for end-of-life considerations between individuals, different societies, healthcare and legal systems. CONCLUSIONS For a variety of reasons, the information and counselling provided on different options for sustaining life or hastening death is often incomplete and insufficient. Since the motives and determinants for the wish to hasten death are extremely diverse, healthcare professionals should investigate the reasons, meaning and strength of the desire to die to detect unmet needs and examine which interventions are appropriate in each individual case.
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Affiliation(s)
- Anke Erdmann
- Institute for History, Ethics and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
- Institute for Experimental Medicine, Medical Ethics Working Group, Kiel University, Kiel, Germany
| | - Celia Spoden
- Institute for History, Ethics and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
| | - Irene Hirschberg
- Institute for History, Ethics and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
| | - Gerald Neitzke
- Institute for History, Ethics and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
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Young C, Pinto S, Grosskreutz J, Hardiman O, Clawson LL, Cudkowicz ME, Andrews JA. Medical therapies for amyotrophic lateral sclerosis-related respiratory decline: an appraisal of needs, opportunities and obstacles. Amyotroph Lateral Scler Frontotemporal Degener 2021; 23:66-75. [PMID: 34392765 DOI: 10.1080/21678421.2021.1920981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A roundtable convened in July 2020 examined issues concerning respiratory support in amyotrophic lateral sclerosis (ALS), with reference to the potential for an early-phase orally administered medication that might either postpone the introduction of noninvasive ventilation (NIV) and/or enhance the benefits to be gained from it. Attention was also given to the impact of the COVID-19 pandemic on usual practice in the assessment and management of ALS-related respiratory difficulties. Implementation of NIV marks a step-change in clinical status for patients and a major increase in burden for caregivers. All means to ease this transition should be explored: an oral therapy that supported respiratory function and patients' independence and sense of well-being would aid discussions to facilitate the eventual successful introduction of NIV. Assessment of a candidate oral therapy that might support respiratory function in ALS patients would be aided by the development of improved patient-reported outcome measures for robust quantification of treatment effect and quality of life. Such instruments could also be used to monitor patients' status during the COVID-19 pandemic, averting some of the risks of face-to-face assessment plus the patient burden and costs of traditional methods. Several oral candidate therapies have recently failed to meet their primary endpoints in clinical trials. However, understanding of the underlying physiology and appropriate trial design have grown and will inform future developments in this field.
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Affiliation(s)
- Carolyn Young
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Susana Pinto
- Translational and Clinical Physiology Unit, Instituto de Medicina Molecular, University of Lisbon, Lisbon, Portugal
| | | | - Orla Hardiman
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
| | - Lora L Clawson
- Department of Neurology, School of Medicine , Johns Hopkins University , Baltimore, MD , USA
| | | | - Jinsy A Andrews
- Neurological Institute of New York, Columbia University, New York, NY, USA
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13
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Costello E, Rooney J, Pinto-Grau M, Burke T, Elamin M, Bede P, McMackin R, Dukic S, Vajda A, Heverin M, Hardiman O, Pender N. Cognitive reserve in amyotrophic lateral sclerosis (ALS): a population-based longitudinal study. J Neurol Neurosurg Psychiatry 2021; 92:460-465. [PMID: 33563807 DOI: 10.1136/jnnp-2020-324992] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/08/2021] [Accepted: 01/10/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is often associated with cognitive and/or behavioural impairment. Cognitive reserve (CR) may play a protective role in offsetting cognitive impairment. This study examined the relationship between CR and longitudinal change in cognition in an Irish ALS cohort. METHODS Longitudinal neuropsychological assessment was carried out on 189 patients over 16 months using the Edinburgh cognitive and behavioural ALS screen (ECAS) and an additional battery of neuropsychological tests. CR was measured by combining education, occupation and physical activity data. Joint longitudinal and time-to-event models were fitted to investigate the associations between CR, performance at baseline and decline over time while controlling for non-random drop-out. RESULTS CR was a significant predictor of baseline neuropsychological performance, with high CR patients performing better than those with medium or low CR. Better cognitive performance in high CR individuals was maintained longitudinally for ECAS, social cognition, executive functioning and confrontational naming. Patients displayed little cognitive decline over the course of the study, despite controlling for non-random drop-out. CONCLUSIONS These findings suggest that CR plays a role in the presentation of cognitive impairment at diagnosis but is not protective against cognitive decline. However, further research is needed to examine the interaction between CR and other objective correlates of cognitive impairment in ALS.
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Affiliation(s)
- Emmet Costello
- Department of Psychology, Beaumont Hospital, Dublin 9, Ireland .,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - James Rooney
- Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland.,Institute and Clinic for Occupational, Social- and Environmental Medicine, University Hospital, Munich, Germany
| | - Marta Pinto-Grau
- Department of Psychology, Beaumont Hospital, Dublin 9, Ireland.,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Tom Burke
- Department of Psychology, Beaumont Hospital, Dublin 9, Ireland.,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Marwa Elamin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Peter Bede
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Roisin McMackin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Stefan Dukic
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland.,Department of Neurology, University Medical Centre Utrecht Brain Centre, Utrecht, The Netherlands
| | - Alice Vajda
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Mark Heverin
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
| | - Niall Pender
- Department of Psychology, Beaumont Hospital, Dublin 9, Ireland.,Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Dublin 2, Ireland
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14
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Poletti B, Carelli L, Lunetta C, Ticozzi N, Silani V. Advance care planning and mental capacity in ALS: a current challenge for an unsolved matter. Neurol Sci 2020; 41:2997-2998. [PMID: 32435995 DOI: 10.1007/s10072-020-04462-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 05/07/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Barbara Poletti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy.
| | - Laura Carelli
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, 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
| | - 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
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15
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Stavrou M, Newton J, Stott G, Colville S, Chandran S, Abrahams S, Pal S, Davenport R. National audit of cognitive assessment in people with pwMND A national audit of cognitive assessment in people with motor neurone disease (pwMND) in Scotland. Amyotroph Lateral Scler Frontotemporal Degener 2020; 21:459-462. [PMID: 32308027 PMCID: PMC7497277 DOI: 10.1080/21678421.2020.1752249] [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: 10/31/2022]
Abstract
Cognitive and behavioral abnormalities are recognized as an integral part of Motor Neurone Disease (MND) and occur at all stages of the disease. The early detection of cognitive and behavioral symptoms in MND is critical. Such symptoms are only reported when we explicitly ask, evaluate, document, and assess. In the National Institute for Health and Care Excellence (NICE) MND guideline (2016), formal cognitive and behavioral assessment is incorporated in MND management and is fundamental to providing appropriate care to pwMND. Cognition is explicitly stated in 14 separate recommendations in the guidelines. The NICE guidelines therefore constitute pre-defined standards which we audited. This audit highlights that health professionals increasingly recognize the significance of cognitive screening in MND and follow more structured approaches in implementing this compared to previous years.
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Affiliation(s)
- Maria Stavrou
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK.,Euan Macdonald Centre of MND Research, Edinburgh, UK.,Anne Rowling Regenerative Neurology Clinic, Edinburgh, UK.,Centre of Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK, and
| | - Judith Newton
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK.,Euan Macdonald Centre of MND Research, Edinburgh, UK.,Anne Rowling Regenerative Neurology Clinic, Edinburgh, UK.,Centre of Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK, and
| | - Gill Stott
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
| | - Shuna Colville
- Euan Macdonald Centre of MND Research, Edinburgh, UK.,Anne Rowling Regenerative Neurology Clinic, Edinburgh, UK.,Centre of Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK, and
| | - Siddharthan Chandran
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK.,Euan Macdonald Centre of MND Research, Edinburgh, UK.,Anne Rowling Regenerative Neurology Clinic, Edinburgh, UK.,Centre of Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK, and.,Clinical Audit Research and Evaluation for Motor Neurone Disease, Scotland, UK
| | - Sharon Abrahams
- Euan Macdonald Centre of MND Research, Edinburgh, UK.,Anne Rowling Regenerative Neurology Clinic, Edinburgh, UK.,Centre of Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK, and
| | - Suvankar Pal
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK.,Euan Macdonald Centre of MND Research, Edinburgh, UK.,Anne Rowling Regenerative Neurology Clinic, Edinburgh, UK.,Centre of Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK, and.,Clinical Audit Research and Evaluation for Motor Neurone Disease, Scotland, UK
| | - Richard Davenport
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK.,Euan Macdonald Centre of MND Research, Edinburgh, UK.,Anne Rowling Regenerative Neurology Clinic, Edinburgh, UK.,Centre of Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK, and.,Clinical Audit Research and Evaluation for Motor Neurone Disease, Scotland, UK
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16
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Labra J, Hogden A, Power E, James N, Flood VM. Gastrostomy uptake in motor neurone disease: a mixed-methods study of patients' decision making. BMJ Open 2020; 10:e034751. [PMID: 32102824 PMCID: PMC7045239 DOI: 10.1136/bmjopen-2019-034751] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Gastrostomy decision making is a complicated, multifaceted process for people with motor neuron disease (MND). This study explored demographic and disease-related factors that may impact on gastrostomy uptake; and reasons why people with MND accepted or declined gastrostomy, with a focus on how perceptions of swallowing and nutrition may influence decision making. DESIGN Prospective, cross sectional, mixed methods. SETTING An Australian multidisciplinary, specialty MND Service. PARTICIPANTS 33 patients were recommended gastrostomy by the treating medical specialist. 16 of 33 were invited to participate in the prospective decision making study; of whom 10 provided informed consent. PRIMARY AND SECONDARY OUTCOME MEASURES Demographic and disease-related factors contributing to uptake are described. A stepped approach was applied to gain a comprehensive understanding of why people with MND accept or decline gastrostomy. Instruments included standardised assessments, nutrition survey and semistructured interview. Data were collected at three separate appointments, spanning a 3-week period. RESULTS Gastrostomy uptake was 73% following medical specialist recommendation. Participants took days, weeks or months to consider their preferences, with lengthy hospital waiting times for the procedure. Gender, site of onset and rate of disease progression were observed to contribute to uptake. Age and symptom duration did not. Integration of quantitative and qualitative data suggests that patient perceptions of swallowing and nutrition contribute to gastrostomy acceptance; however, the decision making process is heterogeneous and these factors may not be the sole or primary reasons for acceptance. Other reported factors included: reducing carer burden, improving quality of life, increasing independence, continuing participation in social outings and gaining control. CONCLUSIONS Future research may give greater insight into how healthcare organisations can better facilitate gastrostomy decision making, to meet the needs of people living with MND. Larger, prospective, multisite studies may build on these findings to better inform clinical guidelines and minimise the impacts of delayed gastrostomy insertion.
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Affiliation(s)
- Julie Labra
- Motor Neurone Disease Service, St Joseph's Hospital, Auburn, New South Wales, Australia
| | - Anne Hogden
- Australian Institute of Health Service Management, University of Tasmania, Sydney, New South Wales, Australia
| | - Emma Power
- Speech Pathology, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Natalie James
- Speech Pathology Department, St Joseph's Hospital, Auburn, New South Wales, Australia
| | - Victoria M Flood
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Research and Education Network, Westmead Hospital, Western Sydney Local Health District, Westmead, New South Wales, Australia
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17
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Paynter C, Cruice M, Mathers S, Gregory H, Vogel AP. Communication and cognitive impairments and health care decision making in MND: A narrative review. J Eval Clin Pract 2019; 25:1182-1192. [PMID: 31282612 DOI: 10.1111/jep.13219] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/22/2019] [Accepted: 06/04/2019] [Indexed: 12/12/2022]
Abstract
RATIONALE Motor neurone disease (MND) is a neurodegenerative disease presenting with progressive weakness of voluntary muscles. For any condition, person-centred health care relies on the sharing of information and a mutual understanding of the person's needs and preferences. Decision making in MND becomes more complex as there is no cure and a high prevalence of co-morbid communication and/or cognitive difficulties. OBJECTIVE To identify the reported impact of communication and/or cognitive impairment on patient and carer involvement in health care decision making in MND. METHODS A review and synthesis of studies addressing issues of communication impairment and/or cognitive impairment in relation to decision making focussed on MND was conducted. Articles were excluded if they were reviews, case studies, conference papers, or commentaries. To be included studies needed to address issues of communication impairment or cognitive impairment specifically in relation to decision making. Relevant data were extracted verbatim and subjected to content analysis to support the narrative summary. RESULTS Seventy-six articles were identified, and 35 articles screened. Six articles met inclusion criteria each describing examples of decision making in MND. There was limited data related to communication and/or cognitive impairment, and the impact these impairments may have on decision making despite recognition that many people with MND may lose verbal communication or develop subtle cognitive impairments. The literature is primarily from the perspective of others. CONCLUSION This review highlights that the current body of literature exploring decision making within the MND population presents us with extremely limited insights into the impact of communication and/or cognitive impairments on health care decision making. Extant literature focuses on interventions (namely, ventilation and gastrostomy), the broad process of decision making, or cognitive assessment of decision-making ability. Whilst most studies acknowledge that deficits in communication or cognition impact the decision-making process, this issue is not the focus of any study.
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Affiliation(s)
- Camille Paynter
- Centre for Neuroscience of Speech, University of Melbourne, Carlton, Victoria, Australia
| | - Madeline Cruice
- Division of Language and Communication Sciences, City, University of London, London, UK
| | - Susan Mathers
- Statewide Progressive Neurological Disease Service, Calvary Health Care Bethlehem, Melbourne, Victoria, Australia.,School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Heidi Gregory
- Statewide Progressive Neurological Disease Service, Calvary Health Care Bethlehem, Melbourne, Victoria, Australia.,Department of Palliative Care, University of Notre Dame, Melbourne, Victoria, Australia
| | - Adam P Vogel
- Centre for Neuroscience of Speech, University of Melbourne, Carlton, Victoria, Australia.,Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, Tubingen, Germany.,Science Department, Redenlab, Melbourne, Victoria, Australia
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18
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Hodgins F, Mulhern S, Abrahams S. The clinical impact of the Edinburgh Cognitive and Behavioural ALS Screen (ECAS) and neuropsychological intervention in routine ALS care. Amyotroph Lateral Scler Frontotemporal Degener 2019; 21:92-99. [DOI: 10.1080/21678421.2019.1674874] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Faith Hodgins
- Psychology, School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Edinburgh, UK,
- Euan MacDonald Centre, University of Edinburgh, Edinburgh, UK
| | - Sharon Mulhern
- Neuropsychology & Neurorehabilitation, Ayreshire Central Hospital, Irvine, UK, and
| | - Sharon Abrahams
- Psychology, School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Edinburgh, UK,
- Euan MacDonald Centre, University of Edinburgh, Edinburgh, UK
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19
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Baxter SK, Johnson M, Clowes M, O’Brien D, Norman P, Stavroulakis T, Bianchi S, Elliott M, McDermott C, Hobson E. Optimizing the noninvasive ventilation pathway for patients with amyotrophic lateral sclerosis/motor neuron disease: a systematic review. Amyotroph Lateral Scler Frontotemporal Degener 2019; 20:461-472. [DOI: 10.1080/21678421.2019.1627372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
| | | | | | | | | | | | - Stephen Bianchi
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK, and
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20
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Gorrie GH, Chandran S, Colville S, Newton J, Leighton D, Mcdonald M, Pal S, Forbes R, Hair M, Swingler R. Improved survival and 30-day mortality after gastrostomy in Scottish motor neurone disease patients: evidence from a national retrospective cohort study using STROBE criteria. Amyotroph Lateral Scler Frontotemporal Degener 2019; 20:165-171. [PMID: 30835562 DOI: 10.1080/21678421.2019.1570271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: Defining historical changes and outcomes in the use of gastrostomy in the management of Scottish MND patients. Methods: The 1989-1998 and 2015-2016 Scottish national MND cohorts were used to examine the frequency, timing, and survival related to gastrostomy. The cohorts were censored for survival analysis. Results: There were 261 cases, 119 (46%) from the new register (2015-2016) and 142 (54%) from the old register (1989-1999). Percutaneous endoscopic gastrostomy (PEG) tubes were used exclusively in the old register vs. the new register where PEG (45%), Radiologically inserted gastrostomy (RIG) (44%) and a small number of peroral image-guided gastrostomy (PIGG) tubes (11%), p < 0.01 were used. Odds of 30-d mortality in the old register were 2.8 times that in the new register, p < 0.01. Median survival time from gastrostomy was significantly higher in the new register, 2.7 months, p < 0.05. Median survival time from onset was also higher in the new register but non-significant, 3.2 months, p = 0.30. Multivariate analysis identified age at onset (hazard ratio [HR] 1.02 p = 0.01), time from onset to diagnosis (HR 0.74 p < 0.01), subtype of onset (HR 1.52 p = 0.01), with gastrostomy and Riluzole interacting as variables that predict risk of death. Conclusions: Gastrostomy use has increased with techniques changing over time. It is safer and survival time has increased post gastrostomy. Being older and diagnosed more quickly increases risk of death whilst taking Riluzole combined with gastrostomy reduced risk of death. Survival from onset has not significantly changed in Scottish MND patients having gastrostomy.
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Affiliation(s)
- George H Gorrie
- a Department of Neurology, Institute of Neurological Sciences , Queen Elizabeth University Hospital , Glasgow , UK
| | - Siddharthan Chandran
- b Centre for Clinical Brain Sciences , The University of Edinburgh , Edinburgh , UK
| | - Shuna Colville
- c Anne Rowling Regenerative Neurology Clinic , The University of Edinburgh, Edinburgh , UK
| | - Judith Newton
- c Anne Rowling Regenerative Neurology Clinic , The University of Edinburgh, Edinburgh , UK
| | - Danielle Leighton
- b Centre for Clinical Brain Sciences , The University of Edinburgh , Edinburgh , UK
| | - Menai Mcdonald
- a Department of Neurology, Institute of Neurological Sciences , Queen Elizabeth University Hospital , Glasgow , UK
| | - Suvankar Pal
- b Centre for Clinical Brain Sciences , The University of Edinburgh , Edinburgh , UK
| | - Raeburn Forbes
- d 4 Department of Neurology , Southern HSC Trust, Craigavon Area Hospital , Craigavon , UK , and
| | - Mario Hair
- a Department of Neurology, Institute of Neurological Sciences , Queen Elizabeth University Hospital , Glasgow , UK
| | - Robert Swingler
- e 5 Department of Neurology , Ealing Hospital , Southall, UK
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21
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Oliver DJ. Palliative care in motor neurone disease: where are we now? Palliat Care 2019; 12:1178224218813914. [PMID: 30718958 PMCID: PMC6348498 DOI: 10.1177/1178224218813914] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 10/16/2018] [Indexed: 12/12/2022] Open
Abstract
Palliative care has a very important role in the care of patients with motor neurone disease and their families. There is increasing emphasis on the multidisciplinary assessment and support of patients within guidelines, supported by research. This includes the telling of the diagnosis, the assessment and management of symptoms, consideration of interventions, such as gastrostomy and ventilatory support, and care at the end of life. The aim of palliative care is to enable patients, and their families, to maintain as good a quality of life as possible and helping to ensure a peaceful death.
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22
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Clare L, Teale JC, Toms G, Kudlicka A, Evans I, Abrahams S, Goldstein LH, Hindle JV, Ho AK, Jahanshahi M, Langdon D, Morris R, Snowden JS, Davies R, Markova I, Busse M, Thompson-Coon J. Cognitive rehabilitation, self-management, psychotherapeutic and caregiver support interventions in progressive neurodegenerative conditions: A scoping review. NeuroRehabilitation 2019; 43:443-471. [DOI: 10.3233/nre-172353] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Linda Clare
- Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
- PenCLAHRC, University of Exeter Medical School, Exeter, UK
- Centre for Research Excellence in Cognitive Health, Australian National University, Canberra City, ACT, Australia
| | | | - Gill Toms
- Wales School for Social Care Research, Bangor University, Bangor, Wales, UK
| | - Aleksandra Kudlicka
- Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
- PenCLAHRC, University of Exeter Medical School, Exeter, UK
| | - Isobel Evans
- Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
| | - Sharon Abrahams
- Psychology-PPLS and Euan MacDonald Centre for Motor Neurone Disease Research, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Laura H. Goldstein
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - John V. Hindle
- Centre for Research in Ageing and Cognitive Health, University of Exeter, Exeter, UK
| | - Aileen K. Ho
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | | | - Dawn Langdon
- Department of Psychology, Royal Holloway University of London, London, UK
| | - Robin Morris
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Julie S. Snowden
- Cerebral Function Unit, Salford Royal NHS Foundation Trust, Salford, UK
| | - Rhys Davies
- Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Ivana Markova
- Hull York Medical School, University of Hull, Hull, UK
| | - Monica Busse
- School of Medicine, Cardiff University, Cardiff, Wales, UK
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23
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Stage at which riluzole treatment prolongs survival in patients with amyotrophic lateral sclerosis: a retrospective analysis of data from a dose-ranging study. Lancet Neurol 2018. [PMID: 29525492 PMCID: PMC5899963 DOI: 10.1016/s1474-4422(18)30054-1] [Citation(s) in RCA: 157] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background Riluzole is the only drug to prolong survival for amyotrophic lateral sclerosis (ALS) and, at a dose of 100 mg, was associated with a 35% reduction in mortality in a clinical trial. A key question is whether the survival benefit occurs at an early stage of disease, late stage, or is spread throughout the course of the disease. To address this question, we used the King's clinical staging system to do a retrospective analysis of data from the original dose-ranging clinical trial of riluzole. Methods In the original dose-ranging trial, patients were enrolled between December, 1992, and November, 1993, in Belgium, France, Germany, Spain, Canada, the USA, and the UK if they had probable or definite ALS as defined by the El Escorial criteria. The censor date for the riluzole survival data was set as the original study end date of Dec 31, 1994. For this analysis, King's clinical ALS stage was estimated from the electronic case record data of the modified Norris scale, UK Medical Research Council score for muscle strength, El Escorial category, vital capacity, and gastrostomy insertion data. The lowest allocated stage was 2 because the original trial only included patients with probable or definite ALS. We used a χ2 test to assess the independence of stage at trial enrolment and treatment group, Kaplan-Meier product limit distribution to test the transition from each stage to subsequent stages, and Cox regression to confirm an effect of treatment group on time in stage, controlling for covariates. We did sensitivity analyses by combining treatment groups, using alternative strategies to stage, stratifying by stage at trial enrolment, and using multistate outcome analysis of treatments (MOAT). Findings We analysed the case records of all 959 participants from the original dose-ranging trial, 237 assigned to 50 mg/day riluzole, 236 to 100 mg/day, 244 to 200 mg/day, and 242 to daily placebo. Clinical stage at enrolment did not significantly differ between treatment groups (p=0·22). Time in stage 4 was longer for patients receiving 100 mg/day riluzole than for those receiving placebo (hazard ratio [HR] 0·55, 95% CI 0·36–0·83; log-rank p=0·037). Combining treatment groups and stratifying by stage at enrolment showed a similar result (HR 0·638, 95% CI 0·464–0·878; p=0·006), as did analysis with MOAT where the mean number of days spent in stage 4 was numerically higher for patients given riluzole at higher doses compared with patients receiving placebo. Time from stages 2 or 3 to subsequent stages or death did not differ between riluzole treatment groups and placebo (p=0·83 for stage 2 and 0·88 for stage 3). Interpretation We showed that riluzole prolongs survival in the last clinical stage of ALS; this finding needs to be confirmed in a prospective study, and treatment effects at stage 1 still need to be analysed. The ALS stage at which benefit occurs is important for counselling of patients before starting treatment. Staging should be used in future ALS clinical trials to assess the stage at which survival benefit occurs, and a similar approach could be used for other neurodegenerative diseases. Funding NIHR Maudsley Biomedical Research Centre, The European Union Joint Programme on Neurodegeneration, and the King's Summer Undergraduate Studentship.
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24
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Crockford C, Newton J, Lonergan K, Madden C, Mays I, O'Sullivan M, Costello E, Pinto-Grau M, Vajda A, Heverin M, Pender N, Al-Chalabi A, Hardiman O, Abrahams S. Measuring reliable change in cognition using the Edinburgh Cognitive and Behavioural ALS Screen (ECAS). Amyotroph Lateral Scler Frontotemporal Degener 2017; 19:65-73. [PMID: 29214872 PMCID: PMC6510059 DOI: 10.1080/21678421.2017.1407794] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: Cognitive impairment affects approximately 50% of people with amyotrophic lateral sclerosis (ALS). Research has indicated that impairment may worsen with disease progression. The Edinburgh Cognitive and Behavioural ALS Screen (ECAS) was designed to measure neuropsychological functioning in ALS, with its alternate forms (ECAS-A, B, and C) allowing for serial assessment over time. Objective: The aim of the present study was to establish reliable change scores for the alternate forms of the ECAS, and to explore practice effects and test-retest reliability of the ECAS’s alternate forms. Method: Eighty healthy participants were recruited, with 57 completing two and 51 completing three assessments. Participants were administered alternate versions of the ECAS serially (A-B-C) at four-month intervals. Intra-class correlation analysis was employed to explore test-retest reliability, while analysis of variance was used to examine the presence of practice effects. Reliable change indices (RCI) and regression-based methods were utilized to establish change scores for the ECAS alternate forms. Results: Test-retest reliability was excellent for ALS Specific, ALS Non-Specific, and ECAS Total scores of the combined ECAS A, B, and C (all > .90). No significant practice effects were observed over the three testing sessions. RCI and regression-based methods produced similar change scores. Conclusion: The alternate forms of the ECAS possess excellent test-retest reliability in a healthy control sample, with no significant practice effects. The use of conservative RCI scores is recommended. Therefore, a change of ≥8, ≥4, and ≥9 for ALS Specific, ALS Non-Specific, and ECAS Total score is required for reliable change.
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Affiliation(s)
- Christopher Crockford
- a Department of Psychology, Human Cognitive Neuroscience , University of Edinburgh , Edinburgh , UK.,b Euan MacDonald Centre for Motor Neurone Disease Research , Royal Infirmary of Edinburgh , Edinburgh , UK
| | - Judith Newton
- a Department of Psychology, Human Cognitive Neuroscience , University of Edinburgh , Edinburgh , UK.,c Anne Rowling Regenerative Neurology Clinic , Royal Infirmary of Edinburgh , Edinburgh , UK
| | - Katie Lonergan
- d Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland.,e Department of Psychology , Beaumont Hospital , Dublin , Ireland
| | - Caoifa Madden
- d Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland.,e Department of Psychology , Beaumont Hospital , Dublin , Ireland
| | - Iain Mays
- d Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland.,e Department of Psychology , Beaumont Hospital , Dublin , Ireland
| | - Meabhdh O'Sullivan
- d Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland
| | - Emmet Costello
- d Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland.,e Department of Psychology , Beaumont Hospital , Dublin , Ireland
| | - Marta Pinto-Grau
- d Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland.,e Department of Psychology , Beaumont Hospital , Dublin , Ireland
| | - Alice Vajda
- d Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland
| | - Mark Heverin
- d Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland
| | - Niall Pender
- e Department of Psychology , Beaumont Hospital , Dublin , Ireland
| | - Ammar Al-Chalabi
- f Department of Basic and Clinical Neuroscience , Maurice Wohl Clinical Neuroscience Institute, King's College London , London , UK , and
| | - Orla Hardiman
- d Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland.,g Department of Neurology , Beaumont Hospital , Dublin , Ireland
| | - Sharon Abrahams
- a Department of Psychology, Human Cognitive Neuroscience , University of Edinburgh , Edinburgh , UK.,b Euan MacDonald Centre for Motor Neurone Disease Research , Royal Infirmary of Edinburgh , Edinburgh , UK.,c Anne Rowling Regenerative Neurology Clinic , Royal Infirmary of Edinburgh , Edinburgh , UK
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Foley G, Hynes G. Decision-making among patients and their family in ALS care: a review. Amyotroph Lateral Scler Frontotemporal Degener 2017; 19:173-193. [DOI: 10.1080/21678421.2017.1353099] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Geraldine Foley
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Ireland, and
| | - Geralyn Hynes
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
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Danel-Brunaud V, Touzet L, Chevalier L, Moreau C, Devos D, Vandoolaeghe S, Defebvre L. Ethical considerations and palliative care in patients with amyotrophic lateral sclerosis: A review. Rev Neurol (Paris) 2017; 173:300-307. [PMID: 28479121 DOI: 10.1016/j.neurol.2017.03.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 03/15/2017] [Accepted: 03/28/2017] [Indexed: 12/12/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is not a curable disease, but it is treatable. By definition, much of the care provided to ALS patients is palliative, even though active life-sustaining strategies are available to prolong survival. Healthcare professionals must develop communication skills that help patients cope with the inexorable progression of the disease and the inevitability of death. Symptomatic treatments as well as respiratory insufficiency and nutritional life-sustaining therapies must be regularly evaluated as the disease progresses, without losing sight of the burden placed on the patient's non-professional caregivers. The decision-making process regarding tracheostomy with invasive ventilation (TIV) is of greater complexity. Providing full information is crucial. Several long interviews are necessary to explain, discuss and allow assimilation of the information. Also, physicians should be careful not to focus exclusively on the biomedical aspects of disease, as ALS patients generally welcome the opportunity to discuss end-of-life issues with their physicians. Psychological factors, education level and cognitive status (especially the level of executive dysfunction) have a major influence on their decisions. However, as many patients do not complete advance directives with regard to TIV, advance care planning may instead be suggested in anticipation of emergency interventions. This should be discussed by healthcare professionals and the patient, and based on the wishes of the patient and caregiver(s), and communicated to all healthcare professionals. Many healthcare professionals are involved in the management of an ALS patient: they include not only those at ALS centers who provide diagnosis, follow-up and treatment initiation (particularly for respiratory and nutritional care), but also the medical and social care networks involved in disability support and home care. Specialist palliative care teams can work in partnership with ALS centers early in the course of the disease, with the center coordinating information-sharing and collaborative discussions.
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Affiliation(s)
- V Danel-Brunaud
- Université de Lille, Faculté de Médecine, Lille, France; Service de Neurologie et Pathologie du Mouvement, CHRU de Lille, Avenue du Professeur Emile Laine, 59037 Lille, France; Espace Éthique Hospitalier et Universitaire, CHRU de Lille, Avenue du Professeur Emile Laine, 59037 Lille, France.
| | - L Touzet
- Service de Soins Palliatifs, CHRU de Lille, Avenue du Professeur Emile Laine, 59037 Lille, France
| | - L Chevalier
- Service de Soins Palliatifs, CHRU de Lille, Avenue du Professeur Emile Laine, 59037 Lille, France
| | - C Moreau
- Université de Lille, Faculté de Médecine, Lille, France; Service de Neurologie et Pathologie du Mouvement, CHRU de Lille, Avenue du Professeur Emile Laine, 59037 Lille, France; Troubles cognitifs, dégénératifs et vasculaires, INSERM U1171, Lille, France
| | - D Devos
- Université de Lille, Faculté de Médecine, Lille, France; Troubles cognitifs, dégénératifs et vasculaires, INSERM U1171, Lille, France; Service de Pharmacologie Médicale, CHU de Lille, Avenue du Professeur Emile Laine, 59037 Lille, France
| | - S Vandoolaeghe
- Espace Éthique Hospitalier et Universitaire, CHRU de Lille, Avenue du Professeur Emile Laine, 59037 Lille, France
| | - L Defebvre
- Université de Lille, Faculté de Médecine, Lille, France; Service de Neurologie et Pathologie du Mouvement, CHRU de Lille, Avenue du Professeur Emile Laine, 59037 Lille, France; Troubles cognitifs, dégénératifs et vasculaires, INSERM U1171, Lille, France
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Keller J, Krimly A, Bauer L, Schulenburg S, Böhm S, Aho-Özhan HEA, Uttner I, Gorges M, Kassubek J, Pinkhardt EH, Abrahams S, Ludolph AC, Lulé D. A first approach to a neuropsychological screening tool using eye-tracking for bedside cognitive testing based on the Edinburgh Cognitive and Behavioural ALS Screen. Amyotroph Lateral Scler Frontotemporal Degener 2017; 18:443-450. [DOI: 10.1080/21678421.2017.1313869] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jürgen Keller
- Department of Neurology, University of Ulm, Ulm, Germany and
| | - Amon Krimly
- Department of Neurology, University of Ulm, Ulm, Germany and
| | - Lisa Bauer
- Department of Neurology, University of Ulm, Ulm, Germany and
| | | | - Sarah Böhm
- Department of Neurology, University of Ulm, Ulm, Germany and
| | | | - Ingo Uttner
- Department of Neurology, University of Ulm, Ulm, Germany and
| | - Martin Gorges
- Department of Neurology, University of Ulm, Ulm, Germany and
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany and
| | | | - Sharon Abrahams
- Human Cognitive Neuroscience-PPLS, Centre for Cognitive Ageing and Cognitive Epidemiology, Euan MacDonald Centre for Motor Neuron Disease Research, and Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, Edinburgh, UK
| | | | - Dorothée Lulé
- Department of Neurology, University of Ulm, Ulm, Germany and
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29
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Keller J, Gorges M, Aho-Özhan HEA, Uttner I, Schneider E, Kassubek J, Pinkhardt EH, Ludolph AC, Lulé D. Eye-Tracking Control to Assess Cognitive Functions in Patients with Amyotrophic Lateral Sclerosis. J Vis Exp 2016. [PMID: 27768047 DOI: 10.3791/54634] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder with pathological involvement of upper and lower motoneurons, subsequently leading to progressive loss of motor and speech abilities. In addition, cognitive functions are impaired in a subset of patients. To evaluate these potential deficits in severely physically impaired ALS patients, eye-tracking is a promising means to conduct cognitive tests. The present article focuses on how eye movements, an indirect means of communication for physically disabled patients, can be utilized to allow for detailed neuropsychological assessment. The requirements, in terms of oculomotor parameters that have to be met for sufficient eye-tracking in ALS patients are presented. The properties of stimuli, including type of neuropsychological tests and style of presentation, best suited to successfully assess cognitive functioning, are also described. Furthermore, recommendations regarding procedural requirements are provided. Overall, this methodology provides a reliable, easy to administer and fast approach for assessing cognitive deficits in patients who are unable to speak or write such as patients with severe ALS. The only confounding factor might be deficits in voluntary eye movement control in a subset of ALS patients.
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Affiliation(s)
| | | | | | | | - Erich Schneider
- Institute of Medical Technology, Brandenburg University of Technology Cottbus-Senftenberg
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30
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Kettemann D, Funke A, Maier A, Rosseau S, Meyer R, Spittel S, Münch C, Meyer T. Clinical characteristics and course of dying in patients with amyotrophic lateral sclerosis withdrawing from long-term ventilation. Amyotroph Lateral Scler Frontotemporal Degener 2016; 18:53-59. [PMID: 27534566 DOI: 10.1080/21678421.2016.1214734] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Non-invasive ventilation (NIV) or tracheotomy with invasive ventilation (TIV) are treatment options in ALS. However, a proportion of patients receiving long-term ventilation decide to have it withdrawn. The objective of this study was to analyse the clinical characteristics and palliative approaches in ALS patients withdrawing from long-term ventilation (WLTV). In a cohort study, two different palliative concepts in WLTV were studied: (1) augmented symptom control (ASC; sedation not intended) in patients with ventilator-free tolerance; (2) continuous deep sedation (CDS; sedation intended) in patients without ventilator-free tolerance. Results showed that WLTV was realised in 49 ALS patients (NIV = 13; TIV = 36). Mean daily ventilation was 23.4 h. The ALS Functional Rating Scale (ALSFRS-R) was low (5.6 of 48). Forty-one per cent of patients (n = 20) presented with ophthalmoplegia. ASC was performed in 20 patients, CDS in 29 patients. The mean time to death following disconnection was 32 (0.3-164) h during ASC and 0.3 (0.2-0.6) h in CDS. In conclusion, a low ALSFRS-R, high incidence of ophthalmoplegia and extended ventilator dependency were found before WLTV. The presence or absence of ventilator-free tolerance determined the approach to the management of symptoms, the setting for immediate end-of-life care and the course of dying in WLTV.
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Affiliation(s)
- Dagmar Kettemann
- a Charité - Universitätsmedizin Berlin , Department of Neurology, Outpatient Clinic for ALS and other Motor Neuron Disorders , Berlin and
| | - Andreas Funke
- a Charité - Universitätsmedizin Berlin , Department of Neurology, Outpatient Clinic for ALS and other Motor Neuron Disorders , Berlin and
| | - André Maier
- a Charité - Universitätsmedizin Berlin , Department of Neurology, Outpatient Clinic for ALS and other Motor Neuron Disorders , Berlin and
| | - Simone Rosseau
- b Charité - Universitätsmedizin Berlin , Department of Infectious Diseases and Pulmonary Medicine , Berlin , Germany
| | - Robert Meyer
- a Charité - Universitätsmedizin Berlin , Department of Neurology, Outpatient Clinic for ALS and other Motor Neuron Disorders , Berlin and
| | - Susanne Spittel
- a Charité - Universitätsmedizin Berlin , Department of Neurology, Outpatient Clinic for ALS and other Motor Neuron Disorders , Berlin and
| | - Christoph Münch
- a Charité - Universitätsmedizin Berlin , Department of Neurology, Outpatient Clinic for ALS and other Motor Neuron Disorders , Berlin and
| | - Thomas Meyer
- a Charité - Universitätsmedizin Berlin , Department of Neurology, Outpatient Clinic for ALS and other Motor Neuron Disorders , Berlin and
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Martin NH, Lawrence V, Murray J, Janssen A, Higginson I, Lyall R, Burman R, Leigh PN, Al-Chalabi A, Goldstein LH. Decision Making About Gastrostomy and Noninvasive Ventilation in Amyotrophic Lateral Sclerosis. QUALITATIVE HEALTH RESEARCH 2016; 26:1366-1381. [PMID: 25918114 DOI: 10.1177/1049732315583661] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We used thematic analysis to investigate factors affecting decision making about gastrostomy and noninvasive ventilation (NIV) by people with Amyotrophic Lateral Sclerosis (ALS) from the viewpoint of the health care professionals (HCPs) supporting them. We conducted 20 in-depth interviews with 19 HCPs nominated by people with ALS who had made a decision to accept or decline NIV or gastrostomy. We found the main themes influencing decision making were patient-centric, caregiver-related or related to HCPs' own beliefs, perspectives, and actions. HCPs felt patients should be, and were, in control of decision making, although caregivers and HCPs played a role. The patient's evaluation of quality of life, the desirability of prolonging life, and acceptance of the disease and its progression by both patient and caregiver were the most important factors identified by HCPs. HCPs should be aware of the importance of multiprofessional discussions, and the potential influences (identified above) that might require discussion with patients and caregivers.
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Affiliation(s)
| | | | | | | | | | - Rebecca Lyall
- King's College Hospital NHS Foundation Trust, London, United Kingdom
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32
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Faull C, Oliver D. Withdrawal of ventilation at the request of a patient with motor neurone disease: guidance for professionals: Table 1. BMJ Support Palliat Care 2016; 6:144-6. [DOI: 10.1136/bmjspcare-2016-001139] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 05/05/2016] [Indexed: 12/12/2022]
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33
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Nutrition with Gastrostomy Feeding Tubes for Amyotrophic Lateral Sclerosis in Canada. Can J Neurol Sci 2016; 43:796-800. [DOI: 10.1017/cjn.2016.28] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AbstractBackground: Amyotrophic lateral sclerosis (ALS) is a rapidly progressing degenerative motor neuron disease that results in significant muscle weakness. Defects in energy metabolism and difficulties in swallowing eventually lead to a reduction in body mass. Weight loss exacerbates symptoms and serves as an independent negative prognostic factor. Percutaneous endoscopic gastrostomy (PEG) is often inserted in patients with ALS to either supplement or replace oral feeding. However, the criteria for PEG placement and timing of insertion are important clinical decisions that have not been fully studied. Given the absence of guiding evidence, the aim of this project was to better understand how Canadian ALS clinics make decisions regarding gastrostomy feeding. Methods: ALS clinical directors across Canada were asked if they had written guidelines for timing of PEG insertion and if not, what criteria they use to make this decision. Responses from 10 of 17 centres contacted were received. Results: The approach to supplemental nutrition management in Canadian clinics varies in the absence of formal guidelines. Only one centre has a written set of centre-specific protocols in place. Most clinics considered some combination of respiratory decline, weight loss, dysphagia and/or patient readiness when reaching a decision. However, the absolute threshold and mechanism of measuring the individual criteria differed between clinics. Conclusions: Practices generally reflect international published recommendations but vary on the emphasis of specific criteria. Further research is required to determine the optimal timing and criteria to place gastrostomy feeding tubes in the ALS population.
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Hsieh S, Caga J, Leslie FVC, Shibata M, Daveson N, Foxe D, Ramsey E, Lillo P, Ahmed RM, Devenney E, Burrell JR, Hodges JR, Kiernan MC, Mioshi E. Cognitive and Behavioral Symptoms in ALSFTD: Detection, Differentiation, and Progression. J Geriatr Psychiatry Neurol 2016; 29:3-10. [PMID: 26251110 DOI: 10.1177/0891988715598232] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 04/29/2015] [Indexed: 11/16/2022]
Abstract
Brief screening tools that detect and differentiate patients with amyotrophic lateral sclerosis and frontotemporal dementia (ALSFTD) from those more subtle cognitive or behavioral symptoms (ALS plus) and motor symptoms only (ALS pure) is pertinent in a clinical setting. The utility of 2 validated and data-driven tests (Mini-Addenbrooke's Cognitive Examination [M-ACE] and Motor Neuron Disease Behavioral Scale [MiND-B]) was investigated in 70 ALS patients (24 ALSFTD, 19 ALS plus, and 27 ALS pure). More than 90% of patients with ALSFTD scored at or below the cutoff on the M-ACE, whereas this was seen in only about 20% of ALS patients without dementia. The MiND-B differentiated between ALS pure and ALS plus diagnostic categories. Rasch modeling of M-ACE and MiND-B items revealed early cognitive (fluency, memory recall) and behavioral (apathy) symptoms in ALSFTD. The combined use of the M-ACE and MiND-B detects patients with ALSFTD, differentiates along the ALS continuum, and offers insight into the progression of nonmotor symptomatology in ALSFTD.
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Affiliation(s)
- Sharpley Hsieh
- Brain and Mind Research Institute, Sydney, New South Wales, Australia Neuroscience Research Australia, Sydney, New South Wales, Australia ARC Centre of Excellence in Cognition and its Disorders, University of New South Wales, Sydney, New South Wales, Australia
| | - Jashelle Caga
- Brain and Mind Research Institute, Sydney, New South Wales, Australia
| | | | - Marlene Shibata
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Naomi Daveson
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - David Foxe
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - Eleanor Ramsey
- Brain and Mind Research Institute, Sydney, New South Wales, Australia
| | - Patricia Lillo
- Departamento de Neurología Sur, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Rebekah M Ahmed
- Brain and Mind Research Institute, Sydney, New South Wales, Australia Neuroscience Research Australia, Sydney, New South Wales, Australia Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Emma Devenney
- Brain and Mind Research Institute, Sydney, New South Wales, Australia Neuroscience Research Australia, Sydney, New South Wales, Australia Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - James R Burrell
- Neuroscience Research Australia, Sydney, New South Wales, Australia Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - John R Hodges
- Neuroscience Research Australia, Sydney, New South Wales, Australia ARC Centre of Excellence in Cognition and its Disorders, University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew C Kiernan
- Brain and Mind Research Institute, Sydney, New South Wales, Australia
| | - Eneida Mioshi
- Neuroscience Research Australia, Sydney, New South Wales, Australia Department of Psychiatry, Cambridge University, Cambridge, United Kingdom
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Eye-tracking controlled cognitive function tests in patients with amyotrophic lateral sclerosis: a controlled proof-of-principle study. J Neurol 2015; 262:1918-26. [PMID: 26041615 DOI: 10.1007/s00415-015-7795-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 05/19/2015] [Accepted: 05/21/2015] [Indexed: 10/23/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) primarily affects motor and speech abilities. In addition, cognitive functions are impaired in a subset of patients. There is a need to establish an eye movement-based method of neuropsychological assessment suitable for severely physically impaired patients with ALS. Forty-eight ALS patients and thirty-two healthy controls matched for age, sex and education performed a hand and speech motor-free version of the Raven's coloured progressive matrices (CPM) and the D2-test which had been especially adapted for eye-tracking control. Data were compared to a classical motor-dependent paper-pencil version. The association of parameters of the eye-tracking and the paper-pencil version of the tests and the differences between and within groups were studied. Subjects presented similar results in the eye-tracking and the corresponding paper-pencil versions of the CPM and D2-test: a correlation between performance accuracy for the CPM was observed for ALS patients (p < 0.001) and controls (p < 0.001) and in the D2-test for controls (p = 0.048), whereas this correlation did not reach statistical significance for ALS patients (p = 0.096). ALS patients performed worse in the CPM than controls in the eye-tracking (p = 0.053) and the paper-pencil version (p = 0.042). Most importantly, eye-tracking versions of the CPM (p < 0.001) and the D2-test (p = 0.024) reliably distinguished between more and less cognitively impaired patients. Eye-tracking-based neuropsychological testing is a promising approach for assessing cognitive deficits in patients who are unable to speak or write such as patients with severe ALS.
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36
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Connolly S, Galvin M, Hardiman O. End-of-life management in patients with amyotrophic lateral sclerosis. Lancet Neurol 2015; 14:435-42. [PMID: 25728958 DOI: 10.1016/s1474-4422(14)70221-2] [Citation(s) in RCA: 124] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Most health-care professionals are trained to promote and maintain life and often have difficulty when faced with the often rapid decline and death of people with terminal illnesses such as amyotrophic lateral sclerosis (ALS). By contrast, data suggest that early and open discussion of end-of-life issues with patients and families allows time for reflection and planning, can obviate the introduction of unwanted interventions or procedures, can provide reassurance, and can alleviate fear. Patients' perspectives regarding end-of-life interventions and use of technologies might differ from those of the health professionals involved in their care, and health-care professionals should recognise this and respect the patient's autonomy. Advance care directives can preserve autonomy, but their legal validity and use varies between countries. Clinical management of the end of life should aim to maximise quality of life of both the patient and caregiver and, when possible, incorporate appropriate palliation of distressing physical, psychosocial, and existential distress. Training of health-care professionals should include the development of communication skills that help to sensitively manage the inevitability of death. The emotional burden for health-care professionals caring for people with terminal neurological disease should be recognised, with structures and procedures developed to address compassion, fatigue, and the moral and ethical challenges related to providing end-of-life care.
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Affiliation(s)
- Sheelah Connolly
- Academic Unit of Neurology, Trinity College Dublin, Trinity Biomedical Sciences Institute, 152-160 Pearse Street, Dublin 2, Republic of Ireland.
| | - Miriam Galvin
- School of Nursing and Human Sciences, Dublin City University, Glasnevin, Dublin 9, Republic of Ireland
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity College Dublin, Trinity Biomedical Sciences Institute, 152-160 Pearse Street, Dublin 2, Republic of Ireland; Department of Neurology, Beaumont Hospital, Beaumont Road, Dublin 9, Republic of Ireland
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37
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Accepting or declining non-invasive ventilation or gastrostomy in amyotrophic lateral sclerosis: patients’ perspectives. J Neurol 2015; 262:1002-13. [DOI: 10.1007/s00415-015-7665-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 01/31/2015] [Accepted: 02/02/2015] [Indexed: 12/12/2022]
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