1
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Erb MK, Calcagno N, Brown R, Burke KM, Scheier ZA, Iyer AS, Clark A, Higgins MP, Keegan M, Gupta AS, Johnson SA, Chew S, Berry JD. Longitudinal comparison of the self-administered ALSFRS-RSE and ALSFRS-R as functional outcome measures in ALS. Amyotroph Lateral Scler Frontotemporal Degener 2024:1-11. [PMID: 38501453 DOI: 10.1080/21678421.2024.2322549] [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: 12/05/2023] [Accepted: 02/19/2024] [Indexed: 03/20/2024]
Abstract
Objective: Test the feasibility, adherence rates and optimal frequency of digital, remote assessments using the ALSFRS-RSE via a customized smartphone-based app. Methods: This fully remote, longitudinal study was conducted over a 24-week period, with virtual visits every 3 months and weekly digital assessments. 19 ALS participants completed digital assessments via smartphone, including a digital version of the ALSFRS-RSE and mood survey. Interclass correlation coefficients (ICC) and Bland-Altman plots were used to assess agreement between staff-administered and self-reported ALSFRS-R pairs. Longitudinal change was evaluated using ANCOVA models and linear mixed models, including impact of mood and time of day. Impact of frequency of administration of the ALSFRS-RSE on precision of the estimate slope was tested using a mixed effects model. Results: In our ALS cohort, digital assessments were well-accepted and adherence was robust, with completion rates of 86%. There was excellent agreement between the digital self-entry and staff-administered scores computing multiple ICCs (ICC range = 0.925-0.961), with scores on the ALSFRS-RSE slightly higher (1.304 points). Digital assessments were associated with increased precision of the slope, resulting in higher standardized response mean estimates for higher frequencies, though benefit appeared to diminish at biweekly and weekly frequency. Effects of participant mood and time of day on total ALSFRS-RSE score were evaluated but were minimal and not statistically significant. Conclusion: Remote collection of digital patient-reported outcomes of functional status such as the ALSFRS-RSE yield more accurate estimates of change over time and provide a broader understanding of the lived experience of people with ALS.
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Affiliation(s)
| | - Narghes Calcagno
- Department of Neurology, Massachusetts General Hospital, Sean M. Healey & AMG Center for ALS, Boston, MA, USA, and
- Neurology Residency Program, University of Milan, Milan, Italy
| | | | - Katherine M Burke
- Department of Neurology, Massachusetts General Hospital, Sean M. Healey & AMG Center for ALS, Boston, MA, USA, and
| | - Zoe A Scheier
- Department of Neurology, Massachusetts General Hospital, Sean M. Healey & AMG Center for ALS, Boston, MA, USA, and
| | - Amrita S Iyer
- Department of Neurology, Massachusetts General Hospital, Sean M. Healey & AMG Center for ALS, Boston, MA, USA, and
| | - Alison Clark
- Department of Neurology, Massachusetts General Hospital, Sean M. Healey & AMG Center for ALS, Boston, MA, USA, and
| | - Max P Higgins
- Department of Neurology, Massachusetts General Hospital, Sean M. Healey & AMG Center for ALS, Boston, MA, USA, and
| | - Mackenzie Keegan
- Department of Neurology, Massachusetts General Hospital, Sean M. Healey & AMG Center for ALS, Boston, MA, USA, and
| | - Anoopum S Gupta
- Department of Neurology, Massachusetts General Hospital, Sean M. Healey & AMG Center for ALS, Boston, MA, USA, and
| | - Stephen A Johnson
- Department of Neurology, Massachusetts General Hospital, Sean M. Healey & AMG Center for ALS, Boston, MA, USA, and
| | - Sheena Chew
- Biogen, Inc, Cambridge, MA, USA
- Department of Neurology, Massachusetts General Hospital, Sean M. Healey & AMG Center for ALS, Boston, MA, USA, and
| | - James D Berry
- Department of Neurology, Massachusetts General Hospital, Sean M. Healey & AMG Center for ALS, Boston, MA, USA, and
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2
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Mitsumoto H, Cheung K, Oskarsson B, Andrews HF, Jang GE, Andrews JA, Shah JS, Fernandes JA, McElhiney M, Santella RM. Randomized double-blind personalized N-of-1 clinical trial to test the safety and potential efficacy of TJ-68 for treating muscle cramps in amyotrophic lateral sclerosis (ALS): study protocol for a TJ-68 trial. Trials 2023; 24:449. [PMID: 37430314 DOI: 10.1186/s13063-023-07424-8] [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: 12/22/2022] [Accepted: 05/31/2023] [Indexed: 07/12/2023] Open
Abstract
INTRODUCTION/AIMS Muscle cramps are a common and often disabling symptom in amyotrophic lateral sclerosis (ALS), a devastating and incurable neurodegenerative disorder. To date, there are no medications specifically approved for the treatment of muscle cramps. Ameliorating muscle cramps in ALS may improve and sustain quality of life. A widely prescribed traditional Japanese (Kampo) medicine against muscle cramps, shakuyakukanzoto (TJ-68), has been studied in advanced liver disease, spinal stenosis, kidney failure, and diabetic neuropathy. The Japanese ALS Management Guideline mentions TJ-68 for difficult muscle cramps in ALS. Therefore, the rationale of our trial is to investigate the safety and effectiveness of TJ-68 in treating painful and disabling muscle cramps in people with ALS outside of Japan. Accordingly, we are conducting a randomized clinical trial to test the safety and efficacy of TJ-68 in participants with ALS reporting frequent muscle cramps using an innovative, personalized N-of-1 design. If successful, TJ-68 may be used for muscle cramps in a broader population of people with ALS. METHODS This is a two-site, double-blind, randomized personalized N-of-1 early clinical trial with TJ-68. At least 22 participants with ALS and daily muscle cramps will receive drug or placebo for 2 weeks (one treatment period) followed by a 1-week washout in a four-period cross-over design. While the primary objective is to evaluate the safety of TJ-68, the study has 85% power to detect a one-point shift on the Visual Analog Scale for Muscle Cramps Affecting Overall Daily Activity of the Columbia Muscle Cramp Scale (MCS). Secondary outcomes include the full MCS score, a Cramp Diary, Clinical Global Impression of Changes, Goal Attainment Scale, quality of life scale and ALS functional rating scale-revised (ALSFRS-R). DISCUSSION The study is underway. A personalized N-of-1 trial design is an efficient approach to testing medications that alleviate muscle cramps in rare disorders. If TJ-68 proves safe and efficacious then it may be used to treat cramps in ALS, and help to improve and sustain quality of life. TRIAL REGISTRATION This clinical trial has been registered with ClinicalTrials.gov (NCT04998305), 8/9/2021.
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Affiliation(s)
- Hiroshi Mitsumoto
- Department of Neurology, Columbia University Irving Medical Center, 710 West 186 St, New York, NY, 10032, USA.
| | - Ken Cheung
- Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 W 168Th St, New York, NY, 10032, USA
| | - Björn Oskarsson
- Department of Neurology, Mayo Clinic Jacksonville, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
| | - Howard F Andrews
- Data Coordinating Center (DCC) at New York State Psychiatric Institute and Columbia University, 722 W 168Th St, New York, NY, 10032, USA
| | - Grace E Jang
- Department of Neurology, Columbia University Irving Medical Center, 710 West 186 St, New York, NY, 10032, USA
| | - Jinsy A Andrews
- Department of Neurology, Columbia University Irving Medical Center, 710 West 186 St, New York, NY, 10032, USA
| | - Jaimin S Shah
- Department of Neurology, Mayo Clinic Jacksonville, 4500 San Pablo Rd S, Jacksonville, FL, 32224, USA
| | - Joseph Americo Fernandes
- Department of Neurology, University of Nebraska, 4242 Farnam Street, Suite 650, Omaha, NE, 68198, USA
| | - Martin McElhiney
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, 722 W 168Th St, New York, NY, 10032, USA
| | - Regina M Santella
- Department of Environmental Science, Mailman School of Public Health, Columbia University, 722 W 168Th St, New York, NY, 10032, USA
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3
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Maier A, Münch C, Meyer T. Der Einsatz von Patient-reported Outcome Measures (PROM) und die
Perspektive digitaler Biomarker bei der Amyotrophen
Lateralsklerose. KLIN NEUROPHYSIOL 2023. [DOI: 10.1055/a-2019-3500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
ZusammenfassungDie systematische Erfassung des klinischen Zustands sowie der Erfahrung mit
Behandlung oder Versorgung durch einen strukturierten Bericht des Patienten wird
als „Patient-reported Outcome Measures“ (PROM) bezeichnet. Bei
der Amyotrophen Lateralsklerose (ALS) haben sich PROM insbesondere zur
Dokumentation funktioneller Defizite, z. B. mit der ALS-Funktionsskala,
und weiterer komplexer Symptome im Rahmen von klinischer Forschung etabliert. In
der Behandlungspraxis werden PROM dazu genutzt, den Verlauf und die Prognose der
Erkrankung einzuschätzen. Mit PROM werden neue biologische Biomarker
(z. B. Neurofilamente) und digitale Biomarker (z. B. durch den
Einsatz von Sensorik) auf ihre patientenzentrierte Relevanz evaluiert. Durch die
digitale Anwendung von PROM und die Verknüpfung mit digitalen Biomarkern
kann eine engmaschigere Erhebung von zu Hause aus erfolgen und damit die
Datenqualität erhöht werden. Patienten können selbst den
Gesundheitszustand monitorieren sowie Behandlungs- und Versorgungsergebnisse
dokumentieren. Damit nehmen sie zunehmend eine aktive Rolle in der individuellen
Behandlung und Versorgung ein.
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Affiliation(s)
- André Maier
- Ambulanz für ALS und andere Motoneuronenenerkrankungen, Klinik
für Neurologie, Charité Universitätsmedizin Berlin,
Berlin, Germany
| | - Christoph Münch
- Ambulanz für ALS und andere Motoneuronenenerkrankungen, Klinik
für Neurologie, Charité Universitätsmedizin Berlin,
Berlin, Germany
- Ambulanzpartner Soziotechnologie APST GmbH, Berlin,
Germany
| | - Thomas Meyer
- Ambulanz für ALS und andere Motoneuronenenerkrankungen, Klinik
für Neurologie, Charité Universitätsmedizin Berlin,
Berlin, Germany
- Ambulanzpartner Soziotechnologie APST GmbH, Berlin,
Germany
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4
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Maier A, Boentert M, Reilich P, Witzel S, Petri S, Großkreutz J, Metelmann M, Lingor P, Cordts I, Dorst J, Zeller D, Günther R, Hagenacker T, Grehl T, Spittel S, Schuster J, Ludolph A, Meyer T. ALSFRS-R-SE: an adapted, annotated, and self-explanatory version of the revised amyotrophic lateral sclerosis functional rating scale. Neurol Res Pract 2022; 4:60. [PMID: 36522775 PMCID: PMC9753252 DOI: 10.1186/s42466-022-00224-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The ALS Functional Rating Scale in its revised version (ALSFRS-R) is a disease-specific severity score that reflects motor impairment and functional deterioration in people with amyotrophic lateral sclerosis (ALS). It has been widely applied in both clinical practice and ALS research. However, in Germany, several variants of the scale, each differing slightly from the others, have developed over time and are currently in circulation. This lack of uniformity potentially hampers data interpretation and may decrease item validity. Furthermore, shortcomings within the standard ALSFRS-R questions and answer options can limit the quality and conclusiveness of collected data. METHODS In a multistage consensus-building process, 18 clinical ALS experts from the German ALS/MND network analyzed the ALSFRS-R in its current form and created an adapted, annotated, and revised scale that closely adheres to the well-established standardized English version. RESULTS Ten German-language variants of the ALSFRS-R were collected, three of which contained instructions for self-assessment. All of these variants were compiled and a comprehensive linguistic revision was undertaken. A short introduction was added to the resulting scale, comprising general instructions for use and explanations for each of the five reply options per item. This adapted version of the scale, named ALSFRS-R-SE (with the "SE" referring to "self-explanatory"), was carefully reviewed for language and comprehensibility, in both German and English. CONCLUSION An adapted and annotated version of the ALSFRS-R scale was developed through a multistage consensus process. The decision to include brief explanations of specific scale items and reply options was intended to facilitate ALSFRS-R-SE assessments by both healthcare professionals and patients. Further studies are required to investigate the accuracy and utility of the ALSFRS-R-SE in controlled trials and clinical real-world settings.
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Affiliation(s)
- André Maier
- grid.6363.00000 0001 2218 4662Department of Neurology, Center for ALS and Other Motor Neuron Disorders, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Matthias Boentert
- grid.16149.3b0000 0004 0551 4246Department of Neurology, Universitätsklinikum Münster, Münster, Germany ,Department of Medicine, UKM-Marienhospital Steinfurt, Steinfurt, Germany
| | - Peter Reilich
- grid.411095.80000 0004 0477 2585Friedrich-Baur-Institut und Neurologische Klinik und Poliklinik, LMU Klinikum, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Simon Witzel
- grid.410712.10000 0004 0473 882XKlinik für Neurologie, Universitätsklinikum Ulm, Ulm, Germany
| | - Susanne Petri
- grid.10423.340000 0000 9529 9877Hannover Medical School, Department of Neurology, Hannover, Germany
| | - Julian Großkreutz
- grid.412468.d0000 0004 0646 2097Department of Neurology, Campus Lübeck, Universitätsmedizin Schleswig-Holstein, Lübeck, Germany
| | - Moritz Metelmann
- grid.411339.d0000 0000 8517 9062Department of Neurology, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Paul Lingor
- grid.15474.330000 0004 0477 2438Department of Neurology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Isabell Cordts
- grid.15474.330000 0004 0477 2438Department of Neurology, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Johannes Dorst
- grid.410712.10000 0004 0473 882XKlinik für Neurologie, Universitätsklinikum Ulm, Ulm, Germany
| | - Daniel Zeller
- grid.411760.50000 0001 1378 7891Department of Neurology, Universitätsklinikum Würzburg, Würzburg, Germany
| | - René Günther
- grid.4488.00000 0001 2111 7257Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany ,grid.424247.30000 0004 0438 0426DZNE, German Center for Neurodegenerative Diseases, Research Site Dresden, Dresden, Germany
| | - Tim Hagenacker
- grid.477805.90000 0004 7470 9004Klinik für Neurologie und Center for Translational Neuro- and Behavioral Science, Universitätsmedizin Essen, Essen, Germany
| | - Torsten Grehl
- grid.476313.4Department of Neurology, Centre for ALS and Other Motor Neuron Disorders, Alfried Krupp Krankenhaus, Essen, Germany
| | | | - Joachim Schuster
- grid.410712.10000 0004 0473 882XKlinik für Neurologie, Universitätsklinikum Ulm, Ulm, Germany ,grid.424247.30000 0004 0438 0426DZNE, German Centre for Neurodegenerative Diseases, Research Site Ulm, Ulm, Germany
| | - Albert Ludolph
- grid.410712.10000 0004 0473 882XKlinik für Neurologie, Universitätsklinikum Ulm, Ulm, Germany ,grid.424247.30000 0004 0438 0426DZNE, German Centre for Neurodegenerative Diseases, Research Site Ulm, Ulm, Germany
| | - Thomas Meyer
- grid.6363.00000 0001 2218 4662Department of Neurology, Center for ALS and Other Motor Neuron Disorders, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany ,Ambulanzpartner Soziotechnologie APST GmbH, Berlin, Germany
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5
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Fournier CN, James V, Glass JD. Clinically meaningful change: evaluation of the Rasch-built Overall Amyotrophic Lateral Sclerosis Disability Scale (ROADS) and the ALSFRS-R. Amyotroph Lateral Scler Frontotemporal Degener 2022; 24:311-316. [PMID: 36476010 DOI: 10.1080/21678421.2022.2153607] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To investigate clinically meaningful change for ROADS and ALSFRS-R using a patient-defined approach. METHODS Data were reviewed from participants assessed at the Emory ALS Center from 2019-2022 with two assessments using both ROADS and ALSFRS-R and a completed patient-reported global impression of change scale at the second visit. Minimal important difference (MID), or the smallest amount of change that is clinically relevant, was assessed based on patient reported impression of change for ROADS and ALSFRS-R. Minimal detectable change (MDC), the smallest amount of change exceeding the threshold for measurement error, was assessed for ROADS and ALSFRS-R using standard deviations for participants self-rated as "unchanged". RESULTS Data were included from 162 participants. For ROADS (total possible normed score = 146), MID = 5.81 and MDC = 2.83 points. For ALSFRS-R (total possible sum-score = 48), MID = 3.24 and MDC = 1.59 points. Clinically meaningful decline during the assessment period was observed in 98/162 (60.49%) participants on ROADS and 75/162 (46.30) participants on ALSFRS-R (OR = 1.63, 95% CI [1.0009, 2.66]). CONCLUSIONS Changes that are on average less than 5.81 points (3.98%) on the normed ROADS score or less than 3.24 points (6.75%) on the ALSFRS-R sum-score may not be clinically meaningful according to a patient-defined approach. Understanding the clinical and statistical limitations of these scales is crucial when designing and interpreting ALS research studies.
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Affiliation(s)
- Christina N. Fournier
- Emory University Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA and
- Department of Veterans Affairs, Atlanta VA Medical Center, Atlanta, GA, USA
| | - Virginia James
- Emory University Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA and
- Department of Veterans Affairs, Atlanta VA Medical Center, Atlanta, GA, USA
| | - Jonathan D. Glass
- Emory University Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA and
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6
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Mitsumoto H, Chiuzan C, Gilmore M, Zhang Y, Simmons Z, Paganoni S, Kisanuki YY, Zinman L, Jawdat O, Sorenson E, Floeter MK, Pioro EP, Fernandes Filho JAM, Heitzman D, Fournier CN, Oskarsson B, Heiman‐Patterson T, Maragakis N, Joyce N, Hayat G, Nations S, Scelsa S, Walk D, Elman L, Hupf J, McHale B. Primary lateral sclerosis (PLS) functional rating scale: PLS‐specific clinimetric scale. Muscle Nerve 2019; 61:163-172. [DOI: 10.1002/mus.26765] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/07/2019] [Accepted: 11/19/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Hiroshi Mitsumoto
- Department of Neurology, Eleanor and Lou Gehrig ALS CenterColumbia University Irvine Medical Center New York New York
| | - Codruta Chiuzan
- Department of BiostatisticsMailman School of Medicine, Columbia University New York New York
| | - Madison Gilmore
- Department of Neurology, Eleanor and Lou Gehrig ALS CenterColumbia University Irvine Medical Center New York New York
| | - Yuan Zhang
- Department of BiostatisticsMailman School of Medicine, Columbia University New York New York
| | - Zachary Simmons
- Department of NeurologyPennsylvania State University Hershey Pennsylvania
| | - Sabrina Paganoni
- Sean M. Healey & AMG Center for ALS, Department of NeurologyMassachusetts General Hospital Boston Massachusetts
- Department of Physical Medicine and RehabilitationSpaulding Rehabilitation Hospital, Harvard Medical School Boston Massachusetts
| | | | - Lorne Zinman
- Department of NeurologyUniversity of Toronto, Sunnybrook Hospital Toronto Ontario Canada
| | - Omar Jawdat
- Department of NeurologyUniversity of Kansas Kansas City Kansas
| | - Eric Sorenson
- Department of NeurologyMayo Clinic, Minnesota Rochester Minnesota
| | - Mary Kay Floeter
- Clinical Unit, National Institute of Neurological Diseases and Stroke Bethesda Maryland
| | - Erik P. Pioro
- Department of NeurologyCleveland Clinic Cleveland Ohio
| | | | | | | | - Bjorn Oskarsson
- Department of NeurologyMayo Clinic Jacksonville Jacksonville Florida
| | | | | | - Nanette Joyce
- Department of Neurology University of California Davis Davis California
| | - Ghazala Hayat
- Department of NeurologySt Louis University St Louis Missouri
| | - Sharon Nations
- Department of NeurologyUniversity of Texas Southwestern Dallas Texas
| | - Stephen Scelsa
- Department of NeurologyMount Sinai/Beth Israel Hospital New York New York
| | - David Walk
- Department of NeurologyUniversity of Minnesota Minneapolis Minnesota
| | - Lauren Elman
- Department of NeurologyUniversity of Pennsylvania Philadelphia Pennsylvania
| | - Jonathan Hupf
- Department of Neurology, Eleanor and Lou Gehrig ALS CenterColumbia University Irvine Medical Center New York New York
| | - Brittany McHale
- Department of Neurology, Eleanor and Lou Gehrig ALS CenterColumbia University Irvine Medical Center New York New York
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7
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Benbrika S, Desgranges B, Eustache F, Viader F. Cognitive, Emotional and Psychological Manifestations in Amyotrophic Lateral Sclerosis at Baseline and Overtime: A Review. Front Neurosci 2019; 13:951. [PMID: 31551700 PMCID: PMC6746914 DOI: 10.3389/fnins.2019.00951] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 08/22/2019] [Indexed: 12/11/2022] Open
Abstract
It is now well recognized that, in addition to motor impairment, amyotrophic lateral sclerosis (ALS) may cause extra-motor clinical signs and symptoms. These can include the alteration of certain cognitive functions, impaired social cognition, and changes in the perception and processing of emotions. Where these extra-motor manifestations occur in ALS, they usually do so from disease onset. In about 10% of cases, the cognitive and behavioral changes meet the diagnostic criteria for frontotemporal dementia. The timecourse of behavioral and cognitive involvement in ALS is unclear. Whereas longitudinal studies have failed to show cognitive decline over time, some cross-sectional studies have demonstrated poorer cognitive performances in the advanced stages of the disease. Neuroimaging studies show that in ALS, extra-motor signs and symptoms are associated with specific brain lesions, but little is known about how they change over time. Finally, patients with ALS appear less depressed than might be expected, given the prognosis. Moreover, many patients achieve satisfactory psychosocial adjustment throughout the course of the disease, regardless of their degree of motor disability. There are scant longitudinal data on extra-motor impairment in ALS, and to our knowledge, no systematic review on this subject has yet been published. Even so, a better understanding of patients' clinical trajectory is essential if they are to be provided with tailored care and given the best possible support. We therefore undertook to review the evidence for extra-motor changes and their time course in ALS, in both the cognitive, emotional and psychological domains, with a view to identifying mechanisms that may help these patients cope with their disease.
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Affiliation(s)
| | - Béatrice Desgranges
- Neuropsychology and Imaging of Human Memory, Normandy University-PSL Research University-EPHE-INSERM U1077, Caen University Hospital, Caen, France
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8
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Green JR, Allison KM, Cordella C, Richburg BD, Pattee GL, Berry JD, Macklin EA, Pioro EP, Smith RA. Additional evidence for a therapeutic effect of dextromethorphan/quinidine on bulbar motor function in patients with amyotrophic lateral sclerosis: A quantitative speech analysis. Br J Clin Pharmacol 2018; 84:2849-2856. [PMID: 30152872 PMCID: PMC6256051 DOI: 10.1111/bcp.13745] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/23/2018] [Accepted: 08/16/2018] [Indexed: 12/28/2022] Open
Abstract
Aims A recent double‐blind placebo‐controlled crossover 70‐day trial demonstrated that a fixed combination of dextromethorphan and quinidine (DM/Q) improves speech and swallowing function in most patients with amyotrophic lateral sclerosis. In this study, a subset of participants, many of whom did not substantially improve while on DM/Q, were re‐evaluated using computer‐based speech analyses and expert clinician ratings of the overall severity of speech impairment. Methods Speech samples were recorded from the subset of 10 patients at four visits made at approximately 30‐day intervals. The recordings were analysed by automated computer‐based analysis of speech pausing patterns. Severity of speech impairment was rated by three experienced speech‐language pathologists using direct magnitude estimation. Scores on patient‐reported and clinician‐administered scales of bulbar motor involvement were obtained at each visit. Results The effects of DM/Q were detected on several of the objective speech measures, including total pause duration (s) (Cohen's d = 0.73, 95% confidence interval (CI) –1.70, 0.24), pause time (%) (d = 0.77, 95% CI –1.75, 0.21), and mean speech event duration (s) (d = 0.52, 95% CI –0.44, 1.47), but not on clinician ratings of speech or the speech components of the self‐report or clinician‐administered scales. Conclusions These findings suggest that even patients with modest improvement while on DM/Q may experience quantifiable improvements in speech when assessed using sensitive and objective measures. This study provides additional evidence of the positive impact of DM/Q on one or more of the neural systems that control bulbar motor function and production of speech.
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Affiliation(s)
- Jordan R Green
- Speech and Feeding Disorders Lab, MGH Institute of Health Professions, Charlestown, MA, USA.,Program in Speech and Hearing Bioscience and Technology Program, Division of Medical Sciences, Harvard University, Boston, MA, USA
| | - Kristen M Allison
- Speech and Feeding Disorders Lab, MGH Institute of Health Professions, Charlestown, MA, USA.,Department of Communication Sciences and Disorders, Bouve College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Claire Cordella
- Speech and Feeding Disorders Lab, MGH Institute of Health Professions, Charlestown, MA, USA.,Program in Speech and Hearing Bioscience and Technology Program, Division of Medical Sciences, Harvard University, Boston, MA, USA
| | - Brian D Richburg
- Speech and Feeding Disorders Lab, MGH Institute of Health Professions, Charlestown, MA, USA
| | - Gary L Pattee
- Department of Neurology, University of Nebraska Medical College, Omaha, NE, USA
| | - James D Berry
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Eric A Macklin
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Erik P Pioro
- Department of Neurology, Cleveland Clinic Neuromuscular Center, Cleveland, OH, USA
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9
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Robison R, Tabor-Gray LC, Wymer JP, Plowman EK. Combined respiratory training in an individual with C9orf72 amyotrophic lateral sclerosis. Ann Clin Transl Neurol 2018; 5:1134-1138. [PMID: 30250869 PMCID: PMC6144454 DOI: 10.1002/acn3.623] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 06/20/2018] [Accepted: 06/27/2018] [Indexed: 12/11/2022] Open
Abstract
This case study examined the impact of a respiratory strength training program targeting inspiratory and expiratory musculature in an individual with C9orf72 amyotrophic lateral sclerosis (ALS). The individual tolerated 24 months of respiratory training completed at home, 50 repetitions per day, and 5 days per week. Significant increases in maximum inspiratory pressure (from 71 to 134 centimeters of water), maximum expiratory pressure (from 108 to 197 centimeters of water) and peak cough flow (from 331 to 655 Liters per minute) were noted and forced vital capacity remained unchanged. A moderate intensity respiratory strength training program applied early in the disease progression improved function in this C9orf72 ALS individual.
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Affiliation(s)
- Raele Robison
- Swallowing Systems Core University of Florida Gainesville Florida.,Speech, Language and Hearing Science Department University of Florida Gainesville Florida
| | - Lauren C Tabor-Gray
- Swallowing Systems Core University of Florida Gainesville Florida.,Speech, Language and Hearing Science Department University of Florida Gainesville Florida
| | - James P Wymer
- Department of Neurology University of Florida Gainesville Florida
| | - Emily K Plowman
- Swallowing Systems Core University of Florida Gainesville Florida.,Speech, Language and Hearing Science Department University of Florida Gainesville Florida.,Department of Neurology University of Florida Gainesville Florida
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10
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van der Kleij LA, Jones AR, Steen IN, Young CA, Shaw PJ, Shaw CE, Leigh PN, Turner MR, Al-Chalabi A. Regionality of disease progression predicts prognosis in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2015; 16:442-7. [DOI: 10.3109/21678421.2015.1051987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Lisa A. van der Kleij
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Ashley R. Jones
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - I Nick Steen
- Institute of Health and Society, University of Newcastle, UK
| | | | - Pamela J. Shaw
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
| | - Christopher E. Shaw
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - P. Nigel Leigh
- Brighton and Sussex Medical School, Trafford Centre for Biomedical Research, Falmer, Brighton, UK
| | - Martin R. Turner
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
| | - Ammar Al-Chalabi
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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Abstract
A variety of outcome measures are used in clinical practice and in research to assess patients with amyotrophic lateral sclerosis (ALS). However, there may be discordance between traditional outcome measures such as strength and physical function, and patient-perceived measures of well-being. One such self-perceived measure, reflecting the patient's view, is quality of life (QOL). QOL in patients with severe medical disorder is often underestimated by others. Patients with ALS often have high QOL, and this may persist throughout the disease due to shifting expectations and to reprioritization of factors contributing to QOL. QOL instruments can measure health-related QOL (HRQOL) or global QOL, and can be generic or disease-specific. HRQOL refers primarily to physical and mental health. Global QOL is much broader, and is also determined by non-health-related factors. The choice of a QOL instrument depends on whether the setting is routine patient care or clinical research, whether or not the outcome of a specific intervention is being assessed, and upon the expected efficacy or toxicity of the intervention. Global QOL instruments are best for individual clinical patient care or for comparing groups. HRQOL or a combination of HRQOL and global QOL instruments are most appropriate for assessing specific interventions.
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Affiliation(s)
- Zachary Simmons
- Department of Neurology, Penn State Hershey Medical Center, EC 037, Hershey, PA, 17033, USA,
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