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Mavroudis I, Alexiou P, Petridis F, Ciobica A, Balmus IM, Gireadă B, Gurzu IL, Novac O, Novac B. Patients' and caregivers' attitudes towards patient assisted suicide or euthanasia in amyotrophic lateral sclerosis-a meta-analysis. Acta Neurol Belg 2024:10.1007/s13760-024-02578-x. [PMID: 38758353 DOI: 10.1007/s13760-024-02578-x] [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: 01/02/2024] [Accepted: 05/10/2024] [Indexed: 05/18/2024]
Abstract
Assisted suicide and euthanasia are long debated topics in amyotrophic lateral sclerosis (ALS) patients care. We conducted a meta-analysis to evaluate the attitudes of ALS patients and their caregivers toward physician-assisted suicide (PAS) and euthanasia. Also, we were interested to identify the factors associated with the positive or negative attitude of patients and caregivers towards PAS/euthanasia. A thorough search of the online databases (PubMed, Cochrane Library, and Web of Science) was conducted and eligibility criteria according to the PRISMA guidelines were used to include the studies in the current meta-analysis. The assessment of the quality of the selected studies was carried out using a pre-specified set of criteria by Cochrane. The studies that were selected for this meta-analysis suggested that the expression of the wish to die is more likely correlated with depression, anxiety, hopelessness, and lack of optimism. The overall prevalence of considering PAS/euthanasia significantly varies in a dependent manner over the cultural, legal, and societal factors. In this context, we found that the opinion on this topic can be deeply personal and may vary widely among individuals and communities. Lower quality of life and lower religiosity were associated with a positive attitude toward PAS/euthanasia. On the other hand, patients who are more religious are less likely to choose PAS/euthanasia. Gender does not appear to play a significant role in determining attitudes towards PAS/euthanasia in ALS patients. Other factors, such as education and psychological state, could also be important. In conclusion, end-of-life decisions in ALS patients are complex and require careful consideration of individual values, beliefs, and preferences. Understanding the factors that influence a patient's attitude towards PAS/euthanasia can help healthcare providers to offer appropriate care and support for these patients and their families.
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Affiliation(s)
- Ioannis Mavroudis
- Department of Neuroscience, Leeds Teaching Hospitals, Leeds, UK
- Leeds University, Leeds, UK
| | - Pavlina Alexiou
- School of Theology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Foivos Petridis
- Third Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alin Ciobica
- Department of Biology, Faculty of Biology, Alexandru Ioan Cuza University of Iasi, Carol I Avenue, No. 20A, 700506, Iasi, Romania.
- Centre of Biomedical Research, Romanian Academy, Iasi Branch, Teodor Codrescu 2, 700481 , Iasi, Romania.
- Academy of Romanian Scientists, 3 Ilfov, 050044, Bucharest, Romania.
- ″Ioan Haulica″ Institute, Apollonia University, Păcurari Street 11, 700511, Iasi, Romania.
| | - Ioana Miruna Balmus
- Department of Exact Sciences and Natural Sciences, Institute of Interdisciplinary Research, Alexandru Ioan Cuza University of Iasi, Alexandru Lapusneanu Street, No. 26, 700057, Iasi, Romania
| | - Bogdan Gireadă
- Department of Medicine III, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 Universitătii Street, 700115, Iasi, Romania
- Institute of Psychiatry "Socola", 36 Bucium Street, 700282, Iasi, Romania
| | - Irina Luciana Gurzu
- Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 Universitătii Street, 700115, Iasi, Romania.
| | - Otilia Novac
- Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 Universitătii Street, 700115, Iasi, Romania
| | - Bogdan Novac
- Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 16 Universitătii Street, 700115, Iasi, Romania
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Jellinger KA. Understanding depression with amyotrophic lateral sclerosis: a short assessment of facts and perceptions. J Neural Transm (Vienna) 2024; 131:107-115. [PMID: 37922093 DOI: 10.1007/s00702-023-02714-6] [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: 09/14/2023] [Accepted: 10/19/2023] [Indexed: 11/05/2023]
Abstract
Depression with an average prevalence of 25-40% is a serious condition in amyotrophic lateral sclerosis (ALS) that can impact quality of life and survival of patients and caregiver burden, yet the underlying neurobiology is poorly understood. Preexisting depression has been associated with a higher risk of developing ALS, while people with ALS have a significantly higher risk of developing depression that can cause multiple complications. Depression may be a prodromal or subclinical symptom prior to motor involvement, although its relations with disease progression and impairment of quality of life are under discussion. Unfortunately, there are no studies existing that explore the pathogenic mechanisms of depression associated with the basic neurodegenerative process, and no specific neuroimaging data or postmortem findings for the combination of ALS and depression are currently available. Experience from other neurodegenerative processes suggests that depressive symptoms in ALS may be the consequence of cortical thinning in prefrontal regions and other cortex areas, disruption of mood-related brain networks, dysfunction of neurotransmitter systems, changing cortisol levels and other, hitherto unknown mechanisms. Treatment of both ALS and depression is a multidisciplinary task, depression generally being treated with a combination of antidepressant medication, physiotherapy, psychological and other interventions, while electroconvulsive therapy and deep brain stimulation might not be indicated in the majority of patients in view of their poor prognosis. Since compared to depression in other neurodegenerative diseases, our knowledge of its molecular basis in ALS is missing, multidisciplinary clinicopathological studies to elucidate the pathomechanism of depression in motor system disorders including ALS are urgently warranted.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150, Vienna, Austria.
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Hirayama T, Shibukawa M, Yanagihashi M, Warita H, Atsuta N, Yamanaka K, Kano O. Investigation of non-motor symptoms in patients with amyotrophic lateral sclerosis. Acta Neurol Belg 2023; 123:1797-1804. [PMID: 35987973 PMCID: PMC10505101 DOI: 10.1007/s13760-022-02036-6] [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: 04/07/2022] [Accepted: 07/14/2022] [Indexed: 11/01/2022]
Abstract
[Objective] Few studies have comprehensively investigated the non-motor symptoms of amyotrophic lateral sclerosis (ALS). We aimed to investigate this aspect of ALS. [Methods] We held a nationwide webinar, titled "ALS Café," and distributed self-report questionnaires to ALS patients. In addition to the frequency of non-motor symptoms such as fatigue, pain, sleep disorders, defecation disorders, sialorrhea, and sexual problems, we evaluated the quality of life (QoL), ALS Functional Rating Scale-Revised (ALSFRS-R), and Patient Health Questionnaire-9 (PHQ-9). [Results] The average age of the 33 respondents (19 male, 14 female) was 60.8 ± 11.2; 96.7% of respondents had some non-motor symptoms. The median ALSFRS-R was 32.0, and seven (21.2%) of the respondents had a PHQ-9 score of 10 or higher. Fatigue was the most common non-motor symptom (81.8%), followed by pain (60.6%), defecation disorders (57.6%), sleep disorders (48.5%), sialorrhea (48.5%), and sexual problems (24.2%). Fatigue was more frequent in females (P = 0.03). Among the non-motor symptoms, pain was the most common factor affecting QoL, followed by fatigue. More than 90% of ALS patients answered that they had never consulted a physician/counselor about sexual problems. Patients with pain had higher PHQ-9 scores than those without (P = 0.01). There was no correlation between the ALSFRS-R score and QoL and PHQ-9. [Conclusions] Most patients with amyotrophic lateral sclerosis had non-motor symptoms, and fatigue and pain were the most common. We showed that many non-motor symptoms affected QoL without correlating with ALSFRS-R score. Attention should be paid to those even if the motor symptoms of ALS are mild.
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Affiliation(s)
- Takehisa Hirayama
- Department of Neurology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Mari Shibukawa
- Department of Neurology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Masaru Yanagihashi
- Department of Neurology, Faculty of Medicine, Toho University, Tokyo, Japan
| | - Hitoshi Warita
- Department of Neurology, Tohoku University Hospital, Sendai, Japan
| | - Naoki Atsuta
- Department of Neurology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Koji Yamanaka
- Department of Neuroscience and Pathobiology, Research Institute of Environmental Medicine, Nagoya University, Nagoya, Japan
| | - Osamu Kano
- Department of Neurology, Faculty of Medicine, Toho University, Tokyo, Japan.
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Volpato E, Pierucci P, De Candia ML, Casparrini M, Volpi V, Pagnini F, Carpagnano GE, Banfi P. Life Experiences in Neuromuscular Tracheotomized Patients in Times of Covid-19. J Neuromuscul Dis 2023:JND221597. [PMID: 37212066 DOI: 10.3233/jnd-221597] [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: 05/23/2023]
Abstract
BACKGROUND The management of tracheotomy at home can be very complex, affecting the patient's quality of life. OBJECTIVES This case series study aimed to explore the experiences of patients affected by neuromuscular diseases (NMD) concerning tracheostomy and Invasive Mechanical Ventilation (IMV) management at home during the COVID-19 health emergency in Italy. METHODS Semi-structured interviews and the following instruments were used: Connor and Davidson Resilience Scale (CD-RISC-25); Acceptance and Action Questionnaire-II (AAQ-II); State-Trait Anxiety Inventory (STAI); Langer Mindfulness Scale (LMS). Descriptive analyses, correlations, and qualitative analyses were carried out. RESULTS 22 patients [50% female, mean age = 50.2 (SD = 21.2)] participated in the study. Participants who showed high levels of dispositional mindfulness in terms of novelty-seeking (r = 0.736, p = 0.013) and novelty production (r = 0.644, p = 0.033) were those with higher resilience. The main emotion that emerged was the fear of contagion (19 patients, 86.36%), due to the previous fragile condition, leading to a significant sense of abandonment. The tracheostomy's perception is seen in extremes as a lifesaver or a condemnation. The relationship with the health professionals moves from satisfaction to a feeling of abandonment with a lack of preparation. CONCLUSIONS The relationship between resilience, flexibility, state anxiety and dispositional mindfulness offers ways to reinforce tracheostomy management at home, even in critical periods when going to the hospital may be difficult.
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Affiliation(s)
- Eleonora Volpato
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Paola Pierucci
- Cardiothoracic Department, Respiratory and Critical care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Maria Luisa De Candia
- Cardiothoracic Department, Respiratory and Critical care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Massimo Casparrini
- Cardiothoracic Department, Respiratory and Critical care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | | | - Francesco Pagnini
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Giovanna Elisiana Carpagnano
- Cardiothoracic Department, Respiratory and Critical care Unit Bari Policlinic University Hospital, B. Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy
| | - Paolo Banfi
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
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Mazzola MA, Russell JA. Neurology ethics at the end of life. HANDBOOK OF CLINICAL NEUROLOGY 2023; 191:235-257. [PMID: 36599511 DOI: 10.1016/b978-0-12-824535-4.00012-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Ethical challenges in medical decision making are commonly encountered by clinicians caring for patients afflicted by neurological injury or disease at the end of life (EOL). In many of these cases, there are conflicting opinions as to what is right and wrong originating from multiple sources. There is a particularly high prevalence of impaired patient judgment and decision-making capacity in this population that may result in a misrepresentation of their premorbid values and goals. Conflict may originate from a discordance between what is legal or from stakeholders who view and value life and existence differently from the patient, at times due to religious or cultural influences. Promotion of life, rather than preservation of existence, is the goal of many patients and the foundation on which palliative care is built. Those who provide EOL care, while being respectful of potential cultural, religious, and legal stakeholder perspectives, must at the same time recognize that these perspectives may conflict with the optimal ethical course to follow. In this chapter, we will attempt to review some of the more notable ethical challenges that may arise in the neurologically afflicted at the EOL. We will identify what we believe to be the most compelling ethical arguments both in support of and opposition to specific EOL issues. At the same time, we will consider how ethical analysis may be influenced by these legal, cultural, and religious considerations that commonly arise.
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Viader F. La sclérose latérale amyotrophique : une maladie neurodégénérative emblématique. BULLETIN DE L'ACADÉMIE NATIONALE DE MÉDECINE 2023. [DOI: 10.1016/j.banm.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Chuang MH, Hsu JR, Hung CW, Hwang YL, Lee CC, Shen HY, Chang FK, Kuo LL, Chen SSS, Huang SJ. Factors affecting do-not-resuscitate decisions among patients with amyotrophic lateral sclerosis in Taiwan. PLoS One 2023; 18:e0282805. [PMID: 36913360 PMCID: PMC10010504 DOI: 10.1371/journal.pone.0282805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/22/2023] [Indexed: 03/14/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease. Usually, patients survive for approximately 2-4 years after the onset of the disease, and they often die of respiratory failure. This study examined the factors associated with signing a "do not resuscitate" (DNR) form in patients with ALS. This cross-sectional study included patients diagnosed with ALS between January 2015 and December 2019 in a Taipei City hospital. We recorded patients' age at disease onset; sex; presence of diabetes mellitus, hypertension, cancer, or depression; use of invasive positive pressure ventilator (IPPV) or non-IPPV (NIPPV); use of nasogastric tube (NG) or percutaneous endoscopic gastrostomy (PEG) tube; follow-up years; and number of hospitalizations. Data from 162 patients were recorded (99 men). Fifty-six (34.6%) signed a DNR. Multivariate logistic regression analyses revealed that the factors associated with DNR included NIPPV (OR = 6.95, 95% CI = 2.21-21.84), PEG tube feeding (OR = 2.86, 95% CI = 1.13-7.24), NG tube feeding (OR = 5.75, 95% CI = 1.77-18.65), follow-up years (OR = 1.13, 95% CI = 1.02-1.26), and number of hospital admissions (OR = 1.26, 95% CI = 1.02-1.57). The findings suggest that end-of-life decision making among patients with ALS may often be delayed. DNR decisions should be discussed with patients and their families during the early stages of disease progression. Physicians are advised to discuss DNR with patients when they can speak and to offer palliative care options.
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Affiliation(s)
- Mei-Hsing Chuang
- Division of Family Medicine, Taipei City Hospital Zhong Xiao Branch, Taipei, Taiwan
- Department of Family Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jiunn-Rong Hsu
- Division of Chest Medicine, Department of Internal Medicine, Taipei City Hospital Zhong Xiao Branch, Taipei, Taiwan
| | - Chia-Wei Hung
- Division of Neurology, Department of Internal Medicine, Taipei City Hospital Zhong Xiao Branch, Taipei, Taiwan
| | - Yu Long Hwang
- Division of Neurology, Department of Internal Medicine, Taipei City Hospital Zhong Xiao Branch, Taipei, Taiwan
| | - Chih-Ching Lee
- Division of Palliative Medicine, Department of Internal Medicine, Taipei City Hospital Zhong Xiao Branch, Taipei, Taiwan
| | - Hsiu-Yi Shen
- Department of Nursing, Taipei City Hospital Zhong Xiao Branch, Taipei, Taiwan
| | - Fu-Kang Chang
- Division of Chest Medicine, Department of Internal Medicine, Taipei City Hospital Zhong Xiao Branch, Taipei, Taiwan
- * E-mail:
| | - Li-Lin Kuo
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan
| | - Saint Shiou-Sheng Chen
- Division of Urology, Taipei City Hospital Zhong Xiao Branch, Taipei, Taiwan
- Department of Urology, National Yang Ming Chiao Tung University, School of Medicine, Taipei, Taiwan
- Commission for General Education, College of Applied Science, National Taiwan University of Science and Technology, Taipei, Taiwan
- General Education Center, University of Taipei, Taipei, Taiwan
| | - Sheng-Jean Huang
- Department of Surgery, College of Medicine, National Taiwan University, Taipei, Taiwan
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Hu N, Ji H. Medications on hypertension, hyperlipidemia, diabetes, and risk of amyotrophic lateral sclerosis: a systematic review and meta-analysis. Neurol Sci 2022; 43:5189-5199. [DOI: 10.1007/s10072-022-06131-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/11/2022] [Indexed: 02/06/2023]
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Chiò A, Canosa A, Calvo A, Moglia C, Cicolin A, Mora G. Developments in the assessment of non-motor disease progression in amyotrophic lateral sclerosis. Expert Rev Neurother 2021; 21:1419-1440. [PMID: 34554894 DOI: 10.1080/14737175.2021.1984883] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The burden of non-motor symptoms is a major determinant of quality of life and outcome in amyotrophic lateral sclerosis (ALS) and has profound negative effect also on caregivers. AREAS COVERED Non-motor symptoms in ALS include cognitive impairment, neurobehavioral symptoms, depression and anxiety, suicidal ideation, pain, disordered sleep, fatigue, weight loss and reduced appetite, and autonomic dysfunctions. This review summarizes the measures used for the assessment of non-motor symptoms and their properties and recaps the frequency and progression of these symptoms along the course of ALS. EXPERT OPINION Non-motor symptoms in ALS represent a major component of the disease and span over several domains. These symptoms require a high level of medical attention and should be checked at each visit using ad hoc questionnaires and proactively treated. Several instruments assessing non-motor symptoms have been used in ALS. Specific screening questionnaires for non-motor symptoms can be used for monitoring patients during telehealth visits and for remote surveillance through sensors and apps installed on smartphones. Novel trials for non-motor symptoms treatment specifically designed for ALS are necessary to increase and refine the therapeutic armamentarium. Finally, scales assessing the most frequent and burdensome non-motor symptoms should be included in clinical trials.
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Affiliation(s)
- Adriano Chiò
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,Neurology I, Azienda Ospedaliera Città Della Salute E Della Scienza of Turin, Turin, Italy
| | - Antonio Canosa
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,Neurology I, Azienda Ospedaliera Città Della Salute E Della Scienza of Turin, Turin, Italy
| | - Andrea Calvo
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,Neurology I, Azienda Ospedaliera Città Della Salute E Della Scienza of Turin, Turin, Italy
| | - Cristina Moglia
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,Neurology I, Azienda Ospedaliera Città Della Salute E Della Scienza of Turin, Turin, Italy
| | - Alessandro Cicolin
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.,Sleep Medicine Center, Azienda Ospedaliera Città Della Salute E Della Scienza of Turin, Turin, Italy
| | - Gabriele Mora
- Neurorehabilitation Department, Ics Maugeri Irccs, Institute of Milan, Milan, Italy
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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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Alam M, Yadav RK, Minj E, Tiwari A, Mehan S. Exploring Molecular Approaches in Amyotrophic Lateral Sclerosis: Drug Targets from Clinical and Pre-Clinical Findings. Curr Mol Pharmacol 2021; 14:263-280. [PMID: 32342825 DOI: 10.2174/1566524020666200427214356] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/24/2019] [Accepted: 12/26/2019] [Indexed: 11/22/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a fatal motor neuron disease (MND) characterized by the death of upper and lower motor neurons (corticospinal tract) in the motor cortex, basal ganglia, brain stem, and spinal cord. The patient experiences the sign and symptoms between 55 to 75 years of age, which include impaired motor movement, difficulty in speaking and swallowing, grip loss, muscle atrophy, spasticity, and sometimes associated with memory and cognitive impairments. Median survival is 3 to 5 years after diagnosis and 5 to 10% of the patients live for more than 10 years. The limited intervention of pharmacologically active compounds, that are used clinically, is majorly associated with the narrow therapeutic index. Pre-clinically established experimental models, where neurotoxin methyl mercury mimics the ALS like behavioural and neurochemical alterations in rodents associated with neuronal mitochondrial dysfunctions and downregulation of adenyl cyclase mediated cAMP/CREB, is the main pathological hallmark for the progression of ALS in central as well in the peripheral nervous system. Despite the considerable investigation into neuroprotection, it still constrains treatment choices to strong care and organization of ALS complications. Therefore, this current review specially targeted the investigation of clinical and pre-clinical features available for ALS to understand the pathogenic mechanisms and to explore the pharmacological interventions associated with the up-regulation of intracellular adenyl cyclase/cAMP/ CREB and activation of mitochondrial-ETC coenzyme-Q10 as a future drug target in the amelioration of ALS mediated motor neuronal dysfunctions.
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Affiliation(s)
- Mamtaj Alam
- Department of Pharmacology, ISF College of Pharmacy, Moga-142001, Punjab, India
| | - Rajeshwar K Yadav
- Department of Pharmacology, ISF College of Pharmacy, Moga-142001, Punjab, India
| | - Elizabeth Minj
- Department of Pharmacology, ISF College of Pharmacy, Moga-142001, Punjab, India
| | - Aarti Tiwari
- Department of Pharmacology, ISF College of Pharmacy, Moga-142001, Punjab, India
| | - Sidharth Mehan
- Department of Pharmacology, ISF College of Pharmacy, Moga-142001, Punjab, India
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Sharma G, Gujral JS, Agarwal A, Jat M, Mohanty S, Pandey RM. Exploring knowledge, attitude and practice regarding yoga among patients attending cardiology and neurology clinics in a tertiary care hospital in northern India. THE NATIONAL MEDICAL JOURNAL OF INDIA 2021; 34:201-205. [PMID: 35112541 DOI: 10.25259/nmji_11_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background The use of complementary and alternative medicine, particularly yoga is increasing in non-communicable diseases (NCDs). We assessed the overall awareness regarding yoga among patients and their opinion about it as an adjunct therapy for NCDs. Methods We included 384 patients attending the cardiology and neurology clinics at a tertiary care centre in northern India. A questionnaire was developed to assess the knowledge, attitude and practice of yoga as a therapy. Results Ninety per cent of patients were aware of yoga, mainly through print and electronic media. Of the surveyed patients, 22% practised yoga. Lack of time and knowledge were cited as the main reasons for non-practice among the non-practising patients (88%), of which 82% believed that yoga could be practised along with modern medicine. In addition, 61% were ready to accept treatment if offered at the surveyed tertiary care centre. Conclusions Adequate knowledge, awareness and attitude towards yoga appears to be present in contrast to the low practice among the patient population surveyed. If implemented in an integrated fashion, the patients were willing to accept yoga as an adjunct therapy for their cardiac and neurological disorders-an encouraging sign given the burden of NCDs in India.
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Affiliation(s)
- Gautam Sharma
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Jaskaran Singh Gujral
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Aman Agarwal
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Mansingh Jat
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Sriloy Mohanty
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - R M Pandey
- Centre for Integrative Medicine and Research, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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13
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Andersen PM, Kuźma-Kozakiewicz M, Keller J, Maksymowicz-Śliwińska A, Barć K, Nieporęcki K, Finsel J, Vazquez C, Helczyk O, Linse K, Häggström AC, Stenberg E, Semb O, Ciećwierska K, Szejko N, Uttner I, Herrmann A, Petri S, Meyer T, Ludolph AC, Lulé D. Caregivers' divergent perspectives on patients' well-being and attitudes towards hastened death in Germany, Poland and Sweden. Amyotroph Lateral Scler Frontotemporal Degener 2021; 23:252-262. [PMID: 34187249 DOI: 10.1080/21678421.2021.1936064] [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: 10/21/2022]
Abstract
Background: During the course of amyotrophic lateral sclerosis (ALS), patients and their families are faced with existential decisions concerning life-prolonging and -shortening measures. Correct anticipation of patient's well-being and preferences is a prerequisite for patient-centered surrogate decision making. Methods: In Germany (N = 84), Poland (N = 77) and Sweden (N = 73) patient-caregiver dyads were interviewed. Standardized questionnaires on well-being (ADI-12 for depressiveness; ACSA for global quality of life) and wish for hastened death (SAHD) were used in ALS patients. Additionally, caregivers were asked to fill out the same questionnaires by anticipating patients' perspective (surrogate perspective). Results: Caregivers significantly underestimated patients' well-being in Germany and Poland. For Swedish caregivers, there were just as many who underestimated and overestimated well-being. The same was true for wish for hastened death in all three countries. For Swedish and Polish patients, caregivers' estimation of well-being was not even associated with patients' responses and the same was true for estimation of wish for hastened death in all three countries. Older caregivers and those with the most frequent encounter with the patient were the closest in their rating of well-being and wish for hastened death to the patients' actual state, while caregivers with chronic disease him/herself were more likely to underestimate patient's well-being. Discussion: Despite distinct cultural differences, there was a clear discrepancy between patients' and caregivers' perspective on patients' well-being and preferences towards life in all three countries. This possible bias in caregivers' judgment needs to be taken into account in surrogate decision making.
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Affiliation(s)
- Peter M Andersen
- Institute of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Magdalena Kuźma-Kozakiewicz
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland.,Neurodegenerative Diseases Research Group, Medical University of Warsaw, Warsaw, Poland
| | - Jürgen Keller
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | - Krzysztof Barć
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | | | - Julia Finsel
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | - Olga Helczyk
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Katharina Linse
- Department of Neurology, Technische Universität Dresden, and German Center for Neurodegenerative Diseases (DZNE), Dresden, Germany
| | | | - Erica Stenberg
- Institute of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Olof Semb
- Department of Clinical Science, Umeå University, Umeå, Sweden
| | | | - Natalia Szejko
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Ingo Uttner
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Andreas Herrmann
- Department of Neurology, Technische Universität Dresden, and German Center for Neurodegenerative Diseases (DZNE), Dresden, Germany
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Thomas Meyer
- Department of Neurology, Charité CVK, Berlin, Germany
| | - Albert C Ludolph
- Department of Neurology, University of Ulm, Ulm, Germany.,German Center for Neurodegenerative Diseases (DZNE), Ulm, Germany
| | - Dorothée Lulé
- Department of Neurology, University of Ulm, Ulm, Germany
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14
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Mitsumoto H, Garofalo DC, Gilmore M, Andrews L, Santella RM, Andrews H, McElhiney M, Murphy J, Nieves JW, Rabkin J, Hupf J, Horton DK, Mehta P, Factor-Litvak P. Case-control study in ALS using the National ALS Registry: lead and agricultural chemicals are potential risk factors. Amyotroph Lateral Scler Frontotemporal Degener 2021; 23:190-202. [PMID: 34137650 DOI: 10.1080/21678421.2021.1936556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: To identify occupational risk factors for ALS using well-characterized participants with ALS (P-ALS), sibling controls (S-controls), and matched population controls (P-controls) within the National ALS Registry. We also compared oxidative stress (OS) biomarkers between groups. Methods: P-ALS were recruited over 4 years. Demographic, socioeconomic, and medical data were ascertained from medical records and structured interviews. P-ALS were followed prospectively for 2 years or until death, whichever came sooner. S-controls and age-, sex-, race/ethnicity-, and residential location-matched P-controls were recruited over 3 years. Occupational exposure to lead and agricultural chemicals (ACs) were assigned by an occupational hygienist, blinded to case status. OS biomarkers in urine were measured. Results: P-ALS (mean age 62.8 years; 63% males) resided across the United States. Demographic and socioeconomic variables did not differ among P-ALS, S-controls, and P-controls. P-ALS were more likely to report occupations with exposure to lead (adjusted OR (aOR)=2.3, 95% CI 1.1, 4.6) and ACs (aOR = 2.4, 95% CI 1.2, 4.6) compared to pooled controls. Among those with occupations with exposure to both lead and ACs, aOR was 7.2 (95% CI 2.0, 26.1). Urinary 8-oxo-dG was significantly elevated among P-ALS (11.07 ± 5.42 ng/mL) compared to S-controls, P-controls, or pooled controls (pooled 7.43 ± 5.42 ng/mL; p < 0.0001) but was not associated with occupational exposure to either lead or ACs. Conclusions: Findings reveal increased risk of ALS diagnosis among those with occupational exposure to lead and ACs and increased OS biomarkers among cases compared to controls. OS may be an important pathogenic mechanism in ALS.
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Affiliation(s)
- Hiroshi Mitsumoto
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Diana C Garofalo
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Madison Gilmore
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Leslie Andrews
- Department of Environmental Health, Columbia University, New York, NY, USA
| | - Regina M Santella
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Howard Andrews
- Department of Biostatistics, Mailman School of Public Health, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Martin McElhiney
- Department of Clinical Psychology, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Jennifer Murphy
- Department of Neurology, University of California, San Francisco, CA, USA, and
| | - Jeri W Nieves
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Judith Rabkin
- Department of Clinical Psychology, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Jonathan Hupf
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - D Kevin Horton
- Centers for Disease Control and Prevention/Agency for Toxic Substance and Disease Registry (CDC/ATSDR), Atlanta, GA, USA
| | - Paul Mehta
- Centers for Disease Control and Prevention/Agency for Toxic Substance and Disease Registry (CDC/ATSDR), Atlanta, GA, USA
| | - Pam Factor-Litvak
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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15
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Heidari ME, Nadali J, Parouhan A, Azarafraz M, Tabatabai SM, Irvani SSN, Eskandari F, Gharebaghi A. Prevalence of depression among amyotrophic lateral sclerosis (ALS) patients: A systematic review and meta-analysis. J Affect Disord 2021; 287:182-190. [PMID: 33799036 DOI: 10.1016/j.jad.2021.03.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) people have a high risk of severe mental disorders, like depression, which impacts their function, quality of life, and mobility. However, there are no estimates of depression based paper published. This study aimed conduct a systematic review and meta-analysis of the prevalence of depression in ALS patients around the world. METHODS PubMed/Medline, Web of science, Scopus, Embase, and Ovid are searched to identify papers that reporting the prevalence of depression. Studies are included in random-effects meta-analyses of the prevalence of depression. Subgroup analyses are performed on the severity of depression, instruments of depression, type of studies, and study regions. RESULTS 46 eligible studies reported prevalence of depression. The pooled prevalence of depression among ALS people was 34% (27%-41%). According to the severity of depression, mild, moderate, and severe depression were 29%, 16%, and 8%, respectively. For studies using BDI, PHQ, and HADS, the pooled prevalence of depression was 50%, 20%, and 15%, respectively. CONCLUSIONS ALS people have a high prevalence of depression. The high prevalence of depression causes a reduction of quality of life and mobility. The study identifies a population group at high risk needing special attention in clinical practice.
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Affiliation(s)
| | - Javad Nadali
- School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran.
| | - Ali Parouhan
- Student 's scientific research center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Theran, Iran.
| | - Mahdi Azarafraz
- Young Researchers Elite Club, Islamic Azad University Tehran Medical Branch, Tehran, Iran.
| | | | - Seyed Sina Naghibi Irvani
- Research Institute for Endocrine Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Fereshte Eskandari
- Student 's scientific research center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Theran, Iran.
| | - Alireza Gharebaghi
- Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
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16
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Russell JA. Hastened death in veterans with amyotrophic lateral sclerosis. Muscle Nerve 2021; 63:785-786. [PMID: 33660291 DOI: 10.1002/mus.27210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 02/19/2021] [Accepted: 02/27/2021] [Indexed: 11/06/2022]
Affiliation(s)
- James A Russell
- Division of Neurology - Emeritus, Lahey Hospital and Medical Center (Beth Israel Lahey Health), Burlington, Massachusetts, 01085, USA.,Clinical Professor of Neurology, Tufts University School of Medicine, Boston, Massachusetts, USA
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17
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Silva-Moraes MH, Bispo-Torres AC, Barouh JL, Lucena PH, Armani-Franceschi G, Dorea-Bandeira I, Vieira F, Miranda-Scippa Â, Quarantini LC, Lucena R, Bandeira ID. Suicidal behavior in individuals with amyotrophic lateral sclerosis: A systematic review. J Affect Disord 2020; 277:688-696. [PMID: 32911219 DOI: 10.1016/j.jad.2020.08.066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 07/01/2020] [Accepted: 08/24/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Amyotrophic Lateral Sclerosis (ALS) leads to a drastic reduction in quality of life, generating intense psychological distress and predisposing those affected to mental illness and, in more severe cases, suicidal behavior. OBJECTIVE This is a systematic review aiming to estimate the frequency of wish to die, suicide ideation and suicide in individuals with ALS using the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). METHODS The following databases were used: Pubmed/MEDLINE, PsycINFO, Embase, SciELO, Biblioteca Virtual de Saúde (BVS), and Cochrane Library. The choice of appropriate descriptors, or their equivalents, to define the search terms was based on the technical and scientific vocabulary of each database. RESULTS 13 articles were included in the present systematic review, of which three were cross-sectional studies, nine were cohort-type and there was one case-control study. The studies show that individuals with ALS have a higher risk of suicide in relation to the general population, and there is evidence that this risk is even higher in the early stages of the disease. Major Depressive Disorder was the most prevalent mental disorder in the studies included. This mental health concern is often undertreated, leading to the increased susceptibility of this population to suicide. LIMITATIONS In general, the study samples represent a highly heterogeneous population while many instruments used in the data collection were not uniform. CONCLUSIONS The high degree of psychological vulnerability of this population, associated with a greater predisposition to suicidal behavior, should be minimized through public health measures.
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Affiliation(s)
| | | | - Judah L Barouh
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil; Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Harvard University, Boston, United States
| | - Pedro H Lucena
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | | | - Ingrid Dorea-Bandeira
- Faculdade de Tecnologia e Ciências, Salvador, Brazil; Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria do Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil
| | - Flavia Vieira
- Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria do Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil; Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Praça XV de Novembro, s/n - Largo do Terreiro de Jesus, Salvador, Bahia, Brazil
| | - Ângela Miranda-Scippa
- Departamento de Neurociências e Saúde Mental, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | - Lucas C Quarantini
- Departamento de Neurociências e Saúde Mental, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil; Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria do Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil
| | - Rita Lucena
- Departamento de Neurociências e Saúde Mental, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil
| | - Igor D Bandeira
- Laboratório de Neuropsicofarmacologia, Serviço de Psiquiatria do Hospital Universitário Professor Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil; Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Praça XV de Novembro, s/n - Largo do Terreiro de Jesus, Salvador, Bahia, Brazil.
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18
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Vázquez Medrano CR, Aho-Özhan HEA, Weiland U, Uttner I, Ludolph AC, Lulé D. Disease progression but not physical state per se determines mental wellbeing in ALS. J Neurol 2020; 267:3593-3601. [PMID: 32638110 PMCID: PMC7674363 DOI: 10.1007/s00415-020-10027-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/22/2020] [Accepted: 06/25/2020] [Indexed: 12/12/2022]
Abstract
Background Studies provide inconclusive results on the question whether loss of mental wellbeing is actually associated with decline in physical function in amyotrophic lateral sclerosis (ALS). The purpose of this study was to determine predictors of mental wellbeing in ALS. Methods In total, n = 330 ALS patients were interviewed on parameters of mental wellbeing to evaluate the patients’ capacity of psychosocial adaptation. These parameters were global and subjective quality of life (QoL), and depressiveness. A subsample of n = 82 ALS patients were interviewed again within approximately a year (mean 14.34 ± 5.53 months). Results Both global and subjective QoL were stable, whereas depressiveness increased within the course of 1 year after diagnosis. Physical function decline was associated with mental wellbeing. Progression of physical disabilities and symptom duration were significant predictors of wellbeing in the sense that fast progression and short time since symptom onset (both indicating short time to adapt) were associated with low wellbeing. Conclusions There is evidence for subsamples in ALS with regard to mental wellbeing, which are mainly determined by clinical parameters. Those subjects being reported in the literature to present with high mental wellbeing are often long survivors. High progression rate and low physical function when attending the clinic for the first time should be red flags and need special attention in clinical counseling.
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Affiliation(s)
| | - Helena E A Aho-Özhan
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Ulrike Weiland
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Ingo Uttner
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Albert C Ludolph
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Dorothée Lulé
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
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19
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Dürst A, Spencer B, Büla C, Fustinoni S, Mazzocato C, Rochat E, Rubli Truchard E, Monod S, Jox RJ. Wish to Die in Older Patients: Development and Validation of Two Assessment Instruments. J Am Geriatr Soc 2020; 68:1202-1209. [DOI: 10.1111/jgs.16392] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/27/2020] [Accepted: 02/06/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Anne‐Véronique Dürst
- Service of Geriatric Medicine & Geriatric Rehabilitation University of Lausanne Hospital (CHUV) Lausanne Switzerland
| | - Brenda Spencer
- Centre for Primary Care and Public Health (Unisanté) University of Lausanne Lausanne Switzerland
| | - Christophe Büla
- Service of Geriatric Medicine & Geriatric Rehabilitation University of Lausanne Hospital (CHUV) Lausanne Switzerland
| | - Sarah Fustinoni
- Centre for Primary Care and Public Health (Unisanté) University of Lausanne Lausanne Switzerland
| | - Claudia Mazzocato
- Service of Palliative and Supportive Care Lausanne University Hospital (CHUV) Lausanne Switzerland
| | - Etienne Rochat
- Institute of Humanities in Medicine Lausanne University Hospital (CHUV) and University of Lausanne Lausanne Switzerland
| | - Eve Rubli Truchard
- Service of Geriatric Medicine & Geriatric Rehabilitation University of Lausanne Hospital (CHUV) Lausanne Switzerland
- Chair in Geriatric Palliative Care Lausanne University Hospital (CHUV) and University of Lausanne Lausanne Switzerland
| | - Stéfanie Monod
- General Health Department Ministry of Health and Social Action Lausanne Switzerland
| | - Ralf J. Jox
- Service of Palliative and Supportive Care Lausanne University Hospital (CHUV) Lausanne Switzerland
- Institute of Humanities in Medicine Lausanne University Hospital (CHUV) and University of Lausanne Lausanne Switzerland
- Chair in Geriatric Palliative Care Lausanne University Hospital (CHUV) and University of Lausanne Lausanne Switzerland
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20
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Rosa Silva JP, Santiago Júnior JB, Dos Santos EL, de Carvalho FO, de França Costa IMP, Mendonça DMFD. Quality of life and functional independence in amyotrophic lateral sclerosis: A systematic review. Neurosci Biobehav Rev 2020; 111:1-11. [PMID: 31917162 DOI: 10.1016/j.neubiorev.2019.12.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 11/08/2019] [Accepted: 12/29/2019] [Indexed: 12/11/2022]
Abstract
Amyotrophic Lateral Sclerosis (ALS) leads to functional capacity decline, generating great impact in quality of life. Quality of life is directly related to physical integrity and functional independence. This systematic review aimed to analyze treatment protocols and their outcomes from clinical trials with focus on ALS rehabilitation that evaluated the effects on quality of life and functional independence from their intervention process. A literature search was conducted through MEDLINE-PubMed, Science Direct, Web of Science and Scopus databases. A total of 3630 articles were identified. Eleven studies met the inclusion criteria. They focused on different aspects of quality of life or functional independence, which are: respiratory care, mental health, communication skills and exercises. Use of bipap and inspiratory muscle training, anxiety and depression, communication devices implementation and exercises safety and tolerability were considered as key points. However, the drastic evolution of the disease is a limiting factor to the perception of quality of life improvement by patients. Further studies should be done to validate the benefits on patients' quality of life.
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Affiliation(s)
- Jéssica Paloma Rosa Silva
- Department of Physical Therapy, Federal University of Sergipe, Lagarto, SE, Brazil; Laboratory of Neurobiology of Degenerative Diseases of the Nervous System, Department of Biosciences, Federal University of Sergipe, Itabaiana, SE, Brazil
| | - José Bomfim Santiago Júnior
- Laboratory of Neurobiology of Degenerative Diseases of the Nervous System, Department of Biosciences, Federal University of Sergipe, Itabaiana, SE, Brazil
| | - Elizabete Lima Dos Santos
- Laboratory of Neurobiology of Degenerative Diseases of the Nervous System, Department of Biosciences, Federal University of Sergipe, Itabaiana, SE, Brazil
| | - Fernanda Oliveira de Carvalho
- Department of Physical Therapy, Federal University of Sergipe, Lagarto, SE, Brazil; Health Sciences Post-Graduation Nucleus, Federal University of Sergipe, SE, Brazil
| | | | - Deise Maria Furtado de Mendonça
- Laboratory of Neurobiology of Degenerative Diseases of the Nervous System, Department of Biosciences, Federal University of Sergipe, Itabaiana, SE, Brazil.
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21
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Martins AP, Prado LDGR, Lillo P, Mioshi E, Teixeira AL, de Souza LC. Deficits in Emotion Recognition as Markers of Frontal Behavioral Dysfunction in Amyotrophic Lateral Sclerosis. J Neuropsychiatry Clin Neurosci 2019; 31:165-169. [PMID: 30537912 DOI: 10.1176/appi.neuropsych.18040086] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with prominent motor symptoms. Patients with ALS may also manifest frontal behavior symptoms and cognitive decline, including impairment in facial emotion recognition. The authors aimed to investigate whether deficits in emotion recognition were associated with frontal behavior symptoms in ALS. METHODS Participants were patients with probable or definite sporadic ALS (N=21; male:female ratio, 11:10; median age, 62 years; median disease duration, 3 years) and age-matched and education-matched healthy control subjects (N=25; male:female ratio, 14:11; median age, 61 years). The Facial Emotion Recognition Test (FERT) was administered to all participants. Patients with ALS were assessed using the Cambridge Behavior Inventory-Revised and were classified into two groups according to the presence of frontal behavioral symptoms: ALS with no behavioral symptom (ALSns; N=9) and ALS with at least one behavioral symptom (ALSbs; N=12). RESULTS Apathy and mood symptoms were the most frequent neuropsychiatric symptoms in the patient group. Patients with ALS performed worse than control subjects in the recognition of sadness (p<0.004). There were no differences between control subjects and patients in the ALSns group in all FERT scores, but the ALSbs group had lower performance than control subjects in sadness (p<0.003). CONCLUSIONS Emotion recognition deficit may be a marker of frontal behavior in ALS.
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Affiliation(s)
- Aldrin Pedroza Martins
- From the Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil (Martins, Prado, Teixeira, de Souza); Programa de Pós-Graduação em Neurociências, da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil (Prado, Teixeira, de Souza); the Departamento de Neurología Sur/Departamento de Neurociencia, Facultad de Medicina, Universidad de Chile, Santiago, Chile (Lillo); the Geroscience Center for Brain Health and Metabolism, Santiago, Chile (Lillo); the School of Health Sciences, University of East Anglia, Norwich, United Kingdom (Mioshi); and the Department of Internal Medicine, Faculdade de Medicina, da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil (Teixeira, de Souza)
| | - Laura de Godoy Rousseff Prado
- From the Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil (Martins, Prado, Teixeira, de Souza); Programa de Pós-Graduação em Neurociências, da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil (Prado, Teixeira, de Souza); the Departamento de Neurología Sur/Departamento de Neurociencia, Facultad de Medicina, Universidad de Chile, Santiago, Chile (Lillo); the Geroscience Center for Brain Health and Metabolism, Santiago, Chile (Lillo); the School of Health Sciences, University of East Anglia, Norwich, United Kingdom (Mioshi); and the Department of Internal Medicine, Faculdade de Medicina, da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil (Teixeira, de Souza)
| | - Patricia Lillo
- From the Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil (Martins, Prado, Teixeira, de Souza); Programa de Pós-Graduação em Neurociências, da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil (Prado, Teixeira, de Souza); the Departamento de Neurología Sur/Departamento de Neurociencia, Facultad de Medicina, Universidad de Chile, Santiago, Chile (Lillo); the Geroscience Center for Brain Health and Metabolism, Santiago, Chile (Lillo); the School of Health Sciences, University of East Anglia, Norwich, United Kingdom (Mioshi); and the Department of Internal Medicine, Faculdade de Medicina, da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil (Teixeira, de Souza)
| | - Eneida Mioshi
- From the Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil (Martins, Prado, Teixeira, de Souza); Programa de Pós-Graduação em Neurociências, da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil (Prado, Teixeira, de Souza); the Departamento de Neurología Sur/Departamento de Neurociencia, Facultad de Medicina, Universidad de Chile, Santiago, Chile (Lillo); the Geroscience Center for Brain Health and Metabolism, Santiago, Chile (Lillo); the School of Health Sciences, University of East Anglia, Norwich, United Kingdom (Mioshi); and the Department of Internal Medicine, Faculdade de Medicina, da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil (Teixeira, de Souza)
| | - Antônio Lúcio Teixeira
- From the Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil (Martins, Prado, Teixeira, de Souza); Programa de Pós-Graduação em Neurociências, da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil (Prado, Teixeira, de Souza); the Departamento de Neurología Sur/Departamento de Neurociencia, Facultad de Medicina, Universidad de Chile, Santiago, Chile (Lillo); the Geroscience Center for Brain Health and Metabolism, Santiago, Chile (Lillo); the School of Health Sciences, University of East Anglia, Norwich, United Kingdom (Mioshi); and the Department of Internal Medicine, Faculdade de Medicina, da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil (Teixeira, de Souza)
| | - Leonardo Cruz de Souza
- From the Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil (Martins, Prado, Teixeira, de Souza); Programa de Pós-Graduação em Neurociências, da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil (Prado, Teixeira, de Souza); the Departamento de Neurología Sur/Departamento de Neurociencia, Facultad de Medicina, Universidad de Chile, Santiago, Chile (Lillo); the Geroscience Center for Brain Health and Metabolism, Santiago, Chile (Lillo); the School of Health Sciences, University of East Anglia, Norwich, United Kingdom (Mioshi); and the Department of Internal Medicine, Faculdade de Medicina, da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil (Teixeira, de Souza)
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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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Zucchi E, Ticozzi N, Mandrioli J. Psychiatric Symptoms in Amyotrophic Lateral Sclerosis: Beyond a Motor Neuron Disorder. Front Neurosci 2019; 13:175. [PMID: 30914912 PMCID: PMC6421303 DOI: 10.3389/fnins.2019.00175] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 02/14/2019] [Indexed: 12/11/2022] Open
Abstract
The historical view that Amyotrophic Lateral Sclerosis (ALS) as a pure motor disorder has been increasingly challenged by the discovery of cognitive and behavioral changes in the spectrum of Frontotemporal Dementia (FTD). Less recognized and still significant comorbidities that ALS patients may present are prior or concomitant psychiatric illness, such as psychosis and schizophrenia, or mood disorders. These non-motor symptoms disturbances have a close time relationship with disease onset, may constitute part of a larger framework of network disruption in motor neuron disorders, and may impact ALS patients and families, with regards to ethical choices and end-of-life decisions. This review aims at identifying the most common psychiatric alterations related to ALS and its prognosis, looking at a common genetic background and shared structural brain pathology.
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Affiliation(s)
- Elisabetta Zucchi
- Department of Neuroscience, Azienda Ospedaliero Universitaria di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Nicola Ticozzi
- Department of Neurology and Laboratory of Neuroscience, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy.,Department of Pathophysiology and Transplantation, 'Dino Ferrari' Center, Università degli Studi di Milano, Milan, Italy
| | - Jessica Mandrioli
- Department of Neuroscience, Azienda Ospedaliera Universitaria Modena, St. Agostino- Estense Hospital, Modena, Italy
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Grabler MR, Weyen U, Juckel G, Tegenthoff M, Mavrogiorgou-Juckel P. Death Anxiety and Depression in Amyotrophic Lateral Sclerosis Patients and Their Primary Caregivers. Front Neurol 2018; 9:1035. [PMID: 30559710 PMCID: PMC6287003 DOI: 10.3389/fneur.2018.01035] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 11/16/2018] [Indexed: 12/13/2022] Open
Abstract
Background: Given the lethal severity of amyotrophic lateral sclerosis (ALS), the aim of this study was to illuminate the coherence of depression and death anxiety in both ALS patients and caregivers and in how far patients and caregivers are influenced by the mindset of their respective counterpart. Methods: 30 couples of patients (mean age 60.57; 13 women, 17 men) and primary caregivers (mean age 57.33; 16 women, 14 men) were included into the study. Death anxiety was assessed using the newly developed BOFRETTA scale, depression via Beck Depression Inventory, anxiety by means of State Trait Anxiety Inventory and caregivers' exertion using the Caregiver Strain Index. Patients' impairment was assessed with the ALS functional rating scale. Results: We found that while death anxiety was related to depression in both patients and caregivers, death anxiety was related to anxiety only in patients. Caregiver strain correlated with both caregiver's depression and anxiety. Moreover, patients' and caregivers' depression, anxiety and death anxiety correlated to the ones of their counterpart. Conclusion: These results suggest that despite little depressive symptoms in ALS patients the fatal prognosis of the disease takes into account, depression and death anxiety influence each other and might be addressed together in pharmacological and especially psychotherapeutic interventions to the benefit of the patient. Medical professionals should not forget to offer sufficient support to caregivers tending patients affected by depression and death anxiety as they are likely to mirror their patient's feelings.
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Affiliation(s)
- Marvin R. Grabler
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL-University Hospital of Ruhr-University Bochum, Bochum, Germany
| | - Ute Weyen
- Department of Neurology, Bergmannsheil University Hospital of Ruhr-University Bochum, Bochum, Germany
| | - Georg Juckel
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL-University Hospital of Ruhr-University Bochum, Bochum, Germany
| | - Martin Tegenthoff
- Department of Neurology, Bergmannsheil University Hospital of Ruhr-University Bochum, Bochum, Germany
| | - Paraskevi Mavrogiorgou-Juckel
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL-University Hospital of Ruhr-University Bochum, Bochum, Germany
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25
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Verschueren A, Kianimehr G, Belingher C, Salort-Campana E, Loundou A, Grapperon AM, Attarian S. Wish to die and reasons for living among patients with amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2018; 20:68-73. [PMID: 30430868 DOI: 10.1080/21678421.2018.1530265] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE In Amyotrophic lateral sclerosis (ALS), disease severity, ineffective treatment, and increasing dependence on caregivers may give rise to hopelessness and suicidal ideation among patients. In clinical practice, the desire for death among patients with ALS often accompanies the desire to live and fear of death. Thus, we decided to study suicidal ideation among patients with ALS and examine protective factors and reasons for living. METHODS We conducted a prospective, observational cohort study that recruited patients during routine visits to the outpatient multidisciplinary reference center for ALS. Depression was measured using the Beck Depression Inventory, suicidal ideation was assessed using the Columbia Suicide Severity Rating Scale, and reasons for living were assessed using the Reasons for Living inventory for adults. RESULTS Among the 71 patients included, 39% expressed either passive (wish to die) or active suicidal ideation. Patients who expressed suicidal ideation were more likely to report depressive symptoms and have worse disability scores. A significant difference in the survival and coping beliefs subscore of the RFL inventory, which was negatively associated with suicidal ideation, had been found between those who did and did not have suicidal ideation. CONCLUSION These findings have stressed the need for caregivers to recognize depression and other distressing expressions as well as provide adequate treatment. Therefore, close attention should be given to those suffering from depression while providing optimal care in terms of not only drug treatment but also psychological support.
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Affiliation(s)
- Annie Verschueren
- a Reference Centre for neuromuscular disorders and ALS, CHU La Timone, Aix-Marseille University , Marseille , France
| | - Gilda Kianimehr
- b Shariati Hospital, Tehran University of Medical Science , Tehran , Iran
| | - Carole Belingher
- a Reference Centre for neuromuscular disorders and ALS, CHU La Timone, Aix-Marseille University , Marseille , France
| | - Emmanuelle Salort-Campana
- a Reference Centre for neuromuscular disorders and ALS, CHU La Timone, Aix-Marseille University , Marseille , France
| | - Anderson Loundou
- c Department of Public Health , Clinical Research Unit, University Hospital System, Aix-Marseille University , Marseille , France
| | - Aude-Marie Grapperon
- a Reference Centre for neuromuscular disorders and ALS, CHU La Timone, Aix-Marseille University , Marseille , France
| | - Shahram Attarian
- a Reference Centre for neuromuscular disorders and ALS, CHU La Timone, Aix-Marseille University , Marseille , France
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Disability in amyotrophic lateral sclerosis compared with traumatic brain injury using the World Health Organization Disability Assessment Schedule 2.0 and the International Classification of Functioning minimal generic set. Int J Rehabil Res 2018; 41:224-229. [PMID: 30095553 DOI: 10.1097/mrr.0000000000000292] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We compared the functioning of two neurological patient groups, amyotrophic lateral sclerosis (ALS) and traumatic brain injury (TBI), using brief and validated International Classification of Functioning (ICF)-based tools. A 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0) questionnaire was mailed to ALS and TBI patients and their significant others 2 weeks before their appointment at an outpatient clinic of a university hospital. In addition, a neurologist filled in the ICF minimal generic set. Two years after diagnosis, no significant differences between the two diagnosis groups were found in overall functioning or in working ability using either patient or proxy WHODAS or physician-rated minimal generic set. In single items, however, clear differences were found. Patients and significant others rated household activities, mobility, and self-care as more impaired in the group with ALS, and learning, concentrating, and maintaining friendships in the group with TBI. There were no differences between the two diagnosis groups in the WHODAS items emotional functions, engaging in community, relating with strangers, or in working ability. Both brief ICF-based generic scales, WHODAS and the ICF generic set, could show differences between these patient groups with severe disability. The results of this study should promote assessment of disability with WHODAS 2.0 in ALS and TBI.
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Woolley SC, Rush BK. Considerations for Clinical Neuropsychological Evaluation in Amyotrophic Lateral Sclerosis. Arch Clin Neuropsychol 2018; 32:906-916. [PMID: 29028904 DOI: 10.1093/arclin/acx089] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 09/14/2017] [Indexed: 12/11/2022] Open
Abstract
The clinical neuropsychologist has the opportunity to be uniquely involved in the evaluation and treatment of individuals with amyotrophic lateral sclerosis (ALS). We review the current literature that defines cognitive and behavioral symptoms in ALS, including current knowledge of the neuropathological and genetic underpinning for these symptoms. There are unique considerations for clinical neuropsychological evaluation and clinical research in ALS and we highlight these in this review. Specifically, we shed light on special factors that contribute to our understanding of cognitive and behavioral impairment in ALS, including co-morbid symptoms, differential diagnosis, and considerations for longitudinal tracking of phenotypes. We discuss the rationale for proposing a specific approach to such as cognitive screening, test selection, response modality consideration, and test-retest intervals. With this didactic overview, the clinical neuropsychologist has the potential to learn more about the heterogeneous presentation of motor and neuropsychological symptoms in ALS. Furthermore, the reader has the opportunity to understand what it takes to develop a valid assessment approach particularly when the phenotype of ALS remains undefined in some regards. This clinical practice review sets the stage for the clinical neuropsychologist to further contribute to our clinical and scientific understanding of ALS and cognition.
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Affiliation(s)
| | - Beth K Rush
- Mayo Clinic Florida, Department of Psychiatry and Psychology, 4500 San Pablo Road, Jacksonville, FL 32224, USA
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Abstract
PURPOSE OF REVIEW Although there is no cure for motor neurone disease (MND), the advent of multidisciplinary care and neuroprotective agents has improved treatment interventions and enhanced quality of life for MND patients and their carers. RECENT FINDINGS Evidence-based multidisciplinary care, respiratory management and disease-modifying therapy have improved the outcomes of patients diagnosed with MND. Supportive approaches to nutritional maintenance and optimization of symptomatic treatments, including management of communication and neuropsychiatric issues, improve the quality of life for MND patients. SUMMARY Recent progress in the understanding of the clinical, pathophysiological and genetic heterogeneity of MND has improved the approach of clinicians to treatment. Notwithstanding improvement to care and quality of life, survival benefit has become evident with the advent of a multidisciplinary care framework, early treatment with riluzole and noninvasive ventilation. Weight maintenance remains critical, with weight loss associated with more rapid disease progression. The end-of-life phase is poorly defined and treatment is challenging, but effective symptom control through palliative care is achievable and essential. Encouragingly, current progress of clinical trials continues to close the gap towards the successful development of curative treatment in MND.
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Prado LDGR, Bicalho ICS, Vidigal-Lopes M, Prado VDGR, Gomez RS, de Souza LC, Teixeira AL. Depression and anxiety in a case series of amyotrophic lateral sclerosis: frequency and association with clinical features. EINSTEIN-SAO PAULO 2017; 15:58-60. [PMID: 28444090 PMCID: PMC5433308 DOI: 10.1590/s1679-45082017ao3870] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 01/04/2017] [Indexed: 12/13/2022] Open
Abstract
Objective To investigate the frequency of anxiety and depression and their association with clinical features of amyotrophic lateral sclerosis. Methods This is a cross-sectional and descriptive study including a consecutive series of patients with sporadic amyotrophic lateral sclerosis according to Awaji’s criteria. Patients underwent clinical and psychiatric assessment (anxiety and depression symptoms). Results We included 76 patients. The men/women ratio was 1.6:1. Participants’ mean age at disease onset was 55 years (SD±12.1). Sixty-six patients (86.8%) were able to complete psychiatric evaluation. Clinically significant anxiety was found in 23 patients (34.8%) while clinically significant depression was found in 24 patients (36.4%). When we compared patients with and without depression a significant difference was seen only in the frequency of anxiety symptoms (p<0.001). We did further analysis comparing subgroups of patients classified according to the presence or not of anxiety and or depression, without any significant difference regarding sex, age at onset, initial form, disease duration or functional measures. A positive correlation between anxiety and depressive symptoms was found (p<0.001). Conclusion Anxiety and depressive symptoms were highly correlated and frequent in patients with amyotrophic lateral sclerosis. In addition, anxiety and depression were not associated with disease duration and presentation, sex, age at onset, and functional score.
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Affiliation(s)
| | | | - Mauro Vidigal-Lopes
- Fundação Hospitalar do Estado de Minas Gerais, Hospital Júlia Kubitschek, Belo Horizonte, MG, Brazil
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Thakore NJ, Pioro EP. Laughter, crying and sadness in ALS. J Neurol Neurosurg Psychiatry 2017; 88:825-831. [PMID: 28572273 PMCID: PMC5629932 DOI: 10.1136/jnnp-2017-315622] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/16/2017] [Accepted: 04/12/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pseudobulbar affect (PBA) is prevalent in amyotrophic lateral sclerosis (ALS), but there is limited information on its associations and course. OBJECTIVES Explore prevalence, associations, course and manifestations of PBA in outpatient cohort of patients with ALS and examine its relationship to depression. METHODS Self-reported measures of PBA and depression (Center for Neurologic Study-Lability Scale (CNS-LS) and Patient Health Questionnaire (PHQ-9), respectively) were obtained from consecutive patients with ALS using tablet devices in waiting rooms (Knowledge Program). RESULTS PBA (CNS-LS ≥13) was seen in 209/735 patients (28.4%). PBA was associated with bulbar onset and dysfunction, upper motor neuron dysfunction, cognitive impairment, depression and lower quality of life. A multivariable model that included lower bulbar and gross motor subscores, female gender, younger age and shorter duration of disease predicted PBA with 74% accuracy. CNS-LS scores increased only slowly with time. Women with PBA reported more crying than men. Crying (but not laughter) correlated with depression, and crying was associated with poorer quality of life. Exploratory factor analysis of pooled questions of CNS-LS and PHQ-9 identified three underlying factors (laughter, crying and depression) loaded on appropriate questions of the respective instruments. CONCLUSION This study identifies associations of PBA and additionally finds PBA (especially crying-predominant PBA) more prevalent in women with ALS. Although the two self-report instruments (CNS-LS and PHQ-9) discriminate well between PBA and depression, there is significant overlap between depression and crying in PBA. Studies of PBA should stratify for gender, examine crying and laughter as separate outcomes and adjust for depression.
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Affiliation(s)
- Nimish J Thakore
- Department of Neurology, Neuromuscular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Erik P Pioro
- Department of Neurology, Neuromuscular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
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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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Marrie RA, Salter A, Tyry T, Cutter GR, Cofield S, Fox RJ. High hypothetical interest in physician-assisted death in multiple sclerosis. Neurology 2017; 88:1528-1534. [PMID: 28298551 DOI: 10.1212/wnl.0000000000003831] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 01/12/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the opinions of persons with multiple sclerosis (MS) regarding physician-assisted death (PAD). METHODS We surveyed participants in the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry regarding PAD. For each of 5 hypothetical situations, respondents indicated whether they definitely would, probably would, probably would not, or definitely would not consider PAD. They also reported their sociodemographics, disability status using Patient-Determined Disease Steps, depression status, pain status, religiosity, and degree of social support. Using multivariable logistic regression models, we evaluated the factors associated with an individual reporting that he or she would definitely or probably consider PAD in each situation. RESULTS Of 7,534 respondents, 6,011 (79.8%) were female, and 6,884 (92.9%) were white. Their mean (SD) age was 59.9 (10.2) years. Fifty percent of respondents reported at least moderate disability. Of the 6,792 respondents who responded to any of the PAD questions, 6,400 responded to all questions. Of these, 458 (7.1%) indicated that they would definitely consider PAD in all of the situations listed, while 1,275 (19.9%) indicated that they definitely would not consider PAD in any of the situations listed. If experiencing unbearable pain, 4,383 (65.3%) of respondents would definitely or probably consider PAD. On multivariable analysis, religiosity, social support, depression, pain, disability, sex, and race were associated with considering PAD in some or all of the situations presented. CONCLUSIONS Depending upon the situation, a large proportion of persons with MS would consider PAD. The association of depression with considering PAD emphasizes the importance of diagnosing and treating depression.
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Affiliation(s)
- Ruth Ann Marrie
- From the Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Division of Biostatistics (A.S.), Washington University in St. Louis, MO; Dignity Health (T.T.), St. Joseph's Hospital and Medical Center, Phoenix, AZ; Department of Biostatistics (G.R.C., S.C.), University of Alabama at Birmingham; and Mellen Center, Department of Neurology (R.J.F.), Cleveland Clinic, OH.
| | - Amber Salter
- From the Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Division of Biostatistics (A.S.), Washington University in St. Louis, MO; Dignity Health (T.T.), St. Joseph's Hospital and Medical Center, Phoenix, AZ; Department of Biostatistics (G.R.C., S.C.), University of Alabama at Birmingham; and Mellen Center, Department of Neurology (R.J.F.), Cleveland Clinic, OH
| | - Tuula Tyry
- From the Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Division of Biostatistics (A.S.), Washington University in St. Louis, MO; Dignity Health (T.T.), St. Joseph's Hospital and Medical Center, Phoenix, AZ; Department of Biostatistics (G.R.C., S.C.), University of Alabama at Birmingham; and Mellen Center, Department of Neurology (R.J.F.), Cleveland Clinic, OH
| | - Gary R Cutter
- From the Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Division of Biostatistics (A.S.), Washington University in St. Louis, MO; Dignity Health (T.T.), St. Joseph's Hospital and Medical Center, Phoenix, AZ; Department of Biostatistics (G.R.C., S.C.), University of Alabama at Birmingham; and Mellen Center, Department of Neurology (R.J.F.), Cleveland Clinic, OH
| | - Stacey Cofield
- From the Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Division of Biostatistics (A.S.), Washington University in St. Louis, MO; Dignity Health (T.T.), St. Joseph's Hospital and Medical Center, Phoenix, AZ; Department of Biostatistics (G.R.C., S.C.), University of Alabama at Birmingham; and Mellen Center, Department of Neurology (R.J.F.), Cleveland Clinic, OH
| | - Robert J Fox
- From the Departments of Internal Medicine and Community Health Sciences (R.A.M.), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada; Division of Biostatistics (A.S.), Washington University in St. Louis, MO; Dignity Health (T.T.), St. Joseph's Hospital and Medical Center, Phoenix, AZ; Department of Biostatistics (G.R.C., S.C.), University of Alabama at Birmingham; and Mellen Center, Department of Neurology (R.J.F.), Cleveland Clinic, OH
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Rabkin J, Goetz R, Murphy JM, Factor-Litvak P, Mitsumoto H. Cognitive impairment, behavioral impairment, depression, and wish to die in an ALS cohort. Neurology 2016; 87:1320-8. [PMID: 27496520 PMCID: PMC5573192 DOI: 10.1212/wnl.0000000000003035] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 05/17/2016] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To evaluate relationships among cognitive, behavioral, and psychiatric/psychosocial measures assessed in a multicenter cohort of patients with amyotrophic lateral sclerosis (ALS). METHODS Recently diagnosed patients with definite or probable ALS diagnosis were administered 7 standardized psychiatric/psychosocial measures, including the Patient Health Questionnaire for diagnosis of depression and elicitation of wish to die. The Cognitive Behavioral Screen was used to classify both cognitive and behavioral impairment (emotional-interpersonal function). An ALS version of the Frontal Behavioral Inventory and Mini-Mental State Examination were also administered. RESULTS Of 247 patients included, 79 patients (32%) had neither cognitive nor behavioral impairment, 100 (40%) had cognitive impairment, 23 (9%) had behavioral impairment, and 45 (18%) had comorbid cognitive and behavioral decline. Cognitive impairment, when present, was in the mild range for 90% and severe for 10%. Thirty-one patients (12%) had a major or minor depressive disorder (DSM-IV criteria). Cognitive impairment was unrelated to all psychiatric/psychosocial measures. In contrast, patients with behavioral impairment reported more depressive symptoms, greater hopelessness, negative mood, and more negative feedback from spouse or caregiver. A wish to die was unrelated to either cognitive or behavioral impairment. CONCLUSIONS While we found no association between cognitive impairment and depression or any measure of distress, behavioral impairment was strongly associated with depressive symptoms and diagnoses although seldom addressed by clinicians. Thoughts about ending life were unrelated to either cognitive or behavioral changes, a finding useful to consider in the context of policy debate about physician-assisted death.
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Affiliation(s)
- Judith Rabkin
- From the New York State Psychiatric Institute (J.R., R.G.), Department of Psychiatry (J.R., R.G.), and Eleanor and Lou Gehrig MDA/ALS Research Center, Department of Neurology (H.M.), Columbia University Medical Center, New York, NY; Department of Neurology (J.M.M.), University of California San Francisco; and Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University, New York, NY.
| | - Raymond Goetz
- From the New York State Psychiatric Institute (J.R., R.G.), Department of Psychiatry (J.R., R.G.), and Eleanor and Lou Gehrig MDA/ALS Research Center, Department of Neurology (H.M.), Columbia University Medical Center, New York, NY; Department of Neurology (J.M.M.), University of California San Francisco; and Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University, New York, NY
| | - Jennifer Mary Murphy
- From the New York State Psychiatric Institute (J.R., R.G.), Department of Psychiatry (J.R., R.G.), and Eleanor and Lou Gehrig MDA/ALS Research Center, Department of Neurology (H.M.), Columbia University Medical Center, New York, NY; Department of Neurology (J.M.M.), University of California San Francisco; and Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University, New York, NY
| | - Pam Factor-Litvak
- From the New York State Psychiatric Institute (J.R., R.G.), Department of Psychiatry (J.R., R.G.), and Eleanor and Lou Gehrig MDA/ALS Research Center, Department of Neurology (H.M.), Columbia University Medical Center, New York, NY; Department of Neurology (J.M.M.), University of California San Francisco; and Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University, New York, NY
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Mathis S, Couratier P, Julian A, Vallat JM, Corcia P, Le Masson G. Management and therapeutic perspectives in amyotrophic lateral sclerosis. Expert Rev Neurother 2016; 17:263-276. [DOI: 10.1080/14737175.2016.1227705] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Stéphane Mathis
- Department of Neurology, Neuro-Muscular Unit and ALS Center, CHU de Bordeaux, groupe hospitalier Pellegrin, Bordeaux, France
| | - Philippe Couratier
- Department of Neurology, ALS center, Centre de compétence SLA-fédération Tours-Limoges, CHU de Limoges, Limoges, France
| | - Adrien Julian
- Department of Neurology, CHU Poitiers, University of Poitiers, Poitiers, France
| | - Jean-Michel Vallat
- Department and Laboratory of Neurology, Centre de Référence ‘neuropathies périphériques rares’, University Hospital of Limoges, Limoges, France
| | - Philippe Corcia
- Department of Neurology, ALS center, Centre de compétence SLA-fédération Tours-Limoges, CHU de Tours, Tours, France
| | - Gwendal Le Masson
- Department of Neurology, Neuro-Muscular Unit and ALS Center, CHU de Bordeaux, groupe hospitalier Pellegrin, Bordeaux, France
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36
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Thakore NJ, Pioro EP. Depression in ALS in a large self-reporting cohort. Neurology 2016; 86:1031-8. [DOI: 10.1212/wnl.0000000000002465] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 11/30/2015] [Indexed: 12/13/2022] Open
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Rudnicki S, McVey AL, Jackson CE, Dimachkie MM, Barohn RJ. Symptom Management and End-of-Life Care in Amyotrophic Lateral Sclerosis. Neurol Clin 2015; 33:889-908. [PMID: 26515628 PMCID: PMC5031364 DOI: 10.1016/j.ncl.2015.07.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The number of available symptomatic treatments has markedly enhanced the care of patients with amyotrophic lateral sclerosis (ALS). Once thought to be untreatable, patients with ALS today clearly benefit from multidisciplinary care. The impact of such care on the disease course, including rate of progression and mortality, has surpassed the treatment effects commonly sought in clinical drug trials. Unfortunately, there are few randomized controlled trials of medications or interventions addressing symptom management. In this review, the authors provide the level of evidence, when available, for each intervention that is currently considered standard of care by consensus opinion.
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Affiliation(s)
- Stacy Rudnicki
- University of Arkansas for Medical Sciences, 501 Jackson Stephens Drive, Room 769, Little Rock, Arkansas 72205-7199
| | - April L. McVey
- University of Kansas Medical Center, Dept. of Neurology, 3901 Rainbow Blvd, Mailstop 2012, Kansas City, KS 66160
| | - Carlayne E. Jackson
- University of Texas Health Science Center, 8300 Floyd Curl Drive, Mail Code 7883, San Antonio, TX 78229-3900
| | - Mazen M. Dimachkie
- University of Kansas Medical Center, Dept. of Neurology, 3901 Rainbow Blvd, Mailstop 2012, Kansas City, KS 66160
| | - Richard J. Barohn
- University of Kansas Medical Center, Dept. of Neurology, 3901 Rainbow Blvd, Mailstop 2012, Kansas City, KS 66160
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38
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Matuz T, Birbaumer N, Hautzinger M, Kübler A. Psychosocial adjustment to ALS: a longitudinal study. Front Psychol 2015; 6:1197. [PMID: 26441696 PMCID: PMC4568392 DOI: 10.3389/fpsyg.2015.01197] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 07/28/2015] [Indexed: 12/12/2022] Open
Abstract
For the current study the Lazarian stress-coping theory and the appendant model of psychosocial adjustment to chronic illness and disabilities (Pakenham, 1999) has shaped the foundation for identifying determinants of adjustment to ALS. We aimed to investigate the evolution of psychosocial adjustment to ALS and to determine its long-term predictors. A longitudinal study design with four measurement time points was therefore, used to assess patients' quality of life, depression, and stress-coping model related aspects, such as illness characteristics, social support, cognitive appraisals, and coping strategies during a period of 2 years. Regression analyses revealed that 55% of the variance of severity of depressive symptoms and 47% of the variance in quality of life at T2 was accounted for by all the T1 predictor variables taken together. On the level of individual contributions, protective buffering, and appraisal of own coping potential accounted for a significant percentage in the variance in severity of depressive symptoms, whereas problem management coping strategies explained variance in quality of life scores. Illness characteristics at T2 did not explain any variance of both adjustment outcomes. Overall, the pattern of the longitudinal results indicated stable depressive symptoms and quality of life indices reflecting a successful adjustment to the disease across four measurement time points during a period of about two years. Empirical evidence is provided for the predictive value of social support, cognitive appraisals, and coping strategies, but not illness parameters such as severity and duration for adaptation to ALS. The current study contributes to a better conceptualization of adjustment, allowing us to provide evidence-based support beyond medical and physical intervention for people with ALS.
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Affiliation(s)
- Tamara Matuz
- Institute of Medical Psychology and Behavioral Neurobiology, Eberhard-Karls-University Tübingen Tübingen, Germany
| | - Niels Birbaumer
- Institute of Medical Psychology and Behavioral Neurobiology, Eberhard-Karls-University Tübingen Tübingen, Germany ; Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale San Camillo Venezia, Italy
| | - Martin Hautzinger
- Department of Psychology, Eberhard-Karls-University Tübingen Tübingen, Germany
| | - Andrea Kübler
- Institute of Medical Psychology and Behavioral Neurobiology, Eberhard-Karls-University Tübingen Tübingen, Germany ; Institute of Psychology, University of Würzburg Germany
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Woolley SC, Strong MJ. Frontotemporal Dysfunction and Dementia in Amyotrophic Lateral Sclerosis. Neurol Clin 2015; 33:787-805. [PMID: 26515622 DOI: 10.1016/j.ncl.2015.07.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Although amyotrophic lateral sclerosis (ALS) is classically considered a disorder exclusively affecting motor neurons, there is substantial clinical, neuroimaging, and neuropathologic evidence that more than half of patients have an associated syndrome of frontotemporal dysfunction. These syndromes range from frontotemporal dementia to behavioral or cognitive syndromes. Neuroimaging and neuropathologic findings are consistent with frontotemporal lobar degeneration that underpins alterations in network connectivity. Future clinical trials need to be stratified based on the presence or absence of frontotemporal dysfunction on the disease course of ALS.
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Affiliation(s)
- Susan C Woolley
- Forbes Norris MDA/ALS Research Center, California Pacific Medical Center, 2324 Sacramento Street, Suite 111, San Francisco, CA 94115, USA
| | - Michael J Strong
- Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
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40
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Pizzimenti A, Gori MC, Onesti E, John B, Inghilleri M. Communication of diagnosis in amyotrophic lateral sclerosis: stratification of patients for the estimation of the individual needs. Front Psychol 2015; 6:745. [PMID: 26082745 PMCID: PMC4451690 DOI: 10.3389/fpsyg.2015.00745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 05/19/2015] [Indexed: 12/12/2022] Open
Affiliation(s)
| | | | - Emanuela Onesti
- Department of Neurology and Psychiatry, Sapienza UniversityRome, Italy
| | - Bev John
- School of Psychology, Early Years and Therapeutic Studies, University of South WalesPontypridd, UK
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Paganoni S, Karam C, Joyce N, Bedlack R, Carter GT. Comprehensive rehabilitative care across the spectrum of amyotrophic lateral sclerosis. NeuroRehabilitation 2015; 37:53-68. [PMID: 26409693 PMCID: PMC5223769 DOI: 10.3233/nre-151240] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease) is a neurodegenerative disease that results in progressive muscle weakness and wasting. There is no known cure and the disease is uniformly fatal. PURPOSE This review discusses current concepts in ALS care, from breaking the diagnosis to end-of-life care. People with ALS have several multidisciplinary needs due to a complex and dynamic disease process. They benefit from rehabilitation interventions that are individualized and have the goal of optimizing independence, function, and safety. These strategies also help minimize symptomatic burden and maximize quality of life. CONCLUSION Patient-centered, multidisciplinary care has a significant impact on the life of people with ALS and is the current standard of care for this patient population.
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Affiliation(s)
- Sabrina Paganoni
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Massachusetts General Hospital and Boston VA Healthcare System, Boston, MA, USA
| | - Chafic Karam
- Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Nanette Joyce
- Department of Physical Medicine and Rehabilitation, Neuromuscular Section, University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Richard Bedlack
- Duke University School of Medicine and Durham Veterans Affairs Medical Center, Durham, NC, USA
| | - Gregory T Carter
- Department of Physical Medicine and Rehabilitation, St Luke's Rehabilitation Institute, Spokane, WA, USA
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