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Trucco AP, Backhouse T, Mioshi E. Describing and assessing behavioural symptoms in amyotrophic lateral sclerosis with and without frontotemporal dementia: a scoping review. Curr Opin Neurol 2024:00019052-990000000-00176. [PMID: 38946579 DOI: 10.1097/wco.0000000000001293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
PURPOSE OF REVIEW Alongside motor and cognitive symptoms, amyotrophic lateral sclerosis (ALS) and ALS with frontotemporal dementia (ALSFTD) present with behavioural symptoms, which can be challenging for all affected by the disease. A scoping review of studies published between 2011 and 2024 was conducted to present the breadth of behavioural symptoms in ALS and ALSFTD, explore how they are described and assessed, and identify patterns in the literature. FINDINGS This scoping review identified 3939 articles, with 111/3939 meeting eligibility criteria. Most studies were from Australia (23.22%), Italy (16.94%) and the UK (14.29%); 75.67% were cross-sectional. Sample size ranged from 1 to 1013, as case studies were included. Overall mean age (100/111 studies) was 61.32 (SD = 4.15). Proportion of male patients (reported 102/111 studies) was 61.49%; mean disease duration (reported in 86/111 records) was 32.63 months (SD = 24.72). Papers described a broad range of behavioural symptoms (465 examples), which were thematically collated into seven categories: disinhibition (27.74%), apathy (25.16%), perseverative/compulsive behaviours (17.42%), hyperorality (10.53%), loss of sympathy or empathy (8.6%), psychotic symptoms (7.74%), and loss of insight about disease and changes (2.8%). Most studies (78.37%) used validated behavioural assessments that elicited carer's perspectives. SUMMARY Despite extensive evidence of behavioural symptoms in ALS, implementation of assessments and management of behavioural symptoms in clinical care remain limited. Clinicians must assess behavioural symptoms, as these can negatively affect disease prognosis, patient treatment engagement and increase family distress. Measures capturing carers' perspectives through interviews are ideal as they can reveal anosognosia, lack of sympathy and lack of empathy.
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Affiliation(s)
- Ana Paula Trucco
- School of Health Sciences, University of East Anglia, Norwich, Norfolk, UK
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Francis R, Attrill S, Radakovic R, Doeltgen S. Exploring clinical management of cognitive and behavioural deficits in MND. A scoping review. PATIENT EDUCATION AND COUNSELING 2023; 116:107942. [PMID: 37597466 DOI: 10.1016/j.pec.2023.107942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/11/2023] [Accepted: 08/13/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVES Little is known about how cognitive and behavioural decline in MND is managed clinically. This review aimed to summarise clinical management approaches of cognitive and behavioural decline in MND reported in peer-reviewed and grey literature. METHODS A scoping review was conducted across Embase, Medline, Psychinfo and Emcare in October 2022. Grey literature was also searched across Google Scholar and Google in October 2022. RESULTS A total of N = 26 studies and 8 documents were included. Thematic analysis revealed six key areas of clinical management: i. Assessment, ii. Education, iii. Advance Care Planning, iv. Adaptation of Care Plan, v. Communication and vi. Carer Support. CONCLUSIONS The literature on management of cognitive and behavioural decline in MND is sparse. Most peer-reviewed literature consists of expert commentary and there is a lack of primary data to guide practitioners and families on how to manage cognitive and behavioural change in MND. PRACTICE IMPLICATIONS Determining as early as practicable the presence of cognitive and behavioural changes in pwMND will enable practitioners to make adaptations to communication, provide education and supported decision-making for forward planning. This will enable individualised care, planned in partnership with families with MND, which incorporates personal needs and wishes.
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Affiliation(s)
- Rebecca Francis
- Speech Pathology, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, Australia; Swallowing Neurorehabilitation Research Laboratory, Caring Futures Institute, Flinders University, Adelaide, Australia.
| | - Stacie Attrill
- Speech Pathology, School of Allied Health Science and Practice, Faculty of Health and Medicine, The University of Adelaide, Adelaide, Australia
| | - Ratko Radakovic
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK; Euan MacDonald Centre for Motor Neuron Disease Research, University of Edinburgh, Edinburgh, UK; Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Sebastian Doeltgen
- Speech Pathology, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, Australia; Swallowing Neurorehabilitation Research Laboratory, Caring Futures Institute, Flinders University, Adelaide, Australia
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Corveleyn X, Corbel C, Fabre R, Zeghari R, Dujardin K, Robert P, Manera V. Validation study of the apathy motivation index in French adults. Front Psychol 2023; 14:1252965. [PMID: 37928593 PMCID: PMC10624122 DOI: 10.3389/fpsyg.2023.1252965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/25/2023] [Indexed: 11/07/2023] Open
Abstract
Objective Apathy is present in many brain disorders, but it is also prevalent to varying degrees in healthy people. While many tools have been developed to assess levels of apathy in pathology, no standardized measure of apathy in healthy people exists. Method Therefore, this study aimed to validate the French version of the Apathy Motivation Index (f-AMI). The results of 729 participants were analyzed using an exploratory factorial analysis. Results Preliminary analyses suggested that the three domains of apathy extracted in the original AMI scale-behavioral activation (BA), social motivation (SM), and emotional sensitivity (ES)-could be found also in the f-AMI. A further exploratory analysis showed that a higher number of factors could be extracted, particularly for women. Specifically, both social and emotional factors could be divided into two sub-factors: (1) social motivation toward strangers or toward an acquaintance and (2) self-directed emotional sensitivity directed toward others. Regarding construct validity, the scores of f-AMI were correlated with the French Dimensional Apathy Scale results. Concerning the divergent validity, emotional sensitivity in apathy is different from depression, anhedonia, and fatigue levels. Conclusion These results suggest that the f-AMI can be used to assess levels of apathy in healthy adults.
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Affiliation(s)
- Xavier Corveleyn
- LAPCOS, Université Côte d'Azur, Nice, France
- MSHS Sud-Est, Maison des Sciences de l'Homme et de la Société Sud-Est, Nice, France
| | - Camille Corbel
- LAPCOS, Université Côte d'Azur, Nice, France
- MSHS Sud-Est, Maison des Sciences de l'Homme et de la Société Sud-Est, Nice, France
| | - Roxane Fabre
- CoBTeK Lab, Université Côte d'Azur, Nice, France
- Département de Santé Publique, Centre Hospitalier Universitaire de Nice (Public Health Department University Hospital of Nice), Nice, France
| | | | - Kathy Dujardin
- CHU Lille, Lille Neurosciences and Cognition, INSERM, Université Lille, Lille, France
| | - Philippe Robert
- CoBTeK Lab, Université Côte d'Azur, Nice, France
- Centre Hospitalier Universitaire de Nice, Centre mémoire CMRR, Nice, France
- Association Innovation Alzheimer, Nice, France
| | - Valeria Manera
- CoBTeK Lab, Université Côte d'Azur, Nice, France
- Centre Hospitalier Universitaire de Nice, Centre mémoire CMRR, Nice, France
- Association Innovation Alzheimer, Nice, France
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Mercadante S, Al-Husinat L. Palliative Care in Amyotrophic Lateral Sclerosis. J Pain Symptom Manage 2023; 66:e485-e499. [PMID: 37380145 DOI: 10.1016/j.jpainsymman.2023.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/25/2023] [Accepted: 06/21/2023] [Indexed: 06/30/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is an incurable neurodegenerative disease of the motor neurons. Given the evolutive characteristics of this disease, palliative care principles should be a foundation of ALS care. A multidisciplinary medical intervention is of paramount importance in the different phases of disease. The involvement of the palliative care team improves quality of life and symptoms, and prognosis. Early initiation is of paramount importance to ensuring patient-centered care, when the patient has still the capability to communicate effectively and participate in his medical care. Advance care planning supports patients and family members in understanding and sharing their preferences according to their personal values and life goals regarding future medical treatment. The principal problems which require intensive supportive care include cognitive disturbances, psychological distress, pain, sialorrhrea, nutrition, and ventilatory support. Communication skills of health-care professionals are mandatory to manage the inevitability of death. Palliative sedation has peculiar aspects in this population, particularly with the decision of withdrawing ventilatory support.
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Affiliation(s)
- Sebastiano Mercadante
- Main Regional Center of Pain Relief and Supportive/Palliative Care (S.M.), La Maddalena Cancer Center, Palermo, Italy; Regional Home Care Program, SAMOT (S.M.), Palermo, Italy.
| | - Lou'i Al-Husinat
- Department of Clinical Medical Sciences (L.A.H.), Yarmouk University, Irbid, Jordan
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Gomes de Souza e Silva EM, Tomaz da Silva S, Januário de Holanda L, Tezoni Borges D, Mendonça Fernandes AP, Evangelista Rodrigues da Silva K, Souza Ribeiro T, Protásio de Melo L, de Medeiros Valentim RA, Alves Pinto Nagem D, Rodrigues Lindquist AR. Effects of a self-care educational program via telerehabilitation on quality of life and caregiver burden in amyotrophic lateral sclerosis: a single-blinded randomized clinical trial protocol. Front Psychol 2023; 14:1164370. [PMID: 37663359 PMCID: PMC10472276 DOI: 10.3389/fpsyg.2023.1164370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 07/25/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction The implementation of a telerehabilitation protocol for self-care in the routine of caregivers of individuals with amyotrophic lateral sclerosis (ALS) has been associated with reduced levels of stress and improved quality of life. Moreover, it may reduce the difficulty of traveling to perform physical or other self-care activities. Thus, this study designed a clinical trial protocol to investigate the effects of a self-care education program via telerehabilitation on the burden and quality of life of caregivers of individuals with ALS. Methods This single-blinded randomized clinical trial will recruit 26 caregivers and randomly allocate them to the experimental (EG = 13) or control group (CG = 13). The EG will receive an informative booklet and participate in a 6-week synchronous telerehabilitation program with a neuropsychologist, nutritionist, and physiotherapist to discuss physical and mental health. The CG will receive an informative booklet on self-care and physical activity and weekly phone calls for 6 weeks to solve questions about the booklet. Outcomes will include the caregiver burden (Zarit scale), quality of life (World Health Organization Quality of Life BREF), pain (McGill Pain Questionnaire), stress (Perceived Stress Scale), and depression (Beck Depression Inventory), which will be evaluated at the baseline after the six-week program and 30 days after the program. Additionally, we will assess daily the nocturnal awakenings, sleep patterns, level of physical activity, and heart rate variability. Discussion This study aimed to investigate the effectiveness of telerehabilitation for caregivers of individuals with ALS. If effective, this program could be disseminated among health professionals, increasing the possibility of remotely monitoring individuals with difficulty performing physical activities. Trial registration number NCT05884034 (clinicaltrials.gov).
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Affiliation(s)
- Emília Márcia Gomes de Souza e Silva
- Laboratory of Intervention and Analysis of Movement, Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Stephano Tomaz da Silva
- Laboratory of Intervention and Analysis of Movement, Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Ledycnarf Januário de Holanda
- Laboratory of Intervention and Analysis of Movement, Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Daniel Tezoni Borges
- Laboratory of Intervention and Analysis of Movement, Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Ana Paula Mendonça Fernandes
- Laboratory of Intervention and Analysis of Movement, Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | - Tatiana Souza Ribeiro
- Laboratory of Intervention and Analysis of Movement, Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Luciana Protásio de Melo
- Laboratory of Intervention and Analysis of Movement, Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Ricardo Alexsandro de Medeiros Valentim
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Brazil
- Department of Biomedical Engineering, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Danilo Alves Pinto Nagem
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Brazil
- Department of Biomedical Engineering, Federal University of Rio Grande do Norte, Natal, Brazil
| | - Ana Raquel Rodrigues Lindquist
- Laboratory of Intervention and Analysis of Movement, Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
- Laboratory of Technological Innovation in Health, Federal University of Rio Grande do Norte, Natal, Brazil
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Kutlubaev MA, Caga J, Xu Y, Areprintseva DK, Pervushina EV, Kiernan MC. Apathy in amyotrophic lateral sclerosis: systematic review and meta-analysis of frequency, correlates, and outcomes. Amyotroph Lateral Scler Frontotemporal Degener 2023; 24:14-23. [PMID: 35352575 DOI: 10.1080/21678421.2022.2053721] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Objectives: To determine the frequency and correlates of apathy in amyotrophic lateral sclerosis (ALS) and its influence on the prognosis of the disease.Methods: Three databases were searched: MEDLINE, PubMed, and Google Scholar. Quantitative synthesis of the frequency of apathy in ALS was conducted using random effects in Stata (College Station, TX). Meta-regression and subgroup analyses were conducted to investigate the association between frequency of apathy in ALS and different covariates.Results: Fifty-two studies (51 cohorts) were included in the analysis. The pooled frequency of apathy in ALS was 25% (95% confidence interval (CI) 14-35%) according to the studies that used self-rated tools and 34% (95% CI 27-41%) according to studies that used informant-rated tools. The emergence of apathy was associated with cognitive decline and bulbar onset of the disease. There was no consistent relationship between apathy and disease stage or the severity of depression. Structural brain imaging studies established that ALS patients with apathy exhibited more prominent changes with structural and functional brain imaging particularly involving fronto-subcortical regions of the brain. Overall, apathy worsened the long-term prognosis of ALS.Discussion: Apathy affects up to a third of ALS patients аnd develops in the context of progressive neurodegeneration. Increased awareness and understanding of non-motor symptoms in ALS highlights the potential utility of apathy as an outcome measure in future clinical trial design.
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Affiliation(s)
| | - Jashelle Caga
- Brain & Mind Centre, University of Sydney, Sydney, Australia.,Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia and
| | - Ying Xu
- The George Institute for Global Health, Sydney, Australia
| | | | | | - Matthew C Kiernan
- Brain & Mind Centre, University of Sydney, Sydney, Australia.,Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia and
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Shoesmith C. Palliative care principles in ALS. HANDBOOK OF CLINICAL NEUROLOGY 2023; 191:139-155. [PMID: 36599506 DOI: 10.1016/b978-0-12-824535-4.00007-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease associated with progressive dysphagia, dysarthria, extremity weakness, and dyspnea. Although there are some disease-modifying pharmacological treatments available which can modestly slow disease progression, the disease is relentlessly progressive and is ultimately fatal. Patients living with ALS should be supported using the principles of palliative care, and in particular, the use of a holistic approach to support the patients and their families. Evidence would support management of patients living with ALS by a multidisciplinary ALS specialty clinic. These multidisciplinary clinics will help support the multitude of symptoms a patient living with ALS can experience, including dysphagia, communication impairments, dexterity impairments, mobility deficits, and respiratory insufficiency. Formal involvement of specialist-trained palliative practitioners can occur throughout the course of the illness, or when the patient is open to their involvement. There are several models of palliative care that can be followed, including integration of palliative care into the multidisciplinary ALS clinic, separate involvement of a palliative care specialty team, home-based palliative care, telemedicine supported care, and hospice care. Key components of palliative care in ALS are goals-of-care discussions advance directive planning, symptoms management, and end-of-life support.
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Affiliation(s)
- Christen Shoesmith
- Department of Clinical Neurological Sciences, Division of Neurology, London Health Sciences Centre, London, ON, Canada.
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Maksymowicz-Śliwińska A, Lulé D, NieporĘcki K, Ciećwierska K, Ludolph AC, Kuźma-Kozakiewicz M. The quality of life and depression in primary caregivers of patients with amyotrophic lateral sclerosis is affected by patient-related and culture-specific conditions. Amyotroph Lateral Scler Frontotemporal Degener 2022; 24:317-326. [PMID: 36510650 DOI: 10.1080/21678421.2022.2126322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective: To analyze the quality of life (QoL) and frequency of depression in primary caregivers of patients with amyotrophic lateral sclerosis (ALS) in two neighboring European countries. Methods: a cross-sectional study performed in 164 dyads of ALS patients and caregivers followed at clinical ALS centers in Poland and Germany between 2015 and 2018. The quality of life (Anamnestic Comparative Self-Assessment - ACSA, Quality of Life in Life-Threatening Illness - Family Carer Version - QOLLTI-F) and depression (ALS-Depression-Inventory 12-Items - ADI-12) of the caregivers was assessed and correlated with caregivers- and patient-related factors. Patient's clinical status was assessed by ALS Functional Rating Scale - revised and the Behavioral Score of the Edinburgh Cognitive and Behavioral ALS Screen. Results: the caregivers reported a positive QoL associated with functional and behavioral status of the patient, disease duration and caregivers's depression The most impaired domains of the QoL differed depending on the country of provenance, cultural background and/or social support of the caregivers. Depression was present in 1/3 of the caregivers and was significantly more frequent in the Polish group. It positively correlated with female gender, disease duration, sleep disturbances and functional decline. Both QoL and mood were significantly lower in the caregivers more burdened with the functional care of the patients. Conclusions: the wellbeing of caregivers of ALS patients is affected by patient-related and culture-specific conditions. Understanding the needs and background of psychological adaptation of the caregivers from various countries may translate into better QoL and local patient care.
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Affiliation(s)
| | - Dorothée Lulé
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Krzysztof NieporĘcki
- Department of Neurology, University Clinical Center of the Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Ciećwierska
- Department of Neurology, University Clinical Center of the Medical University of Warsaw, Warsaw, Poland
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Warrier MG, Thomas PT, Sadasivan A, Nashi S, Vengalil S, Nalini A. Development of Guidelines for Spouses Engaged in Home-Based Care of Persons With Motor Neuron Disease From Indian Context. J Patient Exp 2022; 9:23743735221077535. [PMID: 35128043 PMCID: PMC8814983 DOI: 10.1177/23743735221077535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: The caregivers of persons with motor neuron disease (MND) have several needs that are usually not voiced on any platform. Aim: To explore the lived experience of spouses of persons with MND, identify their needs and develop guidelines for better home-based care. Method: An exploratory study with 3-point in-depth interviews among 13 participants was conducted. Participants were the spouses of persons with MND under treatment at a national quaternary referral center. The interpretative phenomenological analysis identified participants’ needs. These needs, with literature review synthesis, guided the drafting of guidelines, which was validated by experts. Results: The needs were emotional, social, care systems, and skills. The guidelines developed contained 2 sections (1) Information for the spouses: understanding MND, communication, symptom management, marital relationship, palliative care, and everyday life made easier. (2) Well-being of the spouse caregivers: well-being of the spouse caregivers, self-care, mental health, supporting carers in palliative care, where to find help.Conclusion: The guidelines can be developed as a manual for the caregivers and for training healthcare professionals working with neurodegenerative conditions.
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Affiliation(s)
| | | | | | | | | | - A Nalini
- Department of Neurology, NIMHANS, Bangalore, India
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D’Alvano G, Buonanno D, Passaniti C, De Stefano M, Lavorgna L, Tedeschi G, Siciliano M, Trojsi F. Support Needs and Interventions for Family Caregivers of Patients with Amyotrophic Lateral Sclerosis (ALS): A Narrative Review with Report of Telemedicine Experiences at the Time of COVID-19 Pandemic. Brain Sci 2021; 12:brainsci12010049. [PMID: 35053794 PMCID: PMC8773661 DOI: 10.3390/brainsci12010049] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/22/2021] [Accepted: 12/27/2021] [Indexed: 11/27/2022] Open
Abstract
Family caregivers of people with amyotrophic lateral sclerosis (ALS), a severely disabling neurodegenerative disease due to the degeneration of both upper and lower motor neurons, have a very demanding role in managing their relatives, thereby often experiencing heavy care burden. Previous literature has widely highlighted that this situation reduces caregivers’ quality of life and increases their psychological distress and risk of health problems, but there are relatively few studies that focus on psychological interventions for these situations. Family support is more—not less—important during crisis. However, during the COVID-19 pandemic, maintaining public safety has required restricting the physical presence of families for hospitalized patients. Caregivers of ALS patients felt increased sense of loneliness and experienced greater difficulties in the access to both hospital and home assistance. In response, health systems rapidly adapted family-centric procedures and tools to circumvent restrictions on physical presence. In this regard, internet-based and telehealth solutions have been adopted to facilitate the routine, predictable, and structured communication, crucial to family-centered care. This narrative review aims at addressing more current matters on support needs and interventions for improving wellbeing of caregivers of ALS patients. In particular, we aimed at highlighting several gaps related to the complex needs of caregivers of ALS patients, to the interventions carried out in order to respond to these needs, and to the changes that COVID-19 pandemic caused from 2020 to nowadays in clinical managing of ALS patients. Finally, we report ongoing experiences of psychological support for family caregivers of ALS patients through telehealth solutions, which have been reinforced in case of needing of physical distancing during the COVID-19 pandemic.
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Francis R, Attrill S, Doeltgen S. The impact of cognitive decline in amyotrophic lateral sclerosis on swallowing. A scoping review. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 23:604-613. [PMID: 33779439 DOI: 10.1080/17549507.2021.1894235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose: Impaired swallowing is a serious symptom of amyotrophic lateral sclerosis (ALS) impacting on health and wellbeing. Little is known about how cognitive impairment in amyotrophic lateral sclerosis impacts on oropharyngeal swallowing. A scoping review was undertaken to explore how cognitive impairment impacts on a person living with ALS's (plwALS) ability to understand and manage oropharyngeal swallowing function.Method: Subject headings and keywords were searched across MEDLINE, SCOPUS, CINAHL, PsychINFO, Emcare and Google Scholar in May 2019. Articles containing information on amyotrophic lateral sclerosis and cognition and swallowing were reviewed. A secondary search was conducted in July 2020 with broadened search terms.Result: The primary search identified 1055 articles, and 47 were included for full-text review. Of these, no articles directly met the inclusion criteria of both cognitive impairment and swallowing. The secondary search with broadened terms identified an additional 762 studies, and 9 were included for full-text review, but none met the inclusion criteria. Consequently, thematic analysis was completed on articles from the full-text review to identify themes that related to both cognition and swallowing. The themes identified were: (i) early specialised multidisciplinary management of ALS achieves better outcomes; (ii) cognitive impairment impacts on management; and (iii) impaired swallowing occurs in nearly all people living with ALS and is a serious symptom of the disease.Conclusion: The interaction between cognitive impairment and oropharyngeal swallowing function in ALS has not been investigated. This is important, as cognitive impairment impacts insight and decision-making and may have implications for oropharyngeal swallowing management.
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Affiliation(s)
- Rebecca Francis
- Speech Pathology, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Swallowing Neurorehabilitation Research Laboratory, Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Stacie Attrill
- Speech Pathology, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Sebastian Doeltgen
- Speech Pathology, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Swallowing Neurorehabilitation Research Laboratory, Caring Futures Institute, Flinders University, Adelaide, Australia
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12
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Shoesmith C, Abrahao A, Benstead T, Chum M, Dupre N, Izenberg A, Johnston W, Kalra S, Leddin D, O'Connell C, Schellenberg K, Tandon A, Zinman L. Canadian best practice recommendations for the management of amyotrophic lateral sclerosis. CMAJ 2021; 192:E1453-E1468. [PMID: 33199452 DOI: 10.1503/cmaj.191721] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Christen Shoesmith
- London Health Sciences Centre (Shoesmith), London, Ont.; Sunnybrook Health Sciences Centre (Abrahao, Izenberg, Tandon, Zinman), Toronto, Ont.; Dalhousie University (Benstead, Leddin), Halifax, NS; McMaster University (Chum), Hamilton, Ont.; CHU de Québec-Université Laval (Dupre), Québec, Que.; University of Alberta (Johnston, Kalra), Edmonton, Alta.; Stan Cassidy Centre for Rehabilitation (O'Connell), Fredericton, NB; University of Saskatchewan (Schellenberg), Saskatoon, Sask.
| | - Agessandro Abrahao
- London Health Sciences Centre (Shoesmith), London, Ont.; Sunnybrook Health Sciences Centre (Abrahao, Izenberg, Tandon, Zinman), Toronto, Ont.; Dalhousie University (Benstead, Leddin), Halifax, NS; McMaster University (Chum), Hamilton, Ont.; CHU de Québec-Université Laval (Dupre), Québec, Que.; University of Alberta (Johnston, Kalra), Edmonton, Alta.; Stan Cassidy Centre for Rehabilitation (O'Connell), Fredericton, NB; University of Saskatchewan (Schellenberg), Saskatoon, Sask
| | - Tim Benstead
- London Health Sciences Centre (Shoesmith), London, Ont.; Sunnybrook Health Sciences Centre (Abrahao, Izenberg, Tandon, Zinman), Toronto, Ont.; Dalhousie University (Benstead, Leddin), Halifax, NS; McMaster University (Chum), Hamilton, Ont.; CHU de Québec-Université Laval (Dupre), Québec, Que.; University of Alberta (Johnston, Kalra), Edmonton, Alta.; Stan Cassidy Centre for Rehabilitation (O'Connell), Fredericton, NB; University of Saskatchewan (Schellenberg), Saskatoon, Sask
| | - Marvin Chum
- London Health Sciences Centre (Shoesmith), London, Ont.; Sunnybrook Health Sciences Centre (Abrahao, Izenberg, Tandon, Zinman), Toronto, Ont.; Dalhousie University (Benstead, Leddin), Halifax, NS; McMaster University (Chum), Hamilton, Ont.; CHU de Québec-Université Laval (Dupre), Québec, Que.; University of Alberta (Johnston, Kalra), Edmonton, Alta.; Stan Cassidy Centre for Rehabilitation (O'Connell), Fredericton, NB; University of Saskatchewan (Schellenberg), Saskatoon, Sask
| | - Nicolas Dupre
- London Health Sciences Centre (Shoesmith), London, Ont.; Sunnybrook Health Sciences Centre (Abrahao, Izenberg, Tandon, Zinman), Toronto, Ont.; Dalhousie University (Benstead, Leddin), Halifax, NS; McMaster University (Chum), Hamilton, Ont.; CHU de Québec-Université Laval (Dupre), Québec, Que.; University of Alberta (Johnston, Kalra), Edmonton, Alta.; Stan Cassidy Centre for Rehabilitation (O'Connell), Fredericton, NB; University of Saskatchewan (Schellenberg), Saskatoon, Sask
| | - Aaron Izenberg
- London Health Sciences Centre (Shoesmith), London, Ont.; Sunnybrook Health Sciences Centre (Abrahao, Izenberg, Tandon, Zinman), Toronto, Ont.; Dalhousie University (Benstead, Leddin), Halifax, NS; McMaster University (Chum), Hamilton, Ont.; CHU de Québec-Université Laval (Dupre), Québec, Que.; University of Alberta (Johnston, Kalra), Edmonton, Alta.; Stan Cassidy Centre for Rehabilitation (O'Connell), Fredericton, NB; University of Saskatchewan (Schellenberg), Saskatoon, Sask
| | - Wendy Johnston
- London Health Sciences Centre (Shoesmith), London, Ont.; Sunnybrook Health Sciences Centre (Abrahao, Izenberg, Tandon, Zinman), Toronto, Ont.; Dalhousie University (Benstead, Leddin), Halifax, NS; McMaster University (Chum), Hamilton, Ont.; CHU de Québec-Université Laval (Dupre), Québec, Que.; University of Alberta (Johnston, Kalra), Edmonton, Alta.; Stan Cassidy Centre for Rehabilitation (O'Connell), Fredericton, NB; University of Saskatchewan (Schellenberg), Saskatoon, Sask
| | - Sanjay Kalra
- London Health Sciences Centre (Shoesmith), London, Ont.; Sunnybrook Health Sciences Centre (Abrahao, Izenberg, Tandon, Zinman), Toronto, Ont.; Dalhousie University (Benstead, Leddin), Halifax, NS; McMaster University (Chum), Hamilton, Ont.; CHU de Québec-Université Laval (Dupre), Québec, Que.; University of Alberta (Johnston, Kalra), Edmonton, Alta.; Stan Cassidy Centre for Rehabilitation (O'Connell), Fredericton, NB; University of Saskatchewan (Schellenberg), Saskatoon, Sask
| | - Desmond Leddin
- London Health Sciences Centre (Shoesmith), London, Ont.; Sunnybrook Health Sciences Centre (Abrahao, Izenberg, Tandon, Zinman), Toronto, Ont.; Dalhousie University (Benstead, Leddin), Halifax, NS; McMaster University (Chum), Hamilton, Ont.; CHU de Québec-Université Laval (Dupre), Québec, Que.; University of Alberta (Johnston, Kalra), Edmonton, Alta.; Stan Cassidy Centre for Rehabilitation (O'Connell), Fredericton, NB; University of Saskatchewan (Schellenberg), Saskatoon, Sask
| | - Colleen O'Connell
- London Health Sciences Centre (Shoesmith), London, Ont.; Sunnybrook Health Sciences Centre (Abrahao, Izenberg, Tandon, Zinman), Toronto, Ont.; Dalhousie University (Benstead, Leddin), Halifax, NS; McMaster University (Chum), Hamilton, Ont.; CHU de Québec-Université Laval (Dupre), Québec, Que.; University of Alberta (Johnston, Kalra), Edmonton, Alta.; Stan Cassidy Centre for Rehabilitation (O'Connell), Fredericton, NB; University of Saskatchewan (Schellenberg), Saskatoon, Sask
| | - Kerri Schellenberg
- London Health Sciences Centre (Shoesmith), London, Ont.; Sunnybrook Health Sciences Centre (Abrahao, Izenberg, Tandon, Zinman), Toronto, Ont.; Dalhousie University (Benstead, Leddin), Halifax, NS; McMaster University (Chum), Hamilton, Ont.; CHU de Québec-Université Laval (Dupre), Québec, Que.; University of Alberta (Johnston, Kalra), Edmonton, Alta.; Stan Cassidy Centre for Rehabilitation (O'Connell), Fredericton, NB; University of Saskatchewan (Schellenberg), Saskatoon, Sask
| | - Anu Tandon
- London Health Sciences Centre (Shoesmith), London, Ont.; Sunnybrook Health Sciences Centre (Abrahao, Izenberg, Tandon, Zinman), Toronto, Ont.; Dalhousie University (Benstead, Leddin), Halifax, NS; McMaster University (Chum), Hamilton, Ont.; CHU de Québec-Université Laval (Dupre), Québec, Que.; University of Alberta (Johnston, Kalra), Edmonton, Alta.; Stan Cassidy Centre for Rehabilitation (O'Connell), Fredericton, NB; University of Saskatchewan (Schellenberg), Saskatoon, Sask
| | - Lorne Zinman
- London Health Sciences Centre (Shoesmith), London, Ont.; Sunnybrook Health Sciences Centre (Abrahao, Izenberg, Tandon, Zinman), Toronto, Ont.; Dalhousie University (Benstead, Leddin), Halifax, NS; McMaster University (Chum), Hamilton, Ont.; CHU de Québec-Université Laval (Dupre), Québec, Que.; University of Alberta (Johnston, Kalra), Edmonton, Alta.; Stan Cassidy Centre for Rehabilitation (O'Connell), Fredericton, NB; University of Saskatchewan (Schellenberg), Saskatoon, Sask
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13
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Caga J, Zoing MC, Foxe D, Ramsey E, D'Mello M, Mioshi E, Ahmed RM, Kiernan MC, Piguet O. Problem-focused coping underlying lower caregiver burden in ALS-FTD: implications for caregiver intervention. Amyotroph Lateral Scler Frontotemporal Degener 2021; 22:434-441. [PMID: 33438449 DOI: 10.1080/21678421.2020.1867180] [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: 10/22/2022]
Abstract
Objective: Amyotrophic lateral sclerosis (ALS) is a multisystem neurodegenerative disorder which includes cognitive and behavioral symptoms akin to frontotemporal dementia (FTD). Despite the necessity of caregiver intervention to assist with the management of cognitive and behavioral symptoms, there has been a lack of research on the topic. A focus on caregiver coping may offer a promising foundation to guide the development of interventions as part of ALS care. Accordingly, the aim of the present study was to examine the relationships between caregiver coping, psychological morbidity and burden of care in the context of ALS cognitive and behavioral symptoms. Methods: Fifty-five patient-caregiver dyads were recruited from specialized ALS and FTD clinics. Specific coping strategies were examined using the COPE Inventory/Brief COPE and psychological morbidity and burden were assessed using the Depression, Anxiety, and Stress Scale-21 and Zarit Burden Interview. The relationship between coping, psychological morbidity and burden of care were analyzed using univariate and multivariate methods. Results: High-burden caregivers were more likely to be caring for patients with a diagnosis of ALS-FTD (p =.0001). Caregivers used problem-focused strategies (particularly planning) more frequently (M = 71.4, SD = 15.3) compared to emotion-focused (M = 60.8, SD = 12.3) and dysfunctional coping strategies (M = 42.2, SD = 8.6). A diagnosis of ALS-FTD (p=.0001) and problem-focused strategies (p=.024) emerged as significant predictors of caregiver burden. Caregiver anxiety, depression and stress were not predictive of caregiver burden (p=.151). Conclusions: Timely provision of caregiver support optimizing problem-focused coping strategies as part of multidisciplinary ALS care, particularly for caregivers of ALS-FTD patients may mitigate caregiver burden.
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Affiliation(s)
- Jashelle Caga
- Brain & Mind Centre, The University of Sydney, Camperdown, Australia.,Sydney Medical School, The University of Sydney, Camperdown, Australia
| | - Margaret C Zoing
- Brain & Mind Centre, The University of Sydney, Camperdown, Australia
| | - David Foxe
- Brain & Mind Centre, The University of Sydney, Camperdown, Australia.,School of Psychology, The University of Sydney, Camperdown, Australia, and
| | - Eleanor Ramsey
- Brain & Mind Centre, The University of Sydney, Camperdown, Australia
| | - Mirelle D'Mello
- Brain & Mind Centre, The University of Sydney, Camperdown, Australia.,School of Psychology, The University of Sydney, Camperdown, Australia, and
| | - Eneida Mioshi
- School of Health Sciences, The University of East Anglia, Norwich, UK
| | - Rebekah M Ahmed
- Brain & Mind Centre, The University of Sydney, Camperdown, Australia.,Sydney Medical School, The University of Sydney, Camperdown, Australia
| | - Matthew C Kiernan
- Brain & Mind Centre, The University of Sydney, Camperdown, Australia.,Sydney Medical School, The University of Sydney, Camperdown, Australia
| | - Olivier Piguet
- Brain & Mind Centre, The University of Sydney, Camperdown, Australia.,School of Psychology, The University of Sydney, Camperdown, Australia, and
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14
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Leite Neto L, Novais T, França Júnior M, Chun R. Repercussions of language difficulties in people with amyotrophic lateral sclerosis and the impact on their lives and on their caregivers. REVISTA CEFAC 2021. [DOI: 10.1590/1982-0216/202123414120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Purpose: to analyze the repercussions of language difficulties in people presented with Amyotrophic Lateral Sclerosis and in their caregivers, and the impact on their lives. Methods: a cross-sectional study and qualitative approach, structured according to the COREQ. Semi-structured interview was conducted with 30 participants, family members and/or caregivers of people with the disease, most of them diagnosed for less than 5 years, and then transcribed and analyzed under repetition and relevance criteria. Results: most participants were women, spouses, between 50 and 70 years of age, in average being a caregiver for less than 3 years. Most interviewees reported the absence of communication difficulties with the disease, little use of Augmentative and Alternative Communication, restricted social interaction, and the perception of signs of discouragement and sadness in the person under their care. Regarding themselves, they mentioned anguish related to the prognosis, emotional overload, and intense change of routine in their lives. Conclusion: language difficulties were not frequently reported, despite the observation of restricted and social interactions. These findings showed the negative impacts on the quality of life of individuals and that of their family members and caregivers, which are experienced as anguish.
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15
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Beswick E, Park E, Wong C, Mehta AR, Dakin R, Chandran S, Newton J, Carson A, Abrahams S, Pal S. A systematic review of neuropsychiatric and cognitive assessments used in clinical trials for amyotrophic lateral sclerosis. J Neurol 2020; 268:4510-4521. [PMID: 32910255 PMCID: PMC8563523 DOI: 10.1007/s00415-020-10203-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 02/07/2023]
Abstract
Background Up to 50% of people with amyotrophic lateral sclerosis (ALS) experience cognitive dysfunction, whilst depression and anxiety are reported in up to 44% and 33%, respectively. These symptoms impact on quality of life, and are associated with a poorer prognosis. Historically, outcomes in clinical trials have focused on the effect of candidate drugs on physical functioning. Methods We reviewed the past 25 years of clinical trials of investigative medicinal products in people with ALS, since the licensing of riluzole, and extracted data on frequency and type of assessment for neuropsychiatric symptoms and cognitive impairment. Trial registry databases, including WHO International Trials Registry, European Clinical Trials Register, clinicaltrials.gov, and PubMed, were systematically searched for Phase II, III or IV trials registered, completed or published between 01/01/1994 and 31/10/2019. No language restrictions were applied. Outcome measures, exclusion criteria and assessment tool used were extracted. Results 216 trials, investigating 26,326 people with ALS, were reviewed. 35% assessed neuropsychiatric symptoms, and 22% assessed cognition, as Exclusion Criteria or Outcome Measures. 3% (n = 6) of trials assessed neuropsychiatric symptoms as a Secondary Outcome Measure, and 4% (n = 8) assessed cognition as Outcome Measures; only one trial included assessments for both cognition and neuropsychiatric symptoms as Outcome Measures. Three ALS-specific assessments were used in six trials. Conclusions Trials for people with ALS have neglected the importance of neuropsychiatric symptoms and cognitive impairment. Evaluation of these extra-motor features is essential to understanding the impact of candidate drugs on all symptoms of ALS. PROPSERO registration CRD42020175612. Electronic supplementary material The online version of this article (10.1007/s00415-020-10203-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emily Beswick
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland.,Anne Rowling Regenerative Neurology Clinic, 49 Little France Crescent, EH16 4SB, Edinburgh, UK.,Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, Scotland
| | - Emily Park
- The School of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, Scotland
| | - Charis Wong
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland.,Anne Rowling Regenerative Neurology Clinic, 49 Little France Crescent, EH16 4SB, Edinburgh, UK.,Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, Scotland
| | - Arpan R Mehta
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland.,Anne Rowling Regenerative Neurology Clinic, 49 Little France Crescent, EH16 4SB, Edinburgh, UK.,Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, Scotland.,UK Dementia Research Institute, The University of Edinburgh, Edinburgh, Scotland
| | - Rachel Dakin
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland.,Anne Rowling Regenerative Neurology Clinic, 49 Little France Crescent, EH16 4SB, Edinburgh, UK
| | - Siddharthan Chandran
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland.,Anne Rowling Regenerative Neurology Clinic, 49 Little France Crescent, EH16 4SB, Edinburgh, UK.,Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, Scotland.,UK Dementia Research Institute, The University of Edinburgh, Edinburgh, Scotland
| | - Judith Newton
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland.,Anne Rowling Regenerative Neurology Clinic, 49 Little France Crescent, EH16 4SB, Edinburgh, UK
| | - Alan Carson
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland
| | - Sharon Abrahams
- Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, Scotland.,Human Cognitive Neurosciences, Psychology, School of Philosophy, Psychology and Language Sciences, The University of Edinburgh, Edinburgh, Scotland
| | - Suvankar Pal
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, Scotland. .,Anne Rowling Regenerative Neurology Clinic, 49 Little France Crescent, EH16 4SB, Edinburgh, UK. .,Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, Scotland.
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16
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Radakovic R, Copsey H, Moore C, Mioshi E. Development of the MiNDToolkit for management of cognitive and behavioral impairment in motor neuron disease. Neurodegener Dis Manag 2020; 10:15-25. [PMID: 31973641 DOI: 10.2217/nmt-2019-0035] [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: 11/21/2022] Open
Abstract
Aim: To develop structured guidance, recommendations and techniques for nonpharmacological management of cognitive and behavioral impairments in motor neuron disease, called the MiNDToolkit. Methods: A four-round-modified Delphi method was utilized (online and face-to-face meeting), supplemented by recent research, recommendations, expertise from allied health professionals, clinicians, researchers and clients. Results: Round 1 (N = 47) identified allied health professionals techniques. Round 2 (N = 23) and 3 (N = 19) used expert consensus, refining general focus, specific elements and techniques. Round 4 (N = 8) applied personal, lived and occupational experience, finalizing the general structure and content of specific techniques. Conclusion: The MiNDToolkit is composed of multiple tools to structure decision-making through flowcharts, decision trees and checklists, provide information about impairments, assessment recommendations and techniques or strategies for nonpharmacological management cognitive or behavioral impairments in motor neuron disease.
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Affiliation(s)
- Ratko Radakovic
- Faculty of Medicine & Health Sciences, University of East Anglia, Norwich, UK.,Norfolk & Norwich University Hospital, Norwich, UK.,The Euan MacDonald Centre for Motor Neurone Disease, University of Edinburgh, Edinburgh, UK.,Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK.,Centre for Cognitive Ageing & Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Helen Copsey
- Faculty of Medicine & Health Sciences, University of East Anglia, Norwich, UK.,Norfolk & Norwich University Hospital, Norwich, UK
| | - Carmel Moore
- Norfolk & Norwich University Hospital, Norwich, UK
| | - Eneida Mioshi
- Faculty of Medicine & Health Sciences, University of East Anglia, Norwich, UK
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17
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de Wit J, Beelen A, van den Heerik MS, van den Berg LH, Visser-Meily JMA, Schröder CD. Psychological distress in partners of patients with amyotrophic lateral sclerosis and progressive muscular atrophy: what's the role of care demands and perceived control? PSYCHOL HEALTH MED 2019; 25:319-330. [PMID: 31747791 DOI: 10.1080/13548506.2019.1686646] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Caregivers of Amyotrophic Lateral Sclerosis (ALS) and Progressive Muscular Atrophy (PMA) patients often experience psychological distress. Yet, it is unclear which factors explain the variance in psychological distress. This study seeks to evaluate how care demands and perceived control over caregiving influence psychological distress using moderation and mediation analysis. Data were collected as part of a RCT and 148 partners of patients with ALS or PMA were included. Psychological distress was assessed using the Hospital Anxiety and Depression Scale. Care demands were operationalized as physical functioning (Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised) and behavioural changes of the patient (Amyotrophic Lateral Sclerosis-Frontotemporal Dementia-Questionnaire). Perceived control over caregiving was assessed using items adapted from the Job Content Questionnaire. Results showed that more behavioural changes and lower perceived control over caregiving were associated with higher levels of psychological distress in caregivers. Patients' physical functioning was not significantly related to caregivers' psychological distress. No moderation or mediation effects were found of perceived control over caregiving on the relationship between demand and psychological distress. Monitoring, psychoeducation and caregiver support with regard to behavioural changes in patients, seem to be important for the wellbeing of caregivers. Caregivers' perceived control might be a target for future interventions.
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Affiliation(s)
- Jessica de Wit
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Anita Beelen
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Marc S van den Heerik
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Leonard H van den Berg
- Brain Center Rudolf Magnus, Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johanna M A Visser-Meily
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, the Netherlands.,Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Carin D Schröder
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
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18
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Radakovic R, McGrory S, Chandran S, Swingler R, Pal S, Stephenson L, Colville S, Newton J, Starr JM, Abrahams S. The brief Dimensional Apathy Scale: A short clinical assessment of apathy. Clin Neuropsychol 2019; 34:423-435. [PMID: 31154933 DOI: 10.1080/13854046.2019.1621382] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective: Apathy is a prominent syndrome across neurodegenerative diseases. The Dimensional Apathy Scale (DAS) assesses three apathy subtypes-executive, emotional, and initiation-and is sensitive and valid in amyotrophic lateral sclerosis (ALS), Alzheimer's disease (AD), and Parkinson's disease. This study describes the development of the brief DAS (b-DAS), which will enable apathy to be swiftly detected in the clinic.Method: 102 ALS and 102 AD patients' previously collected data were used. Mokken analyses were performed on item-level data of each informant/carer-rated DAS subscale (executive, emotional, and initiation) for the initial scale reduction. Item-total correlational analyses against standard apathy (convergent validity criteria) and depression (divergent validity criteria) measures and qualitative examination of items aided final item selection. Receiver operating curve analysis determined optimal cutoffs for the reduced subscales.Results: Mokken analyses suggested unidimensionality of each DAS subscale. Three items were removed that failed to satisfy monotone homogeneity model requirements, three items were removed due to validity criteria not being met, and six items were removed due to a combination of lower item scalability and item-total correlations. Item-theme examination further reduced the b-DAS to nine items, three per subscale, with a supplemental awareness deficit assessment being added. Sensitivity- and specificity-based optimal cutoffs were calculated for each b-DAS subscale.Conclusions: This study presents the b-DAS, an informant/carer-based robust yet short multidimensional apathy instrument with good convergent and divergent validity, with recommended clinical cutoffs. The b-DAS is appropriate for use in the clinic and for research to quickly and comprehensively screen for apathy subtype impairments.
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Affiliation(s)
- Ratko Radakovic
- Human Cognitive Neuroscience, School of Philosophy, Psychology and Language Science, University of Edinburgh, Edinburgh, UK.,Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK.,Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK.,Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Sarah McGrory
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
| | - Siddharthan Chandran
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - Robert Swingler
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - Suvankar Pal
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - Laura Stephenson
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - Shuna Colville
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - Judy Newton
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - John M Starr
- Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK
| | - Sharon Abrahams
- Human Cognitive Neuroscience, School of Philosophy, Psychology and Language Science, University of Edinburgh, Edinburgh, UK.,Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
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19
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Poletti B, Carelli L, Solca F, Pezzati R, Faini A, Ticozzi N, Mitsumoto H, Silani V. Sexuality and intimacy in ALS: systematic literature review and future perspectives. J Neurol Neurosurg Psychiatry 2019; 90:712-719. [PMID: 30538137 DOI: 10.1136/jnnp-2018-319684] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 11/05/2018] [Accepted: 11/05/2018] [Indexed: 12/12/2022]
Abstract
Several features of amyotrophic lateral sclerosis (ALS) impact on sexuality and intimate relationship; however, the issue has received poor attention so far. We performed a systematic literature review in order to provide an up-to-date account of sexuality in ALS. References were identified by searches of PubMed, Web of Science, Scopus and PsycINFO (1970-2017, English literature). The following were the key terms: 'sexual' OR 'sexuality' OR 'intimacy' OR 'marital' AND 'ALS' OR 'Amyotrophic Lateral Sclerosis' OR 'Motor Neuron Disease' OR 'MND'. Titles and abstracts were screened for relevance and a full-text analysis was performed on the selected articles. Studies were included if they referred to sexual well-being/activities/functions or intimate relationship between patients and their partners and management of such topic by clinicians. Eligibility assessment was performed independently by two reviewers. A thematic and level of evidence classification of studies was performed. Studies' design, objectives, measurements and outcomes were summarised. Thirty articles were included and four topics were identified: intimacy in the dyads; sexual activities in patients and with their partners; sexual function disturbances; and sexuality and cognitive-behavioural alterations. The quality of the studies varies, with globally poor level of evidence. Some sexuality issues have been only sparsely addressed, such as gender-related differences, same-sex relationships and sexual activities other than intercourse. Sexuality in ALS is still not adequately considered by clinicians and researchers. We present preliminary recommendations for improving sexuality and intimacy at any ALS multidisciplinary clinics.
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Affiliation(s)
- Barbara Poletti
- Department of Neurology and Laboratory of Neuroscience, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Laura Carelli
- Department of Neurology and Laboratory of Neuroscience, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Federica Solca
- Department of Pathophysiology and Transplantation, 'Dino Ferrari' Center, Università degli Studi di Milano, Milan, Italy
| | - Rita Pezzati
- University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland.,Centro Terapia Cognitiva, Como, Italy
| | - Andrea Faini
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Nicola Ticozzi
- Department of Neurology and Laboratory of Neuroscience, Istituto Auxologico Italiano, IRCCS, Milan, Italy.,Department of Pathophysiology and Transplantation, 'Dino Ferrari' Center, Università degli Studi di Milano, Milan, Italy
| | - Hiroshi Mitsumoto
- Eleanor and Lou Gehrig ALS Center, Department of Neurology, Columbia University Medical Center, New York City, New York, USA
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, Istituto Auxologico Italiano, IRCCS, Milan, Italy .,Department of Pathophysiology and Transplantation, 'Dino Ferrari' Center, Università degli Studi di Milano, Milan, Italy
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20
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Caga J, Hsieh S, Lillo P, Dudley K, Mioshi E. The Impact of Cognitive and Behavioral Symptoms on ALS Patients and Their Caregivers. Front Neurol 2019; 10:192. [PMID: 30915018 PMCID: PMC6421295 DOI: 10.3389/fneur.2019.00192] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 02/14/2019] [Indexed: 12/11/2022] Open
Abstract
Previously thought to be a pure motor disease, amyotrophic lateral sclerosis (ALS) is now established as multisystem neurodegenerative disorder that lies on a continuum with frontotemporal dementia (FTD). Cognitive and behavioral symptoms primarily extend to executive function, personality, social conduct, and emotion processing. The assessment and management of cognitive and behavioral symptoms is complicated as they must be differentiated from psychological responses to a terminal diagnosis and progressive physical impairment. This is made more difficult by the limited number of studies investigating how these symptoms specifically affect patients and caregivers well-being. The current review focuses on the impact of cognitive and behavioral symptoms on patient and caregiver well-being and their implications for future research and interventions in ALS. This is an important area of research that could form the basis for more tailored, and potentially more successful, non-pharmacological interventions to improve psychological well-being among patients with ALS and their caregivers.
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Affiliation(s)
- Jashelle Caga
- Sydney Medical School, University of Sydney, Camperdown, NSW, Australia.,Brain & Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Sharpley Hsieh
- Faculty of Health and Behavioural Sciences, School of Psychology, University of Queensland, QLD, Australia
| | - Patricia Lillo
- Departamento de Neurología Sur/Neurociencia, Facultad de Medicina, Universidad de Chile & Geroscience Center for Brain Health and Metabolism, Santiago, Chile
| | - Kaitlin Dudley
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Eneida Mioshi
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
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21
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Oliver DJ. Palliative care in motor neurone disease: where are we now? Palliat Care 2019; 12:1178224218813914. [PMID: 30718958 PMCID: PMC6348498 DOI: 10.1177/1178224218813914] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 10/16/2018] [Indexed: 12/12/2022] Open
Abstract
Palliative care has a very important role in the care of patients with motor neurone disease and their families. There is increasing emphasis on the multidisciplinary assessment and support of patients within guidelines, supported by research. This includes the telling of the diagnosis, the assessment and management of symptoms, consideration of interventions, such as gastrostomy and ventilatory support, and care at the end of life. The aim of palliative care is to enable patients, and their families, to maintain as good a quality of life as possible and helping to ensure a peaceful death.
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22
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Caga J, Hsieh S, Highton-Williamson E, Zoing MC, Ramsey E, Devenney E, Ahmed RM, Hogden A, Kiernan MC. The burden of apathy for caregivers of patients with amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2018; 19:599-605. [PMID: 30369270 DOI: 10.1080/21678421.2018.1497659] [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] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Apathy is the most common behavioral symptom of amyotrophic lateral sclerosis (ALS). Despite its known impact on caregiver wellbeing, apathy is typically considered a unitary construct making assessment and targeting treatment problematic. The aim of this study was to explore the relationship between caregiver burden and the behavioral, cognitive, and emotional symptoms of apathy in ALS. METHODS Fifty-one ALS patient-caregiver dyads from an ALS/frontotemporal dementia Clinic were assessed with the Apathy Evaluation Scale which measured the cognitive, behavioral, emotional, and nonspecific symptoms of apathy as well as the Zarit Burden Interview, a measure of perceived burden among caregivers of cognitively impaired older adults. The relationship between apathy and caregiver burden were analyzed using univariate and multivariate methods. RESULTS Apathy was identified in 18% of ALS patients. Greater behavioral (p = 0.011) and nonspecific (p = 0.010) symptoms of apathy exhibited by patients were reported by caregivers with higher levels of burden compared to caregivers with lower levels of burden. Of the cognitive, behavioral, emotional, and nonspecific symptoms of apathy, only the behavioral symptoms explained a significant amount of variance in caregiver burden (p = 0.031). CONCLUSIONS Apathy, specifically the behavioral symptoms of apathy was associated with higher burden of care among ALS caregivers, highlighting the importance of multidimensional assessment of apathy and provision of behavior management support as part of ALS care.
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Affiliation(s)
- Jashelle Caga
- a Brain & Mind Centre , University of Sydney , Camperdown , NSW , Australia , and.,b Sydney Medical School University of Sydney , Camperdown , NSW , Australia
| | - Sharpley Hsieh
- a Brain & Mind Centre , University of Sydney , Camperdown , NSW , Australia , and
| | | | - Margaret C Zoing
- a Brain & Mind Centre , University of Sydney , Camperdown , NSW , Australia , and
| | - Eleanor Ramsey
- a Brain & Mind Centre , University of Sydney , Camperdown , NSW , Australia , and
| | - Emma Devenney
- a Brain & Mind Centre , University of Sydney , Camperdown , NSW , Australia , and
| | - Rebekah M Ahmed
- a Brain & Mind Centre , University of Sydney , Camperdown , NSW , Australia , and
| | - Anne Hogden
- a Brain & Mind Centre , University of Sydney , Camperdown , NSW , Australia , and
| | - Matthew C Kiernan
- a Brain & Mind Centre , University of Sydney , Camperdown , NSW , Australia , and.,b Sydney Medical School University of Sydney , Camperdown , NSW , Australia
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23
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de Wit J, Bakker LA, van Groenestijn AC, van den Berg LH, Schröder CD, Visser-Meily JMA, Beelen A. Caregiver burden in amyotrophic lateral sclerosis: A systematic review. Palliat Med 2018; 32:231-245. [PMID: 28671483 PMCID: PMC5784458 DOI: 10.1177/0269216317709965] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Informal caregivers of patients with amyotrophic lateral sclerosis experience increased levels of caregiver burden as the disease progresses. Insight in the factors related to caregiver burden is needed in order to develop supportive interventions. AIM To evaluate the evidence on patient and caregiver factors associated with caregiver burden in amyotrophic lateral sclerosis informal caregivers. DESIGN A systematic review. DATA SOURCES Four electronic databases were searched up to 2017. Studies that investigated quantitative relations between patient or caregiver factors and caregiver burden were included. The overall quality of evidence for factors was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS A total of 25 articles were included. High quality of evidence was found for the relation between caregiver burden and the factor "behavioral impairments." Moderate quality of evidence was found for the relations between caregiver burden and the factors "feelings of depression" of the caregiver and "physical functioning" of the patient. The remaining rated caregiver factors-"feelings of anxiety," "distress," "social support," "family functioning," and "age"-and patient factors-"bulbar function," "motor function," "respiratory function," "disease duration," "disinhibition," "executive functioning," "cognitive functioning," "feelings of depression," and "age"-showed low to very low quality of evidence for their association with caregiver burden. CONCLUSION Higher caregiver burden is associated with greater behavioral and physical impairment of the patient and with more depressive feelings of the caregiver. This knowledge enables the identification of caregivers at risk for caregiver burden and guides the development of interventions to diminish caregiver burden.
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Affiliation(s)
- Jessica de Wit
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Leonhard A Bakker
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annerieke C van Groenestijn
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Leonard H van den Berg
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Carin D Schröder
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
- Carin D Schröder, Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - Johanna MA Visser-Meily
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anita Beelen
- Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Caga J, Hsieh S, Highton-Williamson E, Zoing MC, Ramsey E, Devenney E, Ahmed RM, Kiernan MC. Apathy and its impact on patient outcome in amyotrophic lateral sclerosis. J Neurol 2017; 265:187-193. [DOI: 10.1007/s00415-017-8688-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 11/08/2017] [Accepted: 11/20/2017] [Indexed: 11/24/2022]
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25
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Oh J, Kim JA. Factor analysis of the Zarit Burden Interview in family caregivers of patients with amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2017; 19:50-56. [DOI: 10.1080/21678421.2017.1385636] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Juyeon Oh
- Division of Nursing, Hanyang University, Seoul, South Korea and
- Cell Therapy Center for Intractable Disorders, Hanyang University Hospital, Seoul, South Korea
| | - Jung A. Kim
- Division of Nursing, Hanyang University, Seoul, South Korea and
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26
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Geng D, Ou R, Miao X, Zhao L, Wei Q, Chen X, Liang Y, Shang H, Yang R. Patients’ self-perceived burden, caregivers’ burden and quality of life for amyotrophic lateral sclerosis patients: a cross-sectional study. J Clin Nurs 2017; 26:3188-3199. [PMID: 27874996 DOI: 10.1111/jocn.13667] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2016] [Indexed: 02/05/2023]
Affiliation(s)
- Dan Geng
- Department of Neurology; West China Hospital of Sichuan University; Chengdu Sichuan China
| | - RuWei Ou
- Department of Neurology; West China Hospital of Sichuan University; Chengdu Sichuan China
| | - XiaoHui Miao
- Department of Neurology; West China Hospital of Sichuan University; Chengdu Sichuan China
| | - LiHong Zhao
- Department of Neurology; West China Hospital of Sichuan University; Chengdu Sichuan China
| | - QianQian Wei
- Department of Neurology; West China Hospital of Sichuan University; Chengdu Sichuan China
| | - XuePing Chen
- Department of Neurology; West China Hospital of Sichuan University; Chengdu Sichuan China
| | - Yan Liang
- Department of Neurology; West China Hospital of Sichuan University; Chengdu Sichuan China
| | - HuiFang Shang
- Department of Neurology; West China Hospital of Sichuan University; Chengdu Sichuan China
| | - Rong Yang
- Department of Neurology; West China Hospital of Sichuan University; Chengdu Sichuan China
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27
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Rosenbohm A, Peter RS, Erhardt S, Lulé D, Rothenbacher D, Ludolph AC, Nagel G. Epidemiology of amyotrophic lateral sclerosis in Southern Germany. J Neurol 2017; 264:749-757. [PMID: 28220290 DOI: 10.1007/s00415-017-8413-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 01/24/2017] [Accepted: 02/06/2017] [Indexed: 02/03/2023]
Abstract
The objective of this study is to determine the current distribution of clinical phenotypes and to estimate future trends of ALS incidence in Western societies. We report on a clinical-epidemiological registry with a capture-recapture rate of >80% and population-based case-control study in ALS patients in South Western Germany. 1163 incidents of ALS were registered. Clinical and neuropsychological data were prospectively collected from 699 cases. The mean age at onset was 66.6 (SD = 11.6) years in prospective cases (N = 699). The site of onset was more frequently bulbar (34.1%) than lumbosacral (30.7%), cervical (27.0%), or thoracic (3.1%). Cognitive deficits (ranging from 27.5 to 42.1%, depending on the screening instrument) and behavioral changes (29%) were frequently detected. The incidence rate dropped markedly after 79 years of age, and bulbar onset as well as cognitive impairment were more frequent in ALS cases >75 years. The mean survival time of ALS cases from first paresis was 31 months. The age-standardized incidence rate (ASR) of ALS in 2012/2013 was found to be 2.4 (95% CI 2.2-2.7) per 100,000 person-years (resulting in an ASR of 3.1/100,000 with 100% coverage). Based on the predicted age distribution of the German population, the incidence of ALS was estimated to be 4.5/100,000 for men and 3.3/100,000 for women in the year 2050. ALS prevalence will rise to about 9.2-9.8/100,000 person-years in Germany in 2050. An increased proportion of patients with bulbar onset and/or cognitive deficits can be used as basic epidemiologic data on ALS for future health care decisions.
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Affiliation(s)
- Angela Rosenbohm
- Department of Neurology, Ulm University, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Raphael S Peter
- Institute for Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
| | - Siegfried Erhardt
- Institute for Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
| | - Dorothée Lulé
- Department of Neurology, Ulm University, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Dietrich Rothenbacher
- Institute for Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
| | - Albert C Ludolph
- Department of Neurology, Ulm University, Oberer Eselsberg 45, 89081, Ulm, Germany.
| | - Gabriele Nagel
- Institute for Epidemiology and Medical Biometry, Ulm University, Helmholtzstr. 22, 89081, Ulm, Germany
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28
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Siciliano M, Santangelo G, Trojsi F, Di Somma C, Patrone M, Femiano C, Monsurrò MR, Trojano L, Tedeschi G. Coping strategies and psychological distress in caregivers of patients with Amyotrophic Lateral Sclerosis (ALS). Amyotroph Lateral Scler Frontotemporal Degener 2017. [PMID: 28631956 DOI: 10.1080/21678421.2017.1285316] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) causes distress in caregivers. The present study aims to examine the association between coping strategies and psychological distress in caregivers of ALS patients. METHODS Coping strategies were assessed in 96 ALS informal caregivers by means of the Coping Inventory for Stressful Situations. Data about caregivers' demographic characteristics, levels of burden, depression and anxiety (psychological distress) were also gathered by standardised questionnaires. Patients' clinical, cognitive and behavioural disturbances were evaluated by ALS specific assessment tools. RESULTS Sequential logistic regression analysis showed that emotion-oriented coping strategy was significantly associated with high levels of depressive (p < 0.01) and anxiety (p < 0.05) symptoms and high levels of burden (p < 0.05), after controlling for all other variables. Moreover, a significant relationship of patients' functional dependence levels with burden experienced by caregivers was observed. No relationships were detected between task-oriented and avoidance-oriented coping strategies and caregivers' levels of psychological distress. CONCLUSIONS The present study supported the mediating effects of coping strategies on intensity of burden, depression and anxiety experienced by ALS caregivers. These findings suggest that interventions aimed at reducing utilisation of maladaptive coping strategies may improve well-being in ALS caregivers, and, possibly, management of symptoms in ALS patients.
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Affiliation(s)
- Mattia Siciliano
- a Department of Psychology , Second University of Naples , Caserta , Italy.,b Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences , Second University of Naples (SUN) , Naples , Italy.,c Department of Neuroscience, Reproductive and Odontostomatologic Sciences , University "Federico II" , Naples , Italy
| | - Gabriella Santangelo
- a Department of Psychology , Second University of Naples , Caserta , Italy.,d IDC-Hermitage-Capodimonte , Naples , Italy , and
| | - Francesca Trojsi
- b Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences , Second University of Naples (SUN) , Naples , Italy
| | - Carmela Di Somma
- a Department of Psychology , Second University of Naples , Caserta , Italy
| | - Manila Patrone
- a Department of Psychology , Second University of Naples , Caserta , Italy
| | - Cinzia Femiano
- b Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences , Second University of Naples (SUN) , Naples , Italy
| | - Maria Rosaria Monsurrò
- b Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences , Second University of Naples (SUN) , Naples , Italy
| | - Luigi Trojano
- a Department of Psychology , Second University of Naples , Caserta , Italy.,e Salvatore Maugeri Foundation, Scientific Institute of Telese , Telese Terme , Benevento , Italy
| | - Gioacchino Tedeschi
- b Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences , Second University of Naples (SUN) , Naples , Italy
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Factors to consider for motor neurone disease carer intervention research: A narrative literature review. Palliat Support Care 2016; 15:600-608. [PMID: 27995822 DOI: 10.1017/s1478951516000912] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The experience of caregiving in the context of motor neurone disease (MND) is extremely challenging. Over the past 15 years, quantitative and qualitative studies have delineated the psychosocial aspects of this experience, exploring its impact on caregivers' quality of life, rates of depression, distress, anxiety, and burden. Our paper aimed to provide an overview of the lived experience of MND caregivers, identifying the variables that can influence MND caregiver functioning that are relevant to the development of an intervention. METHOD A narrative review was conducted, synthesizing the findings of literature retrieved from 2000 to early 2016. RESULTS A total of 37 articles were included in the review. The articles varied considerably in terms of methodology and quality. The main influential aspects reported and identified were factors pertaining to the patient, factors intrinsic to the caregiver, relationship factors, and social support factors. SIGNIFICANCE OF RESULTS There is evidence to support the fact that caregivers have poorer outcomes when they care for patients with a more severe clinical profile, poorer emotional health or neurobehavioral concerns, or when the caregivers themselves struggle with adaptive problem-solving and coping skills. The availability and use of social support are also likely to be important for caregiver psychosocial outcomes. Further investigation is required to clarify the influence of changes in the relationship with the patient. Significant factors affecting the caregiver experience are considered in relation to their amenability to psychosocial intervention. Recommendations are made regarding the optimal features of future psychosocial intervention research.
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