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Serian A, Finsel J, Ludolph AC, Uttner I, Lulé D. Screening instruments of cognition: The relation of the mini-mental state examination to the Edinburgh cognitive and behavioural ALS screen in amyotrophic lateral sclerosis. PLoS One 2024; 19:e0304593. [PMID: 38900757 PMCID: PMC11189171 DOI: 10.1371/journal.pone.0304593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 05/14/2024] [Indexed: 06/22/2024] Open
Abstract
OBJECTIVE The Edinburgh Cognitive and Behavioural ALS Screen (ECAS) is an established cognitive screening instrument for patients with amyotrophic lateral sclerosis (ALS). Different from tools like the Mini-Mental State Examination (MMSE), it is adjusted for motor impairment, yet, the latter remains one of the most widely used screening instruments, also in ALS studies. Thus, it is of utmost importance to relate outcome scores of both instruments to allow for comparison in ALS patients. This study reports on the performance of ALS patients in both tests with regard to incidence and degree of cognitive impairment, and the correspondence of both, ECAS and MMSE scores. METHODS We examined N = 84 ALS patients with the German versions of the ECAS and the MMSE. Performance in both tests regarding incidence and degree of cognitive impairment, and correspondence of frequency of cognitive impairment according to both tests was examined. The relationship between ECAS and MMSE scores was modelled with a non-linear regression model. RESULTS All ALS patients were able to complete the ECAS, 89.3% (N = 75) were capable to complete the MMSE. Prevalence of cognitive impairment was in both tests 22.7%, however agreement was only 52.9%. Despite, regression analyses yielded a strong positive relationship (adjusted R2 = .68) between the ECAS total score and the MMSE total score. Both tests were able to identify all patients with dementia. CONCLUSION These results suggest that the MMSE is not ideal for cognitive screening in early-stage ALS patients. However, a rough translation of MMSE scores in ECAS scores is possible to estimate the cognitive performance level of patients, with the ECAS being more discriminative in the lower range of cognitive dysfunction (ECAS score: 80-136), for which the MMSE does not define cognitive impairment (corresponding MMSE score: 27-30).
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Affiliation(s)
- Angela Serian
- Department of Clinical and Cognitive Neuroscience, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany
| | - Julia Finsel
- Department of Neurology, Ulm University, Ulm, Germany
| | - Albert C. Ludolph
- Department of Neurology, Ulm University, Ulm, Germany
- German Center for Neurodegenerative Diseases (DZNE), Ulm Site, Ulm, Germany
| | - Ingo Uttner
- Department of Neurology, Ulm University, Ulm, Germany
| | - Dorothée Lulé
- Department of Neurology, Ulm University, Ulm, Germany
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Rifai OM, Waldron FM, O'Shaughnessy J, Read FL, Gilodi M, Pastore A, Shneider N, Tartaglia GG, Zacco E, Spence H, Gregory JM. Amygdala TDP-43 pathology is associated with behavioural dysfunction and ferritin accumulation in amyotrophic lateral sclerosis. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.06.01.596819. [PMID: 38854008 PMCID: PMC11160765 DOI: 10.1101/2024.06.01.596819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Background Cognitive and behavioural symptoms associated with amyotrophic lateral sclerosis and frontotemporal spectrum disorders (ALSFTSD) are thought to be driven, at least in part, by the pathological accumulation of TDP-43. Methods Here we examine post-mortem tissue from six brain regions associated with cognitive and behavioural symptoms in a cohort of 30 people with sporadic ALS (sALS), a proportion of which underwent standardized neuropsychological behavioural assessment as part of the Edinburgh Cognitive ALS Screen (ECAS). Results Overall, the behavioural screen performed as part of the ECAS predicted accumulation of pathological phosphorylated TDP-43 (pTDP-43) with 100% specificity and 86% sensitivity in behaviour-associated brain regions. Notably, of these regions, pathology in the amygdala was the most predictive correlate of behavioural dysfunction in sALS. In the amygdala of sALS patients, we show variation in morphology, cell type predominance, and severity of pTDP-43 pathology. Further, we demonstrate that the presence and severity of intra-neuronal pTDP-43 pathology, but not astroglial pathology, or phosphorylated Tau pathology, is associated with behavioural dysfunction. Cases were also evaluated using a TDP-43 aptamer (TDP-43APT), which revealed that pathology was not only associated with behavioural symptoms, but also with ferritin levels, a measure of brain iron. Conclusions Intra-neuronal pTDP-43 and cytoplasmic TDP-43APT pathology in the amygdala is associated with behavioural symptoms in sALS. TDP-43APT staining intensity is also associated with increased ferritin, regardless of behavioural phenotype, suggesting that ferritin increases may occur upstream of clinical manifestation, in line with early TDP-43APT pathology, representing a potential region-specific imaging biomarker of early disease in ALS.
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Affiliation(s)
- Olivia M Rifai
- Centre for Discovery Brain Sciences, University of Edinburgh, UK
- Department of Neurology, Center for Motor Neuron Biology and Disease, Columbia University, New York, USA
| | | | | | - Fiona L Read
- Institute of Medical Sciences, University of Aberdeen, UK
| | - Martina Gilodi
- RNA System Biology Lab, Center for Human Technology, Istituto Italiano di Tecnologia, Genoa, Italy
| | | | - Neil Shneider
- Department of Neurology, Center for Motor Neuron Biology and Disease, Columbia University, New York, USA
| | - Gian Gaetano Tartaglia
- RNA System Biology Lab, Center for Human Technology, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Elsa Zacco
- RNA System Biology Lab, Center for Human Technology, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Holly Spence
- Institute of Medical Sciences, University of Aberdeen, UK
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Finsel J, Rosenbohm A, Peter RS, Bäzner H, Börtlein A, Dempewolf S, Schabet M, Hecht M, Kohler A, Opherk C, Nägele A, Sommer N, Lindner A, Rothenbacher D, Ludolph AC, Nagel G, Lulé DE. Coping as a resource to allow for psychosocial adjustment in fatal disease: results from patients with amyotrophic lateral sclerosis. Front Psychol 2024; 15:1361767. [PMID: 38638511 PMCID: PMC11024296 DOI: 10.3389/fpsyg.2024.1361767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/11/2024] [Indexed: 04/20/2024] Open
Abstract
Background Amyotrophic lateral sclerosis (ALS) is a fatal disorder, which imposes a severe emotional burden on patients. Appropriate coping mechanisms may alleviate this burden and facilitate wellbeing, with social support known to be a successful coping strategy. This observational study aimed to determine the interplay of general coping traits of hope for success and fear of failure, coping behavior of social activity, and patients' wellbeing. Methods In this cross-sectional study, patients with ALS from a clinical-epidemiological registry in Southwestern Germany were interviewed regarding coping traits (achievement-motivated behavior: hope for success and fear of failure), coping behavior of social activity, and psychosocial adjustment, determined using measures of depressiveness, anxiety [both measured by Hospital Anxiety and Depression Scale (HADS)], and quality of life [Anamnestic Comparative Self-Assessment (ACSA)]. Demographics, clinical [ALS Functional Rating Scale revised version (ALSFRS-R)], and survival data were recorded. Results A total of 868 patients [60.70% male patients, mean age: 64.70 (±10.83) years, mean ALSFRS-R: 37.36 ± 7.07] were interviewed. Anxiety in patients was found to be associated with a high fear of failure. In contrast, a generally positive attitude in patients exemplified in high hopes for success was associated with better wellbeing. Finally, coping behavior of social activity explained up to 65% of the variance of depressiveness among the patients with ALS. Conclusion In this study, we present evidence that the wellbeing of patients with ALS is not an immediate fatalistic consequence of physical degradation but rather determined by coping traits and behavior, which may be trained to substantially increase the wellbeing of patients with ALS.
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Affiliation(s)
- Julia Finsel
- Department of Neurology, Ulm University, Ulm, Germany
| | | | - Raphael S. Peter
- Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Hansjörg Bäzner
- Department of Neurology, Katharinenhospital Stuttgart, Stuttgart, Germany
| | - Axel Börtlein
- Department of Neurology, Katharinenhospital Stuttgart, Stuttgart, Germany
| | - Silke Dempewolf
- Department of Neurology, RKH Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Martin Schabet
- Department of Neurology, RKH Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Martin Hecht
- Department of Neurology, Klinikum Kaufbeuren, Kliniken Oberallgäu-Kaufbeuren, Kaufbeuren, Germany
| | - Andreas Kohler
- Department of Neurology, Klinikum am Gesundbrunnen Heilbronn, Heilbronn, Germany
| | - Christian Opherk
- Department of Neurology, Klinikum am Gesundbrunnen Heilbronn, Heilbronn, Germany
| | - Andrea Nägele
- Department of Neurology, Christophsbad Göppingen, Göppingen, Germany
| | - Norbert Sommer
- Department of Neurology, Christophsbad Göppingen, Göppingen, Germany
| | - Alfred Lindner
- Department of Neurology, Marienhospital Stuttgart, Stuttgart, Germany
| | | | - Albert C. Ludolph
- Department of Neurology, Ulm University, Ulm, Germany
- German Center for Neurodegenerative Diseases (DZNE), Ulm Site, Ulm, Germany
| | - Gabriele Nagel
- Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
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Wiesenfarth M, Huppertz HJ, Dorst J, Lulé D, Ludolph AC, Müller HP, Kassubek J. Structural and microstructural neuroimaging signature of C9orf72-associated ALS: A multiparametric MRI study. Neuroimage Clin 2023; 39:103505. [PMID: 37696099 PMCID: PMC10500452 DOI: 10.1016/j.nicl.2023.103505] [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: 07/28/2023] [Revised: 09/01/2023] [Accepted: 09/03/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND ALS patients with hexanucleotide expansion in C9orf72 are characterized by a specific clinical phenotype, including more aggressive disease course and cognitive decline. Computerized multiparametric MRI with gray matter volumetry and diffusion tensor imaging (DTI) to analyze white matter structural connectivity is a potential in vivo biomarker. OBJECTIVE The objective of this study was to develop a multiparametric MRI signature in a large cohort of ALS patients with C9orf72 mutations. The aim was to investigate how morphological features of C9orf72-associated ALS differ in structural MRI and DTI compared to healthy controls and ALS patients without C9orf72 mutations. METHODS Atlas-based volumetry (ABV) and whole brain-based DTI-based analyses were performed in a cohort of n = 51 ALS patients with C9orf72 mutations and compared with both n = 51 matched healthy controls and n = 51 C9orf72 negative ALS patients, respectively. Subsequently, Spearman correlation analysis of C9orf72 ALS patients' data with clinical parameters (age of onset, sex, ALS-FRS-R, progression rate, survival) as well as ECAS and p-NfH in CSF was performed. RESULTS The whole brain voxel-by-voxel comparison of fractional anisotropy (FA) maps between C9orf72 ALS patients and controls showed significant bilateral alterations in axonal structures of the white matter at group level, primarily along the corticospinal tracts and in fibers projecting to the frontal lobes. For the frontal lobes, these alterations were also significant between C9orf72 positive and C9orf72 negative ALS patients. In ABV, patients with C9orf72 mutations showed lower volumes of the frontal, temporal, and parietal lobe, with the lowest values in the gray matter of the superior frontal and the precentral gyrus, but also in hippocampi and amygdala. Compared to C9orf72 negative ALS, the differences were shown to be significant for cerebral gray matter (p = 0.04), especially in the frontal (p = 0.01) and parietal lobe (p = 0.01), and in the thalamus (p = 0.004). A correlation analysis between ECAS and averaged regional FA values revealed significant correlations between cognitive performance in ECAS and frontal association fibers. Lower FA values in the frontal lobes were associated with worse performance in all cognitive domains measured (language, verbal fluency, executive functions, memory and spatial perception). In addition, there were significant negative correlations between age of onset and atlas-based volumetry results for gray matter. CONCLUSIONS This study demonstrates a distinct pattern of DTI alterations of the white matter and ubiquitous volume reductions of the gray matter early in the disease course of C9orf72-associated ALS. Alterations were closely linked to a more aggressive cognitive phenotype. These results are in line with an expected pTDP43 propagation pattern of cortical affection and thus strengthen the hypothesis that an underlying developmental disorder is present in ALS with C9orf72 expansions. Thus, multiparametric MRI could contribute to the assessment of the disease as an in vivo biomarker even in the early phase of the disease.
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Affiliation(s)
| | | | - Johannes Dorst
- Department of Neurology, University Hospital Ulm, Ulm, Germany; German Centre of Neurodegenerative Diseases (DZNE), Ulm, Germany
| | - Dorothée Lulé
- Department of Neurology, University Hospital Ulm, Ulm, Germany
| | - Albert C Ludolph
- Department of Neurology, University Hospital Ulm, Ulm, Germany; German Centre of Neurodegenerative Diseases (DZNE), Ulm, Germany
| | | | - Jan Kassubek
- Department of Neurology, University Hospital Ulm, Ulm, Germany; German Centre of Neurodegenerative Diseases (DZNE), Ulm, Germany.
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Nanning F, Braune K, Uttner I, Ludolph AC, Gorges M, Lulé D. Altered Gaze Control During Emotional Face Exploration in Patients With Amyotrophic Lateral Sclerosis. Neurology 2023; 101:264-269. [PMID: 36997323 PMCID: PMC10424840 DOI: 10.1212/wnl.0000000000207214] [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: 09/28/2022] [Accepted: 02/07/2023] [Indexed: 04/01/2023] Open
Abstract
OBJECTIVES Up to 50% of patients with amyotrophic lateral sclerosis (ALS) present with cognitive problems and behavioral dysfunctions including recognition of human faces presenting different emotions. We investigated whether impaired processing of emotional faces is associated with abnormal scan paths during visual exploration. METHODS Cognitively unimpaired patients with ALS (n = 45) and matched healthy controls (n = 37) underwent neuropsychological assessment and video-based eye tracking. Eye movements were recorded while participants visually explored faces expressing different emotions (neutral, disgusted, happy, fearful, and sad) and houses mimicking faces. RESULTS Compared with controls, patients with ALS fixated significantly longer to regions which are not relevant for emotional information when faces expressed fear (p = 0.007) and disgust (p = 0.006), whereas the eyes received less attention in faces expressing disgust (p = 0.041). Fixation duration in any area of interest was not significantly associated with the cognitive state or clinical symptoms of disease severity. DISCUSSION In cognitively unimpaired patients with ALS, altered gaze patterns while visually exploring faces expressing different emotions might derive from impaired top-down attentional control with possible involvement of subliminal frontotemporal areas. This may account for indistinctness in emotion recognition reported in previous studies because nonsalient features retrieve more attention compared with salient areas. Current findings may indicate distinct emotion processing dysfunction of ALS pathology, which may be different from, for example, executive dysfunction.
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Affiliation(s)
- Felix Nanning
- From the Department of Neurology (F.N., K.B., I.U., A.C.L., D.L.), University of Ulm; German Center for Neurodegenerative Diseases (DZNE) (A.C.L.), Ulm; and Institute of Medical Technology (M.G.), Brandenburg University of Technology, Cottbus-Senftenberg, Germany
| | - Katharina Braune
- From the Department of Neurology (F.N., K.B., I.U., A.C.L., D.L.), University of Ulm; German Center for Neurodegenerative Diseases (DZNE) (A.C.L.), Ulm; and Institute of Medical Technology (M.G.), Brandenburg University of Technology, Cottbus-Senftenberg, Germany
| | - Ingo Uttner
- From the Department of Neurology (F.N., K.B., I.U., A.C.L., D.L.), University of Ulm; German Center for Neurodegenerative Diseases (DZNE) (A.C.L.), Ulm; and Institute of Medical Technology (M.G.), Brandenburg University of Technology, Cottbus-Senftenberg, Germany
| | - Albert Christian Ludolph
- From the Department of Neurology (F.N., K.B., I.U., A.C.L., D.L.), University of Ulm; German Center for Neurodegenerative Diseases (DZNE) (A.C.L.), Ulm; and Institute of Medical Technology (M.G.), Brandenburg University of Technology, Cottbus-Senftenberg, Germany
| | - Martin Gorges
- From the Department of Neurology (F.N., K.B., I.U., A.C.L., D.L.), University of Ulm; German Center for Neurodegenerative Diseases (DZNE) (A.C.L.), Ulm; and Institute of Medical Technology (M.G.), Brandenburg University of Technology, Cottbus-Senftenberg, Germany
| | - Dorothée Lulé
- From the Department of Neurology (F.N., K.B., I.U., A.C.L., D.L.), University of Ulm; German Center for Neurodegenerative Diseases (DZNE) (A.C.L.), Ulm; and Institute of Medical Technology (M.G.), Brandenburg University of Technology, Cottbus-Senftenberg, Germany.
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6
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Finsel J, Winroth I, Ciećwierska K, Helczyk O, Stenberg EA, Häggström AC, Ludolph AC, Uttner I, Semb O, Pilczuk B, Szejko N, Rosentul S, Lulé D, Kuźma-Kozakiewicz M, Andersen PM. Determining impairment in the Swedish, Polish and German ECAS: the importance of adjusting for age and education. Amyotroph Lateral Scler Frontotemporal Degener 2023; 24:475-484. [PMID: 36994762 DOI: 10.1080/21678421.2023.2192248] [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: 11/23/2022] [Accepted: 03/13/2023] [Indexed: 03/31/2023]
Abstract
Objective: Age and years of education are strong predictors of cognitive performance in several versions of the Edinburgh Cognitive and Behavioral ALS Screen (ECAS) and cutoffs for the Swedish and Polish versions are not established yet. Here we evaluated the performance of healthy subjects on the national versions of the Swedish and Polish ECAS and compared cognitive performance on three European translations of the ECAS. Methods: The ECAS performances of healthy subjects from Sweden (n = 111), Poland (n = 124) and Germany (n = 86) were compared. Based on the test results on the national versions of ECAS, age- and education-adjusted cutoffs were compared for the German, Swedish and Polish versions, respectively. Results: Age and years of education correlated with performance in the ECAS. Swedish subjects under the age of 60 years and Swedish subjects with low education level scored significantly higher in memory than the respective German and Polish subgroups. German and Polish subjects over 60 years of age performed significantly better in language than the respective Swedish subgroup. The Polish cohort in total had lower executive scores compared to the Swedish cohort, and lower than the German subjects in the higher education subgroup. Conclusions: The results highlight the importance of establishing age- and education-adjusted ECAS cutoffs not only in general, but also for seemingly similar populations of different origins. The results should be taken into account when comparing cognition data across patient populations including in drug trials where an ECAS test result is being used as an inclusion criterium or outcome measure.
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Affiliation(s)
- Julia Finsel
- Department of Neurology, Ulm University, Ulm, Germany
| | - Ivar Winroth
- Department of Clinical Science, Neurosciences, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Katarzyna Ciećwierska
- Department of Neurology, University Clinical Centre of Medical University of Warsaw, Warsaw, Poland
| | - Olga Helczyk
- Department of Neurology, Ulm University, Ulm, Germany
| | - Erica A Stenberg
- Department of Clinical Science, Neurosciences, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Ann-Christin Häggström
- Department of Clinical Science, Neurosciences, Faculty of Medicine, Umeå University, Umeå, Sweden
| | | | - Ingo Uttner
- Department of Neurology, Ulm University, Ulm, Germany
| | - Olof Semb
- Department of Bioethics, Medical University of Warsaw, Warsaw, Poland
| | - Beata Pilczuk
- Department of Neurology, University Clinical Centre of Medical University of Warsaw, Warsaw, Poland
| | - Natalia Szejko
- Department of Neurology, University Clinical Centre of Medical University of Warsaw, Warsaw, Poland
- Department of Bioethics, Medical University of Warsaw, Warsaw, Poland
| | - Simona Rosentul
- Department of Clinical Sciences, Psychiatry, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Dorothée Lulé
- Department of Neurology, Ulm University, Ulm, Germany
| | - Magdalena Kuźma-Kozakiewicz
- Department of Neurology, University Clinical Centre of Medical University of Warsaw, Warsaw, Poland
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland, and
- Neurodegenerative Diseases Research Group, Medical University of Warsaw, Warsaw, Poland
| | - Peter M Andersen
- Department of Clinical Science, Neurosciences, Faculty of Medicine, Umeå University, Umeå, Sweden
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Vidovic M, Freigang M, Aust E, Linse K, Petzold D, Günther R. Cognitive performance of adult patients with SMA before and after treatment initiation with nusinersen. BMC Neurol 2023; 23:216. [PMID: 37280513 DOI: 10.1186/s12883-023-03261-z] [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: 10/24/2022] [Accepted: 05/26/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Spinal muscular atrophy (SMA) is a genetic neuromuscular disease caused by mutations of the SMN1 gene. Deficient SMN protein causes irreversible degeneration of alpha motor neurons characterized by progressive muscle weakness and atrophy. Considering that SMA is a multi-systemic disorder and SMN protein was found to be expressed in cortical structures, the cognitive profile of adult patients with SMA has recently been of particular interest. With nusinersen, a novel, disease-modifying drug has been established, but its effects on neuropsychological functions have not been validated yet. Aim of this study was to investigate the cognitive profile of adult patients with SMA during treatment initiation with nusinersen and to reveal improvement or deterioration in cognitive performance. METHODS This monocentric longitudinal study included 23 patients with SMA type 2 and 3. All patients were assessed with the Edinburgh Cognitive and Behavioral ALS Screen (ECAS) before and after 14 months of treatment initiation with nusinersen. Additionally, motor function was evaluated by Hammersmith Functional Motor Scale Expanded (HFMSE), Revised Upper Limb Module (RULM) and Amyotrophic Lateral Sclerosis Functional Rating Scale Revised (ALSFRS-R). RESULTS Of the treatment-naive patients, only three were below the age- and education-matched cut-off for cognitive impairment in the ECAS total score. Significant differences between SMA type 2 and 3 were only detected in the domain of Language. After 14 months of treatment, patients showed significant improvement of absolute scores in all three ALS-specific domains, in the non-ALS-specific domain of Memory, in both subscores and in the ECAS total score. No associations were detected between cognitive and functional outcome measures. CONCLUSIONS In some adult patients with SMA abnormal cognitive performance in ALS-specific functions of the ECAS was evident. However, the presented results suggest no clinically significant cognitive changes during the observed treatment period with nusinersen.
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Affiliation(s)
- Maximilian Vidovic
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Maren Freigang
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Elisa Aust
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Katharina Linse
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- German Center for Neurodegenerative Diseases, Dresden, Dresden, Germany
| | - Daniel Petzold
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - René Günther
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
- German Center for Neurodegenerative Diseases, Dresden, Dresden, Germany.
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García-Escobar G, Bertran-Recasens B, Blavi-Pujol S, Rubio MÁ. Impact of age and education on performance in the Spanish-language version of the Edinburgh Cognitive and Behavioural ALS Screen in a cohort of patients with amyotrophic lateral sclerosis. Neurologia 2022; 38:138-140. [PMID: 36462621 DOI: 10.1016/j.nrleng.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/22/2022] [Indexed: 12/02/2022] Open
Affiliation(s)
- G García-Escobar
- Programa de Neurociencias, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain; Unidad de Esclerosis Lateral Amiotrófica, Servicio de Neurología, Hospital del Mar, Barcelona, Spain.
| | - B Bertran-Recasens
- Unidad de Esclerosis Lateral Amiotrófica, Servicio de Neurología, Hospital del Mar, Barcelona, Spain
| | - S Blavi-Pujol
- Fundació Catalana d'Esclerosi Lateral Amiotròfica Miquel Valls, Programa d'Atenció Integral a Persones amb Malalties Avançades, Obra Social «La Caixa», Barcelona, Spain
| | - M Á Rubio
- Unidad de Esclerosis Lateral Amiotrófica, Servicio de Neurología, Hospital del Mar, Barcelona, Spain.
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McMillan CT, Wuu J, Rascovsky K, Cosentino S, Grossman M, Elman L, Quinn C, Rosario L, Stark JH, Granit V, Briemberg H, Chenji S, Dionne A, Genge A, Johnston W, Korngut L, Shoesmith C, Zinman L, Kalra S, Benatar M. Defining cognitive impairment in amyotrophic lateral sclerosis: an evaluation of empirical approaches. Amyotroph Lateral Scler Frontotemporal Degener 2022; 23:517-526. [PMID: 35253557 PMCID: PMC9448823 DOI: 10.1080/21678421.2022.2039713] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 01/17/2022] [Accepted: 01/30/2022] [Indexed: 11/01/2022]
Abstract
Objective: Amyotrophic lateral sclerosis (ALS) is a multi-system disorder characterized primarily by motor neuron degeneration, but may be accompanied by cognitive dysfunction. Statistically appropriate criteria for establishing cognitive impairment (CI) in ALS are lacking. We evaluate quantile regression (QR), that accounts for age and education, relative to a traditional two standard deviation (SD) cutoff for defining CI. Methods: QR of cross-sectional data from a multi-center North American Control (NAC) cohort of 269 healthy adults was used to model the 5th percentile of cognitive scores on the Edinburgh Cognitive and Behavioral ALS Screen (ECAS). The QR approach was compared to traditional two SD cutoff approach using the same NAC cohort (2SD-NAC) and to existing UK-based normative data derived using the 2SD approach (2SD-UK) to assess the impact of cohort selection and statistical model in identifying CI in 182 ALS patients. Results: QR-NAC models revealed that age and education impact cognitive performance on the ECAS. Based on QR-NAC normative cutoffs, the frequency of CI in the 182 PENN ALS patients was 15.9% for ALS specific, 12.6% for ALS nonspecific, and 15.4% for ECAS total. This frequency of CI is substantially more conservative in comparison to the 2SD-UK (20.3%-34.6%) and modestly more conservative to the 2SD-NAC (14.3%-16.5%) approaches for estimating CI. Conclusions: The choice of normative cohort has a substantial impact and choice of statistical method a modest impact on defining CI in ALS. This report establishes normative ECAS thresholds to identify whether ALS patients in the North American population have CI.
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Affiliation(s)
- Corey T. McMillan
- University of Pennsylvania Perelman School of Medicine, Department of Neurology, Philadelphia, PA, USA
| | - Joanne Wuu
- University of Miami Miller School of Medicine, Department of Neurology, Miami, FL, USA
| | - Katya Rascovsky
- University of Pennsylvania Perelman School of Medicine, Department of Neurology, Philadelphia, PA, USA
| | - Stephanie Cosentino
- Columbia University, The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, New York, NY, USA
| | - Murray Grossman
- University of Pennsylvania Perelman School of Medicine, Department of Neurology, Philadelphia, PA, USA
| | - Lauren Elman
- University of Pennsylvania Perelman School of Medicine, Department of Neurology, Philadelphia, PA, USA
| | - Colin Quinn
- University of Pennsylvania Perelman School of Medicine, Department of Neurology, Philadelphia, PA, USA
| | - Luis Rosario
- University of Pennsylvania Perelman School of Medicine, Department of Neurology, Philadelphia, PA, USA
| | - Jessica H. Stark
- University of Miami Miller School of Medicine, Department of Neurology, Miami, FL, USA
| | - Volkan Granit
- University of Miami Miller School of Medicine, Department of Neurology, Miami, FL, USA
| | - Hannah Briemberg
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Sneha Chenji
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Annie Dionne
- Department of Medicine, Université Laval, Québec, Canada
| | - Angela Genge
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Wendy Johnston
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Lawrence Korngut
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | | | - Lorne Zinman
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | | | - Sanjay Kalra
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
| | - Michael Benatar
- University of Miami Miller School of Medicine, Department of Neurology, Miami, FL, USA
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10
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Behler A, Müller HP, Del Tredici K, Braak H, Ludolph AC, Lulé D, Kassubek J. Multimodal in vivo staging in amyotrophic lateral sclerosis using artificial intelligence. Ann Clin Transl Neurol 2022; 9:1069-1079. [PMID: 35684940 PMCID: PMC9268886 DOI: 10.1002/acn3.51601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/10/2022] [Accepted: 05/26/2022] [Indexed: 01/18/2023] Open
Abstract
Background The underlying neuropathological process of amyotrophic lateral sclerosis (ALS) can be classified in a four‐stage sequential pTDP‐43 cerebral propagation scheme. Using diffusion tensor imaging (DTI), in vivo imaging of these stages has already been shown to be feasible for the specific corticoefferent tract systems. Because both cognitive and oculomotor dysfunctions are associated with microstructural changes at the brain level in ALS, a cognitive and an oculomotor staging classification were developed, respectively. The association of these different in vivo staging schemes has not been attempted to date. Methods A total of 245 patients with ALS underwent DTI, video‐oculography, and cognitive testing using Edinburgh Cognitive and Behavioral ALS Screen (ECAS). A set of tract‐related diffusion metrics, cognitive, and oculomotor parameters was selected for further analysis. Hierarchical and k‐means clustering algorithms were used to obtain an optimal cluster solution. Results According to cluster analysis, differentiation of patients with ALS into four clusters resulted: Cluster A showed the highest fractional anisotropy (FA) values and thereby the best performances in executive oculomotor tasks and cognitive tests, whereas cluster D showed the lowest FA values, the lowest ECAS scores, and the worst executive oculomotor performance across all clusters. Clusters B and C showed intermediate results regarding parameter values. Discussion In a multimodal dataset of technical assessments of brain structure and function in ALS, an artificial intelligence‐based cluster analysis showed high congruence of DTI, executive oculomotor function, and neuropsychological performance for mapping in vivo correlates of neuropathological spreading.
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Affiliation(s)
- Anna Behler
- Department of Neurology, University of Ulm, Germany
| | | | | | - Heiko Braak
- Department of Neurology, University of Ulm, Germany
| | - Albert C Ludolph
- Department of Neurology, University of Ulm, Germany.,Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Ulm, Germany
| | | | - Jan Kassubek
- Department of Neurology, University of Ulm, Germany.,Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Ulm, Germany
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11
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Influencia de la edad y la escolaridad sobre el rendimiento de la versión española del Edinburgh Cognitive and Behavioural ALS Screen en una cohorte de pacientes con esclerosis lateral amiotrófica. Neurologia 2022. [DOI: 10.1016/j.nrl.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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12
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Lulé D, Michels S, Finsel J, Braak H, Del Tredici K, Strobel J, Beer AJ, Uttner I, Müller HP, Kassubek J, Juengling FD, Ludolph AC. Clinicoanatomical substrates of selfish behaviour in amyotrophic lateral sclerosis - An observational cohort study. Cortex 2021; 146:261-270. [PMID: 34923303 DOI: 10.1016/j.cortex.2021.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/28/2021] [Accepted: 11/09/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE ALS primarily affects motor functions, but cognitive functions, including social understanding, may also be impaired. Von Economo neurons (VENs) are part of the neuronal substrate of social understanding and these cells are histopathologically altered in ALS. We investigated whether activity in areas including VENs is associated with an impairment of cognitive tasks that mirror social functioning. METHODS In this observational prospective study, ALS patients (N = 26) were tested for cognitive behavioural function, encompassing different aspects of empathetic understanding (interpersonal reactivity index, IRI), social behaviour (ultimatum game), recognition of faux-pas situations, and general cognitive functioning (Edinburgh Cognitive and Behavioural ALS Screen, ECAS). For in vivo pathological staging according to Braak, DTI-MRI was performed to determine those ALS patients with expected pathological involvement of VENs (B ALS stages 3 + 4) compared to those without (B ALS stages 1 + 2). Expected hypometabolism of cerebral areas was determined with 18F-FDG PET in N = 20 ALS patients and compared to N = 20 matched healthy controls. Volume of interest analysis was performed in the anterior cingulate cortex (ACC) and the anterior insular cortex (AIC), which contain high numbers of VENs. RESULTS Compared to those without expected pathological involvement of VENs (B/B ALS stages 1 + 2), ALS patients with anticipated pathological involvement of VENs (B/B ALS stages 3 + 4) presented with significantly reduced fantasy to understand the mindset of others (IRI) and, social behaviour was more selfish (ultimatum game) despite the fact that cognitive understanding of socially inappropriate behaviour of others (faux-pas) was unimpaired. 18F-FDG-PET showed hypometabolism in ACC and AIC in ALS patients with anticipated pathological involvement of VENs compared to those without and this was significantly correlated to cognitive-behavioral functions in certain tasks. CONCLUSION Here, we present evidence of altered social behaviour in ALS patients associated with regional 18FDG-PET hypometabolism in areas with a high density of VENs, thereby suggesting a possible causal association.
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Affiliation(s)
- Dorothée Lulé
- Department of Neurology, University of Ulm, Ulm, Germany.
| | | | - Julia Finsel
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Heiko Braak
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | | | - Ambros J Beer
- Department of Nuclear Medicine, University of Ulm, Germany
| | - Ingo Uttner
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Freimut D Juengling
- Department of Oncology, University of Alberta, Edmonton, Canada; Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
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13
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Neuroanatomical associations of the Edinburgh cognitive and Behavioural ALS screen (ECAS). Brain Imaging Behav 2021; 15:1641-1654. [PMID: 33155172 DOI: 10.1007/s11682-020-00359-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cognitive impairment is now recognized in a subset of patients with amyotrophic lateral sclerosis (ALS). The objective of the study was to identify group differences and neuroanatomical correlates of the Edinburgh Cognitive and Behavioural ALS Screen (ECAS) in participants ALS. Fifty-three ALS patients and 43 healthy controls recruited as a part of our multicentre study (CALSNIC) were administered the ECAS and underwent an MRI scan. Voxel-based morphometry and tract based spatial statistics (TBSS) was performed to identify structural changes and associations with impaired ECAS scores. Lower performance in the ECAS verbal fluency and executive domains were noted in ALS patients as compared to controls (p < 0.01). Extensive white matter degeneration was noted in the corticospinal tract in all ALS patients, while ALS patients with impaired verbal fluency or executive domains (ALS-exi, n = 22), displayed additional degeneration in the corpus callosum, cingulum and superior longitudinal fasciculus as compared to controls (p < 0.05, TFCE corrected). Mild grey matter changes and associations with ECAS verbal fluency or executive performance were noted at lenient statistical thresholds (p < 0.001, uncorrected). Executive impairment was detected using the ECAS in our multicentre sample of Canadian ALS patients. White matter degeneration in motor regions was revealed in ALS patients with extensive spread to frontal regions in the ALS-exi sub-group. Mild associations between ECAS verbal fluency, executive function scores and MRI metrics suggest that reduced performance may be associated with widespread structural integrity.
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14
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Behler A, Knehr A, Finsel J, Kunz MS, Lang C, Müller K, Müller HP, Pinkhardt EH, Ludolph AC, Lulé D, Kassubek J. Eye movement alterations in presymptomatic C9orf72 expansion gene carriers. J Neurol 2021; 268:3390-3399. [PMID: 33709219 PMCID: PMC8357645 DOI: 10.1007/s00415-021-10510-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 11/29/2022]
Abstract
Objective The clinical manifestation of amyotrophic lateral sclerosis (ALS) is characterized by motor neuron degeneration, whereas frontotemporal dementia (FTD) patients show alterations of behavior and cognition. Both share repeat expansions in C9orf72 as the most prevalent genetic cause. Before disease-defining symptoms onset, structural and functional changes at cortical level may emerge in C9orf72 carriers. Here, we characterized oculomotor parameters and their association to neuropsychological domains in apparently asymptomatic individuals with mutations in ALS/FTD genes. Patients and methods Forty-eight carriers of ALS genes, without any clinical symptoms underwent video-oculographic examination, including 22 subjects with C9orf72 mutation, 17 with SOD1, and 9 with other ALS associated gene mutations (n = 3 KIF5A; n = 3 FUS/FUS + TBK1; n = 1 NEK1; n = 1 SETX; n = 1 TDP43). A total of 17 subjects underwent a follow-up measurement. Data were compared to 54 age- and gender-matched healthy controls. Additionally, mutation carriers performed a neuropsychological assessment. Results In comparison to controls, the presymptomatic subjects performed significantly worse in executive oculomotor tasks such as the ability to perform correct anti-saccades. A gene mutation subgroup analysis showed that dysfunctions in C9orf72 carriers were much more pronounced than in SOD1 carriers. The anti-saccade error rate of ALS mutation carriers was associated with cognitive deficits: this correlation was increased in subjects with C9orf72 mutation, whereas SOD1 carriers showed no associations. Conclusion In C9orf72 carriers, executive eye movement dysfunctions, especially the increased anti-saccade error rate, were associated with cognitive impairment and unrelated to time. These oculomotor impairments are in support of developmental deficits in these mutations, especially in prefrontal areas.
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Affiliation(s)
- Anna Behler
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Antje Knehr
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Julia Finsel
- Neuropsychology, Department of Neurology, University of Ulm, Ulm, Germany
| | - Martin S Kunz
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Christina Lang
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Kathrin Müller
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Hans-Peter Müller
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Elmar H Pinkhardt
- 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
- Neuropsychology, Department of Neurology, University of Ulm, Ulm, Germany
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
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15
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Vidovic M, Aust E, Hermann A, Günther R. The palmomental reflex in amyotrophic lateral sclerosis - a clinical sign of executive or motor dysfunction? Amyotroph Lateral Scler Frontotemporal Degener 2021; 22:588-591. [PMID: 33655811 DOI: 10.1080/21678421.2021.1883667] [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: 10/22/2022]
Abstract
Objective: The palmomental reflex (PMR) is commonly interpreted as a frontal release sign, but it has also been discussed as a clinical marker of motoneuron affection in amyotrophic lateral sclerosis (ALS). The aim of this study was to investigate the impact of motor dysfunction versus neurocognitive impairment on the appearance of PMR in amyotrophic lateral sclerosis (ALS). Methods: 97 patients with ALS and ALS-variants were enrolled in this prospective, cross-sectional study. PMR was examined in a standardized procedure and the neurocognitive profile was assessed using the Edinburgh Cognitive and Behavioral ALS Screen (ECAS). Disease severity and motor function were recorded using ALS Functional Rating Scale revised (ALSFRS-R) and standardized clinical assessment. Results: 52% of all patients had a positive PMR (PMR+). These patients showed more frequently signs of motor dysfunction in the bulbar region (p < 0.001), impaired cognitive performance in the ECAS ALS-specific score (p < 0.05), predominantly in executive functions (p < 0.01), as well as lower scores in ALSFRS-R (p < 0.05) compared to patients without PMR (PMR-). A multivariate logistic regression analysis revealed that bulbar involvement, executive function impairment, and a lower motor and respiratory (non-bulbar) ALSFRS-R significantly predicted PMR+ (all p < 0.05), with bulbar involvement being a stronger predictor than executive function impairment. Discussion: In this study, we showed that bulbar involvement is a much stronger predictor on the appearance of PMR compared to executive function impairment. PMR is therefore primarily a sign for bulbar involvement, rather than a sign for executive dysfunction in ALS patients.
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Affiliation(s)
- Maximilian Vidovic
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Elisa Aust
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Andreas Hermann
- Translational Neurodegeneration Section "Albrecht-Kossel", Department of Neurology, University Medical Center Rostock, University of Rostock, Rostock, Germany.,German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Rostock, Germany, and
| | - René Günther
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,German Center for Neurodegenerative Diseases (DZNE) Dresden, Dresden, Germany
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16
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Mojtabavi H, Nafissi S, Mahmoodi-Bakhtiari B, Fathi D, Fatehi F. Persian adaptation of Edinburgh Cognitive and Behavioural Screen (ECAS). Amyotroph Lateral Scler Frontotemporal Degener 2021; 22:426-433. [PMID: 33595396 DOI: 10.1080/21678421.2021.1883665] [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
Objectives: To adapt the Edinburgh Cognitive and Behavioral screen (ECAS) English version into Persian. Methods: The ECAS test was adapted and implemented to 30 ALS patients and 31 healthy volunteers in Tehran, Iran. The ECAS results were compared to MoCA and ALS-FRS-r, the other standard tools to determine whether the translated version is reliable and valid in the new language. In addition, the patients' caregivers were interviewed for behavioral and psychiatric changes. Results: The Persian version of ECAS revealed high internal consistency (α = 0.791), alongside the strong correlation of ECAS and its subscales with MoCA and ALS-FRS. Moreover, Persian ECAS discriminated against the patients and the healthy population well. Sensitivity analysis revealed promising results of Persian ECAS with an area under the curve of 0.871 in ROC curve analysis. Cognitive impairment was observed in 43.33% of patients. Conclusion: The Persian version of the ECAS, exclusively designed for the Iranian population, is the first screening tool to assess multiple neuropsychological functions, which provides a rapid and inclusive screen of cognitive and behavioral impairments specifically in ALS patients.
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Affiliation(s)
- Helia Mojtabavi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Systematic Review and Meta-Analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran.,Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahriar Nafissi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Davood Fathi
- Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Fatehi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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17
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Osmanovic A, Wieselmann G, Mix L, Siegler HA, Kumpe M, Ranxha G, Wurster CD, Steinke A, Ludolph AC, Kopp B, Lulé D, Petri S, Schreiber-Katz O. Cognitive Performance of Patients with Adult 5q-Spinal Muscular Atrophy and with Amyotrophic Lateral Sclerosis. Brain Sci 2020; 11:brainsci11010008. [PMID: 33374658 PMCID: PMC7822456 DOI: 10.3390/brainsci11010008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 12/11/2022] Open
Abstract
Motor neuron diseases, such as spinal muscular atrophy (SMA) and amyotrophic lateral sclerosis (ALS), share several clinical similarities while differing substantially in etiology, disease onset and progression. Cognitive dysfunction, a clinically relevant non-motor feature in a substantial proportion of ALS patients, has been less frequently investigated in SMA. In this prospective multicenter cross-sectional study, cognitive function was assessed by the Edinburgh Cognitive (and Behavioural) ALS Screen (ECAS) and a German vocabulary test (Wortschatztest, WST) in 34 adult patients with SMA types 2-4 and in 34 patients with ALS. Demographic and clinical parameters were assessed to identify factors that potentially influence cognitive function. While SMA and ALS patients were comparable in the vocabulary test, on average, SMA patients performed better than ALS patients in the cognitive domains of memory, language and executive function. Better cognitive abilities in SMA patients seemed to be related to the early onset, rather than the extent or the duration, of their physical handicap. Future studies should focus on disease-specific cognitive functions in SMA.
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Affiliation(s)
- Alma Osmanovic
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (A.O.); (G.W.); (H.A.S.); (M.K.); (G.R.); (A.S.); (B.K.); (S.P.)
| | - Gary Wieselmann
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (A.O.); (G.W.); (H.A.S.); (M.K.); (G.R.); (A.S.); (B.K.); (S.P.)
| | - Lucas Mix
- Department of Neurology, Neuropsychology, University of Ulm, 89081 Ulm, Germany; (L.M.); (A.C.L.); (D.L.)
| | - Hannah Alexandra Siegler
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (A.O.); (G.W.); (H.A.S.); (M.K.); (G.R.); (A.S.); (B.K.); (S.P.)
| | - Mareike Kumpe
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (A.O.); (G.W.); (H.A.S.); (M.K.); (G.R.); (A.S.); (B.K.); (S.P.)
| | - Gresa Ranxha
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (A.O.); (G.W.); (H.A.S.); (M.K.); (G.R.); (A.S.); (B.K.); (S.P.)
| | | | - Alexander Steinke
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (A.O.); (G.W.); (H.A.S.); (M.K.); (G.R.); (A.S.); (B.K.); (S.P.)
| | - Albert C. Ludolph
- Department of Neurology, Neuropsychology, University of Ulm, 89081 Ulm, Germany; (L.M.); (A.C.L.); (D.L.)
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), 89081 Ulm, Germany
| | - Bruno Kopp
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (A.O.); (G.W.); (H.A.S.); (M.K.); (G.R.); (A.S.); (B.K.); (S.P.)
| | - Dorothée Lulé
- Department of Neurology, Neuropsychology, University of Ulm, 89081 Ulm, Germany; (L.M.); (A.C.L.); (D.L.)
| | - Susanne Petri
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (A.O.); (G.W.); (H.A.S.); (M.K.); (G.R.); (A.S.); (B.K.); (S.P.)
| | - Olivia Schreiber-Katz
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (A.O.); (G.W.); (H.A.S.); (M.K.); (G.R.); (A.S.); (B.K.); (S.P.)
- Correspondence: ; Tel.: +49-511-532-2392; Fax: +49-511-532-3115
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18
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Canosa A, Palumbo F, Iazzolino B, Peotta L, Di Pede F, Manera U, Vasta R, Grassano M, Solero L, Arena V, Moglia C, Calvo A, Chiò A, Pagani M. The interplay among education, brain metabolism, and cognitive impairment suggests a role of cognitive reserve in Amyotrophic Lateral Sclerosis. Neurobiol Aging 2020; 98:205-213. [PMID: 33316576 DOI: 10.1016/j.neurobiolaging.2020.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 11/08/2020] [Accepted: 11/10/2020] [Indexed: 01/09/2023]
Abstract
We tested the Cognitive Reserve (CR) hypothesis in Amyotrophic Lateral Sclerosis (ALS), enrolling 111 patients, using education as CR proxy, 18F-FDG-PET to assess brain damage, and ECAS to measure cognition. Education was regressed out against brain metabolism, including age, sex, spinal/bulbar onset, ALSFRS-R, and ECAS as covariates. Clusters showing a significant correlation were used as seed regions in an interregional correlation analysis (IRCA) in the ALS group and in 40 controls. In the ALS group, we found a negative correlation between brain metabolism and education in the right anterior cingulate and bilateral medial frontal gyrus. In the IRCA in the ALS group, the medial frontal cluster metabolism positively correlated with that of frontotemporal regions (right > left), bilateral caudate nuclei, and right insula, and negatively correlated with that of corticospinal tracts, cerebellum, and pons. In controls, the IRCA showed significant positive correlations in the same regions but less extended. Our results agree with the CR hypothesis. The negative correlation between the medial frontal cluster and the cerebellum found only in ALS patients might reflect cerebellar compensation.
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Affiliation(s)
- Antonio Canosa
- ALS Centre, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, SC Neurologia 1U, Turin, Italy.
| | - Francesca Palumbo
- ALS Centre, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
| | - Barbara Iazzolino
- ALS Centre, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
| | - Laura Peotta
- ALS Centre, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
| | - Francesca Di Pede
- ALS Centre, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
| | - Umberto Manera
- ALS Centre, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
| | - Rosario Vasta
- ALS Centre, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
| | - Maurizio Grassano
- ALS Centre, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
| | - Luca Solero
- ALS Centre, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy
| | - Vincenzo Arena
- Positron Emission Tomography Centre AFFIDEA-IRMET S.P.A., Turin, Italy
| | - Cristina Moglia
- ALS Centre, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, SC Neurologia 1U, Turin, Italy
| | - Andrea Calvo
- ALS Centre, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, SC Neurologia 1U, Turin, Italy; Neuroscience Institute of Turin (NIT), Turin, Italy
| | - Adriano Chiò
- ALS Centre, "Rita Levi Montalcini" Department of Neuroscience, University of Turin, Turin, Italy; Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, SC Neurologia 1U, Turin, Italy; Neuroscience Institute of Turin (NIT), Turin, Italy; Institute of Cognitive Sciences and Technologies, C.N.R., Rome, Italy
| | - Marco Pagani
- Institute of Cognitive Sciences and Technologies, C.N.R., Rome, Italy; Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
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19
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Lulé DE, Müller HP, Finsel J, Weydt P, Knehr A, Winroth I, Andersen P, Weishaupt J, Uttner I, Kassubek J, Ludolph AC. Deficits in verbal fluency in presymptomatic C9orf72 mutation gene carriers-a developmental disorder. J Neurol Neurosurg Psychiatry 2020; 91:1195-1200. [PMID: 32855285 PMCID: PMC7569387 DOI: 10.1136/jnnp-2020-323671] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/19/2020] [Accepted: 06/28/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND A mutation in C9orf72 constitute a cross-link between amyotrophic lateral sclerosis (ALS) and fronto-temporal dementia (FTD). At clinical manifestation, both patient groups may present with either cognitive impairment of predominantly behaviour or language (in FTD) or motor dysfunctions (in ALS). METHODS In total, 36 non-symptomatic mutation carriers from ALS or FTD families were examined, including 21 subjects with C9orf72 and 15 with SOD1 mutations. Data were compared with 91 age-matched, education-matched and gender-matched healthy subjects (56 were first-degree relatives from ALS or FTD families, 35 with no known family history of ALS/FTD). MRI scanning for diffusion tensor imaging was performed to map fractional anisotropy (FA). Subjects performed an extensive neuropsychological assessment to address verbal fluency, language, executive, memory and visuospatial function. Measurements were repeated after 12 months. RESULTS C9orf72 expansion carriers performed significantly worse in verbal fluency and non-verbal memory and presented with distinct alterations in structural white matter integrity indicated by lower FA values in inferior and orbitofrontal cortical areas compared with carriers of SOD1 mutations or healthy subjects. Loss of structural integrity was associated with decreased verbal fluency performance. White matter alterations and cognitive performance showed no changes over 12 months in all subjects. DISCUSSION Reduced verbal fluency performance seems to be a distinct clinical feature of C9orf72 carriers before symptomatic disease onset without evidence for change over time in our cohort. The results support the emerging hypothesis of a general disorder in development in addition to neurodegeneration in C9orf72 carriers.
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Affiliation(s)
- Dorothée E Lulé
- Department of Neurology, Neuropsychology, Ulm University, Ulm, Germany
| | | | - Julia Finsel
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Patrick Weydt
- Department of Neurodegenerative Diseases and Gerontopsychiatry, University of Bonn, Bonn, Germany
| | - Antje Knehr
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | | | | | - Ingo Uttner
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany
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Watanabe Y, Ogino M, Ichikawa H, Hanajima R, Nakashima K. The Edinburgh Cognitive and Behavioural ALS Screen (ECAS) for Japanese ALS and FTD patients. Amyotroph Lateral Scler Frontotemporal Degener 2020; 22:66-72. [PMID: 32757854 DOI: 10.1080/21678421.2020.1801751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Amyotrophic lateral sclerosis (ALS) patients might present with cognitive and behavioural abnormalities resembling frontotemporal dementia (FTD). The Edinburgh Cognitive and Behavioural ALS Screen (ECAS) was developed as an easy to administer cognitive screen for detecting these symptoms. The aim of the present study was to develop and validate a Japanese version of the ECAS. METHODS In this single centre observational study, 35 ALS patients and 28 healthy controls were enrolled. Three patients in the ALS group fulfilled the criteria for behavioural variant FTD (ALS-FTD) and the rest were grouped as ALS without FTD. Participants were subjected to the Japanese version of the ECAS. ALS patients were also subjected to the Montreal Cognitive Assessment, Frontal Assessment Battery, ALS Functional Rating Scale-Revised, and respiratory function testing. Demographic and disease characteristics (e.g., sex, age at examination, and years of education) were also recorded. RESULTS Internal consistency and correlations with general cognitive screenings were sufficient in the Japanese adaptation. Executive functions were the most commonly affected ECAS domain, followed by fluency and language. Compared to control subjects, ALS patients without FTD had low scores in the ECAS ALS-specific functions but not in ALS-nonspecific functions. Meanwhile ALS-FTD patients markedly underperformed both in the ECAS ALS-specific and ALS-nonspecific functions. Furthermore, the Japanese ECAS score correlated positively with years of education and negatively with age at onset. CONCLUSION The Japanese version of the ECAS is a valid and useful screening tool to identify multiple types of cognitive impairment in ALS patients.
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Affiliation(s)
- Yasuhiro Watanabe
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Mieko Ogino
- School of Medicine, Office of Medical Education, International University of Health and Welfare, Chiba, Japan
| | - Hiroo Ichikawa
- Department of Neurology, Showa University Fujigaoka Hospital, Kanagawa, Japan, and
| | - Ritsuko Hanajima
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Kenji Nakashima
- Department of Neurology, National Hospital Organization, Matsue Medical Center, Matsue, Japan
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21
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SPG7 mutations in amyotrophic lateral sclerosis: a genetic link to hereditary spastic paraplegia. J Neurol 2020; 267:2732-2743. [PMID: 32447552 PMCID: PMC7419373 DOI: 10.1007/s00415-020-09861-w] [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: 03/05/2020] [Revised: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 12/11/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) and hereditary spastic paraplegia (HSP) are motor neuron diseases sharing clinical, pathological, and genetic similarities. While biallelic SPG7 mutations are known to cause recessively inherited HSP, heterozygous SPG7 mutations have repeatedly been identified in HSP and recently also in ALS cases. However, the frequency and clinical impact of rare SPG7 variants have not been studied in a larger ALS cohort. Here, whole-exome (WES) or targeted SPG7 sequencing was done in a cohort of 214 European ALS patients. The consequences of a splice site variant were analyzed on the mRNA level. The resulting protein alterations were visualized in a crystal structure model. All patients were subjected to clinical, electrophysiological, and neuroradiological characterization. In 9 of 214 (4.2%) ALS cases, we identified five different rare heterozygous SPG7 variants, all of which were previously reported in patients with HSP or ALS. All detected SPG7 variants affect the AAA+ domain of the encoded mitochondrial metalloprotease paraplegin and impair its stability or function according to predictions from mRNA analysis or crystal structure modeling. ALS patients with SPG7 mutations more frequently presented with cerebellar symptoms, flail arm or leg syndrome compared to those without SPG7 mutations, and showed a partial clinical overlap with HSP. Brain MRI findings in SPG7 mutation carriers included cerebellar atrophy and patterns suggestive of frontotemporal dementia. Collectively, our findings suggest that SPG7 acts as a genetic risk factor for ALS. ALS patients carrying SPG7 mutations present with distinct features overlapping with HSP, particularly regarding cerebellar findings.
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22
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Gregory JM, McDade K, Bak TH, Pal S, Chandran S, Smith C, Abrahams S. Executive, language and fluency dysfunction are markers of localised TDP-43 cerebral pathology in non-demented ALS. J Neurol Neurosurg Psychiatry 2020; 91:149-157. [PMID: 31515300 PMCID: PMC6996101 DOI: 10.1136/jnnp-2019-320807] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 08/05/2019] [Accepted: 08/18/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Approximately 35% of patients with amyotrophic lateral sclerosis (ALS) exhibit mild cognitive deficits in executive functions, language and fluency, without dementia. The precise pathology of these extramotor symptoms has remained unknown. This study aimed to determine the pathological correlate of cognitive impairment in patients with non-demented ALS. METHODS In-depth neuropathological analysis of 27 patients with non-demented ALS who had undergone cognitive testing (Edinburgh Cognitive and Behaviour ALS Screen (ECAS)) during life. Analysis involved assessing 43 kDa Tar-DNA binding protein (TDP-43) accumulation in brain regions specifically involved in executive functions, language functions and verbal fluency to ascertain whether functional deficits would relate to a specific regional distribution of pathology. RESULTS All patients with cognitive impairment had TDP-43 pathology in extramotor brain regions (positive predictive value of 100%). The ECAS also predicted TDP-43 pathology with 100% specificity in brain regions associated with executive, language and fluency domains. We also detected a subgroup with no cognitive dysfunction, despite having substantial TDP-43 pathology, so called mismatch cases. CONCLUSIONS Cognitive impairment as detected by the ECAS is a valid predictor of TDP-43 pathology in non-demented ALS. The profile of mild cognitive deficits specifically predicts regional cerebral involvement. These findings highlight the utility of the ECAS in accurately assessing the pathological burden of disease.
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Affiliation(s)
- Jenna M Gregory
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - Karina McDade
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - Thomas H Bak
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
- School of Philosophy, Psychology and Language Science, University of Edinburgh, Edinburgh, UK
| | - Suvankar Pal
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - Siddharthan Chandran
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - Colin Smith
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - Sharon Abrahams
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
- School of Philosophy, Psychology and Language Science, University of Edinburgh, Edinburgh, UK
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23
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Kourtesis P, Christidi F, Margioti E, Demenega C, Rentzos M, Evdokimidis I, Abrahams S. The Edinburgh cognitive and behavioral amyotrophic lateral sclerosis screen (ECAS): sensitivity in differentiating between ALS and Alzheimer's disease in a Greek population. Amyotroph Lateral Scler Frontotemporal Degener 2019; 21:78-85. [PMID: 31469297 DOI: 10.1080/21678421.2019.1655059] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Objectives: (1) Adapt the ECAS into Greek, validate it in ALS patients and compare with the ALS-CBS. (2) Determine the sensitivity and specificity of ECAS in the differentiation between AD and non-demented ALS patients as compared with the ACE-III and mini-ACE. Methods: ALS patients (n = 28) were recruited and AD patients (n = 26) were matched in age, sex, and education with ALS patients (n = 24). The normative data were derived from a random sample of controls (n = 52). Bayes correlation analysis was conducted to examine convergent validity. Bayes t-test was performed to assess between groups' differences. Receiver operating characteristics (ROC) curve analyses and area under the curve (AUC) were implemented to appraise the sensitivity and specificity in the differentiation between the AD and non-demented ALS patients. Results: The ECAS and its sub-scores in addition to the behavior interview demonstrated robust correlations with the ALS-CBS. Impairment in language and verbal fluency were the most prominent deficits in the ALS patients. The most frequently reported change was apathy. The ROC analysis demonstrated that the ECAS-ALS nonspecific score (comprising memory and visuospatial domains) is the most sensitive and specific in differentiating the AD from ALS patients. The other measures expressed high sensitivity, yet a poor specificity. Conclusions: The ECAS is a multi-purpose screening tool. The ECAS-ALS specific appraises the whole spectrum of the highly prevalent cognitive impairments in ALS. The ECAS-ALS nonspecific (memory and visuospatial) is a sensitive score to detect AD related deficits and is able to differentiate the AD from the non-demented ALS patients better than the ACE-III and mini-ACE.
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Affiliation(s)
- Panagiotis Kourtesis
- Department of Psychology, Human Cognitive Neuroscience, University of Edinburgh, Edinburgh, UK.,Lab of Experimental Psychology, Suor Orsola Benincasa University of Naples, Naples, Italy.,Interdepartmental Centre for Planning and Research "Scienza Nuova", Suor Orsola, Benincasa University of Naples, Naples, Italy
| | - Foteini Christidi
- A' Department of Neurology, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Margioti
- Laboratory of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Athens Association of Alzheimer's Disease and Related Disorders, Athens, Greece, and
| | - Christina Demenega
- Athens Association of Alzheimer's Disease and Related Disorders, Athens, Greece, and
| | - Michail Rentzos
- A' Department of Neurology, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Evdokimidis
- A' Department of Neurology, Aeginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sharon Abrahams
- Department of Psychology, Human Cognitive Neuroscience, University of Edinburgh, Edinburgh, UK.,Euan MacDonald Centre for Motor Neurone Disease Research, Royal Infirmary of Edinburgh, Edinburgh, UK
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24
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Gregory JM, Elliott E, McDade K, Bak T, Pal S, Chandran S, Abrahams S, Smith C. Neuronal clusterin expression is associated with cognitive protection in amyotrophic lateral sclerosis. Neuropathol Appl Neurobiol 2019; 46:255-263. [PMID: 31386770 PMCID: PMC7318312 DOI: 10.1111/nan.12575] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/12/2019] [Accepted: 07/26/2019] [Indexed: 12/11/2022]
Abstract
AIMS Clusterin is a topologically dynamic chaperone protein with the ability to participate in both intra- and extacellular proteostasis. Clusterin has been shown to be upregulated in the spinal cord of patients with amyotrophic lateral sclerosis (ALS) and has been shown to protect against TDP-43 protein misfolding in animal and cell models. Previous studies have demonstrated an association between the pathological burden of TDP-43 misfolding and cognitive deficits in ALS, demonstrating high specificity, but correspondingly low sensitivity owing to a subset of individuals with no evidence of cognitive deficits despite a high burden of TDP-43 pathology, called mismatch cases. METHODS Hypothesizing that differences in the ability to cope with protein misfolding in these cases may be due to differences in expression of protective mechanisms such as clusterin expression, we assessed the spatial expression of clusterin and another chaperone protein, HspB8, in post mortem brain tissue of mismatch cases. We employed a modified in situ hybridization technique called BaseScope, with single cell, single transcript resolution. RESULTS Mismatch cases demonstrated differential spatial expression of clusterin, with a predominantly neuronal pattern, compared to cases with cognitive manifestations of their TDP-43 pathology who demonstrated a predominantly glial distribution of expression. CONCLUSIONS Our data suggest that, in individuals with TDP-43 pathology, predominantly neuronal expression of clusterin in extra-motor brain regions may indicate a cell protective mechanism delaying clinical manifestations such as cognitive dysfunction.
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Affiliation(s)
- J M Gregory
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - E Elliott
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - K McDade
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - T Bak
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK.,Human Cognitive Neuroscience, Psychology, University of Edinburgh, Edinburgh, UK
| | - S Pal
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - S Chandran
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
| | - S Abrahams
- Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK.,Human Cognitive Neuroscience, Psychology, University of Edinburgh, Edinburgh, UK
| | - C Smith
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh, Edinburgh, UK
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25
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Lulé DE, Aho-Özhan HEA, Vázquez C, Weiland U, Weishaupt JH, Otto M, Anderl-Straub S, Semler E, Uttner I, Ludolph AC. Story of the ALS-FTD continuum retold: rather two distinct entities. J Neurol Neurosurg Psychiatry 2019; 90:586-589. [PMID: 30257969 DOI: 10.1136/jnnp-2018-318800] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/20/2018] [Accepted: 08/11/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine the evolution and profile of cognitive and behavioural deficits in amyotrophic lateral sclerosis (ALS) and behavioural variant frontotemporal dementia (bvFTD) to disentangle the development of FTD in ALS and vice versa. METHODS In a prospective design, cognitive and behavioural profiles of 762 patients with motor predominant ALS (flail arm/leg syndrome, primary lateral sclerosis, pseudobulbar palsy, ALS) and behavioural predominant FTD (bvFTD, ALS-FTD) were determined and caregivers of patients with ALS were asked on the evolution of behavioural symptoms. Data were compared with 49 healthy controls. Cognition was measured with the Edinburgh Cognitive and Behavioral ALS Screen. RESULTS Evolution and features of cognitive profile of patients with motor predominant ALS were distinctly different from patients with behavioural FTD with regard to number and degree of affected cognitive domains. Also, in ALS mostly minus symptoms evolved after physical symptom onset whereas in ALS-FTD plus and minus symptoms were reported with an onset before physical degradation. CONCLUSION Evolution of cognitive and behavioural profile in patients with motor predominant ALS is distinctly different from those psychocognitive findings in patients with behavioural variant dementia. This may support the hypothesis that (possibly genetic) triggers decide in the preclinical phase on either motor or psychocognitive phenotypes.
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Affiliation(s)
| | | | | | - Ulrike Weiland
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | - Markus Otto
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | - Elisa Semler
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Ingo Uttner
- Department of Neurology, University of Ulm, Ulm, Germany
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26
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Keller J, Böhm S, Aho-Özhan HEA, Loose M, Gorges M, Kassubek J, Uttner I, Abrahams S, Ludolph AC, Lulé D. Functional reorganization during cognitive function tasks in patients with amyotrophic lateral sclerosis. Brain Imaging Behav 2019; 12:771-784. [PMID: 28600740 DOI: 10.1007/s11682-017-9738-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cognitive deficits, especially in the domains of social cognition and executive function including verbal fluency, are common in amyotrophic lateral sclerosis (ALS) patients. There is yet sparse understanding of pathogenesis of the underlying, possibly adaptive, cortical patterns. To address this issue, 65 patients with ALS and 33 age-, gender- and education-matched healthy controls were tested on cognitive and behavioral deficits with the Edinburgh Cognitive and Behavioural ALS Screen (ECAS). Using functional magnetic resonance imaging (fMRI), cortical activity during social cognition and executive function tasks (theory of mind, verbal fluency, alternation) adapted from the ECAS was determined in a 3 Tesla scanner. Compared to healthy controls, ALS patients performed worse in the ECAS overall (p < 0.001) and in all of its subdomains (p < 0.02), except memory. Imaging revealed altered cortical activation during all tasks, with patients consistently showing a hyperactivation in relevant brain areas compared to healthy controls. Additionally, cognitively high performing ALS patients consistently exhibited more activation in frontal brain areas than low performing patients and behaviorally unimpaired patients presented with more neuronal activity in orbitofrontal areas than behaviorally impaired patients. In conclusion, hyperactivation in fMRI cognitive tasks seems to represent an early adaptive process to overcome neuronal cell loss in relevant brain areas. The hereby presented cortical pattern change might suggest that, once this loss passes a critical threshold and no cortical buffering is possible, clinical representation of cognitive and behavioral impairment evolves. Future studies might shed light on the pattern of cortical pattern change in the course of ALS.
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Affiliation(s)
- Jürgen Keller
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Sarah Böhm
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Helena E A Aho-Özhan
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Markus Loose
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Martin Gorges
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Jan Kassubek
- 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
| | - Sharon Abrahams
- Psychology-PPLS, Euan MacDonald Centre for Motor Neuron Disease Research & Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, 7 George Square, Edinburgh, EH89JZ, UK
| | - 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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Theme 11 Cognitive and psychological assessment and support. Amyotroph Lateral Scler Frontotemporal Degener 2018; 19:301-324. [DOI: 10.1080/21678421.2018.1510581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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28
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Masuda M, Watanabe H, Tanaka Y, Ohdake R, Ogura A, Yokoi T, Imai K, Kawabata K, Riku Y, Hara K, Nakamura R, Atsuta N, Katsuno M, Sobue G. Age-related impairment in Addenbrooke's cognitive examination revised scores in patients with amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2018; 19:578-584. [PMID: 30379106 DOI: 10.1080/21678421.2018.1510009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Older age is thought to be a risk factor for cognitive impairment in amyotrophic lateral sclerosis (ALS). However, very few clinical studies have investigated this relationship using sufficient numbers of healthy controls that correspond to each generation. The purpose of this study was to determine the age-related changes of Addenbrooke's Cognitive Examination-Revised (ACE-R) score in ALS patients by comparing healthy controls of various ages. METHODS 131 ALS patients (86 males, 45 females; mean age: 64.8 ± 10.2; mean education: 12.5 ± 2.7) and 151 age-, gender-, and education-matched healthy controls were enrolled. We applied ACE-R, which could evaluate not only global cognition but five cognitive subdomains that included orientation/attention, memory, verbal fluency, language, and visuospatial ability. RESULTS ALS patients had significantly lower total and subdomain scores of ACE-R than healthy controls. Multiple regression analysis suggested that age at examination and age at onset had significant influence on ACE-R scores. When we divided ALS patients and healthy controls into 4 groups according to age at examination for ALS, total and each subdomain scores were significantly lower with age, particularly in the older-middle and the oldest group (66.31 years or more) of ALS compared with healthy controls. Locally weighted scatterplot smoothing analysis supported that these reductions of ACE-R total and subdomain scores in ALS patients were more accelerated by approximately 60 years as compared with healthy controls. CONCLUSION ALS patients showed accelerated age-related ACE-R score reduction beyond normal ageing processes.
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Affiliation(s)
- Michihito Masuda
- a Department of Neurology , Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Hirohisa Watanabe
- a Department of Neurology , Nagoya University Graduate School of Medicine , Nagoya , Japan.,b Brain and Mind Research Center, Nagoya University , Nagoya , Japan
| | - Yasuhiro Tanaka
- a Department of Neurology , Nagoya University Graduate School of Medicine , Nagoya , Japan.,b Brain and Mind Research Center, Nagoya University , Nagoya , Japan
| | - Reiko Ohdake
- b Brain and Mind Research Center, Nagoya University , Nagoya , Japan
| | - Aya Ogura
- a Department of Neurology , Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Takamasa Yokoi
- a Department of Neurology , Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Kazunori Imai
- a Department of Neurology , Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Kazuya Kawabata
- a Department of Neurology , Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Yuichi Riku
- a Department of Neurology , Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Kazuhiro Hara
- a Department of Neurology , Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Ryoichi Nakamura
- a Department of Neurology , Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Naoki Atsuta
- a Department of Neurology , Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Masahisa Katsuno
- a Department of Neurology , Nagoya University Graduate School of Medicine , Nagoya , Japan
| | - Gen Sobue
- b Brain and Mind Research Center, Nagoya University , Nagoya , Japan
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29
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De Icaza Valenzuela MM, Bak TH, Pal S, Abrahams S. The Edinburgh Cognitive and Behavioral ALS screen: relationship to age, education, IQ and the Addenbrooke’s Cognitive Examination-III. Amyotroph Lateral Scler Frontotemporal Degener 2018; 19:585-590. [DOI: 10.1080/21678421.2018.1491601] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Mónica M. De Icaza Valenzuela
- Human Cognitive Neuroscience – Department of Psychology, The University of Edinburgh, Edinburgh, UK,
- Centre for Cognitive Ageing and Cognitive Epidemiology (CCACE), The University of Edinburgh, Edinburgh, UK,
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, Edinburgh, UK,
| | - Thomas H. Bak
- Human Cognitive Neuroscience – Department of Psychology, The University of Edinburgh, Edinburgh, UK,
- Centre for Cognitive Ageing and Cognitive Epidemiology (CCACE), The University of Edinburgh, Edinburgh, UK,
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, Edinburgh, UK,
- Euan MacDonald Centre for Motor Neurone Disease Research, The University of Edinburgh, Edinburgh, UK, and
| | - Suvankar Pal
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, Edinburgh, UK,
- Euan MacDonald Centre for Motor Neurone Disease Research, The University of Edinburgh, Edinburgh, UK, and
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Sharon Abrahams
- Human Cognitive Neuroscience – Department of Psychology, The University of Edinburgh, Edinburgh, UK,
- Centre for Cognitive Ageing and Cognitive Epidemiology (CCACE), The University of Edinburgh, Edinburgh, UK,
- Anne Rowling Regenerative Neurology Clinic, The University of Edinburgh, Edinburgh, UK,
- Euan MacDonald Centre for Motor Neurone Disease Research, The University of Edinburgh, Edinburgh, UK, and
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30
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Bakker LA, Schröder CD, Spreij LA, Verhaegen M, De Vocht J, Van Damme P, Veldink JH, Visser-Meily JMA, van den Berg LH, Nijboer TCW, van Es MA. Derivation of norms for the Dutch version of the Edinburgh cognitive and behavioral ALS screen. Amyotroph Lateral Scler Frontotemporal Degener 2018; 20:19-27. [PMID: 30314420 DOI: 10.1080/21678421.2018.1522352] [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: 10/28/2022]
Abstract
BACKGROUND The Edinburgh cognitive and behavioral ALS screen (ECAS) was developed specifically to detect cognitive and behavioral changes in patients with amyotrophic lateral sclerosis (ALS). Differences with regard to normative data of different (language) versions of neuropsychological tests such as the ECAS exist. OBJECTIVE To derive norms for the Dutch version of the ECAS. METHODS Normative data were derived from a large sample of 690 control subjects and cognitive profiles were compared between a matched sample of 428 patients with ALS and 428 control subjects. RESULTS Age, level of education, and sex were significantly associated with performance on the ECAS in the normative sample. ECAS data were not normally distributed and therefore normative data were expressed as percentile ranks. The comparison of ECAS scores between patients and control subjects demonstrated that patients obtained significantly lower scores for language, executive function, verbal fluency, and memory, which is in line with the established cognitive profile of ALS. CONCLUSION For an accurate interpretation of ECAS results, it is important to derive normative data in large samples with nonparametric methods. The present normative data provide healthcare professionals with an accurate estimate of how common or uncommon patients' ECAS scores are and provide a useful supplement to existing cut-off scores.
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Affiliation(s)
- Leonhard A Bakker
- a Department of Neurology , Brain Centre Rudolf Magnus, University Medical Centre Utrecht , Utrecht , The Netherlands.,b Centre of Excellence for Rehabilitation Medicine, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht University and De Hoogstraat Rehabilitation , Utrecht , The Netherlands
| | - Carin D Schröder
- b Centre of Excellence for Rehabilitation Medicine, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht University and De Hoogstraat Rehabilitation , Utrecht , The Netherlands.,c Department of Rehabilitation, Physical Therapy Science, and Sports Medicine , Brain Centre Rudolf Magnus, University Medical Centre Utrecht , Utrecht , The Netherlands
| | - Lauriane A Spreij
- b Centre of Excellence for Rehabilitation Medicine, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht University and De Hoogstraat Rehabilitation , Utrecht , The Netherlands
| | - Marianne Verhaegen
- d Department of Neurology , University Hospitals Leuven , Leuven , Belgium
| | - Joke De Vocht
- d Department of Neurology , University Hospitals Leuven , Leuven , Belgium
| | - Philip Van Damme
- d Department of Neurology , University Hospitals Leuven , Leuven , Belgium.,e Department of Neurosciences , Experimental Neurology and Leuven Institute for Neuroscience and Disease , Leuven , Belgium.,f VIB, Center for Brain & Disease Research, Laboratory of Neurobiology , Leuven , Belgium
| | - Jan H Veldink
- a Department of Neurology , Brain Centre Rudolf Magnus, University Medical Centre Utrecht , Utrecht , The Netherlands
| | - Johanna M A Visser-Meily
- b Centre of Excellence for Rehabilitation Medicine, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht University and De Hoogstraat Rehabilitation , Utrecht , The Netherlands.,c Department of Rehabilitation, Physical Therapy Science, and Sports Medicine , Brain Centre Rudolf Magnus, University Medical Centre Utrecht , Utrecht , The Netherlands
| | - Leonard H van den Berg
- a Department of Neurology , Brain Centre Rudolf Magnus, University Medical Centre Utrecht , Utrecht , The Netherlands
| | - Tanja C W Nijboer
- b Centre of Excellence for Rehabilitation Medicine, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht University and De Hoogstraat Rehabilitation , Utrecht , The Netherlands.,c Department of Rehabilitation, Physical Therapy Science, and Sports Medicine , Brain Centre Rudolf Magnus, University Medical Centre Utrecht , Utrecht , The Netherlands.,g Department of Experimental Psychology , Utrecht University , Utrecht , The Netherlands
| | - Michael A van Es
- a Department of Neurology , Brain Centre Rudolf Magnus, University Medical Centre Utrecht , Utrecht , The Netherlands
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Lulé D, Hörner K, Vazquez C, Aho-Özhan H, Keller J, Gorges M, Uttner I, Ludolph AC. Screening for Cognitive Function in Complete Immobility Using Brain-Machine Interfaces: A Proof of Principle Study. Front Neurosci 2018; 12:517. [PMID: 30158845 PMCID: PMC6104564 DOI: 10.3389/fnins.2018.00517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/10/2018] [Indexed: 12/11/2022] Open
Abstract
Background: In many neurological conditions, there is a combination of decline in physical function and cognitive abilities. For far advanced stages of physical disability where speaking and hand motor abilities are severely impaired, there is a lack of standardized approach to screen for cognitive profile. Methods:N = 40 healthy subjects were included in the study. For proof of principle, N = 6 ALS patients were additionally measured. For cognitive screening, we used the Edinburgh cognitive and behavioral ALS screen (ECAS) in the standard paper-and-pencil version. Additionally, we adapted the ECAS to a brain-machine interface (BMI) control module to screen for cognition in severely advanced patients. Results: There was a high congruency between BMI version and the paper-and-pencil version of the ECAS. Sensitivity and specificity of the ECAS-BMI were mostly high whereas stress and weariness for the patient were low. Discussion/Conclusion: We hereby present evidence that adaptation of a standardized neuropsychological test for BMI control is feasible. BMI driven neuropsychological test provides congruent results compared to standardized tests with a good specificity and sensitivity but low patient load.
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Affiliation(s)
- Dorothée Lulé
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | | | | | - Jürgen Keller
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Martin Gorges
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Ingo Uttner
- Department of Neurology, University of Ulm, Ulm, Germany
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32
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Poletti B, Solca F, Carelli L, Faini A, Madotto F, Lafronza A, Monti A, Zago S, Ciammola A, Ratti A, Ticozzi N, Abrahams S, Silani V. Cognitive-behavioral longitudinal assessment in ALS: the Italian Edinburgh Cognitive and Behavioral ALS screen (ECAS). Amyotroph Lateral Scler Frontotemporal Degener 2018; 19:387-395. [DOI: 10.1080/21678421.2018.1473443] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Barbara Poletti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy,
| | - Federica Solca
- Department of Pathophysiology and Transplantation, “Dino Ferrari” Center, Università degli Studi di Milano, Milan, Italy,
| | - Laura Carelli
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy,
| | - Andrea Faini
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy,
| | - Fabiana Madotto
- Department of Medicine and Surgery, Research Centre on Public Health, University of Milano-Bicocca, Monza, Italy,
| | - Annalisa Lafronza
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy,
| | - Alessia Monti
- Department of Neurorehabilitation Sciences, Casa Cura Policlinico (CCP), Milan, Italy,
| | - Stefano Zago
- Department of Neuroscience and Mental Health, Università degli Studi di Milano, IRCCS Ospedale Maggiore Policlinico, Milan, Italy and
| | - Andrea Ciammola
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy,
| | - Antonia Ratti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy,
- Department of Pathophysiology and Transplantation, “Dino Ferrari” Center, Università degli Studi di Milano, Milan, Italy,
| | - Nicola Ticozzi
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy,
- Department of Pathophysiology and Transplantation, “Dino Ferrari” Center, Università degli Studi di Milano, Milan, Italy,
| | - Sharon Abrahams
- PPLS, Department of Psychology, Euan MacDonald Centre for Motor Neurone Disease Research, Human Cognitive Neuroscience-Psychology, University of Edinburgh, Edinburgh, UK
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy,
- Department of Pathophysiology and Transplantation, “Dino Ferrari” Center, Università degli Studi di Milano, Milan, Italy,
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Sensitivity and Specificity of the ECAS in Parkinson's Disease and Progressive Supranuclear Palsy. PARKINSONS DISEASE 2018; 2018:2426012. [PMID: 29862010 PMCID: PMC5971325 DOI: 10.1155/2018/2426012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 04/19/2018] [Indexed: 12/11/2022]
Abstract
Disentangling Parkinson's disease (PD) and progressive supranuclear palsy (PSP) may be a diagnostic challenge. Cognitive signs may be useful, but existing screens are often insufficiently sensitive or unsuitable for assessing people with motor disorders. We investigated whether the newly developed ECAS, designed to be used with people with even severe motor disability, was sensitive to the cognitive impairment seen in PD and PSP and able to distinguish between these two disorders. Thirty patients with PD, 11 patients with PSP, and 40 healthy controls were assessed using the ECAS, as well as an extensive neuropsychological assessment. The ECAS detected cognitive impairment in 30% of the PD patients, all of whom fulfilled the diagnostic criteria for mild cognitive impairment. The ECAS was also able to detect cognitive impairment in PSP patients, with 81.8% of patients performing in the impaired range. The ECAS total score distinguished between the patients with PSP and healthy controls with high sensitivity (91.0) and specificity (86.8). Importantly, the ECAS was also able to distinguish between the two syndromes, with the measures of verbal fluency offering high sensitivity (82.0) and specificity (80.0). In sum, the ECAS is a quick, simple, and inexpensive test that can be used to support the differential diagnosis of PSP.
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Crockford C, Newton J, Lonergan K, Madden C, Mays I, O'Sullivan M, Costello E, Pinto-Grau M, Vajda A, Heverin M, Pender N, Al-Chalabi A, Hardiman O, Abrahams S. Measuring reliable change in cognition using the Edinburgh Cognitive and Behavioural ALS Screen (ECAS). Amyotroph Lateral Scler Frontotemporal Degener 2017; 19:65-73. [PMID: 29214872 PMCID: PMC6510059 DOI: 10.1080/21678421.2017.1407794] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: Cognitive impairment affects approximately 50% of people with amyotrophic lateral sclerosis (ALS). Research has indicated that impairment may worsen with disease progression. The Edinburgh Cognitive and Behavioural ALS Screen (ECAS) was designed to measure neuropsychological functioning in ALS, with its alternate forms (ECAS-A, B, and C) allowing for serial assessment over time. Objective: The aim of the present study was to establish reliable change scores for the alternate forms of the ECAS, and to explore practice effects and test-retest reliability of the ECAS’s alternate forms. Method: Eighty healthy participants were recruited, with 57 completing two and 51 completing three assessments. Participants were administered alternate versions of the ECAS serially (A-B-C) at four-month intervals. Intra-class correlation analysis was employed to explore test-retest reliability, while analysis of variance was used to examine the presence of practice effects. Reliable change indices (RCI) and regression-based methods were utilized to establish change scores for the ECAS alternate forms. Results: Test-retest reliability was excellent for ALS Specific, ALS Non-Specific, and ECAS Total scores of the combined ECAS A, B, and C (all > .90). No significant practice effects were observed over the three testing sessions. RCI and regression-based methods produced similar change scores. Conclusion: The alternate forms of the ECAS possess excellent test-retest reliability in a healthy control sample, with no significant practice effects. The use of conservative RCI scores is recommended. Therefore, a change of ≥8, ≥4, and ≥9 for ALS Specific, ALS Non-Specific, and ECAS Total score is required for reliable change.
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Affiliation(s)
- Christopher Crockford
- a Department of Psychology, Human Cognitive Neuroscience , University of Edinburgh , Edinburgh , UK.,b Euan MacDonald Centre for Motor Neurone Disease Research , Royal Infirmary of Edinburgh , Edinburgh , UK
| | - Judith Newton
- a Department of Psychology, Human Cognitive Neuroscience , University of Edinburgh , Edinburgh , UK.,c Anne Rowling Regenerative Neurology Clinic , Royal Infirmary of Edinburgh , Edinburgh , UK
| | - Katie Lonergan
- d Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland.,e Department of Psychology , Beaumont Hospital , Dublin , Ireland
| | - Caoifa Madden
- d Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland.,e Department of Psychology , Beaumont Hospital , Dublin , Ireland
| | - Iain Mays
- d Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland.,e Department of Psychology , Beaumont Hospital , Dublin , Ireland
| | - Meabhdh O'Sullivan
- d Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland
| | - Emmet Costello
- d Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland.,e Department of Psychology , Beaumont Hospital , Dublin , Ireland
| | - Marta Pinto-Grau
- d Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland.,e Department of Psychology , Beaumont Hospital , Dublin , Ireland
| | - Alice Vajda
- d Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland
| | - Mark Heverin
- d Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland
| | - Niall Pender
- e Department of Psychology , Beaumont Hospital , Dublin , Ireland
| | - Ammar Al-Chalabi
- f Department of Basic and Clinical Neuroscience , Maurice Wohl Clinical Neuroscience Institute, King's College London , London , UK , and
| | - Orla Hardiman
- d Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland.,g Department of Neurology , Beaumont Hospital , Dublin , Ireland
| | - Sharon Abrahams
- a Department of Psychology, Human Cognitive Neuroscience , University of Edinburgh , Edinburgh , UK.,b Euan MacDonald Centre for Motor Neurone Disease Research , Royal Infirmary of Edinburgh , Edinburgh , UK.,c Anne Rowling Regenerative Neurology Clinic , Royal Infirmary of Edinburgh , Edinburgh , UK
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35
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Crockford CJ, Kleynhans M, Wilton E, Radakovic R, Newton J, Niven EH, Al-Chalabi A, Hardiman O, Bak TH, Abrahams S. ECAS A-B-C: alternate forms of the Edinburgh Cognitive and Behavioural ALS Screen. Amyotroph Lateral Scler Frontotemporal Degener 2017; 19:57-64. [PMID: 29205065 DOI: 10.1080/21678421.2017.1407793] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The Edinburgh Cognitive and Behavioural ALS Screen (ECAS) is a short assessment by which neuropsychological symptoms can be detected and quantified in people with ALS. To avoid potential practice effects with repeated administration, here we present alternative versions of the ECAS suitable for measuring change over time. OBJECTIVE To develop two alternate versions of the ECAS: ECAS-B and ECAS-C. METHOD One hundred and forty-nine healthy adult participants were recruited. Thirty participants completed a pilot study in developing the alternate versions. Two groups of 40 participants were administered the ECAS-B or ECAS-C and compared to published data of the original ECAS (ECAS-A) to determine equivalence. An additional 39 participants were administered the ECAS consecutively, either repeating the original version (ECAS-A-A-A) serially or the different versions (ECAS-A-B-C) to determine potential practice effects. Recordings of assessments were scored by a second researcher to determine inter-rater reliability. RESULTS No significant differences were found between versions (A, B, C) of the composite performance measures of ALS Specific, ALS Non-Specific, and ECAS Total scores. Repeated serial administration of ECAS-A (A-A-A) produced some practice effects for composite scores, whereas no such effects were found when alternate versions were administered serially (A-B-C). Exceptionally high intra-class correlations were found for all three versions of the ECAS suggesting a high degree of rater agreement. CONCLUSION The newly developed alternate forms of the ECAS are both highly equitable to the original ECAS-A and enable avoidance of practice effects, thus supporting their use in measuring cognition and behaviour over time.
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Affiliation(s)
- Christopher J Crockford
- a Department of Psychology , University of Edinburgh , Edinburgh , UK.,b Euan MacDonald Centre for Motor Neurone Disease Research , Royal Infirmary of Edinburgh , Edinburgh , UK
| | | | - Evelyn Wilton
- a Department of Psychology , University of Edinburgh , Edinburgh , UK
| | - Ratko Radakovic
- a Department of Psychology , University of Edinburgh , Edinburgh , UK.,c Anne Rowling Regenerative Neurology Clinic , Royal Infirmary of Edinburgh , Edinburgh , UK.,d Alzheimer Scotland Dementia Research Centre , University of Edinburgh , Edinburgh , UK
| | - Judith Newton
- a Department of Psychology , University of Edinburgh , Edinburgh , UK.,c Anne Rowling Regenerative Neurology Clinic , Royal Infirmary of Edinburgh , Edinburgh , UK
| | - Elaine H Niven
- a Department of Psychology , University of Edinburgh , Edinburgh , UK
| | - Ammar Al-Chalabi
- e Department of Basic and Clinical Neuroscience , Maurice Wohl Clinical Neuroscience Institute, King's College London , London , UK , and
| | - Orla Hardiman
- f Academic Unit of Neurology , Trinity College Dublin , Dublin , Ireland
| | - Thomas H Bak
- a Department of Psychology , University of Edinburgh , Edinburgh , UK.,b Euan MacDonald Centre for Motor Neurone Disease Research , Royal Infirmary of Edinburgh , Edinburgh , UK.,c Anne Rowling Regenerative Neurology Clinic , Royal Infirmary of Edinburgh , Edinburgh , UK
| | - Sharon Abrahams
- a Department of Psychology , University of Edinburgh , Edinburgh , UK.,b Euan MacDonald Centre for Motor Neurone Disease Research , Royal Infirmary of Edinburgh , Edinburgh , UK.,c Anne Rowling Regenerative Neurology Clinic , Royal Infirmary of Edinburgh , Edinburgh , UK
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