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Larsson BJ, Nordin K, Nygren I. Symptoms of anxiety and depression in patients with amyotrophic lateral sclerosis and their relatives during the disease trajectory. J Neurol Sci 2023; 455:122780. [PMID: 37976792 DOI: 10.1016/j.jns.2023.122780] [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: 08/10/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023]
Abstract
OBJECTS The aim of this study was to describe the presence of anxiety and depression among patients with Amyotrophic Lateral Sclerosis (ALS) and their relatives from diagnosis and during the disease progression. An additional aim was to explore if the patient's physical function correlated with the patients' or relatives' anxiety and depression. METHODS A prospective and longitudinal study, including 33 patients with ALS and their relatives who filled out the Hospital Anxiety and Depression Scale (HADS) at the time of diagnosis and over a period of two years. The patient's physical function was measured with the revised Amyotrophic Lateral Sclerosis Functional and Rating Scale (ALS FRS-R). RESULTS The results showed that many patients (45%) and relatives (58%) had symptoms of anxiety and that 13% of the patients and 29% of the relatives had symptoms of depression soon after the patient had been diagnosed with ALS. The prevalence of anxiety decreased over time in the group of patients but remained stable in the group of relatives. Relatives had more symptoms of anxiety compared to patients. There was a correlation between the patient's physical function and HADS in the group of relatives; however, no correlation was found in the group of patients. CONCLUSION The results showed that many patients and relatives suffered from symptoms of anxiety quite soon after their diagnosis, and that many relatives had symptoms of anxiety during the disease trajectory. This highlights the need to continuously measure patients' anxiety/depression level but also to pay attention to symptoms among relatives.
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Affiliation(s)
- Birgitta Jakobsson Larsson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Department of Neurology, Uppsala University Hospital, Uppsala, Sweden.
| | - Karin Nordin
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Ingela Nygren
- Department of Neurology, Uppsala University Hospital, Uppsala, Sweden; Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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Gold ND, Mallard AJ, Hermann JC, Zeifman RJ, Pagni BA, Bogenschutz MP, Ross S. Exploring the Potential Utility of Psychedelic Therapy for Patients With Amyotrophic Lateral Sclerosis. J Palliat Med 2023; 26:1408-1418. [PMID: 37167080 DOI: 10.1089/jpm.2022.0604] [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] [Indexed: 05/13/2023] Open
Abstract
Background: Amyotrophic lateral sclerosis (ALS) is an aggressive, terminal neurodegenerative disease that causes death of motor neurons and has an average survival time of 3-4 years. ALS is the most common motor neuron degenerative disease and is increasing in prevalence. There is a pressing need for more effective ALS treatments as available pharmacotherapies do not reverse disease progression or provide substantial clinical benefit. Furthermore, despite psychological distress being highly prevalent in ALS patients, psychological treatments remain understudied. Psychedelics (i.e., serotonergic psychedelics and related compounds like ketamine) have seen a resurgence of research into therapeutic applications for treating a multitude of neuropsychiatric conditions, including psychiatric and existential distress in life-threatening illnesses. Methods: We conducted a narrative review to examine the potential of psychedelic assisted-psychotherapy (PAP) to alleviate psychiatric and psychospiritual distress in ALS. We also discussed the safety of using psychedelics in this population and proposed putative neurobiological mechanisms that may therapeutically intervene on ALS neuropathology. Results: PAP has the potential to treat psychological dimensions and may also intervene on neuropathological dimensions of ALS. Robust improvements in psychiatric and psychospiritual distress from PAP in other populations provide a strong rationale for utilizing this therapy to treat ALS-related psychiatric and existential distress. Furthermore, relevant neuroprotective properties of psychedelics warrant future preclinical trials to investigate this area in ALS models. Conclusion: PAP has the potential to serve as an effective treatment in ALS. Given the lack of effective treatment options, researchers should rigorously explore this therapy for ALS in future trials.
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Affiliation(s)
- Noah D Gold
- Department of Psychiatry, NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Austin J Mallard
- Department of Psychiatry, NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Jacob C Hermann
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Richard J Zeifman
- Department of Psychiatry, NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Broc A Pagni
- Department of Psychiatry, NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Michael P Bogenschutz
- Department of Psychiatry, NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Stephen Ross
- Department of Psychiatry, NYU Langone Center for Psychedelic Medicine, NYU Grossman School of Medicine, New York, New York, USA
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Gould RL, Rawlinson C, Thompson B, Weeks K, Gossage-Worrall R, Cantrill H, Serfaty MA, Graham CD, McCracken LM, White D, Howard RJ, Bursnall M, Bradburn M, Al-Chalabi A, Orrell R, Chhetri SK, Noad R, Radunovic A, Williams T, Young CA, Dick D, Lawrence V, Goldstein LH, Young T, Ealing J, McLeod H, Williams N, Weatherly H, Cave R, Chiwera T, Pagnini F, Cooper C, Shaw PJ, McDermott CJ. Acceptance and Commitment Therapy for people living with motor neuron disease: an uncontrolled feasibility study. Pilot Feasibility Stud 2023; 9:116. [PMID: 37420261 DOI: 10.1186/s40814-023-01354-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/27/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Motor neuron disease (MND) is a fatal, progressive neurodegenerative disease that causes progressive weakening and wasting of limb, bulbar, thoracic and abdominal muscles. Clear evidence-based guidance on how psychological distress should be managed in people living with MND (plwMND) is lacking. Acceptance and Commitment Therapy (ACT) is a form of psychological therapy that may be particularly suitable for this population. However, to the authors' knowledge, no study to date has evaluated ACT for plwMND. Consequently, the primary aim of this uncontrolled feasibility study was to examine the feasibility and acceptability of ACT for improving the psychological health of plwMND. METHODS PlwMND aged ≥ 18 years were recruited from 10 UK MND Care Centres/Clinics. Participants received up to 8 one-to-one ACT sessions, developed specifically for plwMND, plus usual care. Co-primary feasibility and acceptability outcomes were uptake (≥ 80% of the target sample [N = 28] recruited) and initial engagement with the intervention (≥ 70% completing ≥ 2 sessions). Secondary outcomes included measures of quality of life, anxiety, depression, disease-related functioning, health status and psychological flexibility in plwMND and quality of life and burden in caregivers. Outcomes were assessed at baseline and 6 months. RESULTS Both a priori indicators of success were met: 29 plwMND (104%) were recruited and 76% (22/29) attended ≥ 2 sessions. Attrition at 6-months was higher than anticipated (8/29, 28%), but only two dropouts were due to lack of acceptability of the intervention. Acceptability was further supported by good satisfaction with therapy and session attendance. Data were possibly suggestive of small improvements in anxiety and psychological quality of life from baseline to 6 months in plwMND, despite a small but expected deterioration in disease-related functioning and health status. CONCLUSIONS There was good evidence of acceptability and feasibility. Limitations included the lack of a control group and small sample size, which complicate interpretation of findings. A fully powered RCT to evaluate the clinical and cost-effectiveness of ACT for plwMND is underway. TRIAL REGISTRATION The study was pre-registered with the ISRCTN Registry (ISRCTN12655391).
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Affiliation(s)
- Rebecca L Gould
- Division of Psychiatry, University College London, Wing B, 6th Floor Maple House, 149 Tottenham Court Rd, London, W1T 7NF, UK.
| | - Charlotte Rawlinson
- Division of Psychiatry, University College London, Wing B, 6th Floor Maple House, 149 Tottenham Court Rd, London, W1T 7NF, UK
| | - Ben Thompson
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Kirsty Weeks
- Division of Psychiatry, University College London, Wing B, 6th Floor Maple House, 149 Tottenham Court Rd, London, W1T 7NF, UK
| | - Rebecca Gossage-Worrall
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Hannah Cantrill
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Marc A Serfaty
- Division of Psychiatry, University College London, Wing B, 6th Floor Maple House, 149 Tottenham Court Rd, London, W1T 7NF, UK
- Priory Hospital North London, London, UK
| | - Christopher D Graham
- Strathclyde Psychology, Department of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | | | - David White
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Robert J Howard
- Division of Psychiatry, University College London, Wing B, 6th Floor Maple House, 149 Tottenham Court Rd, London, W1T 7NF, UK
| | - Matt Bursnall
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Mike Bradburn
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Ammar Al-Chalabi
- Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
| | - Richard Orrell
- Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, London, UK
| | - Suresh K Chhetri
- Lancashire Teaching Hospitals NHS Foundation Trust, Lancashire, UK
| | - Rupert Noad
- Department of Neuropsychology, Derriford Hospital, Plymouth, UK
| | | | - Tim Williams
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | | | - David Dick
- Norfolk and Norwich University Hospital, Norwich, UK
| | - Vanessa Lawrence
- Health Services & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Laura H Goldstein
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Tracey Young
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - John Ealing
- Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK
| | - Hamish McLeod
- Mental Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Nicola Williams
- Primary Care Clinical Trials Unit, Oxford University, Oxford, UK
| | | | - Richard Cave
- Language and Cognition, University College London, London, UK
| | - Theresa Chiwera
- Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
| | - Francesco Pagnini
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Cindy Cooper
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Pamela J Shaw
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
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Gould RL, Thompson BJ, Rawlinson C, Kumar P, White D, Serfaty MA, Graham CD, McCracken LM, Bursnall M, Bradburn M, Young T, Howard RJ, Al-Chalabi A, Goldstein LH, Lawrence V, Cooper C, Shaw PJ, McDermott CJ. A randomised controlled trial of acceptance and commitment therapy plus usual care compared to usual care alone for improving psychological health in people with motor neuron disease (COMMEND): study protocol. BMC Neurol 2022; 22:431. [PMID: 36380299 PMCID: PMC9664029 DOI: 10.1186/s12883-022-02950-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/28/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Motor neuron disease (MND) is a rapidly progressive, fatal neurodegenerative disease that predominantly affects motor neurons from the motor cortex to the spinal cord and causes progressive wasting and weakening of bulbar, limb, abdominal and thoracic muscles. Prognosis is poor and median survival is 2-3 years following symptom onset. Psychological distress is relatively common in people living with MND. However, formal psychotherapy is not routinely part of standard care within MND Care Centres/clinics in the UK, and clear evidence-based guidance on improving the psychological health of people living with MND is lacking. Previous research suggests that Acceptance and Commitment Therapy (ACT) may be particularly suitable for people living with MND and may help improve their psychological health. AIMS To assess the clinical and cost-effectiveness of ACT modified for MND plus usual multidisciplinary care (UC) in comparison to UC alone for improving psychological health in people living with MND. METHODS The COMMEND trial is a multi-centre, assessor-blind, parallel, two-arm RCT with a 10-month internal pilot phase. 188 individuals aged ≥ 18 years with a diagnosis of definite, laboratory-supported probable, clinically probable, or possible familial or sporadic amyotrophic lateral sclerosis, and additionally the progressive muscular atrophy and primary lateral sclerosis variants, will be recruited from approximately 14 UK-based MND Care Centres/clinics and via self-referral. Participants will be randomly allocated to receive up to eight 1:1 sessions of ACT plus UC or UC alone by an online randomisation system. Participants will complete outcome measures at baseline and at 6- and 9-months post-randomisation. The primary outcome will be quality of life at six months. Secondary outcomes will include depression, anxiety, psychological flexibility, health-related quality of life, adverse events, ALS functioning, survival at nine months, satisfaction with therapy, resource use and quality-adjusted life years. Primary analyses will be by intention to treat and data will be analysed using multi-level modelling. DISCUSSION This trial will provide definitive evidence on the clinical and cost-effectiveness of ACT plus UC in comparison to UC alone for improving psychological health in people living with MND. TRIAL REGISTRATION ISRCTN Registry, ISRCTN12655391. Registered 17 July 2017, https://www.isrctn.com/ISRCTN12655391 . PROTOCOL VERSION 3.1 (10/06/2020).
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Affiliation(s)
- Rebecca L Gould
- Division of Psychiatry, University College London, Wing B, 6th floor Maple House, 149 Tottenham Court Rd, W1T 7NF, London, UK.
| | - Benjamin J Thompson
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Charlotte Rawlinson
- Division of Psychiatry, University College London, Wing B, 6th floor Maple House, 149 Tottenham Court Rd, W1T 7NF, London, UK
| | - Pavithra Kumar
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - David White
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Marc A Serfaty
- Division of Psychiatry, University College London, Wing B, 6th floor Maple House, 149 Tottenham Court Rd, W1T 7NF, London, UK
- Priory Hospital North London, London, UK
| | | | | | - Matt Bursnall
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Mike Bradburn
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Tracey Young
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Robert J Howard
- Division of Psychiatry, University College London, Wing B, 6th floor Maple House, 149 Tottenham Court Rd, W1T 7NF, London, UK
| | - Ammar Al-Chalabi
- Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
| | - Laura H Goldstein
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Vanessa Lawrence
- Health Services & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Cindy Cooper
- Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Pamela J Shaw
- Sheffield Institute for Translational Neuroscience, University of Sheffield, Sheffield, UK
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Waheed W, Khan F, Naud S, Kasarskis E, Matthews D, Tandan R. Urine specific gravity to identify and predict hydration need in ALS. Amyotroph Lateral Scler Frontotemporal Degener 2022; 23:407-414. [PMID: 34918583 PMCID: PMC9887640 DOI: 10.1080/21678421.2021.2013894] [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: 02/03/2023]
Abstract
Introduction: Multiple factors contribute to increased risk of dehydration in amyotrophic lateral sclerosis (ALS), which contributes to shortened survival independent of nutritional status. The assessment of hydration by doubly labeled water is restricted due to the limited availability of this gold standard technique for clinical use. This prompted us to examine the utility of urine-specific gravity (USG) as a predictor of hydration need in ALS subjects. Material and Methods: Using data from a multicenter study of 80 ALS subjects with 250 visits, we conducted a secondary analysis of the original data set from doubly labeled water experiments. We used a cross-section of the data (one visit per 75 subjects) in the model selection step ("test set"), and a repeated measures analysis in the validation step with data from 63 subjects and 142 follow-up visits. The sensitivity to detect inadequate water turnover rate (a surrogate for water intake) was the goal of the predictive model presented for clinical use. Results and discussion: The final predictive model to estimate water requirement included USG, gender, body mass index, and the ALSFRS gross motor subscale score. We developed a best-fit equation to estimate water intake from USG, determine hydration status, and improve clinical care of real-world ALS subjects.
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Affiliation(s)
- Waqar Waheed
- Department of Neurological Sciences, University of Vermont and the University of Vermont Medical Center, Burlington, VT
| | - Fatima Khan
- Department of Neurological Sciences, University of Vermont and the University of Vermont Medical Center, Burlington, VT
| | - Shelly Naud
- Department of Medical Biostatistics, University of Vermont, Burlington, VT, USA
| | - Edward Kasarskis
- Department of Neurology, University of Kentucky, Lexington, KY, USA
| | - Dwight Matthews
- Department of Chemistry, University of Vermont, Burlington, VT, USA
| | - Rup Tandan
- Department of Neurological Sciences, University of Vermont and the University of Vermont Medical Center, Burlington, VT
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Chowdhury A, Mukherjee A, Sinharoy U, Pandit A, Biswas A. Non-Motor Features of Amyotrophic Lateral Sclerosis: A Clinic-based Study. Ann Indian Acad Neurol 2021; 24:745-753. [PMID: 35002134 PMCID: PMC8680868 DOI: 10.4103/aian.aian_51_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 01/31/2021] [Accepted: 03/08/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder of motor neurons. Spread of pathology to other brain areas leads to development of non-motor symptoms (NMSs). These usually remain undiagnosed because of overwhelming motor problem and are responsible for significant distress to the patient. Our objective was to explore the burden of various NMSs of patients with ALS, compare between limb-onset and bulbar-onset patients, and to correlate with severity and duration of disease. Methods: Fifty patients with ALS diagnosed according to revised El Escorial Criteria and 50 healthy controls were included in this study. They were assessed with NMS Questionnaire, Beck's Depression Inventory, Center for Neurologic Study-Lability Scale, Drooling Frequency and Severity Scale, Epworth Sleepiness scale, Bengali Mental State Examination, and Frontal Assessment Battery and relevant statistical analyses were carried out. Results: The patients with ALS had significantly increased prevalence of almost all NMSs compared to controls. There was also significant increase in depression, suicidal ideation, pseudobulbar affect, and daytime sleepiness in patients with ALS. The bulbar onset subgroup had significantly increased daytime drooling, dysphagia, nausea and vomiting, whereas the limb onset subgroup reported increased frequency of leg swelling. Executive dysfunction was detected in 24% of patients with ALS and 9.8% had mild cognitive impairment. Weight loss, frequency of falling, insomnia, unpleasant nocturnal leg sensations, difficulty having sex, depression, and cognitive impairment increased significantly with an increase in severity of the disease. Conclusion: NMSs were significantly more prevalent in patients with ALS. Some NMSs worsened with advancement of the disease.
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Affiliation(s)
- Abhishek Chowdhury
- Department of Neurology, Institute of Post Graduate Medical Education and Research (IPGME&R) and Bangur Institute of Neurosciences, Kolkata, West Bengal, India
| | - Adreesh Mukherjee
- Department of Neurology, Institute of Post Graduate Medical Education and Research (IPGME&R) and Bangur Institute of Neurosciences, Kolkata, West Bengal, India
| | - Uma Sinharoy
- Department of Neurology, Institute of Post Graduate Medical Education and Research (IPGME&R) and Bangur Institute of Neurosciences, Kolkata, West Bengal, India
| | - Alak Pandit
- Department of Neurology, Institute of Post Graduate Medical Education and Research (IPGME&R) and Bangur Institute of Neurosciences, Kolkata, West Bengal, India
| | - Atanu Biswas
- Department of Neurology, Institute of Post Graduate Medical Education and Research (IPGME&R) and Bangur Institute of Neurosciences, Kolkata, West Bengal, India
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Lund EM, Hostetter TA, Forster JE, Hoffmire CA, Stearns-Yoder KA, Brenner LA, Tahmasbi Sohi M. Suicide among veterans with amyotrophic lateral sclerosis. Muscle Nerve 2021; 63:807-811. [PMID: 33470429 DOI: 10.1002/mus.27181] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 01/12/2021] [Accepted: 01/16/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND The purpose of this study was to estimate the risk of death by suicide for those with amyotrophic lateral sclerosis (ALS) seeking care within the Veterans Health Administration (VHA). METHODS This was a retrospective, cohort study. Extended Cox regression models were used to compare the hazard of suicide between the ALS and the unexposed groups. RESULTS The hazard of suicide was 3.98 times higher for those with ALS than for those without (95% confidence interval [CI] , 2.64-6.00; P < .0001). After adjusting for covariates, those with ALS remained at increased risk (hazard ratio, 3.48; 95% CI, 2.31-5.24; P < .001). CONCLUSIONS Among those seeking care in the VHA, individuals with ALS are at increased risk for dying by suicide. Additional suicide prevention efforts, including strategies for reducing access to lethal means, are warranted.
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Affiliation(s)
- Emily M Lund
- Department of Educational Studies in Psychology, Research Methodology, and Counseling, University of Alabama, Tuscaloosa, Alabama, USA
| | - Trisha A Hostetter
- VHA Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, Colorado, USA
| | - Jeri E Forster
- VHA Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, Colorado, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Claire A Hoffmire
- VHA Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, Colorado, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kelly A Stearns-Yoder
- VHA Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, Colorado, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Lisa A Brenner
- VHA Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, Colorado, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Maryam Tahmasbi Sohi
- VHA Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, Colorado, USA
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Dodd R, Fisher PL, Makin S, Moore P, Cherry MG. The Association Between Maladaptive Metacognitive Beliefs and Emotional Distress in People Living With Amyotrophic Lateral Sclerosis. Front Psychol 2021; 12:609068. [PMID: 33716871 PMCID: PMC7953059 DOI: 10.3389/fpsyg.2021.609068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 02/03/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Approximately half of all people living with amyotrophic lateral sclerosis (ALS) experience persistent or recurrent emotional distress, yet little is known about the psychological processes that maintain emotional distress in this population. The self-regulatory executive functioning (S-REF) model specifies that maladaptive metacognitive beliefs and processes are central to the development and maintenance of emotional distress. This study explored whether maladaptive metacognitive beliefs are associated with emotional distress after controlling for demographic factors, time since diagnosis, and current level of physical functioning. DESIGN In a cross-sectional design, 75 adults with a diagnosis of ALS completed self-report questionnaires. Participants had a mean age of 60.40 years, mean duration of symptoms 63.92 months, and male:female gender ratio of 14:11. MAIN OUTCOME MEASURES Questionnaires assessed emotional distress (HADS, adapted for ALS), physical functioning (ALSFRS-R), repetitive negative thinking (RTQ-10), metacognitive beliefs (MCQ-30), and demographic factors. RESULTS Maladaptive metacognitive beliefs explained additional variance in emotional distress after controlling for age, gender, time since diagnosis, physical functioning, and repetitive negative thinking. Repetitive negative thinking partially mediated the relationships between positive and negative metacognitive beliefs and emotional distress. CONCLUSIONS These data support the utility of the metacognitive model in understanding emotional distress in people with ALS. Examination of the temporal relationship between maladaptive metacognitive beliefs and emotional distress in people living with ALS may help to guide the development of therapeutic approaches.
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Affiliation(s)
- Rachel Dodd
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Peter L. Fisher
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Selina Makin
- Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Perry Moore
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
- Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - Mary Gemma Cherry
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom
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9
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Palmieri A, Kleinbub JR, Pagnini F, Sorarù G, Cipolletta S. Empathy-based supportive treatment in amyotrophic lateral sclerosis: A pragmatic study. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2021; 63:202-216. [PMID: 33617426 DOI: 10.1080/00029157.2020.1797623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Scarce literature has been dedicated to the psychological treatment of amyotrophic lateral sclerosis (ALS). However, there have been some encouraging findings, such as in hypnosis-based studies, which revealed patient improvements in anxiety, depression and quality of life (QoL). We replicated such a design of a pragmatic study on empathy-based supportive counseling treatment in four weekly domiciliary sessions. Twenty-one people with ALS (pALS) consecutively attending the Motor Neuron Disease Center of Padova University were recruited to the study; in total, 21 pALS who did not undergo any kind of psychological treatment served as the control group. In the treatment group, depression, anxiety and QoL (measured respectively with the HADS-D, HADS-A and ALSSQOL-R) were assessed at pre- and post-treatment levels and at 3- and 6-month follow-ups. Statistical mixed-model regression analyses revealed that in the treated group, perceived conditions of anxiety, depression and QoL were significantly stable compared to worsening in the control patients. Interestingly, there were improvements in the QoL domains "Interaction", "Emotion" and "Physical" at the 6-month follow-up. Overall, even if not directly comparable, our current results on support-based counseling, though interesting, seem not to reach the efficacy of a hypnosis-based study in which the observed dimensions were significantly improved with respect to the baseline. The implications of our results from a psychodynamic perspective are highlighted.
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Affiliation(s)
| | | | - Francesco Pagnini
- Catholic University Sacro Cuore, Milano, Italy
- Harvard University, Cambridge, MA, USA
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10
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Barć K, Szacka K, Nieporęcki K, de Carvalho M, Gromicho M, Grosskreutz J, Petri S, Rödiger A, Steinbach R, Uysal H, Kuźma-Kozakiewicz M. Emotional Lability at Disease Onset Is an Independent Prognostic Factor of Faster Disease Progression in Amyotrophic Lateral Sclerosis. Aging Dis 2020; 11:1021-1028. [PMID: 33014519 PMCID: PMC7505264 DOI: 10.14336/ad.2019.1120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 11/20/2019] [Indexed: 12/03/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a fast progressing neurodegenerative disease leading to quadriplegia, anarthria and respiratory insufficiency. A large variety of phenotypes and disability progression requires individually tailored management. Identification of predictors of poor prognosis may not only improve management, but also allow for more precise patients’ stratification for clinical trials or research studies. The aim of the study was to investigate the influence of emotional lability present at disease onset on ALS progression by exploring its direct impact on the decay of the ALS Functional Rating Scale-Revised (ALSFRS-R). The study was performed in a group of 1145 patients from Germany, Poland, Portugal and Turkey between 2014 and 2018. The analysis showed that the presence of emotional lability at ALS onset was linked to a faster decline of ALSFRS-R (0.70 vs 0.50, p<0.0001), in case of either bulbar (0.80 vs 0.65, p<0.05) or limb disease onset (0.59 vs 0.46, p <0.01). It was most prominent in the bulbar subscore of ALSFRS-R. A multiple regression analysis showed a direct influence of emotional lability at ALS onset on disease progression, regardless of age, gender, site of onset, weight loss, cognitive impairment and diagnosis delay (β=0.071; p=0.019). It can therefore be concluded that the presence of emotional lability at the disease onset is an independent factor of faster disease progression in ALS.
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Affiliation(s)
- Krzysztof Barć
- 1Department of Neurology, University Clinical Centre of Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Szacka
- 1Department of Neurology, University Clinical Centre of Medical University of Warsaw, Warsaw, Poland.,2Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Nieporęcki
- 1Department of Neurology, University Clinical Centre of Medical University of Warsaw, Warsaw, Poland
| | | | - Marta Gromicho
- 3Faculdade de Medicina-IMM, Universidade de Lisboa, Lisbon, Portugal
| | | | - Susanne Petri
- 5Department of Neurology, Hannover Medical School, Hannover, Germany
| | | | - Robert Steinbach
- 4Hans-Berger Department of Neurology, Jena University Hospital, Germany
| | - Hilmi Uysal
- 6Department of Neurology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Magdalena Kuźma-Kozakiewicz
- 1Department of Neurology, University Clinical Centre of Medical University of Warsaw, Warsaw, Poland.,2Department of Neurology, Medical University of Warsaw, Warsaw, Poland.,7Neurodegenerative Diseases Research Group, Medical University of Warsaw, Warsaw, Poland
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11
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Everett EA, Pedowitz E, Maiser S, Cohen J, Besbris J, Mehta AK, Chi L, Jones CA. Top Ten Tips Palliative Care Clinicians Should Know About Amyotrophic Lateral Sclerosis. J Palliat Med 2020; 23:842-847. [DOI: 10.1089/jpm.2020.0046] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Elyse A. Everett
- John T. Milliken Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Elizabeth Pedowitz
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samuel Maiser
- Department of Neurology, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Joss Cohen
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Jessica Besbris
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
- Department of Supportive Care Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Ambereen K. Mehta
- Department of Medicine, University of California, Los Angeles, California, USA
| | - Luqi Chi
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Christopher A. Jones
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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12
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Kuraszkiewicz B, Goszczyńska H, Podsiadły-Marczykowska T, Piotrkiewicz M, Andersen P, Gromicho M, Grosskreutz J, Kuźma-Kozakiewicz M, Petri S, Stubbendorf B, Szacka K, Uysal H, de Carvalho M. Potential Preventive Strategies for Amyotrophic Lateral Sclerosis. Front Neurosci 2020; 14:428. [PMID: 32528241 PMCID: PMC7264408 DOI: 10.3389/fnins.2020.00428] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 04/07/2020] [Indexed: 12/11/2022] Open
Abstract
It may seem useless to propose preventive measures for a disease without established pathogenesis and successful therapy, such as amyotrophic lateral sclerosis (ALS). However, we will show that ALS shares essential molecular mechanisms with aging and that established anti-aging strategies, such as healthy diet or individually adjusted exercise, may be successfully applied to ameliorate the condition of ALS patients. These strategies might be applied for prevention if persons at ALS risk could be identified early enough. Recent research advances indicate that this may happen soon.
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Affiliation(s)
- B Kuraszkiewicz
- Department of Methods of Brain Imaging and Functional Research of Nervous System, Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - H Goszczyńska
- Department of Methods of Brain Imaging and Functional Research of Nervous System, Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - T Podsiadły-Marczykowska
- Department of Methods of Brain Imaging and Functional Research of Nervous System, Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - M Piotrkiewicz
- Department of Methods of Brain Imaging and Functional Research of Nervous System, Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
| | - P Andersen
- Department of Clinical Sciences, Umeå University, Umeå, Sweden
| | - M Gromicho
- Institute of Physiology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - J Grosskreutz
- Department of Neurology, University Hospital Jena, Jena, Germany.,Jena Centre for Healthy Aging, University Hospital Jena, Jena, Germany
| | | | - S Petri
- Clinic for Neurology, Hannover Medical School, Hanover, Germany
| | - B Stubbendorf
- Department of Neurology, University Hospital Jena, Jena, Germany
| | - K Szacka
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - H Uysal
- Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - M de Carvalho
- Institute of Physiology, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
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13
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Pawlukowska W, Baumert B, Gołąb-Janowska M, Meller A, Machowska-Sempruch K, Wełnicka A, Paczkowska E, Rotter I, Machaliński B, Nowacki P. Comparative assessment and monitoring of deterioration of articulatory organs using subjective and objective tools among patients with amyotrophic lateral sclerosis. BMC Neurol 2019; 19:241. [PMID: 31629403 PMCID: PMC6800986 DOI: 10.1186/s12883-019-1484-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/09/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is a fatal degenerative disease of a rapid course. In 25% of ALS sufferers, speech disorders occur as prodromal symptoms of the disease. Impaired communication affects physical health and has a negative impact on mental and emotional condition. In this study, we assessed which domains of speech are particularly affected in ALS. Subsequently, we estimated possible correlations between the ALS patients' subjective perception of their speech quality and an objective assessment of the speech organs carried out by an expert. METHODS The study group consisted of 63 patients with sporadic ALS. The patients were examined for articulatory functions by means of Voice Handicap Index (VHI) and the Frenchay Dysarthria Assessment (FDA). RESULTS On the basis of the VHI scores, the entire cohort was divided into 2 groups: group I (40 subjects) with mild speech impairment, and group II (23 subjects) displaying moderate and profound speech deficits. In an early phase of ALS, changes were typically reported in the tongue, lips and soft palate. The FDA and VHI-based measurements revealed a high, positive correlation between the objective and subjective evaluation of articulation quality. CONCLUSIONS Deterioration of the articulatory organs resulted in the reduction of social, physical and emotional functioning. The highly positive correlation between the VHI and FDA scales seems to indicate that the VHI questionnaire may be a reliable, self-contained tool for monitoring the course and progression of speech disorders in ALS. TRIAL REGISTRATION NCT02193893 .
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Affiliation(s)
- Wioletta Pawlukowska
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University, Żołnierska 54, Szczecin, 71-210 Poland
- Department of Neurology, Pomeranian Medical University, Unii Lubelskiej 1, Szczecin, 71-210 Poland
| | - Bartłomiej Baumert
- Department of General Pathology, Pomeranian Medical University, Unii Lubelskie 1, Szczecin, 71-252 Poland
| | - Monika Gołąb-Janowska
- Department of Neurology, Pomeranian Medical University, Unii Lubelskiej 1, Szczecin, 71-210 Poland
| | - Agnieszka Meller
- Department of Neurology, Pomeranian Medical University, Unii Lubelskiej 1, Szczecin, 71-210 Poland
| | | | - Agnieszka Wełnicka
- Department of Neurology, Pomeranian Medical University, Unii Lubelskiej 1, Szczecin, 71-210 Poland
| | - Edyta Paczkowska
- Department of General Pathology, Pomeranian Medical University, Unii Lubelskie 1, Szczecin, 71-252 Poland
| | - Iwona Rotter
- Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University, Żołnierska 54, Szczecin, 71-210 Poland
| | - Bogusław Machaliński
- Department of General Pathology, Pomeranian Medical University, Unii Lubelskie 1, Szczecin, 71-252 Poland
| | - Przemysław Nowacki
- Department of Neurology, Pomeranian Medical University, Unii Lubelskiej 1, Szczecin, 71-210 Poland
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14
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Fisher P, Dodd R, Barrow E, Makin S, Cherry MG. Predictors of distress in amyotrophic lateral sclerosis: A systematic review. COGENT PSYCHOLOGY 2019. [DOI: 10.1080/23311908.2019.1608031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Peter Fisher
- Institute of Psychology, Health and Society, University of Liverpool, Whelan Building, Brownlow Hill, L69 3GB, Liverpool, UK
- The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Prescott Road, Liverpool, UK
| | - Rachel Dodd
- Institute of Psychology, Health and Society, University of Liverpool, Whelan Building, Brownlow Hill, L69 3GB, Liverpool, UK
- Lower Lane, The Walton Centre, Sid Watkins Building, Liverpool, UK, L9 7BB
| | - Emma Barrow
- Lower Lane, The Walton Centre, Sid Watkins Building, Liverpool, UK, L9 7BB
| | - Selina Makin
- Lower Lane, The Walton Centre, Sid Watkins Building, Liverpool, UK, L9 7BB
| | - Mary Gemma Cherry
- Institute of Psychology, Health and Society, University of Liverpool, Whelan Building, Brownlow Hill, L69 3GB, Liverpool, UK
- The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Prescott Road, Liverpool, UK
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15
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Abstract
Because the patient with amyotrophic lateral sclerosis (ALS) knows at the outset that he or she is facing an incurable and always fatal illness, the experience of hope may be different in the ALS community from that in the general palliative care community. Although the word “hope” is frequently and passionately used by both patients and professionals in the ALS community, to date there has been little published on the subject. Hopelessness and despair are a very real part of the ALS experience. But true hope, of a kind more powerful than mere physical survival, can also be part of the ALS journey. What is this “hope” the professional is expected to engender and the patient is encouraged not to lose? How can professionals help the ALS patient find hope and meaning? This article is an exploration of hope by someone who has experienced ALS, first as an occupational therapist, then as the daughter and caregiver of an ALS patient. Based on literature review and personal experience, factors leading to both hope and hopelessness are explored. Finally, the author offers several strategies that palliative care professionals can use to help ALS patients find hope.
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16
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Clarke DM, McLeod JE, Smith GC, Trauer T, Kissane DW. A Comparison of Psychosocial and Physical Functioning in Patients with Motor Neurone Disease and Metastatic Cancer. J Palliat Care 2019. [DOI: 10.1177/082585970502100310] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although their disease processes and treatments are different, patients with motor neurone disease (MND) and those with late-stage cancer share a common situation—one in which the quality of life, rather than a cure, becomes the focus of care. We report here a comparison of 126 patients with MND and 125 with metastatic cancer on a range of physical and psychosocial measures. Compared to cancer patients, MND patients were younger, had greater social contacts, but were more physically impaired. Cancer patients had more pain and were on more medication (opioids, steroids, and analgesics). Although the Beck depression scores were similar in both groups, MND patients had significantly higher scores for demoralization, hopelessness, and suicidal ideation. Cancer patients, on the other hand, scored significantly higher on anhedonia. We suggest this difference in the quality of depression represents a difference in illness experience of the two groups and has relevance for the ways we treat depression in the medically ill.
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Affiliation(s)
- David M. Clarke
- Monash University, Department of Psychological Medicine, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Janet E. McLeod
- Monash University, Department of Psychological Medicine, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Graeme C. Smith
- Monash University, Department of Psychological Medicine, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Tom Trauer
- Monash University, Department of Psychological Medicine, Monash Medical Centre, Melbourne, Victoria, Australia
| | - David W. Kissane
- Monash University, Department of Psychological Medicine, Monash Medical Centre, Melbourne, Victoria, Australia
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17
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Segerstrom SC, Kasarskis EJ, Fardo DW, Westgate PM. Socioemotional selectivity and psychological health in amyotrophic lateral sclerosis patients and caregivers: a longitudinal, dyadic analysis. Psychol Health 2019; 34:1179-1195. [PMID: 30907138 DOI: 10.1080/08870446.2019.1587441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Socioemotional selectivity theory predicts that as the end of life approaches, goals and resources that provide immediate, hedonic reward become more important than those that provide delayed rewards. This study tested whether these goal domains differentially affected psychological health in the context of marital dyads in which one partner had been diagnosed with amyotrophic lateral sclerosis (ALS), a life-limiting disease. Design: ALS patients (N = 102) being treated in three multidisciplinary clinics and their spouses (N = 100) reported their loneliness, financial worry and psychological health every 3 months for up to 18 months. Main Outcome Measure: Psychological health composite. Results: In multilevel dyadic models, patients and spouses had similar levels of financial worry and loneliness. Both patients and spouses had worse psychological health with higher loneliness, but only spouses had worse psychological health with higher financial worry. Significant interactions with age and disease severity indicated that older spouses were more affected by loneliness than were younger spouses, and patients with less severe disease were more affected by financial worry than patients with more severe disease. Conclusion: The results provide good support for socioemotional selectivity theory's implications for psychological health in a strong test of the theory.
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Affiliation(s)
| | - Edward J Kasarskis
- Department of Neurology, College of Medicine, University of Kentucky , Lexington , KY , USA
| | - David W Fardo
- Department of Biostatistics, College of Public Health, University of Kentucky , Lexington , KY , USA
| | - Philip M Westgate
- Department of Biostatistics, College of Public Health, University of Kentucky , Lexington , KY , USA
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18
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Linse K, Aust E, Joos M, Hermann A. Communication Matters-Pitfalls and Promise of Hightech Communication Devices in Palliative Care of Severely Physically Disabled Patients With Amyotrophic Lateral Sclerosis. Front Neurol 2018; 9:603. [PMID: 30100896 PMCID: PMC6072854 DOI: 10.3389/fneur.2018.00603] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/06/2018] [Indexed: 12/12/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is the most common motor neuron disease, leading to progressive paralysis, dysarthria, dysphagia, and respiratory disabilities. Therapy is mostly focused on palliative interventions. During the course of the disease, verbal as well as nonverbal communicative abilities become more and more impaired. In this light, communication has been argued to be “the essence of human life” and crucial for patients' quality of life. High-tech augmentative and alternative communication (HT-AAC) technologies such as eyetracking based computer devices and brain-computer-interfaces provide the possibility to maintain caregiver-independent communication and environmental control even in the advanced disease state of ALS. Thus, they enable patients to preserve social participation and to independently communicate end-of-life-decisions. In accordance with these functions of HT-AAC, their use is reported to strengthen self-determination, increase patients' quality of life and reduce caregiver burden. Therefore, HT-AAC should be considered as standard of (palliative) care for people with ALS. On the other hand, the supply with individually tailored HT-AAC technologies is limited by external and patient-inherent variables. This review aims to provide an overview of the possibilities and limitations of HT-AAC technologies and discuss their role in the palliative care for patients with ALS.
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Affiliation(s)
- Katharina Linse
- Department of Neurology, Technische Universität Dresden, Dresden, Germany.,German Center for Neurodegenerative Diseases (DZNE) Dresden, Dresden, Germany
| | - Elisa Aust
- Department of Neurology, Technische Universität Dresden, Dresden, Germany
| | - Markus Joos
- Interactive Minds Dresden GmbH, Dresden, Germany
| | - Andreas Hermann
- Department of Neurology, Technische Universität Dresden, Dresden, Germany.,German Center for Neurodegenerative Diseases (DZNE) Dresden, Dresden, Germany
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19
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Galin S, Heruti I, Barak N, Gotkine M. Hope and self-efficacy are associated with better satisfaction with life in people with ALS. Amyotroph Lateral Scler Frontotemporal Degener 2018; 19:611-618. [PMID: 29848125 DOI: 10.1080/21678421.2018.1476546] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The psychological phenotype in amyotrophic lateral sclerosis (ALS) is less negative than in other neurodegenerative diseases, manifested by a lower prevalence of psychopathology, such as anxiety and major depression, and a higher perceived quality of life by patients, irrespective of physical impairment. We hypothesized that positive psychological factors such as hope, optimism, and self-efficacy in people with ALS (PALS) were key determinants of satisfaction with life (SWL), despite physical impairment, and were protective against psychopathology. Forty PALS, at different functional levels, completed objective questionnaires to evaluate psychological factors of hope, optimism, self-efficacy, and SWL. Approximately 41% of the variance in SWL was accounted for by the Agency factor of hope. The results indicated that SWL was significantly correlated to specific positive psychological factors of hope and self-efficacy. Physical impairment was not correlated with positive psychological factors or SWL. These results support the role of hope and self-efficacy in maintaining satisfaction with life in PALS and consideration of these potentially modifiable factors could improve palliative therapy.
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Affiliation(s)
- Shir Galin
- a Department of Medical Psychology graduate studies, School of Behavioral Sciences , Tel Aviv - Yaffo Academic College , Tel Aviv , Israel.,b Meir Medical Center , Kfar Saba , Israel
| | - Irit Heruti
- a Department of Medical Psychology graduate studies, School of Behavioral Sciences , Tel Aviv - Yaffo Academic College , Tel Aviv , Israel.,c Rabin Medical Center, Beilinson Hospital , Petah Tikva , Israel , and
| | - Noa Barak
- a Department of Medical Psychology graduate studies, School of Behavioral Sciences , Tel Aviv - Yaffo Academic College , Tel Aviv , Israel
| | - Marc Gotkine
- d Neuromuscular/EMG service and ALS/Motor Neuron Disease Clinic , Hebrew University-Hadassah Medical Center , Jerusalem , Israel
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20
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Walklet E, Muse K, Meyrick J, Moss T. Do Psychosocial Interventions Improve Quality of Life and Wellbeing in Adults with Neuromuscular Disorders? A Systematic Review and Narrative Synthesis. J Neuromuscul Dis 2018; 3:347-362. [PMID: 27854227 PMCID: PMC5123628 DOI: 10.3233/jnd-160155] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Quality of life and well-being are frequently restricted in adults with neuromuscular disorders. As such, identification of appropriate interventions is imperative. The objective of this paper was to systematically review and critically appraise quantitative studies (RCTs, controlled trials and cohort studies) of psychosocial interventions designed to improve quality of life and well-being in adults with neuromuscular disorders. A systematic review of the published and unpublished literature was conducted. Studies meeting inclusion criteria were appraised using a validated quality assessment tool and results presented in a narrative synthesis. Out of 3,136 studies identified, ten studies met criteria for inclusion within the review. Included studies comprised a range of interventions including: cognitive behavioural therapy, dignity therapy, hypnosis, expressive disclosure, gratitude lists, group psychoeducation and psychologically informed rehabilitation. Five of the interventions were for patients with Amyotrophic Lateral Sclerosis (ALS). The remainder were for patients with post-polio syndrome, muscular dystrophies and mixed disorders, such as Charcot-Marie-Tooth disease, myasthenia gravis and myotonic dystrophy. Across varied interventions and neuromuscular disorders, seven studies reported a short-term beneficial effect of intervention on quality of life and well-being. Whilst such findings are encouraging, widespread issues with the methodological quality of these studies significantly compromised the results. There is no strong evidence that psychosocial interventions improve quality of life and well-being in adults with neuromuscular disorders, due to a paucity of high quality research in this field. Multi-site, randomised controlled trials with active controls, standardised outcome measurement and longer term follow-ups are urgently required.
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Affiliation(s)
- Elaine Walklet
- Health and Social Sciences Department, University of the West of England, Bristol, UK.,Psychology Department, University of Worcester, Worcester, UK
| | - Kate Muse
- Psychology Department, University of Worcester, Worcester, UK
| | - Jane Meyrick
- Health and Social Sciences Department, University of the West of England, Bristol, UK
| | - Tim Moss
- Health and Social Sciences Department, University of the West of England, Bristol, UK
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21
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The interplay between inflammation, oxidative stress, DNA damage, DNA repair and mitochondrial dysfunction in depression. Prog Neuropsychopharmacol Biol Psychiatry 2018; 80:309-321. [PMID: 28669580 DOI: 10.1016/j.pnpbp.2017.06.036] [Citation(s) in RCA: 170] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 06/05/2017] [Accepted: 06/29/2017] [Indexed: 12/13/2022]
Abstract
A growing body of evidence suggests that inflammation, mitochondrial dysfunction and oxidant-antioxidant imbalance may play a significant role in the development and progression of depression. Elevated levels of reactive oxygen and nitrogen species - a result of oxidant-antioxidant imbalance - may lead to increased damage of biomolecules, including DNA. This was confirmed in depressed patients in a research study conducted by our team and other scientists. 8-oxoguanine - a marker of oxidative DNA damage - was found in the patients' lymphocytes, urine and serum. These results were confirmed using a comet assay on lymphocytes. Furthermore, it was shown that the patients' cells repaired peroxide-induced DNA damage less efficiently than controls' cells and that some single nucleotide polymorphisms (SNP) of the genes involved in oxidative DNA damage repair may modulate the risk of depression. Lastly, less efficient DNA damage repair observed in the patients can be, at least partly, attributed to the presence of specific SNP variants, as it was revealed through a genotype-phenotype analysis. In conclusion, the available literature shows that both oxidative stress and less efficient DNA damage repair may lead to increased DNA damage in depressed patients. A similar mechanism may result in mitochondrial dysfunction, which is observed in depression.
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22
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Scagnelli CN, Howard DB, Bromberg MB, Kasarskis EJ, Matthews DE, Mitsumoto HM, Simmons Z, Tandan R. Hydration measured by doubly labeled water in ALS and its effects on survival. Amyotroph Lateral Scler Frontotemporal Degener 2017; 19:220-231. [PMID: 29243507 DOI: 10.1080/21678421.2017.1413117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We present a study of hydration in ALS patients and its effects on survival. This was a multicenter study over 48 weeks in 80 ALS patients who underwent 250 individual measurements using doubly labeled water (DLW). Total body water (TBW) and water turnover (a surrogate for water intake) were 3.4% and 8.6% lower, respectively, in patients compared to age- and gender-matched healthy controls, and both significantly decreased over study duration. In 20% of patients, water turnover measured over 10 d was 2 standard deviations below the mean value in healthy controls. In a separate clinic cohort of 208 patients, water intake estimated from a de novo equation created from common clinical endpoints was a prognostic indicator of survival. Regardless of nutritional state assessed by BMI, survival was two-fold longer in the group above the median for estimated water intake, suggesting that hydration may be a more important predictor of survival than malnutrition. Risk factors for poor hydration were identified. Water intake equations recommended by US Centers for Medicare and Medicaid Services in healthy elderly were inaccurate for use in ALS patients. We developed equations to estimate TBW and water intake in ALS patients for use in clinics to accurately estimate hydration and improve clinical care.
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Affiliation(s)
- Connor N Scagnelli
- a Department of Neurological Sciences , University of Vermont , Burlington , VT , USA
| | - Diantha B Howard
- b Clinical Research Center , University of Vermont College of Medicine , Burlington , VT , USA
| | - Mark B Bromberg
- c Department of Neurology , University of Utah , Salt Lake City , UT , USA
| | - Edward J Kasarskis
- d Department of Neurology , University of Kentucky , Lexington , KY , USA
| | - Dwight E Matthews
- e Departments of Chemistry and Medicine , University of Vermont , Burlington , VT , USA
| | | | - Zachary Simmons
- g Department of Neurology , Pennsylvania State University , Hershey , PA , USA
| | - Rup Tandan
- a Department of Neurological Sciences , University of Vermont , Burlington , VT , USA
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23
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Linse K, Rüger W, Joos M, Schmitz-Peiffer H, Storch A, Hermann A. Usability of eyetracking computer systems and impact on psychological wellbeing in patients with advanced amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2017; 19:212-219. [PMID: 29092645 DOI: 10.1080/21678421.2017.1392576] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Restrictions in communicative abilities are well known in patients with amyotrophic lateral sclerosis (ALS), but only few approaches in terms of evaluation of supportive technologies have been made. We aimed to assess the use and perceived usability of eye-tracking computer devices (ETCS) of severely impacted patients with ALS in an independent, direct manner and relate it to psychological well-being. ETCS enable active communication and social participation in the quadriplegic and anarthric disease state. Therefore, ETCS-based versions of widely used psychosocial questionnaires (ADI-12, SeiQoL-DW, WHO-5) as well as structured questions on communicative functioning and ETCS usage were developed to assess ALS patients, their next of kin and professional caregivers. Eleven patients (ALSFRS-R: 5.3 ± 5.9; ALS duration: 6.5 ± 3.8 years, range 1‒12; 82% invasively ventilated), nine next of kin and 10 professional caregivers could be assessed. Patients reported a mean use of their personal ETCS of 9.1 h per d (range 0.5‒16), with a high user satisfaction, preservation of communicative abilities and subjective indispensability of the ETCS. ETCS use was associated with higher psychological well-being. Next of kin and professional caregivers also nominated some critical aspect, which remains to be clarified. Our results strengthen the evidence that preserved mental autonomy influences psychological well-being in ALS and might even modify disease course and end-of-life-decisions in ALS.
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Affiliation(s)
- Katharina Linse
- a Department of Neurology , Technische Universität Dresden , Dresden , Germany.,c German Center for Neurodegenerative Diseases (DZNE), Research Site Dresden , Dresden , Germany , and
| | | | - Markus Joos
- b Interactive Minds Research , Dresden , Germany
| | | | - Alexander Storch
- a Department of Neurology , Technische Universität Dresden , Dresden , Germany.,c German Center for Neurodegenerative Diseases (DZNE), Research Site Dresden , Dresden , Germany , and.,d Department of Neurology , University of Rostock , Rostock , Germany
| | - Andreas Hermann
- a Department of Neurology , Technische Universität Dresden , Dresden , Germany.,c German Center for Neurodegenerative Diseases (DZNE), Research Site Dresden , Dresden , Germany , and
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Sherman MS, Pillai A, Jackson A, Heiman-Patterson T. Standard Equations Are Not Accurate in Assessing Resting Energy Expenditure in Patients With Amyotrophic Lateral Sclerosis. JPEN J Parenter Enteral Nutr 2017; 28:442-6. [PMID: 15568293 DOI: 10.1177/0148607104028006442] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the utility of standard equations for calculating caloric requirements in patients with amyotrophic lateral sclerosis (ALS). BACKGROUND Malnutrition substantially increases the risk of death in ALS. Weight loss can be stabilized and survival prolonged with early gastrostomy feeding. However the use of standard nutrition equations has not been validated in this population. We therefore compared measured caloric expenditure to 2 predictive equations in patients with varying stages of ALS. METHODS Thirty-four patients were studied. Caloric expenditure and respiratory quotient (R) were measured using indirect calorimetry. Results were compared with the Harris-Benedict equation. RESULTS The prediction error for the Harris-Benedict equation was 18.6 + 14.9%. Limits of agreement showed this equation could overestimate caloric expenditure by 591 kcal/d and underestimate requirements by 677 kcal/d. R was >0.86 in 11 patients, suggesting overfeeding, and <0.8 in 15 patients, suggesting underfeeding. The difference between predicted and measured caloric expenditure did not correlate with disease severity, disease duration, or body mass index. Mechanically ventilated patients had higher than predicted energy expenditure. CONCLUSIONS We found that standard equations used to calculate energy expenditure were not valid for patients with ALS. Moreover, the majority of our patients were either overfed or underfed. As underfeeding can cause diaphragm impairment, and overfeeding can increase ventilatory load, indirect calorimetry should be considered in ALS patients to determine optimal caloric requirement.
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Affiliation(s)
- Michael S Sherman
- Division of Pulmonary and Critical Care Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania 19102, USA.
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López-López A, González J, Guerrero ÁL, Ordás CM, Muñoz I, Cuadrado M. Stress, Coping, and Personality in Patients with Epicrania Fugax, and Their Relation to the Clinical Characteristics of Pain. PAIN MEDICINE 2017; 18:152-160. [PMID: 27330156 DOI: 10.1093/pm/pnw130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective The aim of the present work is to analyze certain psychological features in a group of patients diagnosed with Epicrania fugax (EF; that has been recently included in the appendix of the International Classification of Headache Disorders, third edition, beta version), as well as their association with diverse demographic and clinical characteristics of the sample. Design Case-control. Method Perceived Stress Scale (PSS), Stress Coping (COPE), Big Five Personality Traits (NEO-FFI), Depression (BDI-II), and Trait Anxiety (STAI) were evaluated in 23 patients with EF and 23 matched healthy controls. Differences between EF patients and controls were analyzed using the Mann-Whitney U test. Differences in psychological features as a function of the demographic and clinical characteristics were examined using one-way Analysis of Variance (ANOVA), Mann-Whitney U test, or Pearson's correlations. Results The two groups differed significantly from each other in Denial, Trait anxiety, and Depression. Low-frequency epicrania patients scored significantly higher than controls in Perceived stress, Neuroticism, Denial, Self-blame, Trait anxiety, and Depression and higher than high-frequency EF in Venting. Conclusions The results initially suggest the absence of substantial differences between patients suffering of EF and healthy controls. On the contrary, low-frequency EF patients show a distinctive "negative (unhealthy) psychological profile," in opposition to high-frequency EF patients. This circumstance highlights the potential need to consider low- frequency EF patients as a target for psychological intervention in combination with the most common medical procedures. Longitudinal studies are necessary to correctly elucidate the influence of these psychological variables on the course of EF.
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Affiliation(s)
- Almudena López-López
- Department of Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Faculty of Health Sciences, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - José González
- Department of Medicine and Surgery, Psychology, Preventive Medicine and Public Health, Faculty of Health Sciences, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Ángel L Guerrero
- Departments of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Carlos M Ordás
- Department of Neurology, Hospital Clínico San Carlos, Complutense University of Madrid, Madrid, Spain
| | - Irene Muñoz
- Psychiatry, Hospital Clínico Universitario, Valladolid University, Valladolid, Spain
| | - María Cuadrado
- Department of Neurology, Hospital Clínico San Carlos, Complutense University of Madrid, Madrid, Spain
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Cragg JJ, Seals R, Cashman N, Weisskopf MG. Journal Club: Depression before and after diagnosis with amyotrophic lateral sclerosis. Neurology 2016; 87:e257-e259. [PMID: 27872230 DOI: 10.1212/wnl.0000000000003363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jacquelyn J Cragg
- From the Department of Medicine (Neurology) (J.J.C., N.C.), University of British Columbia and Vancouver Coastal Health Research Institute, Brain Research Centre, Vancouver, Canada; and Departments of Environmental Health (J.J.C., R.S., M.G.W.) and Epidemiology (M.G.W.), Harvard T.H. Chan School of Public Health, Boston, MA.
| | - Ryan Seals
- From the Department of Medicine (Neurology) (J.J.C., N.C.), University of British Columbia and Vancouver Coastal Health Research Institute, Brain Research Centre, Vancouver, Canada; and Departments of Environmental Health (J.J.C., R.S., M.G.W.) and Epidemiology (M.G.W.), Harvard T.H. Chan School of Public Health, Boston, MA
| | - Neil Cashman
- From the Department of Medicine (Neurology) (J.J.C., N.C.), University of British Columbia and Vancouver Coastal Health Research Institute, Brain Research Centre, Vancouver, Canada; and Departments of Environmental Health (J.J.C., R.S., M.G.W.) and Epidemiology (M.G.W.), Harvard T.H. Chan School of Public Health, Boston, MA
| | - Marc G Weisskopf
- From the Department of Medicine (Neurology) (J.J.C., N.C.), University of British Columbia and Vancouver Coastal Health Research Institute, Brain Research Centre, Vancouver, Canada; and Departments of Environmental Health (J.J.C., R.S., M.G.W.) and Epidemiology (M.G.W.), Harvard T.H. Chan School of Public Health, Boston, MA
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Gonzalez Deniselle MC, Liere P, Pianos A, Meyer M, Aprahamian F, Cambourg A, Di Giorgio NP, Schumacher M, De Nicola AF, Guennoun R. Steroid Profiling in Male Wobbler Mouse, a Model of Amyotrophic Lateral Sclerosis. Endocrinology 2016; 157:4446-4460. [PMID: 27571131 DOI: 10.1210/en.2016-1244] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The Wobbler mouse is an animal model for human motoneuron diseases, especially amyotrophic lateral sclerosis (ALS), used in the investigation of both pathology and therapeutic treatment. ALS is a fatal neurodegenerative disease, characterized by the selective and progressive death of motoneurons, leading to progressive paralysis. Previous limited studies have reported steroidal hormone dysregulation in Wobbler mouse and in ALS patients, suggesting endocrine dysfunctions which may be involved in the pathogenesis of the disease. In this study, we established a steroid profiling in brain, spinal cord, plasma, adrenal glands, and testes in 2-month-old male Wobbler mice and their littermates by gas chromatography coupled to mass spectrometry. Our results show in Wobbler mice the following: 1) a marked up-regulation of corticosterone levels in adrenal glands, plasma, spinal cord regions (cervical, thoracic, lumbar) and brain; 2) a strong decrease in T levels in the testis, plasma, spinal cord, and brain; and 3) increased levels of progesterone and especially of its reduced metabolites 5α-dihydroprogesterone, allopregnanolone, and 20α-dihydroprogesterone in the brain, spinal cord, and adrenal glands. Furthermore, Wobbler mice showed a hypothalamic-pituitary-gonadal hypoactivity. Interestingly, plasma concentrations of corticosterone and T correlate well with their respective levels in cervical spinal cord in both control and Wobbler mice. T down-regulation is probably the consequence of adrenal hyperactivity, and the up-regulation of progesterone and its reduced metabolites may correspond to an endogenous protective mechanism in response to motoneuron degeneration. Our findings suggest that increased levels of corticosterone and decreased levels of T in plasma could be a signature of motoneuron degeneration.
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Affiliation(s)
- Maria Claudia Gonzalez Deniselle
- Unité 1195 INSERM and University Paris-Sud and University Paris Saclay (P.L., A.P., F.A., A.C., M.S., R.G.), 94276 Kremlin-Bicêtre, France; Laboratory of Neuroendocrine Biochemistry (M.C.G.-D., M.M., A.F.D.N.) and Laboratory of Neuroendocrinology (N.P.D.G.), Instituto de Biologia y Medicina Experimental-Consejo Nacional de Investigaciones Cientificas y Técnicas, 1428 Buenos Aires, Argentina; and Departamento de Ciencias Fisiológicas (M.C.G.-D.), Facultad de Medicina, Universidad de Buenos Aires, 1121 Buenos Aires, Argentina
| | - Philippe Liere
- Unité 1195 INSERM and University Paris-Sud and University Paris Saclay (P.L., A.P., F.A., A.C., M.S., R.G.), 94276 Kremlin-Bicêtre, France; Laboratory of Neuroendocrine Biochemistry (M.C.G.-D., M.M., A.F.D.N.) and Laboratory of Neuroendocrinology (N.P.D.G.), Instituto de Biologia y Medicina Experimental-Consejo Nacional de Investigaciones Cientificas y Técnicas, 1428 Buenos Aires, Argentina; and Departamento de Ciencias Fisiológicas (M.C.G.-D.), Facultad de Medicina, Universidad de Buenos Aires, 1121 Buenos Aires, Argentina
| | - Antoine Pianos
- Unité 1195 INSERM and University Paris-Sud and University Paris Saclay (P.L., A.P., F.A., A.C., M.S., R.G.), 94276 Kremlin-Bicêtre, France; Laboratory of Neuroendocrine Biochemistry (M.C.G.-D., M.M., A.F.D.N.) and Laboratory of Neuroendocrinology (N.P.D.G.), Instituto de Biologia y Medicina Experimental-Consejo Nacional de Investigaciones Cientificas y Técnicas, 1428 Buenos Aires, Argentina; and Departamento de Ciencias Fisiológicas (M.C.G.-D.), Facultad de Medicina, Universidad de Buenos Aires, 1121 Buenos Aires, Argentina
| | - Maria Meyer
- Unité 1195 INSERM and University Paris-Sud and University Paris Saclay (P.L., A.P., F.A., A.C., M.S., R.G.), 94276 Kremlin-Bicêtre, France; Laboratory of Neuroendocrine Biochemistry (M.C.G.-D., M.M., A.F.D.N.) and Laboratory of Neuroendocrinology (N.P.D.G.), Instituto de Biologia y Medicina Experimental-Consejo Nacional de Investigaciones Cientificas y Técnicas, 1428 Buenos Aires, Argentina; and Departamento de Ciencias Fisiológicas (M.C.G.-D.), Facultad de Medicina, Universidad de Buenos Aires, 1121 Buenos Aires, Argentina
| | - Fanny Aprahamian
- Unité 1195 INSERM and University Paris-Sud and University Paris Saclay (P.L., A.P., F.A., A.C., M.S., R.G.), 94276 Kremlin-Bicêtre, France; Laboratory of Neuroendocrine Biochemistry (M.C.G.-D., M.M., A.F.D.N.) and Laboratory of Neuroendocrinology (N.P.D.G.), Instituto de Biologia y Medicina Experimental-Consejo Nacional de Investigaciones Cientificas y Técnicas, 1428 Buenos Aires, Argentina; and Departamento de Ciencias Fisiológicas (M.C.G.-D.), Facultad de Medicina, Universidad de Buenos Aires, 1121 Buenos Aires, Argentina
| | - Annie Cambourg
- Unité 1195 INSERM and University Paris-Sud and University Paris Saclay (P.L., A.P., F.A., A.C., M.S., R.G.), 94276 Kremlin-Bicêtre, France; Laboratory of Neuroendocrine Biochemistry (M.C.G.-D., M.M., A.F.D.N.) and Laboratory of Neuroendocrinology (N.P.D.G.), Instituto de Biologia y Medicina Experimental-Consejo Nacional de Investigaciones Cientificas y Técnicas, 1428 Buenos Aires, Argentina; and Departamento de Ciencias Fisiológicas (M.C.G.-D.), Facultad de Medicina, Universidad de Buenos Aires, 1121 Buenos Aires, Argentina
| | - Noelia P Di Giorgio
- Unité 1195 INSERM and University Paris-Sud and University Paris Saclay (P.L., A.P., F.A., A.C., M.S., R.G.), 94276 Kremlin-Bicêtre, France; Laboratory of Neuroendocrine Biochemistry (M.C.G.-D., M.M., A.F.D.N.) and Laboratory of Neuroendocrinology (N.P.D.G.), Instituto de Biologia y Medicina Experimental-Consejo Nacional de Investigaciones Cientificas y Técnicas, 1428 Buenos Aires, Argentina; and Departamento de Ciencias Fisiológicas (M.C.G.-D.), Facultad de Medicina, Universidad de Buenos Aires, 1121 Buenos Aires, Argentina
| | - Michael Schumacher
- Unité 1195 INSERM and University Paris-Sud and University Paris Saclay (P.L., A.P., F.A., A.C., M.S., R.G.), 94276 Kremlin-Bicêtre, France; Laboratory of Neuroendocrine Biochemistry (M.C.G.-D., M.M., A.F.D.N.) and Laboratory of Neuroendocrinology (N.P.D.G.), Instituto de Biologia y Medicina Experimental-Consejo Nacional de Investigaciones Cientificas y Técnicas, 1428 Buenos Aires, Argentina; and Departamento de Ciencias Fisiológicas (M.C.G.-D.), Facultad de Medicina, Universidad de Buenos Aires, 1121 Buenos Aires, Argentina
| | - Alejandro F De Nicola
- Unité 1195 INSERM and University Paris-Sud and University Paris Saclay (P.L., A.P., F.A., A.C., M.S., R.G.), 94276 Kremlin-Bicêtre, France; Laboratory of Neuroendocrine Biochemistry (M.C.G.-D., M.M., A.F.D.N.) and Laboratory of Neuroendocrinology (N.P.D.G.), Instituto de Biologia y Medicina Experimental-Consejo Nacional de Investigaciones Cientificas y Técnicas, 1428 Buenos Aires, Argentina; and Departamento de Ciencias Fisiológicas (M.C.G.-D.), Facultad de Medicina, Universidad de Buenos Aires, 1121 Buenos Aires, Argentina
| | - Rachida Guennoun
- Unité 1195 INSERM and University Paris-Sud and University Paris Saclay (P.L., A.P., F.A., A.C., M.S., R.G.), 94276 Kremlin-Bicêtre, France; Laboratory of Neuroendocrine Biochemistry (M.C.G.-D., M.M., A.F.D.N.) and Laboratory of Neuroendocrinology (N.P.D.G.), Instituto de Biologia y Medicina Experimental-Consejo Nacional de Investigaciones Cientificas y Técnicas, 1428 Buenos Aires, Argentina; and Departamento de Ciencias Fisiológicas (M.C.G.-D.), Facultad de Medicina, Universidad de Buenos Aires, 1121 Buenos Aires, Argentina
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Dobratz M. A Comparative Study of Variables That Have an Impact on Noncancer End-of-Life Diagnoses. Clin Nurs Res 2016; 13:309-25. [PMID: 15448282 DOI: 10.1177/1054773804267730] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
By way of analysis of variance, this secondary analysis compared three groups of noncancer home hospice patients (AIDS, amyotrophic lateral sclerosis [ALS],and other) for psychological correlates of adaptation and well-being, pain, and physical function, as measured by the Life Closure Scale (LCS), the Affect Balance Scale, the McGill-Melzack Pain Questionnaire Part I, and the Karnofsky Performance Status Scale. The sample included 10 AIDS patients (Group 1), 6 ALS patients (Group 2), and 5 patients with other noncancer, end-stage diseases (Group 3). A significant difference was found between Group 2 (ALS) and Group 3 (other) on the LCS, F(2, 18) = 4.3, p = .03. Scheffe and Duncan range post hoc tests and at test at the p≤.05 level (t9 = 4.1, p = .003) confirmed the finding. No significant group differences were found among the ALS, AIDS, and other groups in measures of psychological well-being, pain, and physical function.
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Thakore NJ, Pioro EP. Depression in ALS in a large self-reporting cohort. Neurology 2016; 86:1031-8. [DOI: 10.1212/wnl.0000000000002465] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 11/30/2015] [Indexed: 12/13/2022] Open
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Tabor L, Gaziano J, Watts S, Robison R, Plowman EK. Defining Swallowing-Related Quality of Life Profiles in Individuals with Amyotrophic Lateral Sclerosis. Dysphagia 2016; 31:376-82. [PMID: 26837611 DOI: 10.1007/s00455-015-9686-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 12/29/2015] [Indexed: 11/26/2022]
Abstract
Although it is known that dysphagia contributes to significant malnutrition, pneumonia, and mortality in amyotrophic lateral sclerosis (ALS), it remains unclear how swallowing impairment impacts quality of life in this vulnerable patient population. The aim of the current study was to (1) delineate swallow-related quality of life (SR-QOL) profiles in individuals with ALS and (2) evaluate relationships between SR-QOL, degree of swallowing impairment, and ALS global disease progression. Eighty-one ALS patients underwent a standardized videofluoroscopic swallow study and completed the swallowing quality of life (SWAL-QOL) instrument and ALS functional rating scale-revised (ALSFRS-R). Penetration Aspiration Scale (PAS) scores were derived by a blinded rater. Correlation analyses and a between groups ANOVA (safe vs. penetrators vs. aspirators) were performed. Mean SWAL-QOL score for this cohort was 75.94 indicating a moderate degree of SR-QOL impairment with fatigue, eating duration, and communication representing the most affected domains. Correlations were revealed between the SWAL-QOL and (1) PAS (r = -0.39, p < 0.001) and (2) ALSFRS-R (r = 0.23, p < 0.05). Mean (SD) SWAL-QOL scores for safe versus penetrator versus aspirator groups were 81.2 (2.3) versus 77 (3.4) versus 58.7 (5.9), respectively, with a main effect observed [F(2,78) = 9.71, p < 0.001]. Post hoc testing revealed lower SWAL-QOL scores for aspirators versus safe swallowers (p < 0.001) and aspirators versus penetrators (p < 0.001). Overall, SR-QOL was moderately reduced in this cohort of ALS patients and profoundly impacted in ALS aspirators and individuals with advanced disease. These findings highlight the importance of early multidisciplinary intervention to not only avoid malnutrition, weight loss, and pulmonary sequelae but also the associated reduced QOL seen in these individuals.
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Affiliation(s)
- Lauren Tabor
- Department of Speech, Language and Hearing Sciences, College of Public Health and Health Professions, University of Florida, 1225 Center Drive, P.O. Box 100185, Gainesville, FL, 32611, USA.
- Neuromotor Speech and Swallowing Restoration Laboratory, University of Florida, Gainesville, USA.
| | - Joy Gaziano
- Joy McCann Center for Voice and Swallowing Disorders, University of South Florida, Tampa, USA
| | - Stephanie Watts
- Joy McCann Center for Voice and Swallowing Disorders, University of South Florida, Tampa, USA
| | - Raele Robison
- Department of Speech, Language and Hearing Sciences, College of Public Health and Health Professions, University of Florida, 1225 Center Drive, P.O. Box 100185, Gainesville, FL, 32611, USA
- Neuromotor Speech and Swallowing Restoration Laboratory, University of Florida, Gainesville, USA
| | - Emily K Plowman
- Department of Speech, Language and Hearing Sciences, College of Public Health and Health Professions, University of Florida, 1225 Center Drive, P.O. Box 100185, Gainesville, FL, 32611, USA
- Neuromotor Speech and Swallowing Restoration Laboratory, University of Florida, Gainesville, USA
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Wei Q, Zheng Z, Guo X, Ou R, Chen X, Huang R, Yang J, Shang H. Association between depression and survival in Chinese amyotrophic lateral sclerosis patients. Neurol Sci 2016; 37:557-63. [PMID: 26758858 DOI: 10.1007/s10072-015-2472-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 12/28/2015] [Indexed: 02/05/2023]
Abstract
To determine the prevalence of depression, to identify correlated factors for depression, and to explore the impact on the progression or survival of amyotrophic lateral sclerosis (ALS) by depression in a Chinese population. A total of 166 ALS patients were recruited. Diagnosis of depression disorders and the severity of depression were established by using the fourth diagnostic and statistical manual of mental disorders, Hamilton Depression Rating Scale-24 items (HDRS-24) and Beck Depression Inventory (BDI). Major depression was found in 15 patients (9.6 %). The multiple regression analysis showed that a lower ALS Functional Rating Scale-Revised (ALSFRS-R) score was correlated with increasing HDRS scores and BDI scores (P = 0.018 and P = 0.012). No significant difference in the median survival time between ALS patients with and without depression was revealed by Kaplan-Meier analysis (log-rank P = 0.282). Cox hazard model showed that the presence of depression in ALS was unrelated to the survival, while the severity of depression in ALS was correlated with the survival. The presence and severity of depression in ALS did not correlate with the progression of ALS. Major depression in ALS is uncommon. Depression evaluation should be given to ALS patients, especially those with lower ALSFRS-R score. The severity of depression may be associated with the survival; however, depression does not worse the progression of ALS.
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Affiliation(s)
- Qianqian Wei
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Zhenzhen Zheng
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Xiaoyan Guo
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ruwei Ou
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Xueping Chen
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Rui Huang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jing Yang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Huifang Shang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China.
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Couratier P, Corcia P, Lautrette G, Nicol M, Preux PM, Marin B. Epidemiology of amyotrophic lateral sclerosis: A review of literature. Rev Neurol (Paris) 2015; 172:37-45. [PMID: 26727307 DOI: 10.1016/j.neurol.2015.11.002] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 11/10/2015] [Indexed: 12/11/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease of motor neurons, resulting in worsening weakness of voluntary muscles until death occurs from respiratory failure. The incidence of ALS in European populations is two to three people per year per 100,000 of the general population. In Europe, crude prevalences range from 1.1/100,000 population in Yugoslavia to 8.2/100,000 in the Faroe Islands. Major advances have been made in our understanding of the genetic causes of ALS, whereas the contribution of environmental factors has been more difficult to assess and large-scale studies have not yet revealed a replicable, definitive environmental risk factor. The only established risk factors to date are older age, male gender and a family history of ALS. Median survival time from onset to death is usually 3 years from the first appearance of symptoms. Older age and bulbar onset are consistently reported to have poorer outcomes. However, there are conflicting data regarding gender, diagnostic delay and El Escorial criteria. The rate of symptom progression has been revealed to be an independent prognostic factor. Psychosocial factors and impaired cognitive function are negatively related to ALS outcome, while nutritional status and respiratory function are also related to ALS prognosis. The effect of enteral nutrition on survival is still unclear, although noninvasive positive pressure ventilation (NIPPV) has been found to improve survival. These findings have relevant implications for the design of future trials.
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Affiliation(s)
- P Couratier
- Centre de compétence SLA-fédération Tours-Limoges, CHU de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France; Inserm UMR1094, neuroépidémiologie tropicale, université de Limoges, 2, rue du Dr.-Marcland, 87025 Limoges cedex, France.
| | - P Corcia
- Centre de compétence SLA-fédération Tours-Limoges, CHU de Tours, 37044 Tours cedex 9, France
| | - G Lautrette
- Centre de compétence SLA-fédération Tours-Limoges, CHU de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - M Nicol
- Centre de compétence SLA-fédération Tours-Limoges, CHU de Limoges, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - P-M Preux
- Inserm UMR1094, neuroépidémiologie tropicale, université de Limoges, 2, rue du Dr.-Marcland, 87025 Limoges cedex, France
| | - B Marin
- Inserm UMR1094, neuroépidémiologie tropicale, université de Limoges, 2, rue du Dr.-Marcland, 87025 Limoges cedex, France
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Zarei S, Carr K, Reiley L, Diaz K, Guerra O, Altamirano PF, Pagani W, Lodin D, Orozco G, Chinea A. A comprehensive review of amyotrophic lateral sclerosis. Surg Neurol Int 2015; 6:171. [PMID: 26629397 PMCID: PMC4653353 DOI: 10.4103/2152-7806.169561] [Citation(s) in RCA: 377] [Impact Index Per Article: 41.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 08/12/2015] [Indexed: 12/20/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a late-onset fatal neurodegenerative disease affecting motor neurons with an incidence of about 1/100,000. Most ALS cases are sporadic, but 5–10% of the cases are familial ALS. Both sporadic and familial ALS (FALS) are associated with degeneration of cortical and spinal motor neurons. The etiology of ALS remains unknown. However, mutations of superoxide dismutase 1 have been known as the most common cause of FALS. In this study, we provide a comprehensive review of ALS. We cover all aspects of the disease including epidemiology, comorbidities, environmental risk factor, molecular mechanism, genetic factors, symptoms, diagnostic, treatment, and even the available supplement and management of ALS. This will provide the reader with an advantage of receiving a broad range of information about the disease.
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Affiliation(s)
- Sara Zarei
- Department of Medicine, San Juan Bautista School of Medicine, Caguas, USA
| | - Karen Carr
- Department of Medicine, San Juan Bautista School of Medicine, Caguas, USA
| | - Luz Reiley
- Department of Medicine, San Juan Bautista School of Medicine, Caguas, USA
| | - Kelvin Diaz
- Department of Medicine, San Juan Bautista School of Medicine, Caguas, USA
| | - Orleiquis Guerra
- Department of Medicine, San Juan Bautista School of Medicine, Caguas, USA
| | | | - Wilfredo Pagani
- Department of Medicine, San Juan Bautista School of Medicine, Caguas, USA
| | - Daud Lodin
- Department of Medicine, San Juan Bautista School of Medicine, Caguas, USA
| | - Gloria Orozco
- Department of Medicine, San Juan Bautista School of Medicine, Caguas, USA
| | - Angel Chinea
- Neurologist, Caribbean Neurological Center, Caguas, USA
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Fullam T, Stephens HE, Felgoise SH, Blessinger JK, Walsh S, Simmons Z. Compliance with recommendations made in a multidisciplinary ALS clinic. Amyotroph Lateral Scler Frontotemporal Degener 2015; 17:30-7. [DOI: 10.3109/21678421.2015.1074703] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Gould RL, Coulson MC, Brown RG, Goldstein LH, Al-Chalabi A, Howard RJ. Psychotherapy and pharmacotherapy interventions to reduce distress or improve well-being in people with amyotrophic lateral sclerosis: A systematic review. Amyotroph Lateral Scler Frontotemporal Degener 2015; 16:293-302. [PMID: 26174444 DOI: 10.3109/21678421.2015.1062515] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Our objective was to systematically review and critically evaluate the evidence for psychotherapy and pharmacotherapy interventions for reducing distress or improving well-being in people with amyotrophic lateral sclerosis (pwALS). Online bibliographic databases and clinical trial registers were searched and an assessment of study quality was conducted. Seven thousand two hundred and twenty-three studies were identified, of which five met inclusion criteria (four completed and one in progress). All studies examined psychotherapeutic interventions, and no studies investigated pharmacotherapy. Two studies adopted a randomized controlled trial design, one a controlled trial design and two a cohort design. Sample sizes were small in all studies (overall n = 145). The quality of completed studies was generally poor, with evidence that all were at potential risk of bias in numerous areas. Improvements in well-being were found with expressive disclosure (compared to no disclosure), cognitive behavioural therapy/counselling (compared to non-randomized pharmacotherapy) and hypnosis in the short term only, while no improvements were seen with a life review intervention. In conclusion, there is currently insufficient evidence to recommend the use of specific psychotherapy interventions for reducing distress or improving well-being in pwALS, and no evidence to support pharmacotherapy interventions. Research is urgently needed to address these significant gaps in the literature.
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Affiliation(s)
- Rebecca L Gould
- a Department of Old Age Psychiatry , Institute of Psychiatry, King's College London , London , UK
| | - Mark C Coulson
- b Department of Psychology , School of Science and Technology, Middlesex University , London , UK
| | - Richard G Brown
- c Department of Psychology , Institute of Psychiatry, King's College London , London , UK
| | - Laura H Goldstein
- c Department of Psychology , Institute of Psychiatry, King's College London , London , UK
| | - Ammar Al-Chalabi
- d Department of Basic and Clinical Neuroscience , Institute of Psychiatry, Psychology & Neuroscience, King's College London , London , UK
| | - Robert J Howard
- a Department of Old Age Psychiatry , Institute of Psychiatry, King's College London , London , UK
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Kleinbub JR, Palmieri A, Broggio A, Pagnini F, Benelli E, Sambin M, Sorarù G. Hypnosis-based psychodynamic treatment in ALS: a longitudinal study on patients and their caregivers. Front Psychol 2015; 6:822. [PMID: 26136710 PMCID: PMC4469765 DOI: 10.3389/fpsyg.2015.00822] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 05/30/2015] [Indexed: 11/30/2022] Open
Abstract
Background: Evidence of psychological treatment efficacy is strongly needed in ALS, particularly regarding long-term effects. Methods: Fifteen patients participated in a hypnosis treatment and self-hypnosis training protocol after an in-depth psychological and neurological evaluation. Patients' primary caregivers and 15 one-by-one matched control patients were considered in the study. Measurements of anxiety, depression and quality of life (QoL) were collected at the baseline, post-treatment, and after 3 and 6 months from the intervention. Bayesian linear mixed-models were used to evaluate the impact of treatment and defense style on patients' anxiety, depression, QoL, and functional impairment (ALSFRS-r), as well as on caregivers' anxiety and depression. Results: The statistical analyses revealed an improvement in psychological variables' scores immediately after the treatment. Amelioration in patients' and caregivers' anxiety as well as caregivers' depression, were found to persist at 3 and 6 months follow-ups. The observed massive use of primitive defense mechanisms was found to have a reliable and constant buffer effect on psychopathological symptoms in both patients and caregivers. Notably, treated patients decline in ALSFRS-r score was observed to be slower than that of control group's patients. Discussion: Our brief psychodynamic hypnosis-based treatment showed efficacy both at psychological and physical levels in patients with ALS, and was indirectly associated to long-lasting benefits in caregivers. The implications of peculiar psychodynamic factors and mind-body techniques are discussed. Future directions should be oriented toward a convergence of our results and further psychological interventions, in order to delineate clinical best practices for ALS.
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Affiliation(s)
- Johann R Kleinbub
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology, University of Padova Padova, Italy
| | - Arianna Palmieri
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology, University of Padova Padova, Italy ; Center for Cognitive Neuroscience, University of Padova Padova, Italy
| | - Alice Broggio
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology, University of Padova Padova, Italy
| | | | - Enrico Benelli
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology, University of Padova Padova, Italy
| | - Marco Sambin
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology, University of Padova Padova, Italy
| | - Gianni Sorarù
- Department of Neurosciences, University of Padova Padova, Italy
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Körner S, Kollewe K, Abdulla S, Zapf A, Dengler R, Petri S. Interaction of physical function, quality of life and depression in Amyotrophic lateral sclerosis: characterization of a large patient cohort. BMC Neurol 2015; 15:84. [PMID: 25982050 PMCID: PMC4493831 DOI: 10.1186/s12883-015-0340-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 05/06/2015] [Indexed: 11/13/2022] Open
Abstract
Background Due to lack of any curative therapy for ALS, symptomatic treatment and maintenance of quality of life (QoL) is very important. We aimed to characterize the affected domains of QoL in ALS patients and to identify factors which are associated with reduced QoL and increased depression. Methods 159 ALS patients answered standardized questionnaires (Beck Depression Inventory-II, SF-36 Health Survey questionnaire, revised ALS functional rating scale). Multiple regression analysis was used to identify correlations between clinical features of ALS patients and depression/QoL scores. In addition, QoL data from ALS patients were compared to age-matched reference values representing the German normal population. Results QoL of ALS patients was reduced in nearly all SF-36-categories. Progression of physical impairment was positively correlated with depression but reduced QoL scores only in items directly related to physical function. However, QoL was considerably influenced by depression, independently from physical impairment. Regarding distinct patient characteristics one of the most interesting findings was that increasing age was correlated with significantly worse QoL results regarding social functioning. Conclusions Depressive symptoms had a strong influence on QoL, hence their detection and treatment is of particular importance. Different domains of QoL are differently affected in subgroups of ALS patients. Being aware of these differences can be valuable for both ALS professional and family caregivers and physicians. Electronic supplementary material The online version of this article (doi:10.1186/s12883-015-0340-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sonja Körner
- Department of Neurology, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Katja Kollewe
- Department of Neurology, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Susanne Abdulla
- Department of Neurology, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. .,Department of Neurology, Otto von Guericke University, Magdeburg, Germany.
| | - Antonia Zapf
- Department of Medical Statistics, University Göttingen, Göttingen, Germany.
| | - Reinhard Dengler
- Department of Neurology, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. .,Center for Systems Neuroscience (ZSN), Hannover, Germany.
| | - Susanne Petri
- Department of Neurology, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. .,Center for Systems Neuroscience (ZSN), Hannover, Germany.
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Wolf J, Safer A, Wöhrle JC, Palm F, Nix WA, Maschke M, Grau AJ. Factors Predicting Survival in ALS Patients--Data from a Population-Based Registry in Rhineland-Palatinate, Germany. Neuroepidemiology 2015; 44:149-55. [PMID: 25895515 DOI: 10.1159/000381625] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 03/12/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The possibility to survive with amyotrophic lateral sclerosis (ALS) varies considerably and survival extends from a few months to several years. A number of demographic and clinical factors predicting survival have been described; however, existing data are conflicting. We intended to predict patient survival in a population-based prospective cohort of ALS patients from variables known up to the time of diagnosis. METHODS Incident ALS patients diagnosed within three consecutive years were enrolled and regularly followed up. Candidate demographic and disease variables were analysed for survival probability using the Kaplan-Meier method. The Cox proportional hazard regression model was used to assess the influence of selected predictor variables on survival prognosis. RESULTS In the cohort of 193 patients (mean age 65.8, standard deviation 10.2 years), worse prognosis was independently predicted by older age, male gender, bulbar onset, probable or definite ALS according to El Escorial criteria, shorter interval between symptom onset and diagnosis, lower Functional Rating Scale, diagnosis of frontotemporal dementia, and living without a partner. CONCLUSIONS Taking into account these predictor variables, an approximate survival prognosis of individual ALS patients at diagnosis seems feasible.
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Affiliation(s)
- Joachim Wolf
- Department of Neurology, Diakonissenkrankenhaus Mannheim, Mannheim, Germany
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Cui F, Zhu W, Zhou Z, Ren Y, Li Y, Li M, Huo Y, Huang X. Frequency and risk factor analysis of cognitive and anxiety-depressive disorders in patients with amyotrophic lateral sclerosis/motor neuron disease. Neuropsychiatr Dis Treat 2015; 11:2847-54. [PMID: 26604769 PMCID: PMC4639547 DOI: 10.2147/ndt.s90520] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES To examine the frequency and risk factors of cognitive and anxiety-depressive disorders in patients with amyotrophic lateral sclerosis/motor neuron disease (ALS/MND). METHODS This was an observational study of 100 ALS/MND patients treated at our hospital outpatient and inpatient departments between January 2009 and April 2010 and 100 matched healthy controls. Subjects were surveyed using Mini Mental State Examination (MMSE), Zung Self-Rating Anxiety Scale (SAS), and Zung Self-Rating Depression Scale (SDS). Patient neurological status was graded by the ALS Functional Rating Scale (ALSFRS). Multivariate linear regression was used to identify factors associated with the MMSE, SAS, SDS, and ALSFRS scores. RESULTS Patients had significantly lower MMSE scores than controls (P<0.05). MMSE score did not differ by sex or age (<50/≥50 years) (P>0.05). Patients with higher educational level (college and above), shorter disease course (<2 years), and lower ALSFRS score (<20) had significantly higher MMSE scores (all P<0.05). Multivariate analysis revealed that higher education, shorter disease course, and lower ALSFRS score were independent predictors of better cognitive function (higher MMSE score). Patients had significantly higher mean SAS and SDS total scores than controls (both P<0.05), indicating higher subjective anxiety and depression. Female patients, patients with higher education, and those with higher ALSFRS scores had significantly higher SAS and SDS scores (all P<0.05). Age, occupation, diagnostic classification, disease duration, and disease awareness did not influence SAS or SDS scores. Multivariate analysis indicated that lower education and lower ALSFRS were protective factors against anxiety and depression. CONCLUSION The frequency of anxiety-depressive disorders was high among patients with ALS/MND. High educational level, short course of disease, and lower ALSFRS were associated with preserved cognitive function. Female sex, higher education, and lower ALSFRS score conferred a greater risk of anxiety and depression. Tailored pharmacotherapy and psychological interventions may help in reducing anxiety and depression in these patients.
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Affiliation(s)
- Fang Cui
- Department of Neurology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Wenjia Zhu
- Department of Neurology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Zhibin Zhou
- Department of Neurology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yuting Ren
- Department of Neurology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yifan Li
- Department of Neurology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Mao Li
- Department of Neurology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yunyun Huo
- Department of Neurology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xusheng Huang
- Department of Neurology, Chinese PLA General Hospital, Beijing, People's Republic of China
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Levitsky GN, Levitsky AS, Gilod VM. Mental disorders in patients with lateral amyotrophic sclerosis and their family members. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:64-67. [DOI: 10.17116/jnevro20151152164-67] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Pagnini F, Phillips D, Bosma CM, Reece A, Langer E. Mindfulness, physical impairment and psychological well-being in people with amyotrophic lateral sclerosis. Psychol Health 2014; 30:503-17. [PMID: 25361013 DOI: 10.1080/08870446.2014.982652] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abdulla S, Vielhaber S, Kollewe K, Machts J, Heinze HJ, Dengler R, Petri S. The impact of physical impairment on emotional well-being in ALS. Amyotroph Lateral Scler Frontotemporal Degener 2014; 15:392-7. [DOI: 10.3109/21678421.2014.932380] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bentley B, O'Connor M, Kane R, Breen LJ. Feasibility, acceptability, and potential effectiveness of dignity therapy for people with motor neurone disease. PLoS One 2014; 9:e96888. [PMID: 24816742 PMCID: PMC4016138 DOI: 10.1371/journal.pone.0096888] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 04/12/2014] [Indexed: 12/12/2022] Open
Abstract
Background Motor neurone disease (MND) practice guidelines suggest developing interventions that will promote hope, meaning, and dignity to alleviate psychological distress, but very little research has been done. This study begins to address this need by exploring the use of dignity therapy with people with MND. Dignity therapy is a brief psychotherapy that promotes hope, meaning and dignity, and enhances the end of life for people with advanced cancer. The aims of this study are to assess the feasibility, acceptability, and potential effectiveness of dignity therapy for people with MND. Methods/design This cross-sectional feasibility study used a one-group pre-test post-test design with 29 people diagnosed with MND. Study participants completed the following self-report questionnaires: Herth Hope Index, FACIT-sp, Patient Dignity Inventory, ALS Assessment Questionnaire, ALS Cognitive Behavioural Screen, and a demographic and health history questionnaire. Acceptability was measured with a 25-item feedback questionnaire. Feasibility was assessed by examining the length of time taken to complete dignity therapy and how symptoms common in MND affected the intervention. Generalised linear mixed models and reliable change scores were used to analyse the data. Results There were no significant pre-test post-test changes for hopefulness, spirituality or dignity on the group level, but there were changes in hopefulness on the individual level. The results of the feedback questionnaire indicates dignity therapy is highly acceptable to people with MND, who report benefits similar to those in the international randomised controlled trial on dignity therapy, a population who primarily had end-stage cancer. Benefits include better family relationships, improved sense of self and greater acceptance. Dignity therapy with people with MND is feasible if the therapist can overcome time and communication difficulties. Conclusions Dignity therapy for people with MND is feasible and acceptable. Further research is warranted to explore its ability to diminish distress. Trial Registration www.anzctr.org.auACTRN12611000410954
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Affiliation(s)
- Brenda Bentley
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
- * E-mail:
| | - Moira O'Connor
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Robert Kane
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Lauren J. Breen
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
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Pagnini F, Manzoni GM, Tagliaferri A, Gibbons CJ. Depression and disease progression in amyotrophic lateral sclerosis: A comprehensive meta-regression analysis. J Health Psychol 2014; 20:1107-28. [PMID: 24764286 DOI: 10.1177/1359105314530453] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Depression in people with amyotrophic lateral sclerosis, a fatal and progressive neurodegenerative disorder, is a serious issue with important clinical consequences. However, physical impairment may confound the diagnosis when using generic questionnaires. We conducted a comprehensive review of literature. Mean scores from depression questionnaires were meta-regressed on study-level mean time since onset of symptoms. Data from 103 studies (3190 subjects) indicate that the Beck Depression Inventory and, to a lesser degree, the Hospital Anxiety and Depression Scale are influenced by the time since symptom onset, strongly related to physical impairment. Our results suggest that widely used depression scales overestimate depression due to confounding with physical symptoms.
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Affiliation(s)
- Francesco Pagnini
- Department of Psychology, Catholic University of Milan, Italy Azienda Ospedaliera Niguarda Ca' Granda, Italy
| | - Gian Mauro Manzoni
- Department of Psychology, Catholic University of Milan, Italy San Giuseppe Hospital, Istituto Auxologico Italiano, Italy
| | | | - Chris J Gibbons
- NIHR Collaboration for Applied Health Research and Care (CLAHRC-GM), University of Manchester, Manchester, UK Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, UK
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D’Amico E, Factor-Litvak P, Santella RM, Mitsumoto H. Clinical perspective on oxidative stress in sporadic amyotrophic lateral sclerosis. Free Radic Biol Med 2013; 65:509-527. [PMID: 23797033 PMCID: PMC3859834 DOI: 10.1016/j.freeradbiomed.2013.06.029] [Citation(s) in RCA: 216] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 06/14/2013] [Accepted: 06/14/2013] [Indexed: 12/12/2022]
Abstract
Sporadic amyotrophic lateral sclerosis (ALS) is one of the most devastating neurological diseases; most patients die within 3 to 4 years after symptom onset. Oxidative stress is a disturbance in the pro-oxidative/antioxidative balance favoring the pro-oxidative state. Autopsy and laboratory studies in ALS indicate that oxidative stress plays a major role in motor neuron degeneration and astrocyte dysfunction. Oxidative stress biomarkers in cerebrospinal fluid, plasma, and urine are elevated, suggesting that abnormal oxidative stress is generated outside of the central nervous system. Our review indicates that agricultural chemicals, heavy metals, military service, professional sports, excessive physical exertion, chronic head trauma, and certain foods might be modestly associated with ALS risk, with a stronger association between risk and smoking. At the cellular level, these factors are all involved in generating oxidative stress. Experimental studies indicate that a combination of insults that induce modest oxidative stress can exert additive deleterious effects on motor neurons, suggesting that multiple exposures in real-world environments are important. As the disease progresses, nutritional deficiency, cachexia, psychological stress, and impending respiratory failure may further increase oxidative stress. Moreover, accumulating evidence suggests that ALS is possibly a systemic disease. Laboratory, pathologic, and epidemiologic evidence clearly supports the hypothesis that oxidative stress is central in the pathogenic process, particularly in genetically susceptive individuals. If we are to improve ALS treatment, well-designed biochemical and genetic epidemiological studies, combined with a multidisciplinary research approach, are needed and will provide knowledge crucial to our understanding of ALS etiology, pathophysiology, and prognosis.
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Affiliation(s)
- Emanuele D’Amico
- Eleanor and Lou Gehrig MDA/ALS Research Center, The Neurological Institute of New York, Columbia University Medical Center, 710 West 168th Street (NI-9), New York, NY 10032, ;
| | - Pam Factor-Litvak
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, 722 West 168th Street, New York, NY 10032,
| | - Regina M. Santella
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University Medical Center, 722 West 168th Street, New York, NY 10032,
| | - Hiroshi Mitsumoto
- Eleanor and Lou Gehrig MDA/ALS Research Center, The Neurological Institute of New York, Columbia University Medical Center, 710 West 168th Street (NI-9), New York, NY 10032
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Real RGL, Herbert C, Kotchoubey B, Wessig C, Volkmann J, Kübler A. Psychophysiological correlates of coping and quality of life in patients with ALS. Clin Neurophysiol 2013; 125:955-61. [PMID: 24210996 DOI: 10.1016/j.clinph.2013.09.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 09/26/2013] [Accepted: 09/27/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Self-regulation models of coping suggest that patients with chronic diseases reporting low quality of life (QoL), an indicator of failed coping efforts, should show facilitated access to disease related words. Here we investigated whether a reduced N400 amplitude within an incongruent, i.e. unpredictable disease-related context would be a correlate of this facilitated access. METHODS ERPs were recorded in N=18 patients with amyotrophic lateral sclerosis (ALS) and N=20 age-matched healthy controls during reading of sentences, ending either with congruent or incongruent words. Incongruent and congruent words were disease related or disease unrelated. Mean N400 amplitudes were analyzed with mixed models. RESULTS Generally, incongruent words elicited a more negative N400 amplitude than congruent words in all groups and conditions, i.e. an N400 effect. In patients with high QoL this N400 effect did not differ between disease related and unrelated words. In patients with low QoL, however, the N400 effect was significantly smaller for disease related than for disease unrelated words. In healthy controls N400 amplitudes showed no such interaction between congruence, disease relatedness and QoL. Results remained stable when controlling for disease severity, duration and depression. CONCLUSION The N400 indicates increased accessibility to disease related information in ALS patients with low QoL. The increased access may imply a constantly activated disease related context which is linked to low QoL. SIGNIFICANCE N400 modulation by disease related information may serve as a psychophysiological correlate of coping and the patient's QoL.
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Affiliation(s)
- R G L Real
- Department of Psychology I, University of Würzburg, 97070 Würzburg, Germany.
| | - C Herbert
- Institute of Psychology, German Sport University Cologne, 50933 Cologne, Germany
| | - B Kotchoubey
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, 72074 Tübingen, Germany
| | - C Wessig
- Department of Neurology, University Hospital of Würzburg, 97080 Würzburg, Germany
| | - J Volkmann
- Department of Neurology, University Hospital of Würzburg, 97080 Würzburg, Germany
| | - A Kübler
- Department of Psychology I, University of Würzburg, 97070 Würzburg, Germany
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Abstract
Amyotrophic lateral sclerosis (ALS) is a progressive neurological disease with high risk of malnutrition. Symptoms of dysphagia, depression, cognitive impairment, difficulty with self-feeding and meal preparation, hypermetabolism, anxiety, respiratory insufficiency, and fatigue with meals increase the risk of malnutrition. Malnutrition negatively affects prognosis and quality of life, making early and frequent nutrition assessment and intervention essential. Implementation of an adequate calorie diet, dietary texture modification, use of adaptive eating utensils, and placement of a feeding tube aid in preventing malnutrition. When nutrition status is compromised by dysphagia and weight loss (5%-10% of usual body weight) or body mass index <20 kg/m(2) without weight loss and when forced vital capacity is >50%, a percutaneous endoscopic gastrostomy placement is indicated. When forced vital capacity is <50%, a radiologically inserted gastrostomy is the preferred means of enteral placement due to lessened aspiration and respiratory risk. Parenteral nutrition (PN) is indicated only when enteral nutrition (EN) is contraindicated or impossible. This article reviews the background of ALS, nutrition implications and risk of malnutrition, treatment strategies to prevent malnutrition, the role of EN and PN, and feeding tube placement methods according to disease stage.
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Affiliation(s)
- Daniel I Greenwood
- Minneapolis Veterans Affairs Health Care System, Minneapolis VA Medical Center, Minneapolis, MN 55417, USA.
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Vrijsen B, Testelmans D, Belge C, Robberecht W, Van Damme P, Buyse B. Non-invasive ventilation in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2013; 14:85-95. [DOI: 10.3109/21678421.2012.745568] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Jelsone-Swain L, Persad C, Votruba KL, Weisenbach SL, Johnson T, Gruis KL, Welsh RC. The Relationship between Depressive Symptoms, Disease State, and Cognition in Amyotrophic Lateral Sclerosis. Front Psychol 2012; 3:542. [PMID: 23411492 PMCID: PMC3571885 DOI: 10.3389/fpsyg.2012.00542] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 11/14/2012] [Indexed: 12/12/2022] Open
Abstract
Cognitive impairment (CI) in amyotrophic lateral sclerosis (ALS) may present a serious barrier to a patient's wellbeing and significantly decrease quality of life. Although reports of CI in ALS without frank dementia are becoming quite common, questions remain regarding the specific cognitive domains affected, as well as how other psychological and medical factors may impact cognitive functioning in these patients. Additionally, the influence of depressive symptoms on disease processes is not known. We aimed to address these questions by completing extensive neuropsychological tests with 22 patients with ALS and 17 healthy volunteers. A subgroup of these patients also completed questionnaires to measure depressive and vegetative symptoms. We tested for overall cognitive differences between groups, the influence of physical (e.g., bulbar and limb), vegetative (e.g., fatigue), and depressive symptoms on cognitive performance, and the relationship between depressive symptoms and disease severity in ALS. Overall, patients performed more poorly than healthy controls (HCs), most notably on tests of executive functioning and learning and memory. Results suggest that true cognitive performance differences exist between patients with ALS and HCs, as these differences were not changed by the presence of vegetative or depressive symptoms. There was no effect of limb or bulbar symptoms on cognitive functioning. Also, patients were not any more depressed than HCs, however increased depressive scores correlated with faster disease progression and decreased limb function. Collectively, it is suggested that translational advances in psychological intervention for those with CI and depression become emphasized in future research.
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Affiliation(s)
| | - Carol Persad
- Department of Psychiatry, University of MichiganAnn Arbor, MI, USA
| | | | | | - Timothy Johnson
- Department of Biostatistics, University of MichiganAnn Arbor, MI, USA
| | - Kirsten L. Gruis
- Department of Neurology, The State University of New York Upstate Medical UniversitySyracuse, NY, USA
| | - Robert C. Welsh
- Department of Radiology, University of MichiganAnn Arbor, MI, USA
- Department of Psychiatry, University of MichiganAnn Arbor, MI, USA
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