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Kabir V, Ombelet F, Hobin F, Lamaire N, De Vocht J, Van Damme P. Prognostic value of motor and extramotor involvement in ALS. Amyotroph Lateral Scler Frontotemporal Degener 2024; 25:67-74. [PMID: 38006254 DOI: 10.1080/21678421.2023.2284899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/01/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVE Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder resulting in upper and lower motor neuron loss. ALS often has a focal onset of weakness, which subsequently spreads to other body regions. Survival is limited to two to five years after disease onset, often due to respiratory failure. Cognitive impairment is present in approximately 30% to 50% of patients and in 10%-15% of patients, the clinical criteria of frontotemporal dementia (FTD) are met. METHODS In this retrospective single-center ALS cohort study, we examined the occurrence of cognitive and behavioral impairment in relation to motor impairment at disease presentation and studied its impact on survival. RESULTS The degree of lower motor neuron involvement was associated with a worse survival, but there was no effect for upper motor neuron involvement. Patients who were cognitively normal had a significantly better survival compared to patients with cognitive or behavioral impairment and to patients with comorbid FTD. There was no significant difference regarding survival between patients with FTD and patients with cognitive or behavioral impairment. CONCLUSIONS The extent of motor and extramotor involvement in patients with ALS at disease presentation holds complementary prognostic information.
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Affiliation(s)
| | - Fouke Ombelet
- University Hospitals Leuven, Leuven, Belgium
- Neuroscience Department, Leuven Brain Institute, KU Leuven, Leuven, Belgium, and
- Laboratory of Neurobiology, Center for Brain & Disease Research, VIB, Leuven, Belgium
| | - Frederik Hobin
- University Hospitals Leuven, Leuven, Belgium
- Neuroscience Department, Leuven Brain Institute, KU Leuven, Leuven, Belgium, and
- Laboratory of Neurobiology, Center for Brain & Disease Research, VIB, Leuven, Belgium
| | - Nikita Lamaire
- University Hospitals Leuven, Leuven, Belgium
- Neuroscience Department, Leuven Brain Institute, KU Leuven, Leuven, Belgium, and
- Laboratory of Neurobiology, Center for Brain & Disease Research, VIB, Leuven, Belgium
| | - Joke De Vocht
- University Hospitals Leuven, Leuven, Belgium
- Neuroscience Department, Leuven Brain Institute, KU Leuven, Leuven, Belgium, and
- Laboratory of Neurobiology, Center for Brain & Disease Research, VIB, Leuven, Belgium
| | - Philip Van Damme
- University Hospitals Leuven, Leuven, Belgium
- Neuroscience Department, Leuven Brain Institute, KU Leuven, Leuven, Belgium, and
- Laboratory of Neurobiology, Center for Brain & Disease Research, VIB, Leuven, Belgium
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Gray D, Lesley R, Mayberry EJ, Williams L, McHutchison C, Newton J, Pal S, Chandran S, MacPherson SE, Abrahams S. Development, reliability, validity, and acceptability of the remote administration of the Edinburgh Cognitive and Behavioural ALS Screen (ECAS). Amyotroph Lateral Scler Frontotemporal Degener 2024; 25:96-103. [PMID: 37950613 DOI: 10.1080/21678421.2023.2278512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND ALS clinical care and research has changed dramatically since the COVID-19 pandemic, accelerating the need for cognitive assessments to be adapted for remote use. OBJECTIVES To develop the remote administration method of the Edinburgh Cognitive and Behavioural ALS Screen (ECAS), and determine its reliability and validity. Methods: The validation process consisted of: (1) Two versions of the ECAS (A and B) were administered, one in-person and one remotely via video call in a randomized order to 27 people without ALS; (2) The ECAS was administered remotely to 24 pwALS, with a second rater independently scoring performance; and (3) Acceptability was assessed by gathering feedback from 17 pwALS and 19 clinicians and researchers about their experience of using the ECAS remotely. RESULTS In the group without ALS, the remote and in-person ECAS total scores were found to be equivalent, and a Bland-Altman plot showed good agreement between the two administration methods. In pwALS, there was excellent agreement between two raters (ICC = 0.99). Positive feedback was gained from pwALS, researchers and clinicians with regards to ease of process, convenience, time, and the environment. CONCLUSIONS These findings provide evidence of the reliability and validity of the remote administration of the ECAS for pwALS, with clinicians, researchers and pwALS viewing it as a good alternative to face-to-face administration.
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Affiliation(s)
- Debbie Gray
- Human Cognitive Neuroscience, Department of Psychology, School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Edinburgh, UK
- Euan MacDonald Centre for MND Research, University of Edinburgh, Edinburgh, UK
| | - Rosemary Lesley
- Sheffield Motor Neurone Disease Care Centre & Clinical Neuropsychology Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
| | - Emily J Mayberry
- Sheffield Motor Neurone Disease Care Centre & Clinical Neuropsychology Services, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
| | | | - Caroline McHutchison
- Human Cognitive Neuroscience, Department of Psychology, School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Edinburgh, UK
- Euan MacDonald Centre for MND Research, University of Edinburgh, Edinburgh, UK
| | - Judith Newton
- Euan MacDonald Centre for MND Research, University of Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic, Royal Infirmary of Edinburgh, Edinburgh, UK, and
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Suvankar Pal
- Euan MacDonald Centre for MND Research, University of Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic, Royal Infirmary of Edinburgh, Edinburgh, UK, and
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Siddharthan Chandran
- Euan MacDonald Centre for MND Research, University of Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic, Royal Infirmary of Edinburgh, Edinburgh, UK, and
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Sarah E MacPherson
- Human Cognitive Neuroscience, Department of Psychology, School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Edinburgh, UK
| | - Sharon Abrahams
- Human Cognitive Neuroscience, Department of Psychology, School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Edinburgh, UK
- Euan MacDonald Centre for MND Research, University of Edinburgh, Edinburgh, UK
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Abrahams S. Neuropsychological impairment in amyotrophic lateral sclerosis-frontotemporal spectrum disorder. Nat Rev Neurol 2023; 19:655-667. [PMID: 37828358 DOI: 10.1038/s41582-023-00878-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2023] [Indexed: 10/14/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with a rapid course, characterized by motor neuron dysfunction, leading to progressive disability and death. This Review, which is aimed at neurologists, psychologists and other health professionals who follow evidence-based practice relating to ALS and frontotemporal dementia (FTD), examines the neuropsychological evidence that has driven the reconceptualization of ALS as a spectrum disorder ranging from a pure motor phenotype to ALS-FTD. It focuses on changes in cognition and behaviour, which vary in severity across the spectrum: around 50% individuals with ALS are within the normal range, 15% meet the criteria for ALS-FTD, and the remaining 35% are in the mid-spectrum range with milder and more focal impairments. The cognitive impairments include deficits in verbal fluency, executive functions, social cognition and language, and apathy is the most prevalent behavioural change. The pattern and severity of cognitive and behavioural change predicts underlying regional cerebral dysfunction from brain imaging and post-mortem pathology. Our increased recognition of cognition and behaviour as part of the ALS phenotype has led to the development and standardization of assessment tools, which have been incorporated into research and clinical care. Measuring change over the course of the disease is vital for clinical trials, and neuropsychology is proving to be a biomarker for the earliest preclinical changes.
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Affiliation(s)
- Sharon Abrahams
- Human Cognitive Neuroscience, Department of Psychology, School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Edinburgh, UK.
- Euan MacDonald Centre for MND Research, University of Edinburgh, Edinburgh, UK.
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Soliman R, Rashed HR, Moustafa RR, Hamdi N, Swelam MS, Osman A, Fahmy N. Egyptian adaptation and validation of the Edinburgh Cognitive and Behavioral Amyotrophic Lateral Sclerosis Screen (ECAS-EG). Neurol Sci 2023; 44:1871-1880. [PMID: 36753012 PMCID: PMC10175416 DOI: 10.1007/s10072-023-06639-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 01/23/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) is the most common, fatal adult neuromuscular disease. It is a multi-system disorder characterized primarily by motor manifestations, but there is established evidence for cognitive and behavioral impairment, which is associated with poor prognosis, hence, the importance of tools for its assessment. The Edinburgh Cognitive and Behavioral Assessment Screen (ECAS) is an invaluable assessment tool for cognition in ALS-front temporal spectrum dementia (FTSD), as it accommodates physical challenges that usually confound traditional neuropsychological testing in those patients. OBJECTIVE AND METHODS To validate the Egyptian Arabic version of ECAS (ECAS-EG) based on the original English scale. This is a prospective study. The ECAS was adapted and administered to 62 Egyptian ALS patients and 60 healthy controls. Patients were recruited from the Neuromuscular Unit, Ain Shams University Hospital. The ECAS was adapted to Egyptian Arabic after being translated using the back translation method. Internal consistency of the test, inter-rater reliability, and construct validity were assessed. RESULTS The Egyptian Arabic version of ECAS (ECAS-EG) showed good internal consistency using Cronbach's alpha of 0.84. Inter-rater reliability was tested, values for all variables were compared, and no statistically significant differences were found (ICC = .997). ECAS-EG discriminated significantly between the patients from the control subjects (p-value of 0.001). There was a strong positive correlation between the ECAS-EG total score and the MoCA total score with a p-value of 0.001, thus indicating convergent validity. The test showed that 63% of Egyptian ALS patients were cognitively affected; most affected domains were executive functions and verbal fluency. CONCLUSION The current study proves that the Egyptian version of the ECAS (ECAS-EG) is valid and reliable among Egyptian ALS patients and it would be applicable to the general Arabic-speaking population.
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Affiliation(s)
- Radwa Soliman
- Neuromuscular Unit, Neurology and Psychiatry Department, Faculty of Medicine, Ain Shams University, Cairo, 11566, Egypt.
| | - Hebatallah R Rashed
- Neuromuscular Unit, Neurology and Psychiatry Department, Faculty of Medicine, Ain Shams University, Cairo, 11566, Egypt
| | - Ramez R Moustafa
- Neuromuscular Unit, Neurology and Psychiatry Department, Faculty of Medicine, Ain Shams University, Cairo, 11566, Egypt
| | - Nabila Hamdi
- Molecular Pathology Unit, German University in Cairo (GUC), Cairo, Egypt
| | - Mahmoud S Swelam
- Neuromuscular Unit, Neurology and Psychiatry Department, Faculty of Medicine, Ain Shams University, Cairo, 11566, Egypt
| | - Ahmad Osman
- Biotechnology Department, Basic and Applied Sciences Institute, Egypt-Japan University of Science and Technology, Borg Al Arab, 21934, Egypt.,Biochemistry Department, Faculty of Science, Ain Shams University, Cairo, 11566, Egypt
| | - Nagia Fahmy
- Neuromuscular Unit, Neurology and Psychiatry Department, Faculty of Medicine, Ain Shams University, Cairo, 11566, Egypt.
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Fazio R, Soósová N, Bak T, Růžička E, Bezdicek O. A normative study of the Czech Edinburgh Cognitive and Behavioural ALS Screen (ECAS): a brief report. Clin Neuropsychol 2021; 35:S65-S72. [PMID: 34542002 DOI: 10.1080/13854046.2021.1978553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Edinburgh Cognitive and Behavioural ALS Screen (ECAS) is a brief, standardized assessment of cognitiveimpairment inamyotrophic lateral sclerosis. OBJECTIVE We aimed to createa normative dataset for the ECAS Czech version (ECAS-CZ) in order to make the assessment applicable for clinical settings. METHOD Included were 102 healthy participants (mean age: 54.92 ± 14.55; education: 14.52 ± 2.44; 54:48 females/males) that fulfilled rigorous exclusion criteria and controlled for depressive symptoms. RESULTS The internal consistency of ECAS-CZ was acceptable (Cronbach's α = .69). We found medium correlations (rho ≈ .5) of age and education with ECAS-CZ Total score but not with gender. Cut-offs with -2 SD's threshold are presented for the differentiation of cognitive impairment. We report percentile values for ECAS-CZ Total including all subscales. CONCLUSION We provide normative values for ECAS-CZ that are well suited for the detection of cognitive impairment in clinical settings especially for patients with ALS.Supplemental data for this article is available online at https://doi.org/10.1080/13854046.2021.1978553 .
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Affiliation(s)
- Raffaele Fazio
- First Faculty of Medicine, Department of Neurology and Centre of Clinical Neuroscience, Charles University and General University Hospital, Prague, Czech Republic
| | - Nina Soósová
- First Faculty of Medicine, Department of Neurology and Centre of Clinical Neuroscience, Charles University and General University Hospital, Prague, Czech Republic
| | - Thomas Bak
- Human Cognitive Neuroscience - Department of Psychology, The University of Edinburgh, Edinburgh, UK
| | - Evžen Růžička
- First Faculty of Medicine, Department of Neurology and Centre of Clinical Neuroscience, Charles University and General University Hospital, Prague, Czech Republic
| | - Ondrej Bezdicek
- First Faculty of Medicine, Department of Neurology and Centre of Clinical Neuroscience, Charles University and General University Hospital, Prague, Czech Republic
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