1
|
Ball LJ, Geske JA, Burton E, Pattee GL. A clinical bulbar assessment scale (CBAS) for amyotrophic lateral sclerosis. Muscle Nerve 2022; 66:694-701. [PMID: 36217681 DOI: 10.1002/mus.27738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION/AIMS Comprehensive and valid bulbar assessment scales for use within amyotrophic lateral sclerosis (ALS) clinics are critically needed. The aims of this study are to develop the Clinical Bulbar Assessment Scale (CBAS) and complete preliminary validation. METHODS The authors selected CBAS items from among the literature and expert opinion, and content validity ratio (CVR) was calculated. Following consent, the CBAS was administered to a pilot sample of English-speaking adults with El Escorial defined ALS (N = 54) from a multidisciplinary clinic, characterizing speech, swallowing, and extrabulbar features. Criterion validity was assessed by correlating CBAS scores with commonly used ALS scales, and internal consistency reliability was obtained. RESULTS Expert raters reported strong agreement for the CBAS items (CVR = 1.00; 100% agreement). CBAS scores yielded a moderate, significant, negative correlation with ALS Functional Rating Scale-Revised (ALSFRS-R) total scores (r = -0.652, p < .001), and a strong, significant, negative correlation with ALSFRS-R bulbar subscale scores (r = -0.795, p < .001). There was a strong, significant, positive correlation with Center for Neurologic Studies Bulbar Function Scale (CNS-BFS) scores (r = 0.819, p < .001). CBAS scores were significantly higher for bulbar onset (mean = 38.9% of total possible points, SD = 22.6) than spinal onset (mean = 18.7%, SD = 15.8; p = .004). Internal consistency reliability (Cronbach's alpha) values were: (a) total CBAS, α = 0.889; (b) Speech subscale, α = 0.903; and (c) Swallowing subscale, α = 0.801. DISCUSSION The CBAS represents a novel means of standardized bulbar data collection using measures of speech, swallowing, respiratory, and cognitive-linguistic skills. Preliminary evidence suggests the CBAS is a valid, reliable scale for clinical assessment of bulbar dysfunction.
Collapse
Affiliation(s)
- Laura J Ball
- Speech-Language Pathology, Mississippi University for Women, Columbus, Mississippi, USA
| | - Jenenne A Geske
- Department of Family Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Elizabeth Burton
- Speech-Language Pathology, Madonna Rehabilitation Institute, Lincoln, Nebraska, USA
| | - Gary L Pattee
- University of Nebraska Medical Center, Neurology Associates, PC, Lincoln, Nebraska, USA
| |
Collapse
|
2
|
Marin B, Arcuti S, Jesus P, Logroscino G, Copetti M, Fontana A, Nicol M, Raymondeau M, Desport JC, Preux PM, Couratier P. Population-Based Evidence that Survival in Amyotrophic Lateral Sclerosis is Related to Weight Loss at Diagnosis. NEURODEGENER DIS 2016; 16:225-34. [PMID: 26866503 DOI: 10.1159/000442444] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 11/11/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS In a population-based setting, we aimed to (i) describe weight loss (WL) of amyotrophic lateral sclerosis (ALS) patients at the time of diagnosis and (ii) evaluate the association between WL and survival. METHODS All patients recruited in the FRALim register (2000-2013) were considered to be included in this study. Time-to-death analyses were performed using a multivariable Cox model. Model discrimination and calibration were assessed. RESULTS Among 322 patients in the register, 261 (81%) were included. At the time of diagnosis, 50.6% of patients reported a WL of more than 5%: 14.6% with WL between 5 and 10% and 36.0% with a WL of more than 10%. WL was independently associated with survival (p = 0.002). Patients with a WL of 10% or more experienced a 45% increase in the risk of death (95% CI 6-99) with respect to patients with a WL lower than 5% or no WL. The introduction of WL significantly improved the model's discrimination achieving a survival C statistic of 79.5% (95% CI 75.6-83.5, p = 0.006) at 12 months. CONCLUSION More than 50% of ALS patients experience a WL of more than 5% at the time of diagnosis. This finding highlights the need for randomized trials to evaluate the effect of nutritional interventions to improve ALS survival.
Collapse
Affiliation(s)
- Benoît Marin
- INSERM, U1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, University of Limoges, Limoges, France
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Salvioni CCDS, Stanich P, Oliveira ASB, Orsini M. Anthropometry of Arm: Nutritional Risk Indicator in Amyotrophic Lateral Sclerosis. Neurol Int 2015; 7:5952. [PMID: 26788263 PMCID: PMC4704469 DOI: 10.4081/ni.2015.5952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 08/16/2015] [Accepted: 11/12/2015] [Indexed: 12/11/2022] Open
Abstract
The aim of the paper is to examine the correlation between clinical data, nutritional, respiratory and functional parameters in amyotrophic lateral sclerosis (ALS). This is a descriptive study of 111 ALS patients [91 spinal onset (GS) and 20 bulbar onset (GB)] carried on using nutritional and respiratory parameters and amyotrophic lateral sclerosis functional rating scale (ALSFRS). ALSFRS was analyzed in the main domains (D1, D2 and D3). Forced vital capacity and anthropometric measurements, there was significant association for GS and GB, and in GS there was positive correlation with midarm circumference (MAC) (r=0.30; P=0.020), midarm muscle circumference (r=0.29; P=0.026), arm muscle area (r=0.28; P=0.033) and protein-caloric malnutrition score (r=0.27; P=0.039), while for GB only with body weight (r=0.64; P=0.024). On correlation of nutritional parameters and ALSFRS for GS patients we observed that MAC and %MAC presented positive association with both issues of D1 and D2. For GB, the total score in addition to correlate positively with anthropometric parameters related to lean body mass also presented negative association with a parameter associated with body fat. In summary, it is suggested that the application of anthropometry of arm could be useful in routine monitoring of ALS patients.
Collapse
Affiliation(s)
| | - Patricia Stanich
- Department of Neurology and Neurosurgical, Research on Neuromuscular Disease, Federal University of Sao Paulo
| | - Acary Souza Bulle Oliveira
- Department of Neurology and Neurosurgical, Research on Neuromuscular Disease, Federal University of Sao Paulo
| | - Marco Orsini
- Centro Universitário Augusto Motta, Bonsucesso, Rio de Janeiro; Centro Universitario Severino Sombra, Facuty of Medicine, Vassouras, Brazil
| |
Collapse
|
4
|
Fregonezi G, Araújo PRS, Macêdo TLF, Dourado Junior ME, Resqueti VR, Andrade ADFDD. Monitoring respiratory muscle strength assists in early diagnosis of respiratory dysfunction as opposed to the isolated use of pulmonary function evaluation in amyotrophic lateral sclerosis. ARQUIVOS DE NEURO-PSIQUIATRIA 2013; 71:146-52. [DOI: 10.1590/s0004-282x2013000300004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 08/15/2012] [Indexed: 12/13/2022]
Abstract
ObjectiveIt was study the relationship between respiratory muscle strength and forced vital capacity (FVC) in patients with amyotrophic lateral sclerosis (ALS) versus healthy subjects.MethodsPulmonary function and respiratory muscle strength [maximal inspiratory (PImax), maximal expiratory (PEmax) and sniff nasal inspiratory pressure (SNIP)] were assessed in patients with ALS and healthy subjects, matched using cutoffs established in the literature for impaired pulmonary function and respiratory muscle weakness.ResultsTwenty-eight ALS patients and 28 healthy subjects were studied. We found sensitivity and specificity for PImax, PEmax and SNIP of 75/58%, 81/67% and 75/67%. The Receiver Operating Characteristic curve (ROC curve) indicated that the variables PImax, PEmax and SNIP can identify differences in respiratory muscle strength between ALS and healthy individuals at 0.89, 0.9 and 0.82, respectively. A positive correlation was recorded between FVC (%) versus SNIP, PImax and PEmax.ConclusionIn ALS, monitoring respiratory muscle strength assists in early diagnosis of respiratory dysfunction as opposed to the isolated use of FVC.
Collapse
|
5
|
Reich-Slotky R, Andrews J, Cheng B, Buchsbaum R, Levy D, Kaufmann P, Thompson JLP. Body mass index (BMI) as predictor of ALSFRS-R score decline in ALS patients. Amyotroph Lateral Scler Frontotemporal Degener 2013; 14:212-6. [DOI: 10.3109/21678421.2013.770028] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Ronit Reich-Slotky
- Department of Biostatistics, Mailman School of Public Health, Columbia University,
New York, NY
| | - Jinsy Andrews
- Department of Neurology, Hospital for Special Care,
New Britain, Connecticut
- Department of Neurology, University of Connecticut School of Medicine,
Farmington, Connecticut
| | - Bin Cheng
- Department of Biostatistics, Mailman School of Public Health, Columbia University,
New York, NY
| | - Richard Buchsbaum
- Department of Biostatistics, Mailman School of Public Health, Columbia University,
New York, NY
| | - Diane Levy
- Department of Biostatistics, Mailman School of Public Health, Columbia University,
New York, NY
| | - Petra Kaufmann
- Department of Neurology, Columbia University,
New York, NY, USA
| | - John L. P. Thompson
- Department of Biostatistics, Mailman School of Public Health, Columbia University,
New York, NY
| |
Collapse
|
6
|
Ellis AC, Rosenfeld J. Which equation best predicts energy expenditure in amyotrophic lateral sclerosis? ACTA ACUST UNITED AC 2011; 111:1680-7. [PMID: 22027050 DOI: 10.1016/j.jada.2011.08.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Accepted: 03/18/2011] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The purpose of this study was to compare measured resting energy expenditure (REE) with estimates from three common prediction equations with the goal of determining which equation best estimates REE in amyotrophic lateral sclerosis (ALS). DESIGN Cross-sectional measurements of REE from indirect calorimetry were compared to calculations from the Harris Benedict, Mifflin-St Jeor, and Ireton-Jones equations. Additional measurements to identify predictors of REE included pulmonary function tests, fat-free mass by bioelectrical impedance, and anthropometrics. SUBJECTS/SETTING Participants were 56 men and women with ALS. For comparison, subjects were categorized by disease progression into three groups. STATISTICAL ANALYSES Pearson correlations and paired t tests were used to compare measured REE with predicted REE from each equation, and the accuracy of each equation was quantified by the root mean squared prediction error and the percentage of REE estimates within 10% of measured values. Bias for each equation was calculated as the mean percentage difference between calculated and measured REE. Multiple linear regression was used to determine the best predictor variables for REE. RESULTS Across the disease spectrum, the Harris Benedict and Mifflin-St Jeor equations provided clinically acceptable estimates of REE, whereas the Ireton-Jones equations consistently overestimated REE. The best predictors of REE among this cohort were fat-free mass, sex, and age. CONCLUSIONS When estimating energy requirements for patients with ALS, clinicians should choose prediction equations that incorporate sex and age as predictor variables, such as the Harris Benedict and Mifflin-St Jeor equations.
Collapse
Affiliation(s)
- Amy C Ellis
- Department of Nutrition Sciences, University of Alabama at Birmingham, AL, USA.
| | | |
Collapse
|
7
|
Marin B, Jésus P, Preux PM, Couratier P, Desport JC. Troubles nutritionnels lors de la sclérose latérale amyotrophique (SLA). NUTR CLIN METAB 2011. [DOI: 10.1016/j.nupar.2011.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
8
|
Genton L, Viatte V, Janssens JP, Héritier AC, Pichard C. Nutritional state, energy intakes and energy expenditure of amyotrophic lateral sclerosis (ALS) patients. Clin Nutr 2011; 30:553-9. [DOI: 10.1016/j.clnu.2011.06.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 04/04/2011] [Accepted: 06/08/2011] [Indexed: 12/12/2022]
|
9
|
Magnuson B, Peppard A, Auer Flomenhoft D. Hypocaloric considerations in patients with potentially hypometabolic disease States. Nutr Clin Pract 2011; 26:253-60. [PMID: 21586410 DOI: 10.1177/0884533611405673] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The provision of nutrition has traditionally been driven by the desire to provide adequate calories. However, over the past decade it has become evident that provision of excess calories can be detrimental to patients' outcomes in both critical care and long-term care settings. This review examines patient populations for whom hypocaloric nutrition can be both appropriate and beneficial. In specific situations, critically ill patients, such as those with obesity, stroke, and spinal cord injury, may have decreased energy requirements. In patients with spinal cord injury, the level of injury significantly correlates with the extent of reduced caloric energy expenditure. Ventilator-dependent patients with amyotrophic lateral sclerosis (ALS) have decreased energy needs; energy expenditure for ALS patients is lower than the predictive equation value. Aging patients will have decreased energy needs relative to a reduction in lean body mass. Patients with cerebral palsy (CP) have significantly lower caloric requirements than anticipated using predictive equations. Patients with CP pose a particular challenge in nutrition assessment. Several studies demonstrate that patients with CP have significantly lower caloric requirements than anticipated using predictive equations; thus, patients with CP benefit from indirect calorimetry. Provision of nutrition for obese patients is briefly addressed, as this is an increasingly important consideration for nutrition support in both the critical care and long-term care settings. When indirect calorimetry is not available, clinicians should remember that most patients will have low resting energy expenditure regardless of functional status and require frequent evaluation during institution of nutrition recommendations to guard against overfeeding and obesity.
Collapse
|
10
|
Marcos Vidal JM, Bermejo González JC, Baticón Escudero PM. [Noninvasive ventilation through a nasal mask to sedate a man with amyotrophic lateral sclerosis during percutaneous endoscopic gastrostomy]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2011; 58:258-259. [PMID: 21608286 DOI: 10.1016/s0034-9356(11)70052-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
|
11
|
Almeida SRM, Silva LBC, Guerreiro CAM, Nucci A. Amyotrophic lateral sclerosis: prospective study on respiratory parameters. ARQUIVOS DE NEURO-PSIQUIATRIA 2010; 68:258-62. [DOI: 10.1590/s0004-282x2010000200020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Accepted: 11/10/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: To verify how efficient respiratory parameters are in the follow-up of subjects with amyotrophic lateral sclerosis (ALS) and to observe possible correlations between respiratory and nutritional functions. METHOD: Sixteen patients with probable or defined ALS were selected and evaluated over eight months using the following respiratory parameters: spirometry, maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), arterial gasometry and pulse oximetry; and nutritional parameters such as body mass index (BMI) and percentage weight loss. RESULTS: PaCO2 was a significant parameter to follow up disease evolution (p=0.051). There was significant correlation between MIP and MEP (r: 0.83); BMI and MIP (r: 0.70); BMI and MEP (r: 0.72); pulse oximetry and forced vital capacity (r: 0.57). CONCLUSION: PaCO2 was shown to be an efficient and significant parameter in the measurement of respiratory impairment; the correlations among MIP, MEP and BMI indicated that these are significant parameters for periodic clinical evaluation.
Collapse
|
12
|
Silva LBDC, Mourão LF, Silva AA, Lima NMFV, Almeida SR, Franca Jr MC, Nucci A, Amaya-Farfán J. Effect of nutritional supplementation with milk whey proteins in amyotrophic lateral sclerosis patients. ARQUIVOS DE NEURO-PSIQUIATRIA 2010; 68:263-8. [DOI: 10.1590/s0004-282x2010000200021] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Accepted: 11/18/2009] [Indexed: 12/13/2022]
Abstract
OBJECTIVE: We evaluated the efficacy of oral supplementation with milk whey proteins and modified starch (70%WPI:30%MS), on nutritional and functional parameters of patients with ALS. METHOD: A prospective randomized double-blind study was performed with 16 ALS patients, divided in two groups, the treatment group received (70%WPI:30%MS) and the control group received (maltodextrin). They underwent prospective nutritional and functional assessment for 4 months. RESULTS: Patients in the treatment group presented weight gain, increased body mass index (BMI), increased arm muscle area and circumference, higher albumin, white blood cell and total lymphocyte counts, and reduced creatine-kinase, aspartate aminotransferase and alanine aminotransferase. In the control group, biochemical parameters did not change, but weight and BMI declined. CONCLUSION: Our results indicate that the agglomerate 70%WPI:30%MS may be useful in the nutritional therapy of patients with ALS.
Collapse
|