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Katerelos A, Alexopoulos P, Economou P, Polychronopoulos P, Chroni E. Cognitive function in amyotrophic lateral sclerosis: a cross-sectional and prospective pragmatic clinical study with review of the literature. Neurol Sci 2024; 45:2075-2085. [PMID: 38105306 PMCID: PMC11021277 DOI: 10.1007/s10072-023-07262-1] [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: 11/19/2023] [Accepted: 12/08/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Amyotrophic lateral sclerosis (ALS) can present with either bulbar or spinal symptoms, and in some cases, both types of symptoms may be present. In addition, cognitive impairment has been observed in ALS. The study aimed to evaluate the frontal and general cognitive performance in ALS not only cross-sectionally but also longitudinally. METHODS AND MATERIALS The Frontal Assessment Battery (FAB) and the Montreal Cognitive Assessment (MoCA) were employed to assess cognitive function in 52 adults with ALS and 52 cognitively healthy individuals. The statistical analyses encompassed the Pearson Chi square test, the Skillings-Mack test, the Spearman's rank correlation coefficient, and the Proportional Odds Logistic Regression Model (POLR). RESULTS Cross-sectionally, lower cognitive performance was associated with ALS diagnosis, older age, and motor functional decline. The cognitive impairment of individuals with bulbar and spinal-bulbar symptoms showed faster deterioration compared to those with spinal symptoms. The spinal subgroup consistently performed worst in delayed recall and attention, while the spinal-bulbar and bulbar subgroups exhibited inferior scores in delayed recall, attention, visuospatial skills, orientation, and verbal fluency. CONCLUSION The incorporation of cognitive screening in the diagnostic workup of ALS may be beneficial, as early detection can enhance symptom management and improve the quality of life for both individuals with ALS and their care partners.
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Affiliation(s)
- Adamantios Katerelos
- Department of Medicine, School of Health Sciences, University of Patras, Patras, Greece.
- Department of Neurology, Patras University General Hospital, Rio, Greece.
| | - Panagiotis Alexopoulos
- Department of Medicine, School of Health Sciences, University of Patras, Patras, Greece
- Mental Health Services, Patras University General Hospital, Rio, Greece
- Medical School, Trinity College Dublin, Global Brain Health Institute, The University of Dublin, Dublin, Republic of Ireland
- Faculty of Medicine, Klinikum Rechts Der Isar, Department of Psychiatry and Psychotherapy, Technical University of Munich, Munich, Germany
- Patras Dementia Day Care Centre, Patras, Greece
| | - Polychronis Economou
- Department of Civil Engineering (Statistics), School of Engineering, University of Patras, Patras, Greece
| | - Panagiotis Polychronopoulos
- Department of Medicine, School of Health Sciences, University of Patras, Patras, Greece
- Department of Neurology, Patras University General Hospital, Rio, Greece
| | - Elisabeth Chroni
- Department of Medicine, School of Health Sciences, University of Patras, Patras, Greece
- Department of Neurology, Patras University General Hospital, Rio, Greece
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2
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Aiello EN, Solca F, Torre S, Carelli L, Ferrucci R, Priori A, Verde F, Ticozzi N, Silani V, Poletti B. Feasibility and diagnostics of the Frontal Assessment Battery (FAB) in amyotrophic lateral sclerosis. Neurol Sci 2023; 44:587-592. [PMID: 36201126 PMCID: PMC9842552 DOI: 10.1007/s10072-022-06438-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The present study aimed at evaluating the diagnostic properties of the Frontal Assessment Battery (FAB) in non-demented ALS patients by addressing the Edinburgh Cognitive Behavioural ALS Screen (ECAS) as the gold standard, as well as by examining the association between its administrability and scores with motor-functional measures. MATERIALS N = 348 consecutive patients were administered the ECAS and FAB. Disease severity (ALSFRS-R), duration, progression rate (ΔFS), and stages (via King's and Milano-Torino systems) were considered. Administrability rates and prevalence of below-cut-off FAB scores were compared across clinical stages; regression models allowed to test whether, net of the ECAS-Total, motor features predicted the probability of the FAB not being administrable and of a defective FAB score. Intrinsic and post-test diagnostics were explored against a combined defective ECAS-Executive and ECAS-Fluency scores. RESULTS 85.3% of patients managed to complete the FAB. FAB administrability rates decreased with advanced clinical stages, whereas the prevalence of below-cut-off FAB scores did not. The probability of the FAB not being administrable was predicted only by lower ALSFRS-R-bulbar and ALSFRS-R-upper-limb scores; no motor features, but the ECAS-Total, predicted a below-cut-off performance on the FAB. Raw and adjusted FAB scores showed high accuracy (AUC = .85 and .81, respectively) and good intrinsic and post-test properties. DISCUSSION The FAB is featured by optimal diagnostics for detecting executive deficits in ALS, provided that it can be administered according to its original, standardized procedure, and thus that patients have sufficiently spared motor abilities to complete the test.
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Affiliation(s)
- Edoardo Nicolò Aiello
- IRCCS Istituto Auxologico Italiano, Department of Neurology and Laboratory of Neuroscience, Piazzale Brescia 20, Milano, 20149 Italy
- PhD Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Federica Solca
- IRCCS Istituto Auxologico Italiano, Department of Neurology and Laboratory of Neuroscience, Piazzale Brescia 20, Milano, 20149 Italy
| | - Silvia Torre
- IRCCS Istituto Auxologico Italiano, Department of Neurology and Laboratory of Neuroscience, Piazzale Brescia 20, Milano, 20149 Italy
| | - Laura Carelli
- IRCCS Istituto Auxologico Italiano, Department of Neurology and Laboratory of Neuroscience, Piazzale Brescia 20, Milano, 20149 Italy
| | - Roberta Ferrucci
- Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, International Medical School, University of Milan, Milan, Italy
- ASST Santi Paolo E Carlo, San Paolo University Hospital, Milan, Italy
- IRCCS Ca’ Granda Foundation Maggiore Policlinico Hospital, Milan, Italy
| | - Alberto Priori
- Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, International Medical School, University of Milan, Milan, Italy
- ASST Santi Paolo E Carlo, San Paolo University Hospital, Milan, Italy
| | - Federico Verde
- IRCCS Istituto Auxologico Italiano, Department of Neurology and Laboratory of Neuroscience, Piazzale Brescia 20, Milano, 20149 Italy
- Department of Pathophysiology and Transplantation, “Dino Ferrari Center”, Università Degli Studi di Milano, Milan, Italy
| | - Nicola Ticozzi
- IRCCS Istituto Auxologico Italiano, Department of Neurology and Laboratory of Neuroscience, Piazzale Brescia 20, Milano, 20149 Italy
- Department of Pathophysiology and Transplantation, “Dino Ferrari Center”, Università Degli Studi di Milano, Milan, Italy
| | - Vincenzo Silani
- IRCCS Istituto Auxologico Italiano, Department of Neurology and Laboratory of Neuroscience, Piazzale Brescia 20, Milano, 20149 Italy
- Department of Pathophysiology and Transplantation, “Dino Ferrari Center”, Università Degli Studi di Milano, Milan, Italy
| | - Barbara Poletti
- IRCCS Istituto Auxologico Italiano, Department of Neurology and Laboratory of Neuroscience, Piazzale Brescia 20, Milano, 20149 Italy
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3
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Balconi M, Losasso D, Balena A, Crivelli D. Neurocognitive impairment in addiction: A digital tool for executive function assessment. Front Psychiatry 2022; 13:955277. [PMID: 36276307 PMCID: PMC9579426 DOI: 10.3389/fpsyt.2022.955277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 09/12/2022] [Indexed: 12/04/2022] Open
Affiliation(s)
- Michela Balconi
- International Research Center for Cognitive Applied Neuroscience (IrcCAN), Catholic University of the Sacred Heart, Milan, Italy.,Research Unit in Affective and Social Neuroscience, Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Doriana Losasso
- SerD Canzio, Department of Mental Health and Dependence, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Alessandra Balena
- SerD Canzio, Department of Mental Health and Dependence, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Davide Crivelli
- International Research Center for Cognitive Applied Neuroscience (IrcCAN), Catholic University of the Sacred Heart, Milan, Italy.,Research Unit in Affective and Social Neuroscience, Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
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4
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Shen D, Cui B, Liu M, Gao J, Liu C, Li X, Cui L. Strategy for screening cognitive impairment in Chinese patients with amyotrophic lateral sclerosis. J Clin Neurosci 2020; 81:105-110. [PMID: 33222896 DOI: 10.1016/j.jocn.2020.09.016] [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] [Received: 02/14/2020] [Revised: 07/31/2020] [Accepted: 09/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND It is an economical strategy to design a screening method to decide which patients with amyotrophic lateral sclerosis/ motor neuron disease (ALS/MND) should enter into the stage for further comprehensive neuropsychological investigation. METHODS 59 patients (including 8 with frank dementia) were recruited. They underwent the extensive neuropsychological evaluation and short screening batteries, namely the Mini-Mental State Examination (MMSE), the Peking Union Medical College Hospital version of Montreal Cognitive Assessment (MoCA-P) and the Frontal Assessment Battery (FAB). Results of the extensive neuropsychological evaluation were set as the gold standard to diagnose cognitive impairment, and the effectiveness of screening tests were measured against them. RESULTS By comparing the sensitivity and specificity, we found that the combination of FAB plus both or either of the other 2 short batteries provided a satisfactorily high sensitivity, but none of these screening batteries was significantly associated with quantitative behavioral measurements among non-demented subjects, the Frontal Behavioral Inventory-ALS version (FBI-ALS). CONCLUSIONS The combination of the FBI-ALS, the FAB, and the MMSE or the MoCA-P or both could effectively screen comorbid dementia, cognitive and behavioral impairment in ALS but this implicates a limited specificity. And the FAB needed to be validated in large Chinese sample.
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Affiliation(s)
- Dongchao Shen
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Bo Cui
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Mingsheng Liu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Jing Gao
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Caiyan Liu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Xiaoguang Li
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Liying Cui
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China; Neurosciences Center, Chinese Academy of Medical Sciences, Beijing 100730, China.
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5
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Taule T, Søvik M, Lein RK, Wehling E, Aßmus J, Rekand T. Psychometric Properties of Cognitive Assessment in Amyotrophic Lateral Sclerosis: A Systematic Review. PATIENT-RELATED OUTCOME MEASURES 2020; 11:181-194. [PMID: 33061727 PMCID: PMC7519807 DOI: 10.2147/prom.s256828] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 08/04/2020] [Indexed: 12/18/2022]
Abstract
Purpose We aimed to list all tests used to assess cognitive change in patients with amyotrophic lateral sclerosis (ALS) and to provide a descriptive synthesis of the psychometric properties of tests that were evaluated in a population of ALS patients. Materials and Methods The protocol is registered in PROSPERO (ID: CRD42017055603). We systematically search for literature in 11 databases. Full-text articles, in any language, with original research were included. All included articles were scrutinised by two independent authors. Disagreement was resolved by consensus. The framework of Lezak informed conceptualises of the tests identified. To evaluate methodological quality, we used the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN). Data were synthesised using criteria proposed by the Cochrane Back Review Group. Results Of 319 included articles, 46 articles reported information on the psychometric properties of cognitive tests used in patients with ALS. We found that the highest level of evidence was supported for the Reading the Mind in the Eye Test (RME), Addenbrooke’s Cognitive Evaluation (ACE) and Frontal Assessment Battery (FAB). Moderate level of evidence was found for the screening tests; Edinburgh Cognitive and Behavioural ALS Screen (ECAS) and the Montreal Cognitive Assessment (MoCA). Conclusion The screening test, ECAS and the social cognition test, RME, may have some advantages over other tests that have been used for assessing cognitive change in ALS patients. Recommendations of ALS-specific tests with sound psychometric properties are urgently needed.
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Affiliation(s)
- Tina Taule
- Department of Occupational Therapy, Haukeland University Hospital (HUH), Bergen, Norway
| | - Margaret Søvik
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | | | - Eike Wehling
- Department of Physical Medicine and Rehabilitation, HUH, Bergen, Norway.,Department of Biological and Medical Psychology, UiB, Bergen, Norway
| | - Jörg Aßmus
- Centre for Clinical Research, HUH, Bergen, Norway
| | - Tiina Rekand
- Department of Neurology, HUH, Bergen, Norway.,Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Gosselt IK, Nijboer TCW, Van Es MA. An overview of screening instruments for cognition and behavior in patients with ALS: selecting the appropriate tool for clinical practice. Amyotroph Lateral Scler Frontotemporal Degener 2020; 21:324-336. [PMID: 32157912 DOI: 10.1080/21678421.2020.1732424] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective: Patients with amyotrophic lateral sclerosis (ALS) not only show motor deficits, but may also have cognitive and/or behavioral impairments. Recognizing these impairments is crucial as they are associated with lower quality of life, shorter survival, and increased caregiver burden. Therefore, ALS-specific neuropsychological screening instruments have been developed that can account for motor and speech difficulties. This study provides an overview and comparison of these screeners. Methods: A systematic review was conducted using Medline and Embase. Articles describing cognitive/behavioral screening instruments assessed in ALS patients were included. Screening instruments were compared on multiple factors, such as domains, adaptability, required time, and validation. Results: We included 99 articles, reporting on nine cognitive screeners (i.e. ACE-R, ALS-BCA, ALS-CBS, ECAS, FAB, MMSE, MoCA, PSSFTS, and UCSF-SB), of which five ALS-specific. Furthermore, eight behavioral screeners (i.e. ALS-FTD-Q, AES, BBI, DAS, FBI, FrSBe, MiND-B, and NPI) were reported on, of which three ALS-specific. Conclusion: Considering the broad range of cognitive domains, adaptability, and satisfying validity, the ALS-CBS and ECAS appear to be the most suitable screeners to detect cognitive and behavioral changes in ALS. The BBI appears to be the best option to screen for behavioral changes in ALS, since all relevant domains are assessed, motor-related problems are considered, and has a satisfactory validity. The MiND-B and ALS-FTD-Q are promising as well. In general, all screening instruments would benefit from additional validation research to gain greater insights into test characteristics and to aid clinicians in selecting screening tools for use in clinical practice.
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Affiliation(s)
- Isabel K Gosselt
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, Netherlands
| | - Tanja C W Nijboer
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, Netherlands.,Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
| | - Michael A Van Es
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
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7
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Tremolizzo L, Lizio A, Santangelo G, Diamanti S, Lunetta C, Gerardi F, Messina S, La Foresta S, Riva N, Falzone Y, Filippi M, Woolley SC, Sansone VA, Siciliano M, Ferrarese C, Appollonio I. ALS Cognitive Behavioral Screen (ALS-CBS): normative values for the Italian population and clinical usability. Neurol Sci 2019; 41:835-841. [PMID: 31807998 DOI: 10.1007/s10072-019-04154-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 11/14/2019] [Indexed: 11/26/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) patients often express cognitive and behavioral dysfunctions within the so-called "frontotemporal spectrum disorders." Guidelines recommend screening of such dysfunctions, albeit only ALS dedicated tools are eventually suitable, due to the profound motor limitations induced by the disease. ALS Cognitive Behavioral Screen (ALS-CBS) is such a screening tool but normative data are not available, limiting its widespread implementation. Our aim consisted in producing normative data for the Italian version of the ALS-CBS. The scale was administered to n = 458 healthy controls with different age and education. Following translation and back translation of the original version of the test, normative data and correction scores for the ALS-CBS cognitive subtest (ALS-CBSci) were generated. Furthermore, n = 100 ALS consecutive outpatients with a wide range of cognitive and motor severity underwent to the ALS-CBS, besides FAB and Weigl sorting test (WST), in order to check its usability. Completion rate was 100% for ALS-CBS and WST, and 68% for the FAB. Corrected ALS-CBS scores showed 12% detection rate of significant cognitive dysfunction with a moderate kappa with FAB and WST. For the ALS-CBS behavioral subtest (ALS-CBSbi), a caregiver was available for n = 81 ALS patients and asked to complete the subset. The detection rate for behavioral dysfunction was 55.5%, and a mild correlation between with the Caregiver Burden Inventory was present (r = - 0.26, p = 0.04). In conclusion, we offer here normative data for the ALS-CBS, a handy tool for screening frontotemporal spectrum dysfunctions in ALS patients, and confirm its usability and validity in an outpatient setting.
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Affiliation(s)
- Lucio Tremolizzo
- School of Medicine and Surgery and Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, U8 Via Cadore 48 -, 20900, Monza, MB, Italy.
- Neurology, "San Gerardo" Hospital, Monza, Italy.
| | - Andrea Lizio
- NEuroMuscular Omnicentre (NEMO), Fondazione Serena Onlus, Milan, Italy
| | - Gabriella Santangelo
- Department of Psychology, University of Campania "Luigi Vanvitelli", Viale Ellittico 31, 81100, Caserta, Italy.
| | - Susanna Diamanti
- School of Medicine and Surgery and Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, U8 Via Cadore 48 -, 20900, Monza, MB, Italy
- Neurology, "San Gerardo" Hospital, Monza, Italy
| | - Christian Lunetta
- NEuroMuscular Omnicentre (NEMO), Fondazione Serena Onlus, Milan, Italy
| | - Francesca Gerardi
- NEuroMuscular Omnicentre (NEMO), Fondazione Serena Onlus, Milan, Italy
| | - Sonia Messina
- NEuroMuscular Omnicenter (NEMO) SUD Clinical Center, Aurora Onlus Foundation, Messina, Italy
| | - Stefania La Foresta
- NEuroMuscular Omnicenter (NEMO) SUD Clinical Center, Aurora Onlus Foundation, Messina, Italy
| | - Nilo Riva
- Institute of Experimental Neurology (INSPE), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Yuri Falzone
- Institute of Experimental Neurology (INSPE), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Institute of Experimental Neurology (INSPE), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Susan C Woolley
- Sutter Pacific Medical Foundation, 5150 Hill Rd E, Lakeport, CA, 95453, USA
| | - Valeria Ada Sansone
- NEuroMuscular Omnicentre (NEMO), Fondazione Serena Onlus, Milan, Italy
- Department of Biomedical Sciences of Health, University of Milano, Via Festa del Perdono, 7, 20122, Milan, MI, Italy
| | - Mattia Siciliano
- Department of Advanced Medical and Surgical Sciences - MRI Research Center Vanvitelli-FISM, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Carlo Ferrarese
- School of Medicine and Surgery and Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, U8 Via Cadore 48 -, 20900, Monza, MB, Italy
- Neurology, "San Gerardo" Hospital, Monza, Italy
| | - Ildebrando Appollonio
- School of Medicine and Surgery and Milan Center for Neuroscience (NeuroMI), University of Milano-Bicocca, U8 Via Cadore 48 -, 20900, Monza, MB, Italy
- Neurology, "San Gerardo" Hospital, Monza, Italy
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8
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Poletti B, Solca F, Carelli L, Faini A, Madotto F, Lafronza A, Monti A, Zago S, Ciammola A, Ratti A, Ticozzi N, Abrahams S, Silani V. Cognitive-behavioral longitudinal assessment in ALS: the Italian Edinburgh Cognitive and Behavioral ALS screen (ECAS). Amyotroph Lateral Scler Frontotemporal Degener 2018; 19:387-395. [DOI: 10.1080/21678421.2018.1473443] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Barbara Poletti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy,
| | - Federica Solca
- Department of Pathophysiology and Transplantation, “Dino Ferrari” Center, Università degli Studi di Milano, Milan, Italy,
| | - Laura Carelli
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy,
| | - Andrea Faini
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy,
| | - Fabiana Madotto
- Department of Medicine and Surgery, Research Centre on Public Health, University of Milano-Bicocca, Monza, Italy,
| | - Annalisa Lafronza
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy,
| | - Alessia Monti
- Department of Neurorehabilitation Sciences, Casa Cura Policlinico (CCP), Milan, Italy,
| | - Stefano Zago
- Department of Neuroscience and Mental Health, Università degli Studi di Milano, IRCCS Ospedale Maggiore Policlinico, Milan, Italy and
| | - Andrea Ciammola
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy,
| | - Antonia Ratti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy,
- Department of Pathophysiology and Transplantation, “Dino Ferrari” Center, Università degli Studi di Milano, Milan, Italy,
| | - Nicola Ticozzi
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy,
- Department of Pathophysiology and Transplantation, “Dino Ferrari” Center, Università degli Studi di Milano, Milan, Italy,
| | - Sharon Abrahams
- PPLS, Department of Psychology, Euan MacDonald Centre for Motor Neurone Disease Research, Human Cognitive Neuroscience-Psychology, University of Edinburgh, Edinburgh, UK
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy,
- Department of Pathophysiology and Transplantation, “Dino Ferrari” Center, Università degli Studi di Milano, Milan, Italy,
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9
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Kovrazhkina EA, Razinskaya OD, Gubsky LV. [Clinical polymorphism of amyotrophic lateral sclerosis]. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:4-10. [PMID: 28884711 DOI: 10.17116/jnevro2017117814-10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To clarify clinical polymorphism of amyotrophic lateral sclerosis (ALS). MATERIAL AND METHODS The study was based on records of a hospital personalized register. Ninety-four patients, aged from 25 to 81 years, diagnosed with ALS according to El Escorial criteria were included. Electromyography and, if necessary, transcranial magnetic stimulation and magnetic-resonance tomography were used to confirm the diagnosis. Disease progression was assessed with the ARSFRS. Age at disease onset, progression rate and duration of survival of patients, rare symptoms of ALS ('extramotor'), time for palliative care (gastrostomy, non-invasive and invasive lung ventilation) and provision of the care to the patient, family history were recorded in a specially designed questionnaire. RESULTS Most of the patients had sporadic ALS, only two familial cases were identified. Spinal onset ALS was found in 66.0% of the patients, bulbar onset in 29.8%, diffuse onset (spinal and bulbar motor neurons were affected simultaneously) in 4.2%. Moderate ALS progression was observed in 42.6% of the patients, mean time till death was 3.0±1.2 years. A slow progression was found in patients with cervical, low back and bulbar onset. A rapid and even 'momentary' type of progression was in diffuse and breast onset. An extremely slow progression with the long-term hospital treatment and survival >5 years was found in 9.7%. Rare ALS symptoms were represented by specific cognitive and psychological impairments, a type of frontal/temporal dysfunction, but only 5 (5.3%) patients were diagnosed with ALS-dementia. Signs of pathological muscle fatigue (myasthenic syndrome) were identified in 18 (19.1%), extrapyramidal disorders in 5 (5.3%), coordination disorders in 4 (4.3%), pain in 12 (12.8%), sensory symptoms in 5 (5.3%) of the patients. CONCLUSION ALS is a multisystemic neurodegeneration disease though the progressive motor neuron death determines the fatal outcome.
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Affiliation(s)
- E A Kovrazhkina
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - O D Razinskaya
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - L V Gubsky
- Pirogov Russian National Research Medical University, Moscow, Russia
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10
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Terada T, Miyata J, Obi T, Kubota M, Yoshizumi M, Yamazaki K, Mizoguchi K, Murai T. Frontal assessment battery and frontal atrophy in amyotrophic lateral sclerosis. Brain Behav 2017. [PMID: 28638712 PMCID: PMC5474710 DOI: 10.1002/brb3.707] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To determine the potential utility of the frontal assessment battery (FAB) in assessing cognitive impairments in amyotrophic lateral sclerosis (ALS), we investigated the association between the FAB score and regional gray matter volume, and ascertained whether the regional brain alterations related to cognitive impairments occur in relatively mild stage of ALS. MATERIALS AND METHODS Twenty-four ALS patients with a Mini-Mental State Examination score of >23, a normal score on the Self-Rating Depression Scale, little or no disturbance in speech and handling utensils on the ALS Functional Rating Scale (ALSFRS), and normal measures on respiratory tests (respiratory function test and arterial blood gas analysis), and two age-matched normal control groups (one for FAB assessment and the other for brain morphometry) underwent FAB testing and structural magnetic resonance imaging. We applied voxel-based morphometry to investigate the relationship between the FAB score and regional brain alteration, and assessed the relationship between the altered regional brain volume and ALSFRS or respiratory tests. RESULTS Frontal assessment battery scores were significantly lower in ALS patients than in normal controls. Volume reduction in the right orbitofrontal gyrus in ALS was correlated with a lower FAB score. There was no correlation between the right orbitofrontal gyrus volume and ALSFRS or respiratory tests. CONCLUSIONS The results suggest that the FAB is an adequate tool for detecting cognitive impairments related to frontal lobe pathology in the relatively mild stage of ALS, independent of physical dysfunctions.
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Affiliation(s)
- Tatsuhiro Terada
- Department of Neurology Shizuoka Institute of Epilepsy and Neurological Disorders Aoi-ku Shizuoka Japan.,Department of Biofunctional Imaging Medical Photonics Research Centre Hamamatsu University School of Medicine Higashi-ku Hamamatsu Japan
| | - Jun Miyata
- Department of Psychiatry Graduate School of Medicine Kyoto University Sakyo-ku Kyoto Japan
| | - Tomokazu Obi
- Department of Neurology Shizuoka Institute of Epilepsy and Neurological Disorders Aoi-ku Shizuoka Japan
| | - Manabu Kubota
- Department of Psychiatry Graduate School of Medicine Kyoto University Sakyo-ku Kyoto Japan.,Brain Disorder Translational Research Team Department of Functional Brain Imaging Research National Institute of Radiological Sciences National Institutes for Quantum and Radiological Science and Technology Inage-ku Chiba Japan
| | - Miho Yoshizumi
- Department of Psychiatry Graduate School of Medicine Kyoto University Sakyo-ku Kyoto Japan
| | - Kinya Yamazaki
- Department of Neurology Shizuoka Institute of Epilepsy and Neurological Disorders Aoi-ku Shizuoka Japan
| | - Kouichi Mizoguchi
- Department of Neurology Shizuoka Institute of Epilepsy and Neurological Disorders Aoi-ku Shizuoka Japan
| | - Toshiya Murai
- Department of Psychiatry Graduate School of Medicine Kyoto University Sakyo-ku Kyoto Japan
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Burkhardt C, Neuwirth C, Weber M. Longitudinal assessment of the Edinburgh Cognitive and Behavioural Amyotrophic Lateral Sclerosis Screen (ECAS): lack of practice effect in ALS patients? Amyotroph Lateral Scler Frontotemporal Degener 2017; 18:202-209. [PMID: 28165766 DOI: 10.1080/21678421.2017.1283418] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The study objective was to assess whether controls and ALS patients show a practice effect in the Edinburgh Cognitive and Behavioural ALS Screen (ECAS) on repeated longitudinal testing and if the ECAS detects progression of cognitive or behavioural changes over time. METHODS The ECAS was administered serially to ALS patients (n = 24 after six months, n = 10 after 12-18 months) and controls (n = 21 after six months). The ECAS was fully performed by all participants. For comparison purposes the Frontal Assessment Battery (FAB) was administered to a subgroup of 14 patients and 14 controls. RESULTS After six months controls showed a significantly higher overall score (p < 0.001) and significantly higher scores in all subdomains of the ECAS, except for visuospatial function and fluency. ALS patients showed no significant difference in any score of the ECAS after six months and up to18 months. Behavioural changes were increasingly, but not statistically, significant, noted by patient carers. The FAB was no longer applicable due to progressive motor deficits in 20% of ALS patients. CONCLUSIONS In conclusion, in contrast to healthy controls, ALS patients show no practice effects. This could reflect 'pre-symptomatic' cognitive decline and progressive behavioural symptoms.
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Affiliation(s)
- Christian Burkhardt
- a ALS Clinic/Neuromuscular Diseases Unit , Kantonsspital St. Gallen , St Gallen , Switzerland
| | - Christoph Neuwirth
- a ALS Clinic/Neuromuscular Diseases Unit , Kantonsspital St. Gallen , St Gallen , Switzerland
| | - Markus Weber
- a ALS Clinic/Neuromuscular Diseases Unit , Kantonsspital St. Gallen , St Gallen , Switzerland
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The Edinburgh Cognitive and Behavioural ALS Screen in a Chinese Amyotrophic Lateral Sclerosis Population. PLoS One 2016; 11:e0155496. [PMID: 27195772 PMCID: PMC4873026 DOI: 10.1371/journal.pone.0155496] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 04/30/2016] [Indexed: 11/19/2022] Open
Abstract
Objective The existing screening batteries assessing multiple neuropsychological functions are not specific to amyotrophic lateral sclerosis (ALS) patients and are limited to their physical dysfunctions, whereas category cognitive tests are too time-consuming to assess all the domains. The Edinburgh Cognitive and Behavioural ALS Screen (ECAS) was recently developed as a fast and easy cognitive screening tool specifically designed for patients. The purpose of the study was to validate the effectiveness of the Chinese version in Chinese ALS populations. Methods Eighty-four ALS patients and 84 age-, gender- and education-matched healthy controls were included in this cross-sectional study. All the participants took the ECAS, Mini-Mental State Examination (MMSE) and Frontal Assessment Battery (FAB). Primary caregivers of patients were interviewed for behavioural and psychiatric changes. Results Significant differences were noted in language (p = 0.01), fluency, executive function, ALS-specific functions, and ECAS total score (p<0.01) between ALS patients and controls. The cut-off value of the total ECAS score was 81.92. Cognitive impairment was observed in 35.71% of patients, and 27.38% exhibited behavioural abnormalities. The ECAS total score had a medium correlation with education year. Memory was more easily impaired in the lower education group, whereas verbal fluency and language function tended to be preserved in the higher education group. The average time of ECAS was only 18 minutes. Conclusion The Chinese version of the ECAS is the first screening battery assessing multiple neuropsychological functions specially designed for the ALS population in China, which provides an effective and rapid tool to screen cognitive and behavioural impairments.
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Trojsi F, Santangelo G, Caiazzo G, Siciliano M, Ferrantino T, Piccirillo G, Femiano C, Cristillo V, Monsurrò MR, Esposito F, Tedeschi G. Neuropsychological assessment in different King's clinical stages of amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2016; 17:228-35. [PMID: 26905940 DOI: 10.3109/21678421.2016.1143513] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Emerging evidence shows that cognitive deficits associated with frontal lobe dysfunction occur from early stages of amyotrophic lateral sclerosis (ALS). We aimed to assess neuropsychological functioning at different stages of ALS to further delineate the occurrence of cognitive impairment alongside the trajectory of ALS as defined by standard assessment procedures. We investigated several cognitive domains in 74 ALS patients classified into four different clinical stages of disease, according to a recently validated staging system for ALS (known as 'King's' system), and evaluated and compared the corresponding cognitive profiles. We found that data derived from global cognitive assessment and several executive (i.e. Frontal Assessment Battery and Trail Making Test B-A) and long-term memory (i.e. memory prose) tests were significantly different among the subsets of ALS patients, showing poorer performances with increasing clinical disability. In conclusion, our preliminary results support the notion that mainly frontotemporal abilities may be impaired during the ALS course and suggest that neuropsychological information could supplement the current clinical staging of patients. However, ALS-specific multi-domain screening instruments, which allow to correct neuropsychological scores for physical disability, should be validated in larger populations worldwide and routinely introduced in clinical practice.
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Affiliation(s)
- Francesca Trojsi
- a Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences , Second University of Naples , Naples
| | | | - Giuseppina Caiazzo
- a Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences , Second University of Naples , Naples
| | - Mattia Siciliano
- b Department of Psychology , Second University of Naples , Caserta , and
| | - Teresa Ferrantino
- a Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences , Second University of Naples , Naples
| | - Giovanni Piccirillo
- a Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences , Second University of Naples , Naples
| | - Cinzia Femiano
- a Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences , Second University of Naples , Naples
| | - Viviana Cristillo
- a Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences , Second University of Naples , Naples
| | - Maria Rosaria Monsurrò
- a Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences , Second University of Naples , Naples
| | - Fabrizio Esposito
- c Department of Medicine and Surgery , University of Salerno , Baronissi (Salerno) , Italy
| | - Gioacchino Tedeschi
- a Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences , Second University of Naples , Naples
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Barulli MR, Fontana A, Panza F, Copetti M, Bruno S, Tursi M, Iurillo A, Tortelli R, Capozzo R, Simone IL, Logroscino G. Frontal assessment battery for detecting executive dysfunction in amyotrophic lateral sclerosis without dementia: a retrospective observational study. BMJ Open 2015; 5:e007069. [PMID: 26338835 PMCID: PMC4563243 DOI: 10.1136/bmjopen-2014-007069] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The frontal assessment battery (FAB) is a quick and reliable method of screening to evaluate frontal lobe dysfunction in amyotrophic lateral sclerosis (ALS). However, previous studies were generally conducted on small samples representing different stages of disease and severity. We assessed the diagnostic accuracy of the FAB in detecting executive functions and its association with demographic and clinical features in ALS without dementia. DESIGN Retrospective observational study. SETTING A multidisciplinary tertiary centre for motor neuron disease. PARTICIPANTS We enrolled 95 consecutive patients with ALS diagnosed with El Escorial criteria in the period between January 2006 and December 2010. MAIN OUTCOME MEASURES We screened the patients with ALS using the FAB. An Executive Index (EI) was also calculated by averaging the Z scores of analytic executive tests evaluating information-processing speed (Symbol Digit Modalities Test--Oral version), selective attention (Stroop test) and semantic memory (Verbal Fluency Test). RESULTS The FAB detected executive dysfunction in 13.7% of the patients with ALS. Moreover, using the EI standardised cut-off, 37.9% of the patients with ALS showed executive dysfunction. The receiver-operating characteristic curve showed that the optimal cut-off for the FAB in the whole sample was 16, with a sensitivity of 0.889 (95% CIs 0.545 to 1.000), a specificity of 0.593 (95% CI 0.450 to 0.907) and a moderate overall discriminatory power of 0.809. Different levels of respiratory function, duration of disease and depressive symptoms did not affect the FAB validity. CONCLUSIONS In patients with ALS without dementia, a high prevalence of executive dysfunction was present. The FAB showed good validity as a screening instrument to detect executive dysfunction in these patients and may be used when a complete neuropsychological assessment is not possible.
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Affiliation(s)
- Maria Rosaria Barulli
- Department of Clinical Research in Neurology, Neurodegenerative Disease Unit, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Tricase, Lecce, Italy
| | - Andrea Fontana
- Unit of Biostatistics, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Francesco Panza
- Department of Clinical Research in Neurology, Neurodegenerative Disease Unit, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Tricase, Lecce, Italy
- Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Massimiliano Copetti
- Unit of Biostatistics, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | - Stefania Bruno
- Department of Clinical Research in Neurology, Neurodegenerative Disease Unit, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Tricase, Lecce, Italy
| | - Marianna Tursi
- Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Annalisa Iurillo
- Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Rosanna Tortelli
- Department of Clinical Research in Neurology, Neurodegenerative Disease Unit, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Tricase, Lecce, Italy
| | - Rosa Capozzo
- Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Isabella Laura Simone
- Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Giancarlo Logroscino
- Department of Clinical Research in Neurology, Neurodegenerative Disease Unit, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Tricase, Lecce, Italy
- Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
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Lulé D, Burkhardt C, Abdulla S, Böhm S, Kollewe K, Uttner I, Abrahams S, Bak TH, Petri S, Weber M, Ludolph AC. The Edinburgh Cognitive and Behavioural Amyotrophic Lateral Sclerosis Screen: a cross-sectional comparison of established screening tools in a German-Swiss population. Amyotroph Lateral Scler Frontotemporal Degener 2014; 16:16-23. [PMID: 25292386 DOI: 10.3109/21678421.2014.959451] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The Edinburgh Cognitive and Behavioural ALS Screen (ECAS) has recently been developed as a fast and easy cognitive screening tool specifically designed for patients with motor impairments in routine clinical use. The German/Swiss-German version of the ECAS was validated in a German-Swiss consortium. One hundred and thirty-six non-demented ALS patients and 160 healthy controls were included in the study. In addition, the Frontal Assessment Battery (FAB), Montreal Cognitive Assessment (MoCA) and Consortium to Establish a Registry for Alzheimer's Disease plus Scale (CERAD plus) were administered to subgroups of patients. Results showed that administration of ECAS was fast (mean 24 min). Similar to the population in the UK version, ALS patients performed significantly worse in the ALS-specific functions (p < 0.001), specifically in the domain of language (p < 0.001), verbal fluency (p = 0.005) and executive functions (p = 0.02), but not for the non-ALS-specific functions. Carers reported behavioural abnormalities in about 30% and psychotic symptoms in 6% of the patients. Compared to ECAS, FAB, MoCA and CERAD were more generic and performance was not adjusted to motor speed. We conclude that the German/Swiss-German version of the ECAS is a fast and easy to administer cognitive screening instrument sensitive for ALS-specific dysfunctions and behaviour change.
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Affiliation(s)
- Dorothée Lulé
- Department of Neurology, University of Ulm , Germany
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Wei Q, Chen X, Zheng Z, Huang R, Guo X, Cao B, Zhao B, Shang HF. Frontal lobe function and behavioral changes in amyotrophic lateral sclerosis: a study from Southwest China. J Neurol 2014; 261:2393-400. [PMID: 25249295 DOI: 10.1007/s00415-014-7508-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 09/11/2014] [Accepted: 09/12/2014] [Indexed: 02/05/2023]
Abstract
Despite growing interest, the frequency and characteristics of frontal lobe functional and behavioral deficits in Chinese people with amyotrophic lateral sclerosis (ALS), as well as their impact on the survival of ALS patients, remain unknown. The Chinese version of the frontal assessment battery (FAB) and frontal behavioral inventory (FBI) were used to evaluate 126 sporadic ALS patients and 50 healthy controls. The prevalence of frontal lobe dysfunction was 32.5%. The most notable impairment domain of the FAB was lexical fluency (30.7%). The binary logistic regression model revealed that an onset age older than 45 years (OR 5.976, P = 0.002) and a lower educational level (OR 0.858, P = 0.002) were potential determinants of an abnormal FAB. Based on the FBI score, 46.0% of patients showed varied degrees of frontal behavioral changes. The most common impaired neurobehavioral domains were irritability (25.4%), logopenia (20.6%) and apathy (19.0%). The binary logistic regression model revealed that the ALS Functional Rating Scale-Revised scale score (OR 0.127, P = 0.001) was a potential determinant of an abnormal FBI. Frontal functional impairment and the severity of frontal behavioral changes were not associated with the survival status or the progression of ALS by the cox proportional hazard model and multivariate regression analyses, respectively. Frontal lobe dysfunction and frontal behavioral changes are common in Chinese ALS patients. Frontal lobe dysfunction may be related to the onset age and educational level. The severity of frontal behavioral changes may be associated with the ALSFRS-R. However, the frontal functional impairment and the frontal behavioral changes do not worsen the progression or survival of ALS.
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Affiliation(s)
- QianQian Wei
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
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Spectrum of cognitive impairment in Korean ALS patients without known genetic mutations. PLoS One 2014; 9:e87163. [PMID: 24498297 PMCID: PMC3911969 DOI: 10.1371/journal.pone.0087163] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 12/18/2013] [Indexed: 11/29/2022] Open
Abstract
Background Cognitive impairment is associated with a negative prognosis in amyotrophic lateral sclerosis (ALS), as well as with clinical specificity. We investigate neuropsychological function in ALS patients without known genetic mutations in a Korean tertiary clinic. Methods Three hundred and eighteen patients were enrolled in a prospective longitudinal cohort from September 2008 to February 2012. At the time of diagnosis of sporadic ALS, we carried out genetic and comprehensive neuropsychological tests on all patients, and collected demographic and clinical characteristics. Six cognitive domains, namely executive function, attention, language, calculation, visuospatial function and memory were evaluated. ANOVA and t-tests were used to assess differences in clinical characteristics and neuropsychological parameters between sporadic ALS patients. The Kaplan-Meier method and Cox proportional hazard model were used for survival analysis. Results One hundred and sixty-six patients were categorized into five subtypes: normal cognition (ALS pure), cognitive impairment (ALSci), behavioral impairment (ALSbi), frontotemporal dementia (ALS-FTD), and other types of dementia. Seventy patients (70/166, 42.2%) were cognitively or behaviorally impaired. Among the impaired patients, eight (8/166, 4.8%) had FTD-type dementia and one (1/166, 0.6%) was Alzheimer's disease-type. The ALS patients with cognitive impairment (ALSci) and with FTD (ALS-FTD) were more severely impaired in executive function, attention, language and memory than the cognitively intact ALS patients (ALS pure). In a survival analysis, ALSci (β = 1.925, p = 0.025) and ALS-FTD groups (β = 4.150, p = 0.019) tended to have shorter survival than the ALS pure group. Conclusions About half of ALS patients without known genetic variation have cognitive or behavioral impairment. ALS patients with cognitive abnormalities, especially FTD, have a poorer prognosis than those without cognitive impairment. In neuropsychological profiling, executive tasks were effective in identifying cognitive impairment in the ALS patients. It would be useful for clinicians to classify ALS according to neuropsychological profiles, and screen for subtle cognitive impairment.
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Osborne RA, Sekhon R, Johnston W, Kalra S. Screening for frontal lobe and general cognitive impairment in patients with amyotrophic lateral sclerosis. J Neurol Sci 2013; 336:191-6. [PMID: 24239183 DOI: 10.1016/j.jns.2013.10.038] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 09/30/2013] [Accepted: 10/22/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Cognitive impairment occurs in up to 50% of patients with amyotrophic lateral sclerosis (ALS). Simple tools are required to identify such individuals, as cognitive impairment adversely impacts quality of life and survival. Our objective was to determine the potential utility of the Frontal Assessment Battery (FAB) and the Montreal Cognitive Assessment (MoCA) in evaluating frontal lobe and general cognitive impairment, respectively. We also assessed the feasibility of screening for cognitive impairment in those patients with advanced physical disability by modifying selected FAB and MoCA subtasks. METHODS Fifty-four consecutive ALS patients were screened; 44 completed the FAB and 39 completed the MoCA. We administered modified tasks to patients with severe hand weakness or dysarthria. The patients were classified as cognitively impaired on each measure based on published cut-off scores of 14.11 on the FAB and 26 on the MoCA. RESULTS Twenty-one percent and 53% of patients were impaired on the FAB and the MoCA, respectively. Scores from patients receiving modified instructions did not differ from those completing standard versions. There were statistically significant correlations between the MoCA total scores and forced vital capacity (FVC) and ALSFRS-R scores. There was no correlation between these variables and the FAB. CONCLUSIONS Both the FAB and MoCA detected cognitive impairment in ALS patients. While the MoCA classified more patients as cognitively impaired than the FAB, the latter was more feasible for assessing patients with physical impairment. Simple task modifications proved effective in allowing patients with speech and motor impairments to undergo screening. Future studies are required to validate both measures, establish optimal cut-off scores, and validate modifications.
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Affiliation(s)
| | - Ramnik Sekhon
- Division of Neurology, Department of Medicine, University of Alberta, Canada
| | - Wendy Johnston
- Division of Neurology, Department of Medicine, University of Alberta, Canada
| | - Sanjay Kalra
- Centre for Neuroscience, University of Alberta, Canada; Division of Neurology, Department of Medicine, University of Alberta, Canada.
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Benke T, Karner E, Delazer M. FAB-D: German version of the Frontal Assessment Battery. J Neurol 2013; 260:2066-72. [PMID: 23649609 DOI: 10.1007/s00415-013-6929-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 04/03/2013] [Accepted: 04/15/2013] [Indexed: 12/13/2022]
Abstract
Executive dysfunction (ED) is a frequent consequence of neurological disorders, such as stroke, trauma or dementia, but also appears in normal aging. We developed a German version of the Frontal Assessment Battery (FAB-D), a short test which has previously been developed (Dubois et al., Neurology 55:1621-1626, 2000) to detect ED during bedside screening. A sample of 401 cognitively intact subjects aged 50-95 was tested with the FAB-D and several neuropsychological tests tapping executive functions, memory and calculation abilities. Aim of the study was to receive normative data for different age and educational groups, and to learn which tests predict performance on the FAB-D. We found clear effects of age and education; furthermore, FAB-D performance was predicted by other tests of executive functioning, but also by calculation and memory abilities. The present study reports data of healthy individuals and may be useful for comparing patients' performance with a normative sample.
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Affiliation(s)
- Thomas Benke
- Clinic of Neurology, Medical University, Anichstr. 35, 6020 Innsbruck, Austria.
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Abstract
OBJECTIVE Suicidal ideation and behavior have been associated with a variety of neurological illnesses. Studies are ongoing in combat veterans and other groups to examine possible mechanisms and pathways that account for such associations. METHOD This article provides a review of the literature on suicide ideation and suicidal behavior in patients with neurological illnesses including publications on veteran's health and military medicine. Studies of suicide attempts and deaths in people with neurological illnesses are also reviewed. RESULTS The studies summarized in this review indicate that there are important linkages between suicidal ideation and behavior and neurological conditions, including epilepsy, multiple sclerosis, and amyotrophic lateral sclerosis. CONCLUSION Additional studies are needed to further clarify why suicide ideation and suicidal behavior are associated with neurological diseases, in order to improve quality of life, alleviate patient distress, and prevent nonfatal and fatal suicide attempts in veteran and non-veteran populations.
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Affiliation(s)
- Steven S Coughlin
- Post-Deployment Health Epidemiology Program, Office of Public Health, Department of Veterans Affairs, Washington, DC, USA
| | - Leo Sher
- James J. Peters Veterans’ Affairs Medical Center, New York, USA
- Mount Sinai School of Medicine, New York, USA
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21
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Goldstein LH, Abrahams S. Changes in cognition and behaviour in amyotrophic lateral sclerosis: nature of impairment and implications for assessment. Lancet Neurol 2013; 12:368-80. [DOI: 10.1016/s1474-4422(13)70026-7] [Citation(s) in RCA: 258] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Raaphorst J, Beeldman E, Schmand B, Van Den Berg LH, De Visser M, De Haan RJ. Response to ‘Exploring limits of neuropsychological screening in ALS: The FAB problem’. Amyotroph Lateral Scler Frontotemporal Degener 2013; 14:159-60. [DOI: 10.3109/21678421.2012.747541] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Tremolizzo L, Ferrarese C, Appollonio I. Exploring limits of neuropsychological screening in ALS: The FAB problem. Amyotroph Lateral Scler Frontotemporal Degener 2013; 14:157-8. [DOI: 10.3109/21678421.2012.746990] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Ji Y, Wei L, Chui D, Wang K, Fan D. Prospective memory tasks: a more sensitive method for screening cognitive impairment in ALS? BMC Neurol 2012; 12:142. [PMID: 23171421 PMCID: PMC3551782 DOI: 10.1186/1471-2377-12-142] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 10/10/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cognitive change is prevalent in patients with amyotrophic lateral sclerosis (ALS), but still lack a widely accepted and sensitive screening method. In this study, we try to find a sensitive screening battery for detecting subtle cognitive deficits in patients with ALS. METHODS Eighty consecutive ALS patients and 57 matched normal controls underwent the Mini-Mental Status Examination (MMSE), the verbal fluency test (VFT), the Stroop Color Word Interference Test (CWT), and the prospective memory (PM) tests, including event-based (EBPM) and time-based (TBPM). RESULTS The patients did not differ from the controls in the MMSE, the VFT and the CWT. By contrast, statistically significant differences were found in the PM tests (EBPM: P=0.043; TBPM: P<0.001). More interestingly, TBPM was more sensitive than EBPM in the early-phase patients. CONCLUSIONS Prefrontal lobar dysfunction does exist among ALS patients and may spread from the medial to the lateral region. The PM tests seem more sensitive in ALS patients with frontotemporal dysfunction than are the classical cognitive measures.
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Affiliation(s)
- Ying Ji
- Department of Neurology, Peking University Third Hospital, Beijing, China
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Raaphorst J, Beeldman E, Jaeger B, Schmand B, van den Berg LH, Weikamp JG, Schelhaas HJ, de Visser M, de Haan RJ. Is the Frontal Assessment Battery reliable in ALS patients? Amyotroph Lateral Scler Frontotemporal Degener 2012; 14:73-4. [PMID: 22889176 DOI: 10.3109/17482968.2012.712974] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The assessment of frontal functions in ALS patients is important because of the overlap with the behavioural variant of frontotemporal dementia (bvFTD). We investigated the applicability and reliability of the Frontal Assessment Battery (FAB) within a cohort of predominantly prevalent ALS patients. The FAB was administered to 85 ALS patients and eight ALS-bvFTD patients. Original scores and the percentage of items that could be performed were recorded. Item-adjusted scores of the FAB were calculated. The ALS Functional Rating Scale-Revised version (ALSFRS-R) was used to assess disease severity. Eighty-seven patients (94%) had ALS symptoms of more than one year. Twenty patients (21.5%) were not able to perform one or more FAB items. The original FAB score correlated with the ALSFRS-R score (r = 0.30; p < 0.01), while the item-adjusted FAB score did not. In contrast to the original FAB scores, the item-adjusted FAB score was lower in ALS-bvFTD patients (66.7, range 33.3-100) compared to ALS patients without bvFTD (94.4, range 38.9-100; p < 0.01). In summary, 20% of prevalent ALS patients could not complete the FAB, which limits its use in ALS and emphasizes the importance of disease specific instruments and adjusting for motor impairment in cognitive and behavioural examinations of ALS patients.
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