Alteration of interoceptive sensitivity: expanding the spectrum of behavioural disorders in amyotrophic lateral sclerosis

Abstract

Background Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder with progressive loss of upper and lower motor neurons. Non-motor-symptoms, such as cognitive, emotional, autonomic, and somatosensory alterations, have been also described. Interoception represents the link between the body and brain, since it refers to the ability to consciously perceive the physical condition of the inner body, including one’s heartbeat (i.e., interoceptive sensitivity, IS). Objectives To evaluate IS in ALS patients by means of a well-established task: the heartbeat perception task. Moreover, we evaluated possible correlations between IS and neuropsychological, affective, and disease-related characteristics. Methods Fifty-five ALS patients (mean-age = 60.3 ± 12.5 years; mean disease-duration = 20.9 ± 18.8 months) and 41 caregivers (CG) underwent the heartbeat perception task and an extensive evaluation of motor, cognitive, body awareness, affective, and emotion domains. Results ALS patients showed lower IS than CG (0.68 ± 0.24 vs 0.82 ± 0.16; p = 0.003). Significant correlations were found between IS and self-reported measures of alexithymia (subscale of Toronto Alexithymia scale-20 “difficulties in describing feelings”; rho = − .391, p = .003) and interoceptive awareness (subscale of Multidimensional assessment of interoceptive awareness “not worrying about pain”; rho = .405, p = .002). No significant differences were found on questionnaires for depression and anxiety between patients with ALS and their caregivers (p > .05). Conclusions ALS patients show reduced interoceptive sensitivity that is associated with poorer ability to describe feelings and with lower focalization on pain, regardless of cognitive and motor impairment. Alteration of interoception may represent a specific behavioural sign within the spectrum of emotion processing deficits described in ALS patients.

Autonomic dysfunction is associated with disease progression and survival in amyotrophic lateral sclerosis: a prospective longitudinal cohort study

“…Lastly, neuropsychological tests were performed to classify patients according to consensus criteria [ 21 ] as having “normal cognition” (i.e., ALS-nc) or “cognitive and/or behavioral impairment” (i.e., ALS with cognitive impairment, ALS-ci; ALS with combined cognitive and behavioral impairment, ALS-cbi; ALS with behavioral impairment, ALS-bi) [ 22 , 23 ]. A detailed neuropsychological battery has been described elsewhere [ 24 , 25 ].…”

Circulating endocannabinoidome signatures of disease activity in amyotrophic lateral sclerosis.

“…Lastly, neuropsychological tests were performed to classify patients according to consensus criteria 25 as having "normal cognition" (i.e., ALS-nc) or "cognitive and/or behavioural impairment" (i.e., ALS with cognitive impairment, ALS-ci; ALS with combined cognitive and behavioural impairment, ALS-cbi; ALS with behavioural impairment, ALS-bi) 22 . A detailed neuropsychological battery has been described elsewhere 22,26 . We excluded participants if they had (1) acute or chronic infections or autoimmune disorders; (2) kidney or chronic liver diseases or regular alcohol intake (over 80 g/day for 6 months).…”

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“…The cognitive impairment can lead to the increased variability in gait parameters and a higher risk of falls ( 86 ). The behavioral disturbances may result in the refusal of necessary therapeutic interventions in the advanced stages of ALS, such as tracheostomy or PEG tube placement ( 87 ). ALS patients with executive dysfunction have a worse prognosis, and the behavioral changes have a negative impact on the carer quality of life ( 88 , 89 ).…”