Cognitive impairment, behavioral impairment, depression, and wish to die in an ALS cohort

Abstract

Objective: To evaluate relationships among cognitive, behavioral, and psychiatric/psychosocial measures assessed in a multicenter cohort of patients with amyotrophic lateral sclerosis (ALS). Methods:Recently diagnosed patients with definite or probable ALS diagnosis were administered 7 standardized psychiatric/psychosocial measures, including the Patient Health Questionnaire for diagnosis of depression and elicitation of wish to die. The Cognitive Behavioral Screen was used to classify both cognitive and behavioral impairment (emotional-interpersonal function). An ALS version of the Frontal Behavioral Inventory and Mini-Mental State Examination were also administered.Results: Of 247 patients included, 79 patients (32%) had neither cognitive nor behavioral impairment, 100 (40%) had cognitive impairment, 23 (9%) had behavioral impairment, and 45 (18%) had comorbid cognitive and behavioral decline. Cognitive impairment, when present, was in the mild range for 90% and severe for 10%. Thirty-one patients (12%) had a major or minor depressive disorder (DSM-IV criteria). Cognitive impairment was unrelated to all psychiatric/psychosocial measures. In contrast, patients with behavioral impairment reported more depressive symptoms, greater hopelessness, negative mood, and more negative feedback from spouse or caregiver. A wish to die was unrelated to either cognitive or behavioral impairment.Conclusions: While we found no association between cognitive impairment and depression or any measure of distress, behavioral impairment was strongly associated with depressive symptoms and diagnoses although seldom addressed by clinicians. Thoughts about ending life were unrelated to either cognitive or behavioral changes, a finding useful to consider in the context of policy debate about physician-assisted death.

Neurochemicals, Behaviours and Psychiatric Perspectives of Neurological Diseases

“…Rabkin et al [222] clearly indicated that the degree of depression and the wish to die are directly dependent upon the presence or absence, and severity of behavioural and cognitive impairment of the patients [222]. Therefore, patients exhibiting early symptoms of ALS must be screened for dementia and depression for designing proper treatment regime.…”

“…Clinical studies on BD subjects revealed that only 48% chances of complete recovery with 24% chances of functional restoration are possible [228,230]. Studies also indicated that the after effects of manic episodes can be witnessed even at workplace, home and surroundings even after five years [222]. Elevated creativity and productivity was also observed in several BD patients.…”

Depression and risk of cognitive dysfunctions in amyotrophic lateral sclerosis

“…Contrary to what was believed in the past, ALS is not only a motor disorder. Indeed, more than 50% of patients also have cognitive dysfunctions over the disease course, in terms of changes in executive and language functions, behavior, social cognition, memory, and sometimes with the appearance of neuropsychiatric symptoms . According to the literature, roughly 30%‐40% of patients have only cognitive impairment, 10% have only behavioral impairment, and 15%‐20% show clear frontotemporal dementia (FTD), according to the revised diagnostic criteria by Strong .…”

“…It is noted that patients with ALS have a prevalence of depressive disorders higher than healthy subjects, but lower than patients with a variety of other medical and neurological conditions, such as multiple sclerosis, Parkinson's disease, and Alzheimer's disease . The percentage of mood disorders in ALS is variable in different studies, from about 10%‐30%, depending on differing measurements of depression (both in terms of semi‐structured interview and in terms of self‐reported scales, eg, Structured Clinical Interview for DSM‐5, Patient Health Questionnaire, ALS Depression Inventory). However, major depression is uncommon .…”

“…The percentage of mood disorders in ALS is variable in different studies, from about 10%‐30%, depending on differing measurements of depression (both in terms of semi‐structured interview and in terms of self‐reported scales, eg, Structured Clinical Interview for DSM‐5, Patient Health Questionnaire, ALS Depression Inventory). However, major depression is uncommon . To date, only few studies pay close attention to the incidence of depression in the ALS population before diagnosis: A study published by Roos in 2016 describes incidence of depression prior to diagnosis, observing a higher risk of depression diagnosis, and use of antidepressant drugs both before and after diagnosis .…”