Fatigue in amyotrophic lateral sclerosis and correlated factors

Abstract

Background Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease that leads to muscle weakness and paralysis. Fatigue is a disabling symptom, frequently reported in ALS, but remains under-investigated in this population. Thus, an accurate investigation of this symptom and possible associated factors in this clinical condition is needed to assist in the establishment of an adequate treatment approach. Objective To investigate the presence of fatigue in individuals with ALS and possible factors correlated with this symptom. Methods Sixty-five individuals with sporadic ALS participated in the present study. Demographic, clinical, and functional aspects were investigated. Evaluations involved the Fatigue Severity Scale (FSS), ALS Functional Scale (ALSRFS-R), and Quality of Life (QoL) questionnaire (ALSAQ-40). Descriptive and correlation analyses were performed with SPSS statistical program for Windows version 19.0 (IBM Corp., Armonk, NY, USA). Results Among the 65 individuals evaluated, 44.6% (n = 29) presented fatigue based on the FSS. The mean fatigue intensity was 5.4 ± 1.2 and only 10.4% used a specific medication for fatigue. Differences between the groups with and without fatigue were found regarding sex (p = 0.049), pain intensity (p = 0.026), functioning (p = 0.004), disease severity (p = 0.029), and QoL (p = 0.000). Fatigue was correlated with pain intensity (r = 0.425; p = 0.001), muscle strength (r = - 0.356; p = 0.004), functioning (r = - 0.363; p = 0.003), and QoL (r = 0.481; p = 0.000). No correlations were found with age, time since diagnosis, cramps, or other mobility parameters. Conclusions Fatigue is a common symptom among individuals with ALS and may be present in all stages of the disease. This symptom was correlated with worse functioning, poorer QoL, greater pain intensity, disease severity, muscle weakness, and the female sex in individuals with ALS.

Prevalence and correlates of fatigue in amyotrophic lateral sclerosis: A systematic review and meta-analysis

“…As shown in Table 3 , fatigue was associated with lower functional status and poorer quality of life (QoL) and well-being of patients with ALS across the included studies. Four studies reported a negative correlation between fatigue and ALSFRS-R [ 9 , 37 , 40 , 41 ], while two studies found a positive correlation between fatigue and depression [ 9 , 40 ]. Furthermore, our meta-regression confirmed the negative association between fatigue and ALSFRS-R mean ( P = 0.02), as shown in Fig.…”

“…Furthermore, our analysis revealed a significant association between lower ALSFRS-R scores and fatigue in ALS patients. This association may be attributed to less functionality, lower QoL, higher levels of pain, more advanced disease progression, and more pronounced muscle weakness, as discussed in the study conducted by Alencar et al [ 37 ].…”

Non-motor symptoms in patients with amyotrophic lateral sclerosis: current state and future directions

“…Fatigue is a largely overlooked clinical concern in ALS, often evading the notice of healthcare professionals who provide care for individuals with ALS. Nonetheless, it is very important to assess this non-motor symptom in ALS patients, since it can seriously lower the QoL of the patients [115][116][117]. In ALS, both central and peripheral fatigue play a significant role.…”

“…Fatigue exhibits a negative association with the ALSFRS-R score [115,[120][121][122][123]. Hamad et al proposed that this correlation may be attributed to reduced functionality, diminished QoL, higher pain levels, advanced disease progression, and muscle weakness [119].…”

“…Hamad et al proposed that this correlation may be attributed to reduced functionality, diminished QoL, higher pain levels, advanced disease progression, and muscle weakness [119]. Moreover, various studies have revealed a negative correlation between fatigue and QoL [115][116][117], forced vital capacity [121] and sleep quality [121]. On the other side, a positive association has been observed between fatigue and pain [16,115], sleepiness [120,121] and depression [121,122].…”