Magazine article Clinical Psychiatry News

Cognition Impaired in 30% with ALS: A Small Study of Patients with Classic Amyotrophic Lateral Sclerosis Found Cognitive Impairment in 30% of the Patients and Dementia in 23%

Magazine article Clinical Psychiatry News

Cognition Impaired in 30% with ALS: A Small Study of Patients with Classic Amyotrophic Lateral Sclerosis Found Cognitive Impairment in 30% of the Patients and Dementia in 23%

Article excerpt

Cognitive impairment was found in 30% of patients with amyotrophic lateral sclerosis in a study designed to assess the prevalence of cognitive involvement in what used to be considered a disease restricted to the motor system, according to Dr. Gregory A. Rippon and his associates.

In an editorial comment accompanying this report, Dr. Michael J. Strong of the University of Western Ontario, London, said that the 30% prevalence of dementia found in this study may actually underestimate the prevalence in the general population.

These subjects were evaluated "long before the institution of detailed tests of frontotemporal lobe dysfunction," which would likely have detected dementia in more of them. Moreover, subjects with a family history of neurodegenerative diseases were excluded from this study, which again may have led to an underrepresentation of dementia cases, he said.

Dr. Rippon agreed that estimates must be considered unreliable at best, since the studies from which they were derived were flawed by small sample sizes, selection bias, widely varying definitions of cognitive impairment, and very different methods for assessing cognition.

As ALS is increasingly recognized as a multisystem neurodegenerative disorder, researchers have revised their estimates of cognitive involvement from 2% up to as much as 52%.

In what Dr. Rippon and his associates at Columbia University College of Physicians and Surgeons, New York, described as one of the largest studies of the issue to date, the researchers assessed 40 consecutively treated patients with classic ALS seen in a 1-year period at the university's Neurological Institute. These patients, along with 80 control subjects matched for age, sex, and education level, underwent a battery of neuropsychologic tests that evaluated learning and memory, executive function, attention and psychomotor speed, language, and visuospatial ability. …

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