Article

Prospective memory tasks: a more sensitive method for screening cognitive impairment in ALS?

BMC Neurology (Impact Factor: 2.49). 11/2012; 12(1):142. DOI: 10.1186/1471-2377-12-142
Source: PubMed

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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    ABSTRACT: Amyotrophic lateral sclerosis (ALS) is a predominantly motor disease that can be associated in half the patients with a cognitive and/or behavioral impairment. Cognitive/behavioral disorders are subclinical in most cases and need specific testing to be diagnosed. They can meet the diagnostic criteria of FTLD in 10-15 % of patients. The occurrence of cognitive/behavioral changes in patients with ALS is taken as evidence of a continuum between ALS and fronto-temporal dementias. The cognitive changes mostly involve executive functions, language and social cognition. Behavioral changes include apathy, disinhibition, lack of empathy and impulsivity. Cognitive/behavioral changes in the course of ALS are related to a shorter survival. Cognitive/behavioral changes may interfere with decision making, particularly end-of-life decisions, and they increase the burden of carers. Cognitive/behavioral changes should be recognized and assessed so as to tailor therapeutic interventions.
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