Cognitive change in ALS - A prospective study
Cognitive change in ALS - A prospective study
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DOI：
10.1212/01.wnl.0000156519.41681.27
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发表时间：
2005-04-12
期刊：
影响因子：
9.9
通讯作者：
Goldstein, LH
中科院分区：
文献类型：
--
作者：
Abrahams, S;Leigh, PN;Goldstein, LH
目的：纵向研究肌萎缩侧索硬化（ALS）非痴呆患者的认知障碍特征。
方法：对20名ALS非痴呆患者和18名对照者在间隔6个月的两个时间点进行访谈。设计了一套广泛的测试组合以适应ALS患者存在的身体残疾范围，包括执行功能、记忆、语言、视觉空间功能、日常行为和情绪的测量。
结果：在一项简单单词提取测试（计算机化句子完成测试）中，随着时间推移，ALS患者变得更慢，而对照者用恰当单词完成句子的速度更快。当分析考虑到进行性言语残疾时，这种效应仍然存在。在两个时间点，ALS患者在书面和口头语言流畅性指标（想出每个单词的时间）上也都表现出损伤，但没有证据表明随着时间推移情况恶化。在轻微失误简短量表中，ALS患者的照顾者对患者日常行为中认知功能障碍的察觉增加，而对照者对其伴侣的评分降低。此外，与对照者相比，患者在第二次访谈时表现出更多的抑郁症状（尽管远低于临床水平）。在两个时间点，ALS患者也都表现出情绪不稳定，但这种情况没有随着时间推移而增加。
结论：ALS非痴呆患者的认知恶化是一个相对缓慢的过程。以语言流畅性缺陷形式出现的选择性认知障碍，很可能表明执行功能障碍，在疾病过程中相对较早出现，尽管随着疾病进展语言功能可能变得易受影响。
Objectives: To investigate longitudinally the profile of cognitive impairment in nondemented patients with ALS. Methods: Twenty nondemented patients with ALS and 18 controls were interviewed at two time points separated by a 6-month interval. The extensive battery was designed to accommodate the range of physical disability present in ALS, and included measures of executive, memory, language, and visuospatial functions, everyday behavior, and emotion. Results: On a test of simple word retrieval ( Computerised Sentence Completion Test) patients with ALS became slower over time, while controls became faster at completing sentences with appropriate words. This effect remained when the analysis accommodated for progressive speech disability. Patients with ALS also displayed an impairment in both written and spoken verbal fluency indices ( time to think of each word) at both time points, but there was no evidence of deterioration over time. On the Short Inventory of Minor Lapses, carers of patients with ALS displayed increased awareness of cognitive dysfunction in everyday behavior while controls' ratings of their partners decreased. In addition, patients displayed more depressive symptomology ( although well below clinical levels) on the second interview vs controls. Patients with ALS also displayed emotional lability at both time points, although this did not increase over time. Conclusions: Cognitive deterioration in nondemented patients with ALS is a relatively slow process. Selective cognitive impairment in the form of verbal fluency deficits, most likely indicating executive dysfunction, appears relatively early on in the course of the disease, although language functions may become vulnerable as the disease progresses.