Abstract Details

Title High Rates of Cognitive and Behavioral Impairment in a Large Prospective ALS Study

Topic Anterior Horn

Presentation(s) P07 - (-)

Poster/Presentation
Number 063

Objective

Background BACKGROUND: Patients with ALS develop frontotemporal dementia (FTD), more subtle cognitive impairment (ALSci) and behavioral impairment (ALSbi). To recognize this extramotoneuronal involvement is essential to understand the pathogenesis of ALS.

Design/Methods DESIGN/METHODS: 217 patients with confirmed ALS were administered three well-recognized screening cognitive-behavioral measures: the ALS-Cognitive Behavioral Screen (ALS-CBS), Frontal Behavioral Inventory-ALS version, and the Abrahams Written Fluency Test. Cognitive and behavioral impairment was defined using the ALS-CBS, based on Woolley et al. 2010 and the UCSF criteria.

Results RESULTS: The sample was 42.9% female, with a mean age of 60.9 (SD=9.9), mean education of 15.0 years (SD=3.0), mean FVC of 79.7 (SD=22.1) and mean ALSFRS-R of 36.3 (SD=6.3). 9.8% of the sample met criteria for FTD with cognitive impairment, and 18.4% of the sample met criteria for FTD with behavioral impairment. An additional 64.4% and 13.4% met ALSci and ALSbi criteria, respectively. Increased levels of frontotemporal impairment were associated with more bulbar involvement, lower income, and lower education. Illness duration, age, and smoking history were uncorrelated with cognitive and behavioral performance, with the exception of advancing age correlating with cognitive impairment. ALS FRS-R was unassociated with cognitive performance but associated with behavioral changes. FVC was associated with verbal fluency score and ALS-CBS cognitive score. PBA levels correlated with behavioral impairment. Patients had greater negative symptoms such as apathy, and fewer symptoms of disinhibition.

Conclusions CONCLUSIONS: Approximately 10-15% of patients met FTD criteria, with larger proportions of patients meeting criteria for ALSci and ALSbi. Behavioral impairment correlated with more bulbar dysfunction, PBA, and lower socioeconomic status. Longitudinal data are being collected to determine if frontotemporal impairment is a continuum of extraneuronal involvement in ALS.

Authors/Disclosures
Jennifer M. Murphy, PhD (UCSF, Neurology) PRESENTER	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Susan Woolley Levine, PhD	No disclosure on file
Catherine Lomen-Hoerth, MD, PhD, FAAN (UCSF)	Dr. Lomen-Hoerth has nothing to disclose.
Hiroshi Mitsumoto, MD, FAAN (Neurological Institute (NI-9))	Dr. Mitsumoto has nothing to disclose.
Henry L. Paulson, MD, PhD, FAAN (University of Michigan)	Dr. Paulson has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Exicure. The institution of Dr. Paulson has received research support from National Institutes of Health. Dr. Paulson has a non-compensated relationship as a Member, Nominating committee with American Neurological Association that is relevant to AAN interests or activities.

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