Fatigue in amyotrophic lateral sclerosis and correlated factors.

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.

ANTECEDENTES: Esclerose lateral amiotrófica (ELA) é uma doença neurodegenerativa fatal que leva à fraqueza muscular e paralisia. Fadiga é um sintoma incapacitante, frequentemente relatado na ELA, mas permanece pouco investigado nessa população. Assim, uma investigação acurada deste sintoma e dos possíveis fatores associados é necessária para auxiliar em uma abordagem terapêutica adequada. OBJETIVO: Investigar a presença de fadiga em indivíduos com ELA e possíveis fatores correlacionados a este sintoma. MéTODOS: Participaram 65 indivíduos com ELA esporádica. Aspectos demográficos, clínicos e funcionais foram investigados. Foram utilizadas: Escala de Severidade de Fadiga (FSS, na sigla em inglês), Escala Funcional de ELA (ALSRFS-R, na sigla em inglês) e questionário de Qualidade de Vida (QV) (ALSAQ-40, na sigla em inglês). Análises descritivas e de correlação foram realizadas no programa SPSS para Windows versão 19.0 (IBM Corp., Armonk, NY, USA). RESULTADOS: Dos 65 indivíduos avaliados, 44,6% (n = 29) apresentaram fadiga pela FSS. A intensidade da fadiga foi 5,4 ± 1,2 e apenas 10,4% usavam medicamento específico para fadiga. Diferenças entre os grupos com e sem fadiga foram encontradas em relação ao sexo (p = 0,049), intensidade da dor (p = 0,026), funcionalidade (p = 0,004), gravidade da doença (p = 0,029) e QV (p = 0,000). A fadiga foi correlacionada com a intensidade da dor (r = 0,425; p = 0,001), força muscular (r = - 0,356; p = 0,004), funcionalidade (r = - 0,363; p = 0,003) e QV (r = 0,481; p = 0,000). Não foram encontradas correlações com idade, tempo de diagnóstico, cãibras ou outros parâmetros de mobilidade. CONCLUSõES: A fadiga é um sintoma comum entre os indivíduos com ELA e pode estar presente em todos os estágios da doença. Este sintoma estava correlacionado à pior funcionalidade, pior QV, gravidade, intensidade da dor, fraqueza muscular e sexo feminino em indivíduos com ELA.

Fatigue in amyotrophic lateral sclerosis and correlated factors / Fadiga na esclerose lateral amiotrófica e fatores correlacionados

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.

Resumo Antecedentes Esclerose lateral amiotrófica (ELA) é uma doença neurodegenerativa fatal que leva à fraqueza muscular e paralisia. Fadiga é um sintoma incapacitante, frequentemente relatado na ELA, mas permanece pouco investigado nessa população. Assim, uma investigação acurada deste sintoma e dos possíveis fatores associados é necessária para auxiliar em uma abordagem terapêutica adequada. Objetivo Investigar a presença de fadiga em indivíduos com ELA e possíveis fatores correlacionados a este sintoma. Métodos Participaram 65 indivíduos com ELA esporádica. Aspectos demográficos, clínicos e funcionais foram investigados. Foram utilizadas: Escala de Severidade de Fadiga (FSS, na sigla em inglês), Escala Funcional de ELA (ALSRFS-R, na sigla em inglês) e questionário de Qualidade de Vida (QV) (ALSAQ-40, na sigla em inglês). Análises descritivas e de correlação foram realizadas no programa SPSS para Windows versão 19.0 (IBM Corp., Armonk, NY, USA). Resultados Dos 65 indivíduos avaliados, 44,6% (n = 29) apresentaram fadiga pela FSS. A intensidade da fadiga foi 5,4 ± 1,2 e apenas 10,4% usavam medicamento específico para fadiga. Diferenças entre os grupos com e sem fadiga foram encontradas em relação ao sexo (p = 0,049), intensidade da dor (p = 0,026), funcionalidade (p = 0,004), gravidade da doença (p = 0,029) e QV (p = 0,000). A fadiga foi correlacionada com a intensidade da dor (r = 0,425; p = 0,001), força muscular (r = - 0,356; p = 0,004), funcionalidade (r = - 0,363; p = 0,003) e QV (r = 0,481; p = 0,000). Não foram encontradas correlações com idade, tempo de diagnóstico, cãibras ou outros parâmetros de mobilidade. Conclusões A fadiga é um sintoma comum entre os indivíduos com ELA e pode estar presente em todos os estágios da doença. Este sintoma estava correlacionado à pior funcionalidade, pior QV, gravidade, intensidade da dor, fraqueza muscular e sexo feminino em indivíduos com ELA.

Quality of life, disability, and clinical variables in amyotrophic lateral sclerosis.

BACKGROUND: Amyotrophic lateral sclerosis (ALS) is a motor neuron disease that results in a progressive increase in dysfunctions, limitations and restrictions over time, which can impact on quality of life (QoL). Therefore, expanding knowledge on QoL and possible factors associated with ALS can enable the development of actions to ensure greater wellbeing for the population. OBJECTIVE: To investigate QoL in ALS and determine associations with demographic, functional and clinical aspects. METHODS: Forty-five individuals with ALS (56.4±11.1 years) participated in the study. Demographic, clinical and functional aspects were investigated. Functioning and QoL were assessed using disease-specific tools (ALS Functional Ranting Scale-Revised/ALSFRS-R and ALS Assessment Questionnaire/ALSAQ-40). Fatigue was assessed using the Fatigue Severity Scale. Descriptive, correlation and stepwise multiple linear regression analyses were performed with the aid of the SPSS. RESULTS: The mean ALSAQ-40 score was 279.0±118.3. QoL was significantly worse among women (p=0.001) and poor QoL was associated with the inability to walk (p=0.014), pain (p=0.021) and disease severity (p≤0.002). QoL was strongly correlated with the ALSFRS-R score (r=-0.82). Moderate to weak correlations were found for mobility [turning in bed (r=-0.62), locomotion (r=-0.33) and sit to stand (r=-0.40)], strength (r=-0.49), fatigue (r=0.35) and pain (r=-0.32) (p<0.03). The regression analysis revealed that the ALSFRS-R score (ß=-0.76; p=0.00) and fatigue (ß=0.20; p=0.04) were predictors of QoL. CONCLUSIONS: QoL was worse in women, older people, severe stages of ALS, patients with impaired mobility, those with a poorer physical performance and those who reported pain. Functional status and fatigue are predictors of QoL in ALS.

Cognitive impairment in migraine: a systematic review / Alterações cognitivas migrânea: uma revisão sistemática

Patients with migraine of ten report cognitive complaints, especially regarding attention and memory. Objective:To perform a systematic review of the studies available on cognitive evaluation in patients with migraine. Methods: Weevaluated all articles containing the key words: Migraine, Cognition and Cognitive Impairment. Results: The searchstrategy resulted in 23 articles. Fifteen out of the 23 studies (65.3%) retrieved reported abnormalities on neuropsychologicaltests in migraine patients, notably tests of memory, attention and information processing speed. Most of the studies showingcognitive changes in migraine were carried out in neurological care facilities. Conversely, among community-based studies,migraine patients were less likely to present cognitive changes. Conclusion: Patients with migraine, especially those followedat neurology clinics, show an elevated risk of mild changes in several cognitive domains. Further studies with greatermethodological refinement are warranted in order to clearly establish whether this cognitive dysfunction is associated withan underlying migraine pathophysiological process.

Pacientes com migrânea frequentemente se queixam de problemas cognitivos, sobretudo relacionados à memóriae à atenção. Objetivo: Realizar uma revisão sistemática sobre os estudos com avaliação cognitiva em pacientes commigrânea. Métodos: Foram avaliados todos os artigos que incluíram as palavras-chave Migraine, Cognition and Cognitive Impairment. Resultados: Foram encontrados 23 artigos que estudaram desempenho cognitivo em pacientescom migrânea. Dentre estes, quinze (65,3%) relataram alterações em testes neuropsicológicos em pacientes com migrânea,notadamente em testes de memória, atenção e velocidade de processamento. A maioria dos trabalhos que mostraramalterações cognitivas na migrânea foi realizada em serviços neurológicos. Por outro lado, nos estudos de base populacional,essas alterações eram menos comuns. Conclusão: Pacientes com migrânea, especialmente os acompanhados em serviçosneurológicos, apresentam risco aumentado de comprometimento leve em diferentes domínios cognitivos. Estudos commaior refinamento metodológico são necessários para definir claramente se essas alterações cognitivas estão associadasa processo fisiopatológico subjacente à migrânea.