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BRIEF COMMUNICATIONS: Jau-Shin Lou, Alexa Reeves, Theodore Benice, and Gary Sexton Fatigue and depression are associated with poor quality of life in ALS Neurology 2003; 60: 122-123 [Abstract] [Full text] [PDF]

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Fatigue and depression are associated with poor quality of life in ALS

Kazuo Abe, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Japan   (18 November 2003)

Reply to Abe

Jau-Shin Lou   (18 November 2003)

Reply to Letter to the Editor

Jau-Shin Lou, Theodore Benice   (9 April 2003)

Fatigue and depression are associated with poor quality of life in ALS

Yasuo Iwasaki, Hiroaki Iguchi, Yasumitsu Ichikawa, Osamu Igarashi, Joe Aoyagi, and Shingo Konno   (9 April 2003)

Fatigue and depression are associated with poor quality of life in ALS 18 November 2003
Kazuo Abe, MD, PhD D-4, Department of Neurology,, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Japan Send Correspondence to journal: Re: Fatigue and depression are associated with poor quality of life in ALS abe{at}neurol.med.osaka-u.ac.jp Kazuo Abe, et al.	We read with interest the paper by Lou et al. [1] discussing fatigue in ALS. Fatigue in various types of neurological diseases is well known. Friedman originally reported fatigue in Parkinson's disease and defined central fatigue to be distinguished physical fatigue. [2] We also studied fatigue in PD and raised the possible connection to frontal lobe dysfunction. [3] ALS, as we reported before [4], can be divided into some groups regarding frontal lobe dysfunction. We investigated the relationship between fatigue in ALS and frontal lobe dysfunction. To test this hypothesis, we compared severity of fatigue among three ALS patients with and without frontal lobe dysfunction. Consequently, we found ALS patients with frontal lobe dysfunction tended to have greater fatigue compared to ALS patients without frontal lobe dysfunction. Further investigation with large number of ALS patients may be needed. However, we believe that fatigue in ALS patients have some degree of fontal lobe dysfunction. References 1. Lou J-S, Reeves A, Benice T, Sexton G. Fatigue and depression are associated with poor quality of life in ALS. Neurology 2003;60:122-123. 2. Friedman J, Friedman H. Fatigue in ParkinsonÕs disease. Neurology 1993; 43: 2016-2018. 3. Abe K, Takanashi M, Yanagihara T. Fatigue in patients with Parkinson's disease. Behavioural Neurology 12(3);103- 106,2000. 4. Abe K, Fujimura H, Toyooka K, T Hazama, Hirono N, Yorifuji S, Yanagihara T. Single photon emission tomographic investigation of patients with motor neuron disease. Neurology 43(8): 1569-1573, 1993.
Reply to Abe 18 November 2003
Jau-Shin Lou, Oregon Health & Science University Department of Neurology, 3181 SW Sam Jackson's Park Rd, CR120, Portland, OR 97239 Send Correspondence to journal: Re: Reply to Abe Louja{at}ohsu.edu Jau-Shin Lou	We thank Dr. Abe for his interest in our article on fatigue and depression in ALS. [1] They correctly pointed out that fatigue in various neurological diseases has been examined. Our group has also used the Multidimentional Fatigue Inventory (MFI) to examine fatigue in PD. [2] We have demonstrated that fatigue in ALS patients is different from the fatigue reported in PD patients. PD patients, but not ALS patients, reported more mental fatigue than normal controls. We suggested that PD patients might have more cognitive dysfunctions, which could cause mental fatigue. We are very interested in Abe's hypothesis that fatigue in ALS may be related to the frontal lobe dysfunction. A recent study showed that half of the ALS patients have frontal executive deficit. [3] Abe's preliminary data in three ALS patients suggest that ALS patients with frontal lobe dysfunction have more fatigue than those without frontal lobe dysfunction. However, Abe did not mention if ALS patients with frontal lobe dysfunction reported more physical fatigue or mental fatigue. It will be interesting to study if ALS patients with frontal lobe dysfunction report more physical fatigue or mental fatigue compared with ALS patients without frontal lobe dysfunction. References. 1. Lou J-S, Reeves A, Benice T, Sexton G. Fatigue and depression are associated with poor quality of life in ALS. Neurology 2003;60:122- 123. 2. Lou JS, Kearns G, Oken B, Sexton G, and Nutt J. Exacerbated physical fatigue and mental fatigue in Parkinson’s disease. Movement Disorders, 2001,16:190-196. 3. Loemen-Hoerth C, Murphy J, Langmore S, Kramer JH, Olney RK and Miller B. Are amyotrophic lateral sclerosis patients congnitively normal? Neurology 2003;60:1094-1097.
Reply to Letter to the Editor 9 April 2003
Jau-Shin Lou Oregon Health & Science University Portland OR, Theodore Benice Send Correspondence to journal: Re: Reply to Letter to the Editor Louja{at}ohsu.edu Jau-Shin Lou, et al.	We appreciate Iasaki et al. interest in our article on depression and fatigue in ALS patients. [1] We agree that depression may affect the psychological status and survival. [2] Our study was cross-sectional and did not examine the correlation between the Scores in MFI and survival. We have reported that the disease severity as measured by ALSFR did not correlate with the scores in MFI. Iasake et al. do not agree with our statement in the discussion stating that QOL initially worsens and improves subsequently with time because patients adapt and regain hope for their lives. They stated that base on their experience; "mentality well- being ALS patients" keep high QOL, which is not related to clinical stages. A longitudinal study to compare how QOL changes as ALS progresses is needed to address this issue. References: 1. Lou J-S, Reeves A, Bvenice T, Sexton G. Fatigue and depression are associated with poor quality of life in ALS. Neurology 2003;60:122-123. 2. McDonald ER,Wiendenfeld SA, Hillel A, et al. Survival in amyotrophic lateral sclerosis. The role of psychological factors. Arch Neurol 1994;51:17-23
Fatigue and depression are associated with poor quality of life in ALS 9 April 2003
Yasuo Iwasaki Toho University Ohashi Hospital Tokyo Japan, Hiroaki Iguchi, Yasumitsu Ichikawa, Osamu Igarashi, Joe Aoyagi, and Shingo Konno Send Correspondence to journal: Re: Fatigue and depression are associated with poor quality of life in ALS yaso{at}med.toho-u.ac.jp Yasuo Iwasaki, et al.	We read with interest the report by Lou et al. showing fatigue state in ALS. [1] The authors reported ALS patients scored high overall on the multidimensional fatigue inventory (MFI). In addition, generalized and physical figures scored higher on ALS than controls. In their study, forty -four percent of ALS patients had depression. In our experience, about a half of ALS cases exhibited depression. Depressive state and psychological state may influence the survival span in ALS, and psychological well-being ALS patients prolong the survival. [2] It is interesting to know whether there are any differences in the survival span between higher and lower scores of MFI in ALS patients. ALS is characterized clinically by upper and lower motor neuron dysfunction, and bulbar involvement, and is there any correlation between clinical dysfunction and scores of MFI. In our experience in limited numbers of ALS cases, depressive state exhibited remarkably in cases with upper motor neuron involvement. The authors state the quality of life (QOL) initially worsens with the diagnosis and improves subsequently with time because patients adapt and regain hope for their lives. However we can not agree with these statements. Our experience concerning ALS cares, mentality well being ALS patients keeps high QOL with remarkable disables state, which is not related to clinical stage. In the view of QOL, there is a great discrepancy between patients and their caregivers. Improving the QOL for caregivers is crucial point. We agree their comment that amantadine is effective in reducing fatigue in multiple sclerosis and being tested in ALS. [3] Amantadine is a NMDA blocker and NMDA, an excitatory amino acid, may involve the pathological mechanism of ALS. In this view amantadine may be effective in mental fatigue and retard the disease process in ALS. References: 1. Lou J-S, Reeves A, Benice T, Sexton G. Fatigue and depression are associated with poor quality of life in ALS. Neurology 2003;60:122-123. 2. McDonald ER, Wiendenfeld SA, Hillel A, et al. Survival in amyotrophic lateral sclerosis. The role of psychological factors. Arch Neurol 1994;51:17-23 3. Canadian MS research Group. A randomized trial of amantadine in fatigue associated with multiple sclerosis. Can J Neurol Sci 1987;272-278.