Apathy, Depression, and Emotional Lability in Patients with Amyotrophic Lateral Sclerosis

The presence of cognitive and behavioral impairment in some patients with amyotrophic lateral sclerosis (ALS) is now well-known. However, the prevalence of behavioral impairment and the relationship between behavioral and cognitive impairment in ALS is not fully understood. This study is the first to examine systematically cognitive profiles associated with apathy, depression, and emotional lability (EL) in patients with ALS. Participants were 161 consecutive referrals to the Neurology service of the Houston Methodist Hospital MDA-ALS clinic. All patients met El Escorial World Federation of Neurology diagnostic criteria for probable or definite ALS. All participants underwent comprehensive neuropsychological evaluation, including measures of cognition, mood, and behavior. Multiple hierarchical regression analyses were used to predict performance on neuropsychological measures from apathy, depression, and emotional lability. Of the 161 patients, 24.8% were diagnosed with EL and 18.6% met criteria for DSM-IV-TR diagnosis of a mood disorder (including 9.9% with a Major Depressive Disorder (MDD) or Dysthymia and 8.7% with an adjustment disorder). Of the 117 with complete apathy data, 32.5% met criteria for clinically significant apathy. Approximately 22% of patients were experiencing two or more of these neuropsychiatric disorders. After controlling for disease severity, apathy accounted for significant variance in predicting performance on a measure of mental flexibility, over and above depression and emotional lability. Neither MDD nor EL significantly predicted performance on any neuropsychological measure. Results suggested that apathy, depression, and emotional lability co-occur, but are dissociable in ALS. After controlling for disease severity, only apathy was associated with executive functioning.

Name thesis:degree_name

Doctor of Philosophy

Level thesis:degree_level

Doctoral

Discipline thesis:degree_discipline

Psychology, Clinical

Grantor

University of Houston

Year dc:date.issued

2014

Author dc:creator

• Havins, Whitney

Advisors dc:contributor.advisor

• Massman, Paul J.
• Dulay, Mario F., Jr.

Committee members dc:contributor.committeemember

• Hiscock, Merrill
• Bradshaw, Major R.

• Amyotrophic lateral sclerosis
• Apathy
• Depression
• Emotional lability
• Cognition

Statement dc:rights

• The author of this work is the copyright owner. UH Libraries and the Texas Digital Library have their permission to store and provide access to this work. Further transmission, reproduction, or presentation of this work is prohibited except with permission of the author(s).

Language dc:language.iso

eng

Handle dc:identifier.uri

http://hdl.handle.net/10657/871

OAI identifier oai:identifier

oai:uh-ir.tdl.org:10657/871