Amyotrophic Lateral Sclerosis: Exploring the Impact of Bulbar Involvement on Cognitive Function

Published on July 20, 2023

In the world of Amyotrophic Lateral Sclerosis (ALS), scientists are delving into the relationship between bulbar involvement (BI) and cognitive impairment (CI). Imagine ALS as a complex recipe, with different ingredients affecting the final result. One ingredient in particular, BI, seems to be linked to executive impairment, while its severity may be associated with memory deficits. This retrospective study on 347 non-demented ALS patients used various measures to assess cognition and BI. Interestingly, BI at testing predicted a higher chance of abnormal performance on specific cognitive measures. Lower scores on the bulbar involvement scale were also found to be connected to memory issues. It’s fascinating how one aspect of ALS can impact different areas of cognitive function. If you’re curious to learn more about the connection between BI and CI in ALS, dive into the full research article!

BackgroundThis study aimed at clarifying the role of bulbar involvement (BI) as a risk factor for cognitive impairment (CI) in non-demented amyotrophic lateral sclerosis (ALS) patients.MethodsData on N = 347 patients were retrospectively collected. Cognition was assessed via the Edinburgh Cognitive and Behavioral ALS Screen (ECAS). On the basis of clinical records and ALS Functional Rating Scale-Revised (ALSFRS-R) scores, BI was characterized as follows: (1) BI at onset—from medical history; (2) BI at testing (an ALSFRS-R-Bulbar score ≤11); (3) dysarthria (a score ≤3 on item 1 of the ALSFRS-R); (4) severity of BI (the total score on the ALSFRS-R-Bulbar); and (5) progression rate of BI (computed as 12-ALSFRS-R-Bulbar/disease duration in months). Logistic regressions were run to predict a below- vs. above-cutoff performance on each ECAS measure based on BI-related features while accounting for sex, disease duration, severity and progression rate of respiratory and spinal involvement and ECAS response modality.ResultsNo predictors yielded significance either on the ECAS-Total and -ALS-non-specific or on ECAS-Language/-Fluency or -Visuospatial subscales. BI at testing predicted a higher probability of an abnormal performance on the ECAS-ALS-specific (p = 0.035) and ECAS-Executive Functioning (p = 0.018). Lower ALSFRS-R-Bulbar scores were associated with a defective performance on the ECAS-Memory (p = 0.025). No other BI-related features affected other ECAS performances.DiscussionIn ALS, the occurrence of BI itself, while neither its specific features nor its presence at onset, might selectively represent a risk factor for executive impairment, whilst its severity might be associated with memory deficits.

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