Psychiatric Symptoms in Amyotrophic Lateral Sclerosis: Beyond a Motor Neuron Disorder, Zucchi/Ticozzi/Mandrioli, 2019

Psychiatric Symptoms in Amyotrophic Lateral Sclerosis: Beyond a Motor Neuron Disorder

Elisabetta Zucchi, Nicola Ticozzi and Jessica Mandrioli

Abstract

The historical view that Amyotrophic Lateral Sclerosis (ALS) as a pure motor disorder has been increasingly challenged by the discovery of cognitive and behavioral changes in the spectrum of Frontotemporal Dementia (FTD). Less recognized and still significant comorbidities that ALS patients may present are prior or concomitant psychiatric illness, such as psychosis and schizophrenia, or mood disorders. These non-motor symptoms disturbances have a close time relationship with disease onset, may constitute part of a larger framework of network disruption in motor neuron disorders, and may impact ALS patients and families, with regards to ethical choices and end-of-life decisions. This review aims at identifying the most common psychiatric alterations related to ALS and its prognosis, looking at a common genetic background and shared structural brain pathology.


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6421303/

Comment:
There is a genetic component to a forms of ALS which is also associated with not only a form of dementia, but can also cause forms of psychosis. This is a case where physical and psychiatric symptoms can have the same underlying physical cause, but patients who experience the psychosis symptoms first often have their symptoms ignored or dismissed as FND until the nerve degeneration gets so bad that neurologists can no longer deny that there is something wrong with their nerves.

 

There are different forms of MND (ALS), many years ago I remember working with some one with a stereotypical form with relatively slow progression and no cognitive impairment when a near relative was also diagnosed. The family felt really confident that they knew what to expect and that they could successfully deal with this new situation. Unfortunately the relative had a form with a much more rapid progression and an associated dementia. This left them all devastated.

 

I have only met one person with MS dementia but it does happen. It makes sense that anything that affects neurons will affect the brain.

 

Yay, nice to see people addressing the dangers of overuse of the assumption that unusual symptoms = FND = a psychological problem.

 

Agreed.