title: Prevalence and prognostic impact of comorbidities in amyotrophic lateral sclerosis.
abstract: OBJECTIVE
  Amyotrophic lateral sclerosis (ALS) is characterized by rapidly progressive paralysis of striated muscles due to the loss of upper and lower motor neurons. The disease leads to death within 2-5 years, mainly due to respiratory failure. The pathogenesis of ALS is still unexplained for the most part. In this study, we aimed to determine the prevalence of different cardiovascular, metabolic, and neuropsychiatric comorbidities in a large ALS cohort and to evaluate their influence on the disease course.
  
  
  METHODS
  A cohort of 514 patients with ALS of our ALS outpatient clinic was investigated retrospectively with reference to known prognostic factors and comorbidities. The prevalence of concomitant diseases was compared with the data from the German general population. Uni- and multivariate survival analyses were performed using the Cox proportional hazards model and Kaplan-Meier analysis.
  
  
  RESULTS
  The prevalence of cardiovascular diseases and cardiovascular risk factors was significantly lower in patients with ALS compared to the German general population, whilst the prevalence of dementia, parkinsonism, and depressive symptoms was significantly higher in the ALS cohort. None of the investigated comorbidities had an influence on the disease course or on the survival of patients.
  
  
  CONCLUSIONS
  Persons with cardiovascular diseases or risk factors seem to be at lower risk of ALS. Although these diseases are apparently somehow protective regarding ALS susceptibility, their presence did not modify disease progression and survival in patients with ALS. Our study further confirms the well-known continuum between ALS and dementia. It also suggests a link with other neurodegenerative diseases such as Parkinson's disease.
authors.affiliation: Department of Neurology, Hannover Medical School, Hannover, Germany. Koerner.Sonja@mh-hannover.de
authors.forename: S
authors.initials: S
authors.lastname: Körner
authors.forename: K
authors.initials: K
authors.lastname: Kollewe
authors.forename: J
authors.initials: J
authors.lastname: Ilsemann
authors.forename: A
authors.initials: A
authors.lastname: Müller-Heine
authors.forename: R
authors.initials: R
authors.lastname: Dengler
authors.forename: K
authors.initials: K
authors.lastname: Krampfl
authors.forename: S
authors.initials: S
authors.lastname: Petri
mesh_terms: D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications / Q000453:epidemiology*; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D048909:Diabetes Complications / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000453:epidemiology; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012306:Risk; D012307:Risk Factors; D016019:Survival Analysis