title: Emotional disturbance in CADASIL: its impact on quality of life and caregiver burden.
abstract: OBJECTIVE
  Recurrent strokes and cognitive dysfunction are the major symptoms of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). However, emotional disturbances in CADASIL patients are incompletely understood. The aim of this study was to investigate emotional disturbances in CADASIL and their impact on the patients' quality of life (QOL) and caregiver burden.
  
  
  METHODS
  From 54 patients who were diagnosed as CADASIL between January 2000 and August 2012 in the Asan Medical Center, Seoul, Korea, 23 patients were enrolled in this study. The Montgomery-Asberg Depression Rating Scale was used for the assessment of depressive emotional disturbances (DED). For nondepressive emotional disturbances (NDED), the criteria of Kim and Choi-Kwon [Neurology 2000;54:1805-1810] were used for emotional incontinence (excessive/inappropriate expression of laughing or crying), and the modified Spielberger Trait Anger Scale was used for anger proneness (excessive/inappropriate expression of anger). Patients' QOL and caregiver burden were assessed with stroke-specific emotional QOL and the Sense of Competence Questionnaire (SCQ), respectively. Functional disability was assessed by the modified Rankin scale (mRS), and white matter ischemic changes and microbleeds were analyzed using brain magnetic resonance images.
  
  
  RESULTS
  Twelve patients (52.2%) had various emotional disturbances including DED (n=10, 43.5%) and NDED (n=7, 30.4%). The presence of any emotional disturbances was associated with thalamic (p=0.012) and cortical (p=0.037) microbleeds, mRS (p=0.001), cognitive impairment (p=0.002), patients' low QOL (p=0.009) and increased caregiver burden (p=0.002). DED was associated with multiple (≥10) microbleeds (p=0.039), cognitive impairment (p=0.030) and mRS (p=0.030), and negatively influenced all domains of patients' QOL and caregiver burden. NDED was associated with cortical microbleeds (p=0.017) and mRS (p=0.014). Unlike DED, NDED was not associated with patients' poor QOL, except for thinking domain, but was significantly related to total SCQ and subscales 1 and 2 of SCQ (p=0.012).
  
  
  CONCLUSIONS
  More than half the CADASIL patients had emotional disturbances, either DED or NDED. Both are associated with patients' poor QOL and increased caregiver burden, the former more markedly than the latter. Considering that CADASIL is a progressive disease with deteriorating patients' QOL, physicians have to pay more attention to emotional problems in CADASIL patients. Treatment strategies should be investigated in this regard to improve patients' QOL and reduce caregiver burden.
authors: Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: Sang-Mi
authors: SM
authors: Noh
authors: Sun J
authors: SJ
authors: Chung
authors: Kwang-Kuk
authors: KK
authors: Kim
authors: Dong-Wha
authors: DW
authors: Kang
authors: Young-Min
authors: YM
authors: Lim
authors: Sun U
authors: SU
authors: Kwon
authors: Jong S
authors: JS
authors: Kim
mesh_terms: D000203:Activities of Daily Living; D000342:Affective Symptoms / Q000209:etiology* / Q000523:psychology; D000368:Aged; D001479:Basal Ganglia / Q000473:pathology; D001921:Brain / Q000473:pathology; D001933:Brain Stem / Q000473:pathology; D046589:CADASIL / Q000473:pathology / Q000523:psychology*; D017028:Caregivers / Q000523:psychology*; D002540:Cerebral Cortex / Q000473:pathology; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000473:pathology / Q000523:psychology; D003072:Cognition Disorders / Q000209:etiology / Q000473:pathology; D003863:Depression / Q000209:etiology / Q000523:psychology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012307:Risk Factors; D012720:Severity of Illness Index; D013788:Thalamus / Q000473:pathology