title: Cognitive impairment, behavioral impairment, depression, and wish to die in an ALS cohort.
abstract: OBJECTIVE
  To evaluate relationships among cognitive, behavioral, and psychiatric/psychosocial measures assessed in a multicenter cohort of patients with amyotrophic lateral sclerosis (ALS).
  
  
  METHODS
  Recently diagnosed patients with definite or probable ALS diagnosis were administered 7 standardized psychiatric/psychosocial measures, including the Patient Health Questionnaire for diagnosis of depression and elicitation of wish to die. The Cognitive Behavioral Screen was used to classify both cognitive and behavioral impairment (emotional-interpersonal function). An ALS version of the Frontal Behavioral Inventory and Mini-Mental State Examination were also administered.
  
  
  RESULTS
  Of 247 patients included, 79 patients (32%) had neither cognitive nor behavioral impairment, 100 (40%) had cognitive impairment, 23 (9%) had behavioral impairment, and 45 (18%) had comorbid cognitive and behavioral decline. Cognitive impairment, when present, was in the mild range for 90% and severe for 10%. Thirty-one patients (12%) had a major or minor depressive disorder (DSM-IV criteria). Cognitive impairment was unrelated to all psychiatric/psychosocial measures. In contrast, patients with behavioral impairment reported more depressive symptoms, greater hopelessness, negative mood, and more negative feedback from spouse or caregiver. A wish to die was unrelated to either cognitive or behavioral impairment.
  
  
  CONCLUSIONS
  While we found no association between cognitive impairment and depression or any measure of distress, behavioral impairment was strongly associated with depressive symptoms and diagnoses although seldom addressed by clinicians. Thoughts about ending life were unrelated to either cognitive or behavioral changes, a finding useful to consider in the context of policy debate about physician-assisted death.
authors: From the New York State Psychiatric Institute (J.R., R.G.), Department of Psychiatry (J.R., R.G.), and Eleanor and Lou Gehrig MDA/ALS Research Center, Department of Neurology (H.M.), Columbia University Medical Center, New York, NY; Department of Neurology (J.M.M.), University of California San Francisco; and Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University, New York, NY. jgr1@cumc.columbia.edu.
authors: Judith
authors: J
authors: Rabkin
authors: From the New York State Psychiatric Institute (J.R., R.G.), Department of Psychiatry (J.R., R.G.), and Eleanor and Lou Gehrig MDA/ALS Research Center, Department of Neurology (H.M.), Columbia University Medical Center, New York, NY; Department of Neurology (J.M.M.), University of California San Francisco; and Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University, New York, NY.
authors: Raymond
authors: R
authors: Goetz
authors: From the New York State Psychiatric Institute (J.R., R.G.), Department of Psychiatry (J.R., R.G.), and Eleanor and Lou Gehrig MDA/ALS Research Center, Department of Neurology (H.M.), Columbia University Medical Center, New York, NY; Department of Neurology (J.M.M.), University of California San Francisco; and Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University, New York, NY.
authors: Jennifer Mary
authors: JM
authors: Murphy
authors: From the New York State Psychiatric Institute (J.R., R.G.), Department of Psychiatry (J.R., R.G.), and Eleanor and Lou Gehrig MDA/ALS Research Center, Department of Neurology (H.M.), Columbia University Medical Center, New York, NY; Department of Neurology (J.M.M.), University of California San Francisco; and Department of Epidemiology (P.F.-L.), Mailman School of Public Health, Columbia University, New York, NY.
authors: Pam
authors: P
authors: Factor-Litvak
authors: Hiroshi
authors: H
authors: Mitsumoto
mesh_terms: D000690:Amyotrophic Lateral Sclerosis / Q000150:complications / Q000523:psychology*; D001293:Attitude to Death; D017028:Caregivers / Q000523:psychology; D060825:Cognitive Dysfunction / Q000150:complications; D015331:Cohort Studies; D015897:Comorbidity; D003866:Depressive Disorder / Q000150:complications; D030141:Feedback, Psychological; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012959:Socioeconomic Factors; D018454:Spouses / Q000523:psychology; D013315:Stress, Psychological / Q000150:complications; D011795:Surveys and Questionnaires