Dyspnea as a Fatigue-Promoting Factor in ALS and the Role of Objective Indicators of Respiratory Impairment

Vogt, Susanne; Schreiber, Stefanie; Pfau, Giselher; Kollewe, Katja; Heinze, Hans‐Jochen; Dengler, Reinhard; Petri, Susanne; Vielhaber, Stefan; Brinkers, Michael

doi:10.1016/j.jpainsymman.2020.02.021

Cited by 10 publications

(9 citation statements)

References 41 publications

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“…Fatigue was positively associated with sleepiness ( P = 0.007) and depression ( P = 0.003). Patients with fatigue were significantly more disabled ( P < 0.001) and more frequently reported difficulties staying asleep ( P = 0.009) and nocturnal complaints ( P = 0.002) McElhiney 2009 [ 40 ] Fatigue was significantly and negatively associated with ALSFRS-R and positively with depression and ALS severity ( P < 0.001) Panitz 2015 [ 41 ] Patients with fatigue had lower ALSFRS-R values ( P < 0.01) Sandstedt 2016 [ 43 ] Fatigue was associated with worsening health-related quality of life ( P = 0.01) Vangroenestijn 2017 [ 44 ] Fatigue was positively associated with participation restrictions ( P ≤ 0.01) Vogt 2020 [ 36 ] Fatigue was significantly associated with worse health-related quality of life ALSFRS-R , Amyotrophic Lateral Sclerosis Functional Rating Scale- Revised …”

Section: Resultsmentioning

confidence: 99%

Prevalence and correlates of fatigue in amyotrophic lateral sclerosis: A systematic review and meta-analysis

Hamad,

Amer,

Abbas

et al. 2023

Neurol Sci

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Objectives This systematic review and meta-analysis aimed to determine the frequency and correlates of fatigue in patients with amyotrophic lateral sclerosis (ALS). Methods Three databases were searched up to 2nd May 2023 to identify studies reporting fatigue frequency in ALS. Studies included had to identify ALS patients through one of ALS diagnostic criteria and measure fatigue by a validated tool with a specific cut-off value. Meta-analysis was conducted using RStudio's "meta" package with a random-effects model. Subgroup analyses and meta-regression explored the relationship between fatigue frequency in ALS and different covariates. Results Eleven studies, compromising 1072 patients, met the inclusion criteria and were included in our analysis. The pooled frequency of fatigue across all studies was 48% (95% CI = 40% to 57%). Our subgroup analysis based on the ALSFRS-R revealed a higher frequency of fatigue in studies with lower scores (< 30) compared to those with higher scores (≥ 30), with a pooled frequency of 62% (95% CI = 43% to 79%) and 43% (95% CI = 37% to 49%), respectively. Also, the meta-regression analysis showed a significant negative association between fatigue and ALSFRS-R mean (P = 0.02). The included studies reported an association between fatigue and lower functional status and poorer quality of life in patients with ALS. Conclusion Our findings suggest that fatigue is prevalent in almost half of ALS patients and is associated with lower functional status and poorer quality of life, highlighting the importance of assessing and managing fatigue in ALS patients.

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Section: Resultsmentioning

confidence: 99%

Prevalence and correlates of fatigue in amyotrophic lateral sclerosis: A systematic review and meta-analysis

Hamad,

Amer,

Abbas

et al. 2023

Neurol Sci

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“…Some previous studies using neurophysiological measures, such as sustained isometric muscle contraction, to assess the severity of the physical component of fatigue in ALS patients, revealed predominant correlations of lower motor neuron impairment with fatigue (Vucic et al., 2007 ), although these measures have been shown to extend to more sites than those affected by clinical motor weakness (Sanjak et al., 2001 ). Additionally, further studies explored the correlations between measures of the severity of fatigue with some clinical features monitored in ALS (Chiò et al., 2021 ), such as motor functional status (Panitz et al., 2015 ), quality of life (An et al., 2022 ; Young et al., 2022 ), respiratory (Vogt et al., 2020 ), and sleep dysfunction (Lo Coco & La Bella, 2012 ). However, only a few scales evaluated more components of fatigue, such as the MFI and the checklist individual strength (CIS20‐R) (Vercoulen et al., 1994 ).…”

Section: Discussionmentioning

confidence: 99%

Cognitive, behavioral, and brain functional connectivity correlates of fatigue in amyotrophic lateral sclerosis

et al. 2023

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Introduction Fatigue is defined as a symptom of exhaustion unexplained by drug effects or psychiatric disorders and comprises two main components (i.e., central or “mental” and peripheral or “physical” components), both influencing global disability in amyotrophic lateral sclerosis (ALS). We aim at investigating the clinical correlations between “physical” and “mental” components of fatigue, measured by the Multidimensional Fatigue Inventory scale, and motor and cognitive/behavioral disability in a large sample of patients with ALS. We also investigated the correlations between these measures of fatigue and resting‐state functional connectivity of brain functional magnetic resonance imaging (RS‐fMRI) large‐scale networks in a subset of patients. Methods One hundred and thirty ALS patients were assessed for motor disability, cognitive and behavioral dysfunctions, fatigue, anxiety, apathy, and daytime sleepiness. Moreover, the collected clinical parameters were correlated with RS‐fMRI functional connectivity changes in the large‐scale brain networks of 30 ALS patients who underwent MRI. Results Multivariate correlation analysis revealed that “physical” fatigue was related to anxiety and respiratory dysfunction, while “mental” fatigue was related to memory impairment and apathy. Moreover, the mental fatigue score was directly related to functional connectivity in the right and left insula (within the salience network), and inversely related to functional connectivity in the left middle temporal gyrus (within the default mode network). Conclusions Although the “physical” component of fatigue may be influenced by the disease itself, in ALS the “mental” component of fatigue correlates with cognitive and behavioral impairment, as well as with alterations of functional connectivity in extra‐motor networks.

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“…These symptoms are so strongly related that discrimination between them is often difficult for patients and practitioners 59,60 . Interventional studies completed in chronic obstructive pulmonary disease and amyotrophic lateral sclerosis, in which this overlap of dyspnea and fatigue also occurs, have found that relief of one symptom often brings relief of the other 61,62 …”

Section: Discussionmentioning

confidence: 99%

“…59,60 Interventional studies completed in chronic obstructive pulmonary disease and amyotrophic lateral sclerosis, in which this overlap of dyspnea and fatigue also occurs, have found that relief of one symptom often brings relief of the other. 61,62 Pain, however, is considered an underrecognized and poorly understood symptom with high prevalence rates (44%-84.4%). [63][64][65][66] Yet, pain and fatigue often occur together and have demonstrated a reciprocal relationship to each other, one often potentiating the effects of the other, in various chronic disease processes.…”

Section: Physiologic Conceptsmentioning

confidence: 99%

Fatigue in Heart Failure

et al. 2022

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Background: Fatigue in heart failure (HF) is a burdensome symptom with profoundly negative effects on quality of life and an association with worsening prognosis and mortality. Despite its deleterious outcomes, HF-related fatigue remains poorly understood with limited treatment modalities. Objective: The objective of this study was to identify correlates of HF-related fatigue. Methods: A scoping review was completed using the Arksey and O'Malley framework. The theory of unpleasant symptoms was used as a basis for organizing key findings into concepts related to HF-related fatigue. Published, primary studies in English that explored correlates or predictors of fatigue in adult patients with HF were included. Results: The search identified 655 articles, of which 38 were retained. An additional 4 articles were included for final review (N = 42). Nineteen concepts were identified as having a relationship with HF-related fatigue: age, sex, disease severity, inflammation, anemia, volume status, dyspnea, pain, body weight, depression, anxiety, perception of symptoms/health, sleep disturbances, poor social support, poor self-care, polypharmacy, reduced quality of life, risk for hospitalization, and mortality. Concepts were grouped into 4 categories: physiologic, psychologic, situational, and outcome. Conclusions: Heart failure-related fatigue is a complex symptom that has physiologic, psychologic, and situational antecedents that influence the symptom and patient outcomes, all of which should be addressed when developing treatment modalities. Cultural and societal norms, racial disparities, and the co-occurrence of multiple symptoms should also be considered. Inconsistent or weak relationships with multiple physiologic correlates suggest the presence of unrecognized influencing factors.

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Dyspnea as a Fatigue-Promoting Factor in ALS and the Role of Objective Indicators of Respiratory Impairment

Cited by 10 publications

References 41 publications

Prevalence and correlates of fatigue in amyotrophic lateral sclerosis: A systematic review and meta-analysis

Prevalence and correlates of fatigue in amyotrophic lateral sclerosis: A systematic review and meta-analysis

Cognitive, behavioral, and brain functional connectivity correlates of fatigue in amyotrophic lateral sclerosis

Fatigue in Heart Failure

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