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Neurodegeneration
Original research
Relationship between neuropsychiatric disorders and cognitive and behavioural change in MND
  1. Caroline A McHutchison1,2,3,
  2. Danielle Jane Leighton2,4,
  3. Andrew McIntosh3,5,
  4. Elaine Cleary6,
  5. Jon Warner6,
  6. Mary Porteous6,
  7. Siddharthan Chandran2,4,
  8. Suvankar Pal2,4,
  9. Sharon Abrahams1,2
  1. 1 Human Cognitive Neurosciences, Department of Psychology, The University of Edinburgh, Edinburgh, UK
  2. 2 Euan MacDonald Centre for MND Research, The University of Edinburgh, Edinburgh, UK
  3. 3 Centre for Cognitive Ageing and Cognitive Epidemiology, The University of Edinburgh, Edinburgh, UK
  4. 4 Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
  5. 5 Division of Psychiatry, Royal Edinburgh Hospital, Edinburgh, UK
  6. 6 Centre for Genomic & Experimental Medicine, South East Scotland Genetics Service, Western General Hospital, Edinburgh, UK
  1. Correspondence to Ms Caroline A McHutchison, Human Cognitive Neurosciences, Department of Psychology, The University of Edinburgh, Edinburgh, Edinburgh, UK; Caroline.McHutchison{at}ed.ac.uk

Abstract

Objective In this population-based study, we aimed to determine whether neuropsychiatric history, medication or family history of neuropsychiatric disorders predicted cognitive and/or behavioural impairment in motor neuron disease (MND).

Methods People with MND (pwMND) on the Scottish Clinical, Audit, Research and Evaluation of MND (CARE-MND) register, diagnosed from January 2015 to January 2018, with cognitive and/or behavioural data measured using the Edinburgh Cognitive and Behavioural ALS Screen were included. Data were extracted on patient neuropsychiatric, medication and family history of neuropsychiatric disorders. We identified patients with cognitive impairment (motor neuron disease with cognitive impairment (MNDci)), behavioural impairment (motor neuron disease with behavioural impairment (MNDbi), both (motor neuron disease with cognitive and behavioural impairment (MNDcbi)) or motor neuron disease–frontotemporal dementia (MND-FTD).

Results Data were available for 305 pwMND (mean age at diagnosis=62.26 years, SD=11.40), of which 60 (19.7%) had a neuropsychiatric disorder. A family history of neuropsychiatric disorders was present in 36/231 (15.58%) of patients. Patient premorbid mood disorders were associated with increased apathy (OR=2.78, 95% CI 1.083 to 7.169). A family history of any neuropsychiatric disorder was associated with poorer visuospatial scores, MNDbi (OR=3.14, 95% CI 1.09 to 8.99) and MND-FTD (OR=5.08, 95% CI 1.26 to 20.40). A family history of mood disorders was associated with poorer overall cognition (exp(b)=0.725, p=0.026), language, verbal fluency and visuospatial scores, and MND-FTD (OR=7.57, 95% CI 1.55 to 46.87). A family history of neurotic disorders was associated with poorer language (exp(b)=0.362, p<0.001), visuospatial scores (exp(b)=0.625, p<0.009) and MND-FTD (OR=13.75, 95% CI 1.71 to 110.86).

Conclusion Neuropsychiatric disorders in patients and their families are associated with cognitive and behavioural changes post-MND diagnosis, with many occurring independently of MND-FTD and C9orf72 status. These findings support an overlap between MND, frontotemporal dementia and neuropsychiatric disorders, particularly mood disorders.

  • neuropsychiatric disorders
  • cognition
  • behaviour
  • motor neuron disease
  • amyotrophic lateral sclerosis
  • frontotemporal dementia

https://doi.org/10.1136/jnnp-2019-321737

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    Footnotes

    • Twitter @c_mchutchison

    • Contributors CAM contributed to the conception of the project, carried out the data analysis and drafted the manuscript. DJL collected the data included in the analysis and along with SC and SP was involved in the update of the CARE-MND platform. AM, SP and SA contributed to the conception of the project and provided input on the statistical analysis. EMC, JW and MP conducted the C9orf72 screening. The manuscript was reviewed by all authors.

    • Funding Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, UK.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval Ethical approval was obtained for the original (MREC/98/0/56 1989–2010, 10/MRE00/78 2011–2015) and updated CARE-MND platform (Scotland A Research Ethics Committee, 15/SS/0126).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request.

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