Abstract
ObjectivesFatigue was considered as a common symptom in amyotrophic lateral sclerosis (ALS). Previous studies about the impact of fatigue on Quality of Life (QoL) in patients with ALS were limited and inconsistent. Besides, a systematic investigation of fatigue in Chinese patients with ALS was lacking. Therefore, this study aimed to comprehensively evaluate the frequency and associated factors of fatigue and impact on QoL in Chinese patients with ALS.Participants and MethodsProbable and definitive patients with ALS and age- and gender-matched healthy controls (HCs) were consecutively recruited. The frequency of fatigue between both the groups was determined by the Fatigue Severity Scale (FSS). Disease severity, sleep quality, sleepiness, anxiety, depression, and QoL were evaluated in patients with ALS by the ALS Functional Rating Scale-revised (ALSFRS-R) and the ALS Severity Scale (ALSSS), the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), the Hamilton Anxiety Rating Scale (HARS), the Hamilton Depression Rating Scale (HDRS), and the McGill Quality of Life Questionnaire (MQOL). Then, clinical characteristics of patients with ALS with fatigue were compared with those without fatigue. Lastly, associated factors of fatigue and impact on QoL in Chinese patients with ALS were assessed.ResultsA total of 175 patients with ALS and 175 HCs were included. Fatigue was significantly more frequent in patients with ALS than in controls (32.6 vs. 17.7%, p = 0.001). Patients with ALS with fatigue scored lower on the ALSFRS-R, the ALSSS [lower extremity (LE) + upper extremity (UE)], the total ALSSS, higher in the HARS, HDRS, PSQI, ESS scores, and a poorer QoL. Daytime dysfunction and the ALSSS (LE + UE) score were associated with a higher risk of fatigue. The ALSSS (LE + UE), the FSS, age, the HARS, and the HDRS score were significantly associated with various aspects of QoL.ConclusionThis study has described fatigue in Chinese patients with ALS and finding daytime dysfunction and the lower ALSSS (LE + UE) were associated with a higher risk of fatigue. Also, we identified an inverse relationship of fatigue intensity with the psychological domain of QoL.
Highlights
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder of unknown etiology, characterized by the progressive loss of upper and lower motor neurons, causing weakness and atrophy of upper and lower limbs, dysphagia, and dysarthria, eventually resulting in death due to respiratory failure typically within 2–4 years from disease onset [1]
We found that fatigue was more frequent in patients with ALS than in healthy controls (HCs), the frequency of fatigue in our patients was a litter lower than the previous reports [4–7]
A previous study found that patients with ALS with fatigue were younger and had a longer duration of disease [5], which was absent in our observation
Summary
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder of unknown etiology, characterized by the progressive loss of upper and lower motor neurons, causing weakness and atrophy of upper and lower limbs, dysphagia, and dysarthria, eventually resulting in death due to respiratory failure typically within 2–4 years from disease onset [1]. Quality of Life in patients with ALS was affected by the physical manifestations and by the psychosocial effects of living with a terminal, disabling illness [3]. Fatigue has been defined as an overwhelming sense of tiredness, lack of energy, and feeling of exhaustion [8]. It has an important impact on QoL in patients with ALS [4, 9, 10]. Fatigue in ALS has been reported to be associated with age, site of onset, functionality severity, disease duration, and disease progression [5, 6, 11, 12], and forced vital capacity, excessive daytime sleepiness (EDS), depression, and poor quality of sleep [11]. Fatigue in ALS, as in other neurological diseases, can reduce physical endurance and functionality, affecting daily life activities, QoL, and familial, professional, and social interactions [13]. There has been no study to systematically examine fatigue in patients with ALS from China
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