McElhiney M C, Rabkin J G, Gordon P H, Goetz R, Mitsumoto H
New York State Psychiatric Institute, Unit 51, New York, NY 10032, USA.
J Neurol Neurosurg Psychiatry. 2009 Oct;80(10):1146-9. doi: 10.1136/jnnp.2008.163246.
Amyotrophic lateral sclerosis (ALS) patients report both fatigue and depression. It is not clear how frequently each occurs, to what extent they occur together, how each relates to ALS disease status, or their stability over time.
To assess frequency and persistence of fatigue and depression, and relationship to ALS disease status, for patients attending an ALS interdisciplinary centre for routine 3-month visits.
Measures included the Fatigue Severity Scale, Patient Health Questionnaire-9. ALS Functional Rating Scale -- Revised and forced vital capacity, rate of disease progression, and bulbar/nonbulbar disease onset.
223 patients completed the ratings once; of these, 113 completed them twice, and 65 on three visits. At baseline, 44% (99/223) had clinically significant fatigue, including 34 patients who also had a depressive disorder; 7% (16/223) had major or minor depression only, and 48% (108/223) had neither condition. Fatigue was associated with greater ALS severity, but depression was not. Among the 113 patients seen 3 months later, 75% (33/44) who were fatigued at Time 1 remained fatigued, while 48% (10/21) remained depressed. New-onset fatigue was reported by 22% (25/113), and new-onset depression by 6% (7/113). For the 65 patients seen a third time, rates remained nearly the same.
Fatigue was more prevalent and persistent than depression, although 15% (34/223) of patients had both conditions. Fatigue but not depression was associated with ALS severity. The two conditions appear to be independent, although sometimes co-occurring, and both warrant consideration in evaluating patient functioning and treatment.
肌萎缩侧索硬化症（ALS）患者同时存在疲劳和抑郁症状。目前尚不清楚这两种症状各自出现的频率、同时出现的程度、它们与ALS疾病状态的关系以及随时间的稳定性。
评估在ALS跨学科中心进行常规3个月随访的患者中疲劳和抑郁的频率及持续性，以及它们与ALS疾病状态的关系。
测量指标包括疲劳严重程度量表、患者健康问卷-9。ALS功能评定量表修订版、用力肺活量、疾病进展速度以及延髓/非延髓疾病发病情况。
223例患者完成了一次评定；其中，113例完成了两次评定，65例完成了三次评定。在基线时，44%（99/223）有临床显著疲劳，其中34例患者同时患有抑郁症；7%（16/223）仅有轻度或重度抑郁症，48%（108/223）两者均无。疲劳与更高的ALS严重程度相关，但抑郁并非如此。在3个月后复诊的113例患者中，第一次就诊时疲劳的患者中有75%（33/44）在第二次就诊时仍感到疲劳，而48%（10/21）仍患有抑郁症。22%（25/113）的患者报告有新发疲劳，6%（7/113）有新发抑郁。对于第三次复诊的65例患者，发生率几乎相同。
疲劳比抑郁更普遍且持续时间更长，尽管15%（34/223）的患者同时患有这两种疾病。疲劳而非抑郁与ALS严重程度相关。这两种情况似乎是独立的，尽管有时会同时出现，在评估患者功能和治疗时都值得考虑。
