Department of Neurology, Christian-Doppler-Klinik, Paracelsus Medical University and Salzburger Landeskliniken, Salzburg, Austria.
Department of Neuroradiology, Christian-Doppler-Klinik, Paracelsus Medical University and Salzburger Landeskliniken, Salzburg, Austria.
Acta Neurol Scand. 2018 Mar;137(3):329-334. doi: 10.1111/ane.12869. Epub 2017 Nov 17.
Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease causing an upper and lower motor neuron loss. It is neurology textbook knowledge that the mean age of onset is about 60 years. However, recent investigations show an increasing incidence in older persons. We therefore evaluated whether ALS is potentially not considered in elderly people with ALS symptoms, respectively, not recognized.
We included retrospectively all patients with ALS diagnoses after work-up that were admitted to our neurological and geriatric departments from 2007 to 2010 and collected their clinical data. The diagnosis of ALS was based on the El Escorial criteria. Patients were grouped into three categories according to age (<50, between 50 and 70, >70), and differences in clinical and/ or biographical factors were investigated.
We identified 35 patients (18 men and 17 women) with a median age at onset of 71.5 years (range: 36-87 years). When establishing the diagnosis, 51% were older than 70 years, 40% (14/35) between 50 and 70, and only 9% younger than 50. Only in 46 per cent of patients who were sent to our departments with ALS symptoms ALS was considered by the referring physician.
Late age onset of ALS seems to be more common than formerly assumed and is presumably under-recognized in elderly patients. ALS needs to be considered as a differential diagnosis in older patients. Potential factors accounting for older people being underdiagnosed with ALS relate to frequent presentation with symptoms like dysphagia, frailty or general weakness for other reasons.
肌萎缩侧索硬化症（ALS）是一种致命的神经退行性疾病，导致上下运动神经元丧失。教科书上的知识是，发病的平均年龄约为 60 岁。然而，最近的调查显示，老年人的发病率越来越高。因此，我们评估了在有 ALS 症状的老年人中，是否有可能未考虑到 ALS，或者未识别出 ALS。
我们回顾性地纳入了所有在 2007 年至 2010 年间因疑似 ALS 而在我们的神经科和老年科就诊并接受检查的患者，并收集了他们的临床数据。ALS 的诊断基于 El Escorial 标准。根据年龄（<50 岁、50-70 岁、>70 岁）将患者分为三组，研究了临床和/或传记因素的差异。
我们共确定了 35 名患者（18 名男性和 17 名女性），发病年龄中位数为 71.5 岁（范围：36-87 岁）。在确诊时，51%的患者年龄大于 70 岁，40%（14/35）的患者年龄在 50-70 岁之间，只有 9%的患者年龄小于 50 岁。只有 46%的被转诊到我们科室的有 ALS 症状的患者，转诊医生考虑到了 ALS。
ALS 的发病年龄较晚似乎比以前认为的更为常见，而且在老年患者中可能未被充分认识。在老年患者中，应考虑 ALS 作为鉴别诊断。导致老年人 ALS 漏诊的潜在因素与因吞咽困难、虚弱或一般性无力等其他原因而频繁出现的症状有关。
