Associations of patient mood, modulators of quality of life, and pharmaceuticals with amyotrophic lateral sclerosis survival duration

• Authors: Leila Bond, Emory University; Gloria Bowen, Emory University; Benjamin Mertens, Emory University; Keelie Denson, Emory University; Kathleen Jordan, Emory University; Brani Vidakovic, Emory University; Cassie Mitchell, Emory University
• Journal Title: Behavioral Sciences
• Volume: Volume 10, Number 1
• Publisher: MDPI | 2020-01-10, Pages 1-20
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.3390/bs10010033
• Subjects: Engineering, Biomedical; Engineering, System Science; Chemistry, Pharmaceutical; Psychology, Behavioral
• Keywords: ALS; Quality of life; Survival; Mood; Antidepressants; Off-label drugs; Supplements

Abstract

Associations of modulators of quality of life (QoL) and survival duration are assessed in the fatal motor neuron disease, Amyotrophic Lateral Sclerosis. Major categories include clinical impression of mood (CIM); physical health; patient social support; and usage of interventions, pharmaceuticals, and supplements. Associations were assessed at p < 0.05 and p < 0.001 significance thresholds using applicable methods (Chi-square, t-test, ANOVA, logistical regression, random forests, Fisher's exact test) within a retrospective cohort of 1585 patients. Factors significantly correlated with positive (happy or normal) mood included family support and usage of bi-level positive airway pressure (Bi-PAP) and/or cough assist. Decline in physical factors like presence of dysphagia, drooling, general pain, and decrease in ALSFRS-R total score or forced vital capacity (FVC) significantly correlated with negative (depressed or anxious) mood (p < 0.05). Use of antidepressants or pain medications had no association with ALS patient mood (p > 0.05), but were significantly associated with increased survival (p < 0.05). Positive patient mood, Bi-PAP, cough assist, percutaneous endoscopic gastrostomy (PEG), and accompaniment to clinic visits associated with increased survival duration (p < 0.001). Of the 47 most prevalent pharmaceutical and supplement categories, 17 associated with significant survival duration increases ranging +4.5 to +16.5 months. Tricyclic antidepressants, non-opioids, muscle relaxants, and vitamin E had the highest associative increases in survival duration (p < 0.05). Random forests, which examined complex interactions, identified the following pharmaceuticals and supplements as most predictive to survival duration: Vitamin A, multivitamin, PEG supplements, alternative herbs, antihistamines, muscle relaxants, stimulant laxatives, and antispastics. Statins, metformin, and thiazide diuretics had insignificant associations with decreased survival.