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Author Notes:

Correspondence: cassie.mitchell@bme.gatech.edu

Conceptualization, G.B., B.M., C.S.M.; methodology, L.B., G.B., B.M., B.V., C.S.M.; validation, L.B., G.B., B.M., B.V., C.S.M.;

Formal analysis, L.B., G.B., B.M.; data curation, L.B., G.B., B.M., K.J., K.D., C.S.M.; writing of initial manuscript, L.B., G.B., B.M., K.J., K.D., C.S.M.;

Writing—review and editing, L.B., B.V., C.S.M.; visualization, L.B., G.B., B.M., K.J., K.D., C.S.M.; supervision, B.V., C.S.M.; project administration, C.S.M.; funding acquisition, C.S.M.

All authors have read and agreed to the published version of the manuscript.

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.


Research Funding:

This research received funding from National Institute of Health grant NS098228 and Alzheimer’s Association Research Grant 591014 to C.S.M.


  • ALS
  • Quality of life
  • Survival
  • Mood
  • Antidepressants
  • Off-label drugs
  • Supplements

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


Journal Title:

Behavioral Sciences


Volume 10, Number 1


, Pages 1-20

Type of Work:

Article | Final Publisher PDF


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.

Copyright information:

© 2020 by the authors.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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