Kognitive Funktionen und ihr Einfluss auf Entscheidungen zu lebensverlängernden und lebensverkürzenden Maßnahmen bei Patienten mit Amyotropher Lateralsklerose

Abstract

In recent years, Amyotrophic Lateral Sclerosis (ALS) has been understood as a multiple systems disorder that affects cognitive functions in addition to the loss of physical function. Data on the extent of cognitive impairments differ, most studies report that between 35 and 60 % of the patients suffer at least mild impairments. To our knowledge, there are no existing data on the relationship between cognitive functioning and decisions regarding life sustaining treatment (LST) of patients with ALS. The aim of our study was to investigate the character and incidence of cognitive dysfunction in ALS patients. We examined a possible correlation between cognitive functions and the patients´ decisions on life-sustaining treatment. We also investigated differences between spinal and bulbar onset patients. Therefore 48 patients and 58 healthy controls (C1) were tested for vigilance, behavioural inhibition, speech comprehension and verbal memory/intelligence. Patients and another group of 18 healthy controls (C2) were tested for verbal fluency. Quality of life and depressive symptoms were also assessed. It showed that patients had lower scores than controls in vigilance and verbal fluency. Only bulbar patients showed signs of behavioural disinhibition. No differences were found in speech comprehension. There was no relation between cognitive functions and the decisional status on life sustaining treatment options and psychosocial adaptation. Conclusion: We found no evidence for an association between cognitive impairment and decisions regarding life sustaining treatment. This implies that patients with mild cognitive deficits may well be able to make adequate decisions on this matter.