SURVIVAL IN AMYOTROPHIC-LATERAL-SCLEROSIS - THE ROLE OF PSYCHOLOGICAL-FACTORS

Objective: Examining the relationship between psychological status and survival in amyotrophic lateral sclerosis. Our hypothesis is that psy chological distress is associated with greater mortality and shorter s urvival time than psychological well-being. Design: Cross-sectional, l ongitudinal. The baseline evaluations used were disease severity and 1 0 psychometric tests. A psychological status score was derived from th ese tests. Survival status was monitored for 3.5 years. Interviewers w ere blinded to other interviews and data analysis. Setting: Patient's residence. Patients: The criteria for eligibility were diagnosis of am yotrophic lateral sclerosis by a neurologist, dementia or alcoholism a bsent, communication in English, and any severity or length of disease . It was a volunteer sample consisting of 144 patients from amyotrophi c lateral sclerosis clinics or community-based amyotrophic lateral scl erosis support groups. In this sample 66% were men, 94% were white, me an age at diagnosis was 55 years, 79% were married, 60% had some colle ge education, and 61%, died during the study. Interventions: None. Mai n Outcome Measures: End points: mortality during study, survival time from intake to last follow-up. Results: Comparison between high and lo w psychological score groups: 32% of high and 82% of low died; surviva l cur-ves were significantly different. Controlling for confounding fa ctors (length of illness, disease severity, age), patients with psycho logical distress had a greater risk of mortality (relative risk, 6.76; 95% confidence limits, 1.69 to 27.12) and greater likelihood of dying in any given time period (relative risk, 2.24; 95% confidence limits, 1.08 to 4.64) than those with psychological well-being. Conclusion: A djusting for confounding factors, psychological status is strongly rel ated to outcome in amyotrophic lateral sclerosis. Further studies on p sychological status should be done to confirm its prognostic value.