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ALS - Motor Neuron Disease: Mechanism and Development of New Therapies
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Self-Regulation and Executive Functioning as Related to Survival in Motor Neuron Disease: Preliminary Findings

Natasha E Garcia-Willingham1, Abbey R Roach, Edward J Kasarskis

  • 1From the Department of Psychology (Garcia-Willingham, Segerstrom), University of Kentucky, Lexington; Departments of Psychology and Neuropsychology (Roach), Frazier Rehabilitation Institute, Louiseville, Kentucky; and Department of Neurology (Kasarskis), University of Kentucky, Lexington.

Psychosomatic Medicine
|May 18, 2018
PubMed
Abstract

Insights

Self-regulation difficulties in motor neuron disease (MND) patients predict survival. Patient-reported problem-solving issues significantly increase mortality risk, highlighting a key prognostic indicator.

Area of Science:

  • Neurology
  • Cognitive Science
  • Prognostics

Background:

  • Motor neuron disease (MND) progression and survival rates vary significantly among patients.
  • While dementia in MND patients is linked to shorter survival, the impact of milder cognitive and behavioral issues remains unclear.
  • This study investigates the prognostic value of executive functioning and self-regulation in MND patients with largely normal cognitive indices.

Purpose of the Study:

  • To determine the relative contribution of executive functioning and self-regulation difficulties to survival in motor neuron disease (MND) patients over a six-year period.
  • To assess the prognostic significance of mild cognitive and behavioral deficits in MND.
  • To explore the relationship between specific self-regulation domains and mortality risk.

Main Methods:

  • 37 patients with MND completed the Wisconsin Card Sorting Task and the Behavior Rating Inventory of Executive Functions (BRIEF-A) assessing self-regulatory behavior and problem-solving.
  • Cox proportional hazard regression analyses were employed to evaluate survival.
  • Analyses were adjusted for a priori covariates and disease severity in sensitivity testing.

Main Results:

  • A total of 23 deaths occurred during the 6-year follow-up period.
  • Patient-reported difficulties in self-regulatory behavior and problem-solving were associated with a significant increase in mortality risk (94% and 103% respectively).
  • Self-regulatory problem-solving difficulties remained a significant independent predictor of survival, whereas self-regulatory behavior did not in adjusted models. Caregiver reports and Wisconsin Card Sorting Task performance did not predict survival.

Conclusions:

  • Patient-reported self-regulatory problem-solving deficits appear to be a significant indicator of poorer prognosis in motor neuron disease (MND).
  • These findings suggest that difficulties in self-regulation, particularly in problem-solving, are crucial for understanding MND patient survival.
  • Further research is warranted to elucidate the underlying mechanisms linking these deficits to patient survival in MND.

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