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Relationship between neuropsychiatric disorders and cognitive and behavioural change in MND
Caroline A McHutchison1,2,3, Danielle Jane Leighton2,4, Andrew McIntosh3,5
1Human Cognitive Neurosciences, Department of Psychology, The University of Edinburgh, Edinburgh, UK Caroline.McHutchison@ed.ac.uk.
Objective:
In this population-based study, we aimed to determine whether neuropsychiatric history, medication or family history of neuropsychiatric disorders predicted cognitive and/or behavioural impairment in motor neuron disease (MND).
Methods:
People with MND (pwMND) on the Scottish Clinical, Audit, Research and Evaluation of MND (CARE-MND) register, diagnosed from January 2015 to January 2018, with cognitive and/or behavioural data measured using the Edinburgh Cognitive and Behavioural ALS Screen were included. Data were extracted on patient neuropsychiatric, medication and family history of neuropsychiatric disorders. We identified patients with cognitive impairment (motor neuron disease with cognitive impairment (MNDci)), behavioural impairment (motor neuron disease with behavioural impairment (MNDbi), both (motor neuron disease with cognitive and behavioural impairment (MNDcbi)) or motor neuron disease-frontotemporal dementia (MND-FTD).
Results:
Data were available for 305 pwMND (mean age at diagnosis=62.26 years, SD=11.40), of which 60 (19.7%) had a neuropsychiatric disorder. A family history of neuropsychiatric disorders was present in 36/231 (15.58%) of patients. Patient premorbid mood disorders were associated with increased apathy (OR=2.78, 95% CI 1.083 to 7.169). A family history of any neuropsychiatric disorder was associated with poorer visuospatial scores, MNDbi (OR=3.14, 95% CI 1.09 to 8.99) and MND-FTD (OR=5.08, 95% CI 1.26 to 20.40). A family history of mood disorders was associated with poorer overall cognition (exp(b)=0.725, p=0.026), language, verbal fluency and visuospatial scores, and MND-FTD (OR=7.57, 95% CI 1.55 to 46.87). A family history of neurotic disorders was associated with poorer language (exp(b)=0.362, p<0.001), visuospatial scores (exp(b)=0.625, p<0.009) and MND-FTD (OR=13.75, 95% CI 1.71 to 110.86).
Conclusion:
Neuropsychiatric disorders in patients and their families are associated with cognitive and behavioural changes post-MND diagnosis, with many occurring independently of MND-FTD and C9orf72 status. These findings support an overlap between MND, frontotemporal dementia and neuropsychiatric disorders, particularly mood disorders.
Insights
A history of neuropsychiatric disorders in motor neuron disease (MND) patients and their families is linked to cognitive and behavioral changes. These findings suggest a connection between MND, frontotemporal dementia, and neuropsychiatric conditions.
Area of Science:
- Neurology
- Psychiatry
- Genetics
Background:
- Motor neuron disease (MND) is a progressive neurodegenerative disorder.
- Cognitive and behavioral impairments are increasingly recognized in MND.
- The role of neuropsychiatric history in predicting these impairments requires further investigation.
Purpose of the Study:
- To investigate the association between patient neuropsychiatric history, medication, and family history of neuropsychiatric disorders with cognitive and/or behavioral impairment in motor neuron disease (MND).
Main Methods:
- Population-based study using the CARE-MND register (2015-2018).
- Included 305 people with MND (pwMND) assessed with the Edinburgh Cognitive and Behavioural ALS Screen.
- Extracted data on patient neuropsychiatric, medication, and family history.
Main Results:
- 19.7% of pwMND had a neuropsychiatric disorder; 15.58% had a family history.
- Patient premorbid mood disorders correlated with increased apathy.
- Family history of neuropsychiatric disorders was linked to poorer visuospatial scores, MND with behavioral impairment (MNDbi), and MND-frontotemporal dementia (MND-FTD).
- Family history of mood and neurotic disorders showed associations with poorer cognitive scores and MND-FTD.
Conclusions:
- Neuropsychiatric disorders in patients and families are associated with cognitive/behavioral changes post-MND diagnosis.
- These associations often occur independently of MND-FTD and C9orf72 status.
- Findings support an overlap between MND, frontotemporal dementia, and neuropsychiatric disorders, especially mood disorders.
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