Rinsho Shinkeigaku (Clinical Neurology)

Original Article

Communication disorder in amyotrophic lateral sclerosis after ventilation
-A proposal of staging and a study of predictive factor-

Kentaro Hayashi, M.D.1), Yoko Mochizuki, M.D.2)3), Yuki Nakayama, R.N., Ph.D.4), Toshio Shimizu, M.D.1), Akihiro Kawata, M.D.1), Masahiro Nagao, M.D.1), Toshio Mizutani, M.D.2)5) and Shiro Matsubara, M.D., Ph.D.1)

1)Department of Neurology, Tokyo Metropolitan Neurological Hospital
2)Department of Pathology, Tokyo Metropolitan Neurological Hospital
3)Department of Neurology, Tokyo Metropolitan Kita Medical and Rehabilitation Center for the Disabled
4)Laboratory of Nursing Research for Intractable Disease, Tokyo Metropolitan Institute of Medical Science
5)Fuchu Medical Center for the Disabled

ALS patients supported by a ventilator often suffered from difficulty in communicating with others. We herein proposed a new classification of clinical stages of advanced ALS focusing on the degree of communication disturbance. We analyzed the relationship between clinical findings and the prognosis for communication disturbance. Twenty-nine ALS patients without dementia were enrolled in the study. The proposed classification consisted of five stages. Stage I: communicate in sentences, stage II: communicate with one word answers only, stage III: communicate with nonverbal yes/no response only, stage IV: cannot communicate occasionally due to uncertain yes/no responses, stage V: cannot communicate by any means. Clinical analysis showed that patients who reached stage V had begun to use the ventilator significantly earlier than patients with the final stages of IV or less. In addition, patients in stage V frequently had a family history of ALS. Rapid disease progression before ventilator use in patients with a family history might predict a poor long-term prognosis for communication disorder after using the ventilator.
Full Text of this Article in Japanese PDF (1276K)

(CLINICA NEUROL, 53: 98|103, 2013)
key words: amyotrophic lateral sclerosis, communication ability, clinical staging, tracheostomy positive pressure ventilation(TPPV), totally locked-in state (TLS)

(Received: 14-Mar-12)