The effect of non-invasive positive pressure ventilation (NIPPV) on cognitive function in amyotrophic lateral sclerosis (ALS): a prospective study

• Published in: Journal of neurology, neurosurgery and psychiatry Vol. 71; no. 4; pp. 482 - 487
• Main Authors: Newsom-Davis, I C, Lyall, R A, Leigh, P N, Moxham, J, Goldstein, L H
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01.10.2001; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: Age; Aged; Amyotrophic lateral sclerosis; amyotrophic lateral sclerosis (ALS); Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cognition Disorders - diagnosis; Cognition Disorders - therapy; Cognitive ability; cognitive function; Emergency and intensive respiratory care; Female; Gases; Hospitals; Humans; Intensive care medicine; Male; Medical sciences; Memory; Middle Aged; Motor Neuron Disease - diagnosis; Motor Neuron Disease - therapy; Neuropsychological Tests; Patients; Polysomnography; Positive-Pressure Respiration; Prospective Studies; Respiration; Sleep; Sleep Apnea, Central - diagnosis; Sleep Apnea, Central - therapy; Studies; Ventilation; Human; Intensive care; Nervous system diseases; Psychometrics; Amyotrophic lateral sclerosis; Cognition; Artificial ventilation; Positive pressure; Central nervous system disease; Evolution; Degenerative disease; Spinal cord disease; Elderly
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp.71.4.482

OBJECTIVES Neuropsychological investigations have shown a degree of cognitive dysfunction in a proportion of non-demented patients with ALS. Respiratory muscle weakness in ALS can lead to nocturnal hypoventilation, resulting in sleep disturbance and daytime somnolence. Sleep deprivation of this type may cause impairments in cognitive function, but this has not been formally evaluated in ALS. METHODS Cognitive functioning was evaluated in nine patients with ALS with sleep disturbance caused by nocturnal hypoventilation (NIPPV group), and in a comparison group of 10 similar patients without ventilation problems (control group). The NIPPV group then started non-invasive positive pressure ventilation (NIPPV) at night. After about 6 weeks, change in cognitive function was evaluated. RESULTS Statistically significant improvement in scores on two of the seven cognitive tests was demonstrated in the NIPPV group postventilation, and a trend towards significant improvement was found for two further tests. Scores in the control group did not improve significantly for these four tests, although an improvement was found on one other test. CONCLUSIONS Nocturnal hypoventilation and sleep disturbance may cause cognitive dysfunction in ALS. These deficits may be partially improved by NIPPV over a 6 week period. This has important implications for investigations of both cognitive dysfunction in non-demented patients with ALS, and the effect of ventilation on quality of life.