EXECUTIVE DEFICITS IN AMYOTROPHIC LATERAL SCLEROSIS: EXAMINING THE CONSEQUENCES OF SELF-REGULATORY IMPAIRMENT ON QUALITY OF LIFE

• Main Author: Roach, Abbey R.
• Format: Others
• Published: UKnowledge 2010
• Subjects: Amyotropic Lateral Sclerosis (ALS); Self-Regulation; Executive Functioning; Quality of Life; Heart Rate Variability; Clinical Psychology; Mental and Social Health; Psychology
• Online Access: http://uknowledge.uky.edu/gradschool_diss/113; http://uknowledge.uky.edu/cgi/viewcontent.cgi?article=1113&context=gradschool_diss

Amyotrophic Lateral Sclerosis (ALS) is a fatal neurodegenerative disease that attacks the motor system and contributes to a range of cognitive and behavioral impairments (e.g., behavioral and emotional disinhibition, planning and problem solving difficulties, impulsivity, attention, and personality change). This executive dysfunction may contribute to selfregulatory impairment across several domains, including cognitive skills, thought processes, emotion regulation, interpersonal skills, and physiology, that may be crucial to the quality of life (QOL), or well being, of patients and their caregivers. Given the relentless course and prognosis of ALS, palliative treatments for ALS should target the full range of self-regulatory deficits. Thirty-seven patient-caregiver pairs completed questionnaires regarding the patients’ ability to regulate emotions, social behavior, and thought patterns. Patients also completed neuropsychological measures of executive functions and provided measures of glycosylated hemoglobin (A1c) and heart rate variability (HRV). Results suggest that SR and EF deficits exist on a continuum in ALS, such that some patients evidence adequate or superior ability to self-regulate while others evidence deficits. Patient- caregiver agreement about patients’ selfregulatory capacity across domains was generally weak to moderate. Patients perceived themselves to have less capacity for global regulation than caregivers perceived them to have, patients perceived less dyadic cohesion than caregivers, and patients perceived themselves to ruminate more than caregivers indicated. Overall, caregivers tended to perceive a more pervasive pattern of deficits compared to patients. Additionally, measures of SR and EF were not strongly inter-correlated in general, challenging the idea that SR in different domains depends on a common resource. Accordingly, correlations among measures of theoretically similar constructs (i.e., EF and SR) were small to moderate in magnitude and non-significant. With regard to physiological functioning, when patients had better regulated glucose (A1c), patients and caregivers perceived better global regulation. A similar pattern emerged with patient ratings, with higher baseline HRV linked to less emotional lability. Last, mixed results were obtained when predicting patient and caregiver QOL. Less rumination, less dyadic cohesion and more social anxiety were associated with higher QOL for patients. Caregivers’ QOL was not significantly related to their perceptions of patients’ self-regulatory capacity in any area.