Factors influencing the progression of amyotrophic lateral sclerosis: prospective cohort study

Aim. Using factor analysis, identify and rank the parameters potentially influencing the course of amyotrophic lateral sclerosis (ALS) according to their significance. Materials and methods. A prospective cohort study of 70 patients with ALS diagnosed according to the Gold Coast criteria (2020) was performed. We studied basic socio-demographic indicators, education and social status, geography of living, anamnestic data about the disease (appearance of the first symptoms, onset, etc.), clinical picture (symptoms in the main muscle groups), progression of ALSFRS-R score, environmental risk factors (including 23 features, presented in gradation from the lowest to the highest expression). Results. The mean age of the patients was 60.62 ± 10.2 years. The predominant proportion of patients was female, 61.4 % ( n = 43), the proportion of males was 38.6 % ( n = 27). The mean time from onset of symptoms to inclusion in the study and questionnaire was 12 months (95 % confidence interval 9.00–21.50). Low level of education, onset from bulbar symptoms and neck muscle involvement, severity of oral automatism reflexes, difficulty in walking and standing, contact with heavy metals, occupational sports and high stress level were correlated with rapid progression of ALS, while high level of physical activity, frequent caffeine consumption, antioxidant intake, vitamin D deficiency were observed in slow progression of ALS. Conclusion. Our data confirm that ALS is a clinically and pathogenetically heterogeneous disease, whose rate of progression is influenced by a wide range of clinical, anamnestic, and environmental factors.