Motor neurone disease: A review of its emotional and cognitive consequences for patients and its impact on carers

Objectives. Motor neurone disease (MND) has been regarded primarily as a disorder of the motor system. The current review sets our to provide a summary of what is known about the cognitive and psychological consequences of this neurodegenerative disorder, and how this disease impacts on chose caring for a person with MND. Method. A Medline and PsycLit search was undertaken, for the years 1983-1397 supplemented by a manual search, to extract literature on the cognitive and emotional changes described in MND, as well as on styles of coping by MND patients. In addition, articles relating to the reactions of carers of MND patients were reviewed. Results, A consistent body of data is reported indicating the presence of subtle cognitive deficits (of a predominantly fronto-temporal type) in MND patients who do not demonstrate clinical dementia. Emotional disorders (e.g. anxiety and depression), as well as emotional lability, have been documented in patients in cross-sectional studies despite the limited availability of systematic research. Although reactions to the disease and coping skills of carers have been poorly studied, some carers demonstrate difficulty in dealing with physical and emotional stress posed by the disease. Conclusions. The atheoretical nature of much of the research into emotional disorder and coping skills in MND patients and their carers means that as yet it is difficult to predict who will be at particular risk of developing psychopathology during the course of the illness. Research to date also fails to elucidate the role of the patients' possible cognitive dysfunction in determining their coping behaviour. Future research, pre ferably longitudinal in design, should seek to determine whether aspects of the emotional response to MND by patients and their carers are specific to the disorder or characteristic of chronic, terminal neurological disease in general.