Amyotrophic lateral sclerosis sometimes comes hand-in-hand with dementia. An estimated 15 to 41% of ALS patients have cognitive changes, depending on how these changes are tested for. The most common type of dementia associated with ALS is a frontotemporal dementia, with personality changes and less impulse control. There is little consensus on how these dementias may be best managed, but there is certainly no easy cure. Sometimes, an apparent dementia may actually be the result of inadequate sleep or depression, and so it is important to make sure these factors are being treated. Otherwise, the management of these dementias relies on working with a team that may include a social worker, neurologist and psychiatrist to manage the patient's behavior. As always, planning ahead is key.
With all the negative changes that come with a diagnosis of ALS, some depression and anxiety has to be expected. Surprisingly, these feelings tend to be less common among those with ALS than other diseases, such as epilepsy. If these feelings are present, they are best managed with a combination of counseling, therapy, and medications, such as antidepressants.
ALS can cause other changes that mimic more common depression and anxiety. For example, what may feel like depression may actually be fatigue due to muscular effort and poor sleep. Furthermore, due to the neurological changes of ALS, patients may suffer from a pseudobulbar affect, also known as involuntary emotional expression disorder, or IEED. This means that their emotions are unstable, and they may find themselves laughing or crying in inappropriate situations. A combination of dextromethorphan and quinidine has been shown to be effective in helping this symptom.