Assessment and Diagnosis Assessment and Diagnosis
ÎScreening for cognitive and behavioral impairment should be considered (B). Screening tests of executive function may be considered to detect cognitive impairment prior to confirmation with formal neuropsychological evaluation (C). However, there are insufficient data to support or refute treatment to optimize communication, treatment of cognitive or behavioral impairment, or the impact of
cognitive or behavioral impairment on management of ALS (U).
ÎThere is insufficient evidence to support or refute any specific method of disclosing the diagnosis (U).
Text in bold = evidence-based Text in italics = consensus-based
Figure 2. Algorithm for Nutrition Management Diagnosis: ALS
PEG, percutaneous endoscopic gastrostomy
Clinic visits every 3 months Early dysphagia detected
Nutritional education including PEGb
Symptom progressionc or continued weight loss Clinic visits every 3 months
Discuss PEG to stabilize weight and possibly prolong survival
FVC >50% Low risk for PEG PEG accepted
▶ Oral intake as tolerated ▶ Enteral nutrition via PEG as needed
FVC 30-50% Moderate risk
▶ Anesthesia evaluation ▶ Experienced gastroenterologist
FVC <30% High risk PEG declined
▶ Respiratory support during PEG if needed
▶ Oral intake as tolerated ▶ Palliative IV hydration ▶ Palliative NG feeding
a Bulbar questions in the Amyotrophic Lateral Sclerosis Functional Rating Scale or other instrument. b Percutaneous endoscopic gastrostomy: rule out contraindications. c Prolonged mealtime, ending meal prematurely because of fatigue, accelerated weight loss due to poor caloric intake, family concern about feeding difficulties.
Monitor body weight;
Dysphagia assessment instrumenta
speech therapist referral
Nutritionist or respiratory status Monitor
