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Do ecological factors influence the clinical presentation of amyotrophic lateral sclerosis?
Rosario Vasta, Antonio Canosa, Umberto Manera, Francesca Di Pede, Sara Cabras, Fabiola De Marchi, Letizia Mazzini, Cristina Moglia et al.. Journal of Neurology Neurosurgery & Psychiatry, 2021-02-09
Topic: Brain proteins, microglia and lab models
Since its first description by Charcot, amyotrophic lateral sclerosis (ALS) has been classified as a single neurodegenerative disease involving motor neurons. More recently, however, it has become clear that ALS is pleiotropic and its phenotype could vary depending on several factors: age of onset, prevalent damage to the upper (UMN) or the lower motor neuron, body region mostly affected, progression rate and presence of non-motor symptoms, the most frequent being cognitive impairment.1 As a consequence, different phenotypes have been described.2 It remains unclear whether these presentations should be considered as distinct clinical entities or as variants of the same disease.3 More importantly, we do not know if different aetiologies justify this variability.3 Despite these uncertainties, we approach clinical trials by administering the same treatment to all patients with ALS.3 Spatial epidemiology could give some clues on aetiology by identifying clusters and subsequently seeking for causative genetic or environmental factors. Previously, we analysed the spatial distribution of a large ALS cohort in Northwestern Italy. Patients resulted to be homogeneously distributed, suggesting either that a single environmental factor was evenly distributed or that multiple factors acted on distinct subgroups, the latter being the more likely.4 Moving from the hypothesis that aetiology could vary according to phenotypes, here we performed a spatial analysis of ALS cases stratified according to their clinical presentation. Data from the Piemonte and Valle d’Aosta ALS Register were used.4 All patients with ALS diagnosed between 2007 and 2014 and who were resident in Piemonte at the time of diagnosis were included. The cluster analysis was conducted considering municipalities; …
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APA 7th
Vasta, R., Canosa, A., Manera, U., Di Pede, F., Cabras, S., De Marchi, F., et al. (2021). Do ecological factors influence the clinical presentation of amyotrophic lateral sclerosis? Journal of Neurology Neurosurgery & Psychiatry. https://doi.org/10.1136/jnnp-2020-325625
Vancouver
Vasta R, Canosa A, Manera U, Di Pede F, Cabras S, De Marchi F, et al. Do ecological factors influence the clinical presentation of amyotrophic lateral sclerosis? Journal of Neurology Neurosurgery & Psychiatry. 2021. doi:10.1136/jnnp-2020-325625. PMID: 33563811.
BibTeX
@article{vasta2021-33563811,
author = {Vasta, Rosario and Canosa, Antonio and Manera, Umberto and Di Pede, Francesca and Cabras, Sara and De Marchi, Fabiola and Mazzini, Letizia and Moglia, Cristina and others},
title = {{Do ecological factors influence the clinical presentation of amyotrophic lateral sclerosis?}},
journal = {Journal of Neurology Neurosurgery \& Psychiatry},
year = {2021},
doi = {10.1136/jnnp-2020-325625},
pmid = {33563811},
url = {https://doi.org/10.1136/jnnp-2020-325625}
}
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
Key findings
- More recently, however, it has become clear that ALS is pleiotropic and its phenotype could vary depending on several factors: age of onset, prevalent damage to the upper (UMN) or the lower motor neuron, body region mostly affected, progression rate and presence of non-motor symptoms, the most frequent being cognitive impairment.1 As a consequence, different phenotypes have been described.2 It remains unclear whether these presentations should be considered as distinct clinical entities or as variants of the same disease.3 More importantly, we do not know if different aetiologies justify this variability.3 Despite these uncertainties, we approach clinical trials by administering the same treatment to all patients with ALS.3 Spatial epidemiology could give some clues on aetiology by identifying clusters and subsequently seeking for causative genetic or environmental factors.
- Previously, we analysed the spatial distribution of a large ALS cohort in Northwestern Italy.
- Patients resulted to be homogeneously distributed, suggesting either that a single environmental factor was evenly distributed or that multiple factors acted on distinct subgroups, the latter being the more likely.4 Moving from the hypothesis that aetiology could vary according to phenotypes, here we performed a spatial analysis of ALS cases stratified according to their clinical presentation.
- Data from the Piemonte and Valle d’Aosta ALS Register were used.4 All patients with ALS diagnosed between 2007 and 2014 and who were resident in Piemonte at the time of diagnosis were included.
- The cluster analysis was conducted considering municipalities; …
Why it matters
This paper discusses whether ecological factors influence the clinical presentation of amyotrophic lateral sclerosis, a different neurodegenerative disease. It does not report findings on treating, curing, or preventing Alzheimer's disease.
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Study details
- Evidence strengthModerate
How this study scored 37/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of Neurology Neurosurgery & Psychiatry) |
| Journal's citation record | 3 / 4 | Journal of Neurology Neurosurgery & Psychiatry: journal h-index 336 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 3 / 5 | 2021 — within 6 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 2 / 7 | Cited 5 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.7 citations a year over 7 year(s) since 2021 |
| Impact for its field and year | 1 / 6 | Cited 0.5× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 1 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 4 / 4 | Last-listed author Adriano Chiò: h-index 107 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | University of Turin: institution h-index 903 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 3 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 33563811) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 37 / 100 | — |
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