**10. Memory**

It has been difficult to categorize the pattern of memory impairment, but current evidence suggests that memory problems are related to abnormalities in retrieval of the information secondary to frontal dysfunction. (Neary, et al. 2000). Memory problems involve primarily immediate recall, (Phukan. et al. 2007) but impairment of visual memory also has been implicated,(Kew, et al.1993)

Frontal, temporal and thalamic hypoperfusion on SPECT has been shown to correlate with the severity of memory impairment. (Montovan, et al. 2003).

Most strikingly, learning and memory were found to be significantly improved in patients in the later stages of the disease, (Lakerveld et al, 2008).

Motor Neuron Disease 211

Normal motor and sensory nerve conduction (distal motor latencies may be increased)

Regions are defined as follows: brainstem, brachial, thorax and trunk, crural. UMN= Upper

There are no specific investigations for MND. Till now there are no specific biochemical or pathological markers of MND. The aim of Elctrophysiological, Imaging and laboratory investigations is to exclude MND mimics and/ or to support clinical signs presented by the

Allum and Shaw (2010) clarified that investigations are important adjuncts to the clinical diagnosis of MND. Properly used they can provide supportive evidence of the clinical findings and help delineate the extent of disease. Investigations are also important to

Although MND is still incurable disease up till now, in the last two decades MND management has evolved rapidly. Symptomatic treatment of MND still had the upper hand of management plan, especially for respiratory and bulbar complications. A team of work including neurologist, highly qualified nurses, ICU specialist in respiratory complications, psychologist, dietition, physiotherapy and speech therapist must be involved for

1. Delay Progression of the disease and prevent further loss of motor neurons especially in

2. Symptomatomatic treatment to alleviate symptoms of the disease aiming to maintain

**11.2 The diagnosis of ALS requires the absence of** 

**11.3 The diagnosis of ALS is supported by** 

 Fasciculation in one or more regions Neurogenic change in EMG studies

motor neuron; LMN= lower motor neuron.

identify benign or treatable MND mimics.

**12.2 Treatment plan of motor neuron disease** 

management plan and follow up of MND patients, table (5).

Thus treatment strategy of MND was aimed towards;

the early stage of the disease

quality of life

**12. Management of motor neuron disease (MND)** 

Absence of conduction block

**12.1 Investigations** 

patients.

Sensory signs

 Sphincter disturbances Visual disturbances Autonomic dysfunction Parkinson's disease Alzheimer-type dementia ALS "mimic" syndromes


\* (Brooks, 1994 and Brooks, et al. 2000)

\*\* Als: amyotrophic lateral sclerosis

Table 4. Revised El Escorial criteria for the diagnosis of ALS.\*
