Diagnosis pathway for patients with amyotrophic lateral sclerosis: retrospective analysis of the US Medicare longitudinal claims database

Table 2 **Symptoms/diagnoses observed at a frequency > 10% in the ALS cohort* compared with the Medicare cohort** ^†

Symptom group	Symptom/diagnosis	Pre-ALS frequency, %*	Medicare frequency, %^†	Prevalence ratio^‡
Bulbar	Speech disturbance	24	2	15
Bulbar	Voice resonance disorder	15	1	11
Limb	Muscle weakness (generalized)	30	5	5.9
Limb	Lack of coordination	13	3	4
Bulbar	Dysphagia^§	27	7	3.9
Nerve	Hereditary and idiopathic peripheral neuropathies^§	35	10	3.7
Nerve	Cervicalgia	18	5	3.7
Limb	Gait abnormality/difficulty walking	32	11	2.8
Other	Transient cerebral ischemia	13	5	2.8
Other	Loss of weight	17	6	2.7
Other	Stroke	11	4	2.4
Other	Lumbago/backache^§	52	27	1.9
Other	Malaise and fatigue	56	32	1.8
Other	Syncope and collapse	26	14	1.8
Limb	Pain in limb	44	27	1.6
Other	Esophageal reflux	31	21	1.5
Other	Constipation	15	10	1.5
Respiratory	Pulmonary collapse/failure	17	12	1.4
Other	Dizziness and giddiness	12	8	1.4
Other	Swelling in limb	11	8	1.4
Respiratory	Respiratory difficulties^§	62	49	1.3
Other	Hypothyroidism	27	22	1.3
Other	Nausea, vomiting, etc.	11	9	1.3
Limb	Pain in joint	31	26	1.2
Respiratory	Bronchitis	18	14	1.2
Respiratory	Chronic airway obstruction	19	17	1.1
Respiratory	Acute upper respiratory infection	12	11	1.1

ALS, amyotrophic lateral sclerosis.
*Frequency > 10% in the eight quarters before diagnosis of ALS (not including the quarter of diagnosis).
^†Prevalence in the Medicare cohort.
^‡Percentage of patients in the ALS cohort having a given symptom/the percentage of patients in the Medicare cohort with the same symptom.
^§Includes multiple symptom types.

ISSN: 1471-2377