Diagnostic delay is longer in elderly patients with Amyotrophic Lateral Sclerosis

Introduction: Older age has been associated with diagnostic delay in Amyotrophic Lateral Sclerosis (ALS). However, most studies did not account for type of onset (bulbar, spinal) and other patient characteristics. We assessed time-to-diagnosis and evaluated if age is an independent predictor of diagnostic delay. Methods: Our population-based cohort included all patients with incident ALS in Friuli-Venezia Giulia, Italy, 2010–2014, admitted to one of the two regional University Hospitals. We compared Total Diagnostic Time (TDT) (interval from symptoms onset to ALS diagnosis) between groups of patients using Wilcoxon-Mann-Whitney test and identified predictors of a TDT C 1 year using multivariate logistic regression analysis. Results: Among 134 patients with ALS, 79.5% (N = 107) were aged C 60 years at disease onset, 51.5% were women and 64.9% had spinal onset. Median TDT was 11.5 months (interquartile range: 7.1–18.3) and 48.5% had a TDT C 1 year. Diagnostic delay was significantly longer in patients aged C 60 years (12.4 vs. 8.1 months; p = 0.0064) and in those with neurologic comorbidities (19.7 vs. 11.1 months, p = 0.0243). Patients C 60 years at disease onset were 11.5 times more likely of having a TDT[1 year, when type of onset, sex, having undergone physical, rehabilitation or surgical therapy or first referral to a specialist non-neurologist were adjusted for. Key conclusions: Despite it is known that ALS is an aging-related disease, older patients had higher adjusted risk of diagnostic delay, thus raising specific concerns on their opportunities for getting timely adequate healthcare, maybe because symptoms are wrongly attributed to other comorbidities.