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. 2024 Mar 19;19:127. doi: 10.1186/s13023-024-03129-6

Table 3.

Prevalence of symptomatic themes in ALD for the overall sample (n = 109) and subgroups of individuals with ALD

Overall prevalence (%) of full sample (n = 109)
A: Theme
Limitations with mobility or walking 87.2
Problems with balance 90.8
Inability to do activities 82.6
Trouble getting around 75.2
Leg weakness 86.2
Pain 74.3
Stiffness 84.4
Fatigue 86.2
Gastrointestinal issues 64.2
Decreased satisfaction in social situations 73.4
Emotional issues 78.0
Communication difficulties 41.3
Difficulty thinking 47.2
Impaired sleep or daytime sleepiness 71.6
Back, chest, or abdominal weakness 51.9
Problems with shoulders or arms 45.0
Numbness 68.8
Choking or swallowing issues 26.6
Abnormal movements 52.3
Problems with hands or fingers 44.0
Breathing difficulties 13.9
Seizures 6.5
Impaired vision 31.5
Difficulty hearing 31.2
Age (years)
Prevalence (%)
Above mean (> 51 years) (n = 61) Equal to or below mean (≤ 51 years) (n = 48) p value
B: Theme
Limitations with mobility or walking 95.08 77.08 0.0080*
Problems with balance 96.72 83.33 0.0209*
Inability to do activities 86.89 77.08 0.2098
Trouble getting around 80.33 68.75 0.1855
Leg weakness 90.16 81.25 0.2627
Pain 81.97 64.58 0.0482*
Stiffness 90.16 77.08 0.0695
Fatigue 88.52 83.33 0.5769
Gastrointestinal issues 67.21 60.42 0.5471
Decreased satisfaction in social situations 70.49 77.08 0.5155
Emotional issues 73.77 83.33 0.2544
Communication difficulties 39.34 43.75 0.6975
Difficulty thinking 50.00 43.75 0.5642
Impaired sleep or daytime sleepiness 75.41 66.67 0.3933
Back, chest, or abdominal weakness 48.33 56.25 0.4436
Problems with shoulders or arms 50.82 37.50 0.1802
Numbness 70.49 66.67 0.6827
Choking or swallowing issues 29.51 22.92 0.5155
Abnormal movements 55.74 47.92 0.4453
Problems with hands or fingers 50.82 35.42 0.1233
Breathing difficulties 16.67 10.42 0.4113
Seizures 5.00 8.33 0.6975
Impaired vision 31.67 31.25 1.0000
Difficulty hearing 40.98 18.75 0.0212*
Sex
Prevalence (%)
Male (n = 47) Female (n = 62) p value
C: Theme
Limitations with mobility or walking 91.49 83.87 0.2660
Problems with balance 93.62 88.71 0.5100
Inability to do activities 93.62 74.19 0.0100*
Trouble getting around 91.49 62.9 0.0006*
Leg weakness 93.62 80.65 0.0896
Pain 72.34 75.81 0.8252
Stiffness 89.36 80.65 0.2889
Fatigue 87.23 85.48 1.0000
Gastrointestinal issues 63.83 64.52 1.0000
Decreased satisfaction in social situations 80.85 67.74 0.1887
Emotional issues 80.85 75.81 0.6425
Communication difficulties 46.81 37.10 0.3319
Difficulty thinking 48.94 45.90 0.8464
Impaired sleep or daytime sleepiness 65.96 75.81 0.2891
Back, chest, or abdominal weakness 59.57 45.90 0.1782
Problems with shoulders or arms 40.43 48.39 0.4419
Numbness 74.47 64.52 0.3019
Choking or swallowing issues 14.89 35.48 0.0174*
Abnormal movements 61.70 45.16 0.1212
Problems with hands or fingers 36.17 50.00 0.1755
Breathing difficulties 10.64 16.39 0.5759
Seizures 12.77 1.64 0.0414*
Impaired vision 25.53 36.07 0.2981
Difficulty hearing 25.53 35.48 0.3019
Education level
Prevalence (%)
High school, Technical school, none (n = 52) College, Masters, Doctorate (n = 57) p value
D: Theme
Limitations with mobility or walking 88.46 85.96 0.7794
Problems with balance 94.23 87.72 0.3257
Inability to do activities 88.46 77.19 0.1375
Trouble getting around 80.77 70.18 0.2674
Leg weakness 88.46 84.21 0.5864
Pain 82.69 66.67 0.0787
Stiffness 86.54 82.46 0.6063
Fatigue 94.23 78.95 0.0261*
Gastrointestinal issues 61.54 66.67 0.6896
Decreased satisfaction in social situations 78.85 68.42 0.2792
Emotional issues 76.92 78.95 0.821
Communication difficulties 40.38 42.11 1
Difficulty thinking 47.06 47.37 1
Impaired sleep or daytime sleepiness 78.85 64.91 0.1378
Back, chest, or abdominal weakness 56.86 47.37 0.342
Problems with shoulders or arms 55.77 35.09 0.0354*
Numbness 63.46 73.68 0.3026
Choking or swallowing issues 30.77 22.81 0.3904
Abnormal movements 59.62 45.61 0.18
Problems with hands or fingers 51.92 36.84 0.1263
Breathing difficulties 15.69 12.28 0.7815
Seizures 5.88 7.02 1
Impaired vision 37.25 26.32 0.2996
Difficulty hearing 36.54 26.32 0.3026
Employment status
Prevalence (%)
Not working (n = 24) Working (n = 85) p value
E: Theme
Limitations with mobility or walking 95.83 84.71 0.2968
Problems with balance 100.00 88.24 0.1134
Inability to do activities 87.50 81.18 0.5586
Trouble getting around 87.50 71.76 0.1794
Leg weakness 87.50 85.88 1.0000
Pain 95.83 68.24 0.0068*
Stiffness 95.83 81.18 0.1124
Fatigue 100.00 82.35 0.0383*
Gastrointestinal issues 66.67 63.53 0.8149
Decreased satisfaction in social situations 79.17 71.76 0.6040
Emotional issues 100.00 71.76 0.0016*
Communication difficulties 58.33 36.47 0.0638
Difficulty thinking 60.87 43.53 0.1628
Impaired sleep or daytime sleepiness 83.33 68.24 0.2020
Back, chest, or abdominal weakness 70.83 46.43 0.0397*
Problems with shoulders or arms 58.33 41.18 0.1660
Numbness 87.50 63.53 0.0265*
Choking or swallowing issues 29.17 25.88 0.7957
Abnormal movements 75.00 45.88 0.0195*
Problems with hands or fingers 50.00 42.35 0.6421
Breathing difficulties 25.00 10.71 0.0952
Seizures 8.33 5.95 0.6501
Impaired vision 33.33 30.95 0.8084
Difficulty hearing 16.67 35.29 0.1328
Disability status
Prevalence (%)
On disability (n = 16) Not on disability (n = 93) p value
F: Theme
Limitations with mobility or walking 100.00 84.95 0.2163
Problems with balance 100.00 89.25 0.3524
Inability to do activities 87.50 81.72 0.7331
Trouble getting around 87.50 73.12 0.3481
Leg weakness 87.50 86.02 1.0000
Pain 93.75 70.97 0.0655
Stiffness 100.00 81.72 0.0711
Fatigue 100.00 83.87 0.1205
Gastrointestinal issues 62.50 64.52 1.0000
Decreased satisfaction in social situations 75.00 73.12 1.0000
Emotional issues 100.00 74.19 0.0204*
Communication difficulties 68.75 36.56 0.0258*
Difficulty thinking 53.33 46.24 0.7815
Impaired sleep or daytime sleepiness 81.25 69.89 0.5494
Back, chest, or abdominal weakness 62.50 50.00 0.4232
Problems with shoulders or arms 56.25 43.01 0.4170
Numbness 81.25 66.67 0.3816
Choking or swallowing issues 43.75 23.66 0.1248
Abnormal movements 68.75 49.46 0.1832
Problems with hands or fingers 50.00 43.01 0.7860
Breathing difficulties 25.00 11.96 0.2318
Seizures 12.50 5.43 0.2766
Impaired vision 31.25 31.52 1.0000
Difficulty hearing 18.75 33.33 0.3816
Has ALD impacted your employment status or choice?
Prevalence (%)
Yes (n = 60) No (n = 40) p value
G: Theme
Limitations with mobility or walking 93.33 77.50 0.0321*
Problems with balance 95.00 85.00 0.1505
Inability to do activities 93.33 67.50 0.0011*
Trouble getting around 88.33 60.00 0.0015*
Leg weakness 91.67 80.00 0.1287
Pain 88.33 55.00 0.0003*
Stiffness 91.67 72.50 0.0134*
Fatigue 90.00 80.00 0.2387
Gastrointestinal issues 66.67 60.00 0.5291
Decreased satisfaction in social situations 85.00 55.00 0.0013*
Emotional issues 90.00 55.00  < 0.0001*
Communication difficulties 55.00 20.00 0.0008*
Difficulty thinking 61.02 32.50 0.0076*
Impaired sleep or daytime sleepiness 80.00 55.00 0.0135*
Back, chest, or abdominal weakness 64.41 32.50 0.0022*
Problems with shoulders or arms 55.00 25.00 0.0039*
Numbness 80.00 52.50 0.0045*
Choking or swallowing issues 31.67 17.50 0.1625
Abnormal movements 68.33 27.50  < 0.0001*
Problems with hands or fingers 51.67 32.50 0.0672
Breathing difficulties 16.95 2.50 0.0461*
Seizures 10.17 2.50 0.2361
Impaired vision 35.59 22.50 0.1874
Difficulty hearing 30.00 35.00 0.6642
Years since first noticed symptoms
Prevalence (%)
Above mean (> 15 years) (n = 51) Equal to or below mean (≤ 15 years) (n = 57) p value
H: Theme
Limitations with mobility or walking 92.16 84.21 0.2468
Problems with balance 94.12 89.47 0.4953
Inability to do activities 86.27 78.95 0.4485
Trouble getting around 86.27 66.67 0.0237*
Leg weakness 88.24 84.21 0.5893
Pain 82.35 66.67 0.0797
Stiffness 90.20 78.95 0.1220
Fatigue 90.20 82.46 0.2782
Gastrointestinal issues 70.59 57.89 0.2287
Decreased satisfaction in social situations 76.47 70.18 0.5185
Emotional issues 78.43 77.19 1.0000
Communication difficulties 50.98 33.33 0.0794
Difficulty thinking 54.00 42.11 0.2483
Impaired sleep or daytime sleepiness 76.47 68.42 0.3948
Back, chest, or abdominal weakness 62.00 42.11 0.0528
Problems with shoulders or arms 58.82 31.58 0.0065*
Numbness 74.51 64.91 0.3030
Choking or swallowing issues 37.25 17.54 0.0293*
Abnormal movements 64.71 42.11 0.0217*
Problems with hands or fingers 56.86 31.58 0.0114*
Breathing difficulties 26.00 3.51 0.0014*
Seizures 8.00 5.26 0.7031
Impaired vision 30.00 31.58 1.0000
Difficulty hearing 39.22 24.56 0.1459
Diagnosed with AMN?
Prevalence (%)
Yes (n = 71) No (n = 27) p value
I: Theme
Limitations with mobility or walking 94.37 70.37 0.0030*
Problems with balance 95.77 85.19 0.0886
Inability to do activities 88.73 66.67 0.0161*
Trouble getting around 81.69 62.96 0.1974
Leg weakness 91.55 77.78 0.0852
Pain 81.69 59.26 0.0339*
Stiffness 92.96 70.37 0.0063*
Fatigue 87.32 85.19 0.7487
Gastrointestinal issues 70.42 51.85 0.1000
Decreased satisfaction in social situations 76.06 62.96 0.2135
Emotional issues 78.87 77.78 1.0000
Communication difficulties 45.07 29.63 0.1779
Difficulty thinking 50.00 37.04 0.2673
Impaired sleep or daytime sleepiness 71.83 70.37 1.0000
Back, chest, or abdominal weakness 52.11 51.85 1.0000
Problems with shoulders or arms 46.68 37.04 0.4962
Numbness 76.06 44.44 0.0041*
Choking or swallowing issues 25.35 25.93 1.0000
Abnormal movements 57.75 44.44 0.2638
Problems with hands or fingers 45.07 33.33 0.3621
Breathing difficulties 14.08 11.11 1.0000
Seizures 5.63 3.70 1.0000
Impaired vision 21.13 44.44 0.0409
Difficulty hearing 25.35 40.74 0.1462
Diagnosed with cerebral ALD?
Prevalence (%)
Yes (n = 18) No (n = 81) p value
J: Theme
Limitations with your mobility or walking 83.33 86.42 0.7152
Problems with balance 77.78 92.59 0.0800
Inability to do activities 88.89 80.25 0.5138
Trouble getting around 77.78 74.07 1.0000
Leg weakness 77.78 86.42 0.4653
Pain 66.67 76.54 0.3826
Stiffness 77.78 86.42 0.4653
Fatigue 83.33 86.42 0.7152
Gastrointestinal issues 66.67 62.96 1.0000
Decreased satisfaction in social situations 83.33 72.94 0.5495
Emotional issues 88.89 77.78 0.5158
Communication difficulties 50 37.04 0.4243
Difficulty thinking 50 46.25 0.7994
Impaired sleep or daytime sleepiness 66.67 71.6 0.7758
Back, chest, or abdominal weakness 55.56 48.75 0.7948
Problems with shoulders or arms 50 41.98 0.6038
Numbness 72.22 67.9 0.7868
Choking or swallowing issues 22.22 27.16 0.7743
Abnormal movements 66.67 50.62 0.2975
Problems with hands or fingers 44.44 44.44 1
Breathing difficulties 16.67 11.25 0.6899
Seizures 11.11 6.25 0.609
Impaired vision 38.89 26.25 0.3861
Difficulty hearing 22.22 30.86 0.5748
Diagnosed with Addison's disease (adrenal insufficiency)?
Prevalence (%)
Yes (n = 35) No (n = 71) p value
K: Theme
Limitations with mobility or walking 88.57 85.92 1.0000
Problems with balance 94.29 88.73 0.4913
Inability to do activities 91.43 77.46 0.1068
Trouble getting around 91.43 66.20 0.0046*
Leg weakness 91.43 83.10 0.3756
Pain 68.57 76.06 0.4841
Stiffness 85.71 83.10 1.0000
Fatigue 88.57 84.51 0.7688
Gastrointestinal issues 62.86 64.79 1.0000
Decreased satisfaction in social situations 77.14 70.42 0.4984
Emotional issues 80.00 76.06 0.8061
Communication difficulties 42.86 38.03 0.6762
Difficulty thinking 48.57 44.29 0.6842
Impaired sleep or daytime sleepiness 65.71 73.24 0.4975
Back, chest, or abdominal weakness 57.14 49.30 0.5365
Problems with shoulders or arms 28.57 50.70 0.0379*
Numbness 77.14 64.79 0.2655
Choking or swallowing issues 17.14 30.99 0.1626
Abnormal movements 65.71 45.07 0.0627
Problems with hands or fingers 40.00 46.48 0.5419
Breathing difficulties 14.29 14.08 1.0000
Seizures 14.29 2.82 0.0381*
Impaired vision 31.43 32.39 1.0000
Difficulty hearing 28.57 32.39 0.8243
Ambulatory status
Prevalence (%)
Mobility assistance needed (n = 59) Walk independently (n = 50) p value
L: Theme
Limitations with mobility or walking 98.31 74.00 0.0002*
Problems with balance 100.00 80.00 0.0002*
Inability to do activities 100.00 62.00 < 0.0001*
Trouble getting around 98.31 48.00 < 0.0001*
Leg weakness 96.61 74.00 0.0007*
Pain 81.36 66.00 0.0808
Stiffness 93.22 74.00 0.0077*
Fatigue 91.53 80.00 0.0991
Gastrointestinal issues 64.41 64.00 1.0000
Decreased satisfaction in social situations 83.05 62.00 0.0169*
Emotional issues 81.36 74.00 0.3661
Communication difficulties 50.85 30.00 0.0329*
Difficulty thinking 51.72 42.00 0.3394
Impaired sleep or daytime sleepiness 74.58 68.00 0.5247
Back, chest, or abdominal weakness 63.79 38.00 0.0117*
Problems with shoulders or arms 49.15 40.00 0.4398
Numbness 74.58 62.00 0.2132
Choking or swallowing issues 32.20 20.00 0.1932
Abnormal movements 62.71 40.00 0.0217*
Problems with hands or fingers 42.37 46.00 0.8466
Breathing difficulties 13.79 14.00 1.0000
Seizures 10.34 2.00 0.1200
Impaired vision 34.48 28.00 0.5360
Difficulty hearing 33.90 28.00 0.5401
Speech status
Prevalence (%)
Speech change (n = 20) Talks clearly (n = 89) p value
M: Theme
Limitations with mobility or walking 100.00 84.27 0.0685
Problems with balance 100.00 88.76 0.2028
Inability to do activities 95.00 79.78 0.1883
Trouble getting around 100.00 69.66 0.0030*
Leg weakness 100.00 83.15 0.0682
Pain 85.00 71.91 0.2713
Stiffness 95.00 82.02 0.1897
Fatigue 90.00 85.39 0.7335
Gastrointestinal issues 75.00 61.80 0.3119
Decreased satisfaction in social situations 95.00 68.54 0.0222*
Emotional issues 100.00 73.03 0.0059*
Communication difficulties 100.00 28.09 < 0.0001*
Difficulty thinking 73.68 41.57 0.0126*
Impaired sleep or daytime sleepiness 95.00 66.29 0.0117*
Back, chest, or abdominal weakness 78.95 46.07 0.0113*
Problems with shoulders or arms 75.00 38.2 0.0052*
Numbness 95.00 62.92 0.0061*
Choking or swallowing issues 75.00 15.73 < 0.0001*
Abnormal movements 80.00 46.07 0.0067*
Problems with hands or fingers 75.00 37.08 0.0026*
Breathing difficulties 42.11 7.87 0.0007*
Seizures 5.26 6.74 1.0000
Impaired vision 47.37 28.09 0.1110
Difficulty hearing 35.00 30.34 0.7903
Functional ability
Prevalence (%)
Slight through severe disability (n = 79) No symptoms or no significant disability (n = 30) p value
N: Theme
Limitations with mobility or walking 98.73 56.67  < 0.0001*
Problems with balance 97.47 73.33 0.0005*
Inability to do activities 98.73 40.00 < 0.0001*
Trouble getting around 94.94 23.33 < 0.0001*
Leg weakness 96.2 60.00 < 0.0001*
Pain 84.81 46.67 0.0001*
Stiffness 92.41 63.33 0.0005*
Fatigue 93.67 66.67 0.0008*
Gastrointestinal issues 68.35 53.33 0.1807
Decreased satisfaction in social situations 84.81 43.33 < 0.0001*
Emotional issues 83.54 63.33 0.0367*
Communication difficulties 51.90 13.33 0.0002*
Difficulty thinking 55.13 26.67 0.0099*
Impaired sleep or daytime sleepiness 77.22 56.67 0.0555
Back, chest, or abdominal weakness 61.54 26.67 0.0013*
Problems with shoulders or arms 54.43 20.00 0.0013*
Numbness 77.22 46.67 0.0048*
Choking or swallowing issues 29.11 20.00 0.4674
Abnormal movements 64.56 20.00 < 0.0001*
Problems with hands or fingers 48.10 33.33 0.1983
Breathing difficulties 15.38 10.00 0.5518
Seizures 8.97 0.00 0.1866
Impaired vision 34.62 23.33 0.3556
Difficulty hearing 30.38 33.33 0.8187
Home health aide per week
Prevalence (%)
Receive aide (n = 34) None (n = 75) p value
O: Theme
Limitations with mobility or walking 100.00 81.33 0.0046*
Problems with balance 100.00 86.67 0.0292*
Inability to do activities 100.00 74.67 0.0006*
Trouble getting around 100.00 64.00 < 0.0001*
Leg weakness 94.12 82.67 0.1395
Pain 82.35 70.67 0.2414
Stiffness 97.06 78.67 0.0199*
Fatigue 97.06 81.33 0.0340*
Gastrointestinal issues 70.59 61.33 0.3947
Decreased satisfaction in social situations 88.24 66.67 0.0199*
Emotional issues 91.18 72.00 0.0265*
Communication difficulties 52.94 36.00 0.1410
Difficulty thinking 52.94 44.59 0.5340
Impaired sleep or daytime sleepiness 79.41 68.00 0.2585
Back, chest, or abdominal weakness 72.73 42.67 0.0062*
Problems with shoulders or arms 61.76 37.33 0.0226*
Numbness 76.47 65.33 0.2733
Choking or swallowing issues 38.24 21.33 0.1001
Abnormal movements 76.47 41.33 0.0008*
Problems with hands or fingers 55.88 38.67 0.1014
Breathing difficulties 18.18 12.00 0.3837
Seizures 18.18 1.33 0.0031*
Impaired vision 33.33 30.67 0.8241
Difficulty hearing 38.24 28.00 0.3723

*Values of p < 0.05 are marked by an asterisk, and values of statistical significance, by the Benjamini–Hochberg method, are bolded