Evidence map›Paper›PMID 40074931›Full record

ArticleJournal of neurology2025

Cognitive impairment within and beyond the FTD spectrum in ALS: development of a complementary cognitive screen.

Annebelle Michielsen, Kevin van Veenhuijzen, Fenna Hiemstra, Ilse M Jansen, Boaz Kalkhoven, Jan H Veldink, Esther T Kruitwagen, Michael van Es, Martine J E van Zandvoort, Leonard H van den Berg and 1 more

Abstract read
In one paragraph

Article in Journal of neurology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Article
  2. Review
  3. Neurotoxic mechanisms of cadmium in neurodegenerative diseases.Frontiers in cell and developmental biology · 2026
    Review
  4. Article
  5. New developments in imaging in ALS.Journal of neurology · 2025
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Annebelle MichielsenDepartment of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, G03.232, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.ORCID http://orcid.org/0009-0001-9775-4700
Kevin van VeenhuijzenDepartment of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, G03.232, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.ORCID http://orcid.org/0000-0002-4386-2351
Fenna HiemstraDepartment of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, G03.232, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
Ilse M JansenDepartment of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, G03.232, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
Boaz KalkhovenDepartment of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, G03.232, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
Jan H VeldinkDepartment of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, G03.232, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.ORCID http://orcid.org/0000-0001-5572-9657
Esther T KruitwagenDepartment of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.ORCID http://orcid.org/0000-0002-5930-9681
Michael van EsDepartment of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, G03.232, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.ORCID http://orcid.org/0000-0002-7709-5883
Martine J E van ZandvoortDepartment of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, G03.232, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.ORCID http://orcid.org/0000-0003-3992-2750
Leonard H van den Berg *Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, G03.232, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.ORCID http://orcid.org/0000-0002-6559-3965
Henk-Jan Westeneng *Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, G03.232, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands. H.J.Westeneng@umcutrecht.nl.ORCID http://orcid.org/0000-0001-7138-3852

Funding

H2020 European Research Council grant agreement no 772376- EScORIAL
6 · The paper itself

Abstract

objectiveTo investigate cognitive impairments in amyotrophic lateral sclerosis (ALS), extending both within and beyond the established frontotemporal dementia (FTD) spectrum, using the Complementary Cognitive ALS Screen (C-CAS).

methodsThe C-CAS, designed to complement the Edinburgh cognitive and behavioural ALS screen (ECAS), explores cognitive (sub)domains not investigated by the ECAS. Normative data were collected, and models adjusted for age, sex, and education level were developed. Item scores below the 5th percentile in controls were considered abnormal. A sum score was constructed, and C-CAS impairments were compared between ALS patients and controls, and to ECAS impairments.

resultsData from 314 controls and 184 ALS patients were analyzed. The C-CAS is feasible, well-tolerated, and takes 15-20 min to complete. ALS patients performed worse across all 12 items. Within the FTD spectrum, impairments in social cognition, inhibition, and cognitive flexibility were identified in up to 16%, 14%, and 12% of ALS patients, respectively, with minimal overlap with ECAS impairments. Beyond the FTD spectrum, impairments were found in visuoconstruction, incidental non-verbal memory and body orientation (13% each), with minimal overlap with ECAS memory or visuospatial impairments. Overall, 24% of the ALS patients obtained an abnormal C-CAS sum score. Compared to the ECAS, the C-CAS detected additional impairments in 15% of ALS patients. Item-specific and sum score results based on normative data can be accessed at ( https://apps4mnd.com/ccas/ ).

interpretationWe identified cognitive impairments in ALS within and beyond the FTD spectrum not captured by existing screening tools. The C-CAS complements the ECAS, improving personalized counseling and research stratification in ALS.

Indexed as

Amyotrophic Lateral SclerosisCognitive DysfunctionFrontotemporal DementiaNeuropsychological TestsAdultAgedFemaleHumansMaleMiddle AgedAmyotrophic lateral sclerosisCognitionCognitive screening instrumentFrontotemporal dementiaMotor neuron diseaseSocial cognition

Identifiers

PMID40074931
PMCPMC11903523

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.