Medical decisions are independent of cognitive impairment in amyotrophic lateral sclerosis

Cognitive impairment has been reported in up to 40% of patients with amyotrophic lateral sclerosis (ALS). Alterations in social behavior, such as apathy or reduced empathy, are present in up to 30% of patients.1,2 Therefore, there is concern whether patients with ALS are able to judge pending medical decisions appropriately and some colleagues have even called for surrogate decision-making.3,4 However, systematic studies addressing the question of possible association between cognitive and behavioral impairment and decision-making in ALS are rare. Here, we provide prospective data obtained in a large cohort of patients with ALS to address this issue with relevance for patients' crucial decisions in everyday life and clinical context.