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Research paper
Is language impairment more common than executive dysfunction in amyotrophic lateral sclerosis?
  1. Lorna J Taylor1,2,
  2. Richard G Brown1,2,
  3. Stella Tsermentseli1,3,
  4. Ammar Al-Chalabi2,4,
  5. Christopher E Shaw2,4,
  6. Catherine M Ellis5,
  7. P Nigel Leigh6,
  8. Laura H Goldstein1,2
  1. 1King's College London, Institute of Psychiatry, Department of Psychology, London, UK
  2. 2King's College London, KHP Centre for Neurodegeneration Research, Institute of Psychiatry, London, UK
  3. 3Department of Psychology and Counselling, School of Health and Social Care, University of Greenwich, London, UK
  4. 4King's College London, Institute of Psychiatry, Department of Clinical Neuroscience, London, UK
  5. 5King's MND Care and Research Centre, King's College Hospital NHS Foundation Trust, London, UK
  6. 6Trafford Centre for Biomedical Research, Brighton and Sussex Medical School, University of Sussex, Falmer, UK
  1. Correspondence to Professor Laura H Goldstein, Department of Psychology, Institute of Psychiatry, King's College London, PO 77, De Crespigny Park, London SE5 8AF, UK; laura.goldstein{at}


Background Systematic explorations of language abilities in patients with amyotrophic lateral sclerosis (ALS) are lacking in the context of wider cognitive change.

Methodology Neuropsychological assessment data were obtained from 51 patients with ALS and 35 healthy controls matched for age, gender and IQ. Composite scores were derived for the domains of language and executive functioning. Domain impairment was defined as a composite score ≤5th centile relative to the control mean. Cognitive impairment was also classified using recently published consensus criteria.

Results The patients with ALS were impaired on language and executive composite scores. Language domain impairment was found in 43% of patients with ALS, and executive domain impairment in 31%. Standardised language and executive composite scores correlated in the ALS group (r=0.68, p<0.001). Multiple regression analyses indicated that scores on the executive composite accounted for 44% of the variance in language composite scores.

Conclusions Language impairments are at least as prevalent as executive dysfunction in ALS. While the two domains are strongly associated, executive dysfunction does not fully account for the profile of language impairments observed, further highlighting the heterogeneity of cognitive impairment in non-demented patients with ALS.

  • Motor Neuron Disease
  • Cognition
  • Aphasia
  • Cognitive Neuropsychology

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