We improved standard treatment approaches by systematically addressing cognitive and behavioral change in association with frontal and temporal dysfunction in ALS. We evaluated the profile of inchange 198 ALS patients with a 20-minute screen exam. Significant deficiencies in letter fluency and reading comprehension (N=59) were found in 22.7% and 12.8% of limb onset and 36.4% and 20% of bulbar-onset patients. Deficiencies in abstract reasoning and judgment were found in 17%, and 29.5% of limb onset and 19.2%, and 46.7% of bulbar-onset patients. Significant behavioral change (N=89) was also reported in 2.4% of limb onset and 4.3% of bulbar-onset patients. Accommodations were provided from the time of initial detection of acquired deficiencies, with the goal of optimizing the patient's role in decision making throughout the process of treatment planning and implementation. This screen is of practical clinical value for assessment and intervention of deficiencies that affect treatment and quality of life.