Insights and considerations on predicting cognitive and behavioral disturbances in MND with pure motor onset.

This commentary discusses the study by Bicaj et al., which examines baseline predictors of cognitive and behavioral disturbances (C/BI) in motor neuron diseases (MNDs) with pure motor onset. The study's longitudinal design and use of the Edinburgh Cognitive and Behavioral ALS Screen (ECAS) provide valuable insights into extramotor progression in MNDs. While the study offers important findings, including potential predictors such as age at onset and specific ECAS scores, it is limited by sample size and potential biases. Suggestions for future research include larger multicenter studies, incorporating biomarkers, and addressing confounding factors to refine risk stratification and clinical management of MND.