This standardised tool assesses ALS-related cognitive deficits (verbal fluency, executive and language functions) and is sensitive to milder cognitive impairments.1 11 Using the ECAS, we have been able to demonstrate an association between the presence of cognitive impairment and synaptic loss in the prefrontal cortex of patients with ALS.7 Here we are the first to examine the relationship between the profile of cognitive impairment as detected by the ECAS in non-demented ALS and the localised distribution of TDP-43. The gene discussed is TARDBP; the disease is amyotrophic lateral sclerosis.