In ALS brains, TDP-43 pathology can be widespread in cases of ALS-related/FTD and some have suggested a sequential spread.8 A non-specific association was found between the presence of cognitive impairment (yes/no) as measured by a dementia screening tool, the Mini Mental State Examination and moderate to severe TDP-43 pathology.9 Using more detailed neuropsychology, Prudlo and colleagues divided the patients with ALS into three clinical groups: ALS with no cognitive impairment, ALS with cognitive impairment and ALS-FTD. Here, TARDBP is linked to amyotrophic lateral sclerosis.