ANXA11 and amyotrophic lateral sclerosis: In the current study, patients with the same D40G mutation have different clinical symptoms: (1) five of six European patients and one Korean patient who carried the mutation initially showed difficulty in swallowing and speaking (bulbar-onset ALS) (17); (2) a Chinese patient initially displayed left arm weakness at the age of 59 years (15); (3) in the present study, proband 1 with the ANXA11 p.D40G mutation initially presented abnormal behaviors, executive deficits, and anomia, and later progressed to classic upper motor nervous system damage in the bulbar and limbs.