There is a need to define the presence of the major ALS mutations, including the C9orf72 expansion mutations, SOD1 and TARDBP gene mutations, in MMC residents, and this study further highlights the need to consider early TDP-43 pathological changes as an opportunity to explore pathomechanistic avenues where we could intervene to halt neurodegenerative processes. The gene discussed is SOD1; the disease is amyotrophic lateral sclerosis.