On the other hand, although several risk factors for cognitive impairment appearance in ALS patients (like the presence of C9orf72 repeat expansion, positive ALS family history, bulbar disease onset etc.)are well known, the TCS related predictors of cognitive decline in these patients are still underexplored among current literature data [44, 45]. This evidence concerns the gene C9orf72 and amyotrophic lateral sclerosis.