Edinburgh Cognitive and Behavioural ALS Screen (ECAS)
Research into Motor Neurone Disease helps healthcare professionals assess patients for changes in cognition and behaviour
Motor Neurone Disease (MND) is a rare progressive neurological disorder. Early physical symptoms, such as weakening, twitching or cramping muscles, occur in the legs, arms, or tongue/mouth and people can suffer from problems walking, using their hands, slurred speech or difficulties swallowing. Several variations of MND exist, with amyotrophic lateral sclerosis (ALS) being the most common.
MND has traditionally been considered a disease of the motor system. However, PPLS researchers have demonstrated that MND can also impact people with MND’s cognition (language and thinking including problem solving, paying attention to two things at once and understanding of social situations) and their behaviour ( such asapathy and disinhibition). Cognitive and/or behavioural changes are present in up to half of people living with ALS/MND.
To help healthcare professionals assess changes in cognition and behaviour in people with MND, Sharon Abrahams, Thomas Bak and colleagues from the Euan MacDonald Centre have developed a standardised screening tool: the Edinburgh Cognitive and Behavioural ALS Screen (ECAS) based on their research. The ECAS is a 20-minute assessment which provides an accurate and comprehensive picture of cognitive and behavioural changes in MND patients by assessing multiple cognitive functions.
Since its development, the ECAS has proved an international success. As of 2022, over 600 healthcare professionals have been trained to administer the ECAS. A cognitive assessment using the ECAS is routinely carried out with all new MND diagnoses in Scotland, at 21 of 22 MND centres across the UK and at 45 MND services in 25 countries worldwide. The ECAS has been translated into 22 languages and has been recognised as the gold standard of cognitive assessment in ALS as it is more sensitive and specific than other available screening tool for ALS.
People with MND benefit from cognitive assessments as this enables clinicians to attend to patients' specific needs, for example, by aiding communication and supporting decision-making around treatments. According to an international survey, 56% of MND centres that responded routinely use ECAS. Combined, these 45 centres treat over 7,000 patients and receive over 3,000 new patients annually. Most of these centres agreed that MND patients screened for cognitive changes receive better clinical care. And ECAS is also used as an outcome measure in several international clinical drug trials testing therapies for MND.
Thanks to Sharon Abrahams and Thomas Bak's research, the UK's National Institute for Health and Care Excellence updated their guidelines. They now endorse cognitive screening for all newly diagnosed MND patients. Furthermore, the MND Association, the Royal College of Nursing and the European Network to Cure ALS all now recommend that patients with MND be assessed with the ECAS.
More information about the ECAS and to gain access to training and the tool:
About the researchers
- Professor Sharon Abrahams (Professor of Neuropsychology)
- Dr Thomas Bak (Reader in Psychology)