Edinburgh Cognitive and Behavioural ALS Screen (ECAS)

Research into Motor Neurone Disease helps healthcare professionals assess patients for changes in cognition and behaviour

Image generated by a high-tech brain scan

What was the problem?

Motor Neurone Disease (also known as Amyotrophic Lateral Sclerosis) is a progressive neurological disorder. In some people, early physical symptoms occur in the legs or arms, such as weakening, twitching or cramping of muscles. 

Cognitive changes - changes in thinking, learning and behaviour - may be present even before the onset of physical symptoms and occur in roughly 50% of people with MND. The most common behavioural change is apathy which comes across as a lack of interest, motivation or concern.  

Despite the increasing knowledge of MND’s effects on cognition and behaviour, the lack of an appropriate cognitive screening tool for people with varying and often severe physical disability meant that the cognitive status of the majority of patients attending clinics was unknown and clinicians were unaware of their patients’ cognitive (and, consequently, care) needs.

What did we do?

The Edinburgh Cognitive Behavioural ALS Screen (ECAS) was designed by Professor Sharon Abrahams, Dr Thomas Bak and colleagues from the Euan MacDonald Centre. 

The Euan MacDonald Centre

It was developed to help healthcare professionals assess patients with MND for changes in cognition and behaviour. Early screening for these changes could help patients and carers minimise the impact of these changes by providing appropriate support and care.

Launched in 2018, the ECAS website for health professionals and researchers provides information about the ECAS, links to download materials, information on accessing training, as well as the latest ECAS news and publications.

ECAS - Edinburgh Cognitive and Behavioural ALS Screen

What happened next?

Professor Sharon Abrahams' pioneering research demonstrated that over half of MND patients experience cognitive and/or behavioural changes. Since then, several research centres have undertaken a lot of research in this area. This led to an update in the NICE guidelines and MND Association information, which now for the first time explicitly recommend a cognitive assessment.

Cognitive assessment in MND is now recommended for MND patients. The ECAS is the tool of choice by MND charities such as the MND Association and in routine clinical use by health professionals across the UK and worldwide.

It has allowed researchers to systematically assess the extent of cognitive changes in MND patients, contributing to a better understanding of these changes - an important step towards better supporting patients and their carers. 

The patients’ care pathway is now being adapted to their individual needs based on their ECAS results. Nearly 500 healthcare professionals in the UK and Europe have been trained to undertake the ECAS in clinical practice, and the ECAS has been standardised across 22 languages.

About the researchers

Professor Sharon Abrahams (Professor of Neuropsychology)

Dr Thomas Bak (Reader in Psychology)

Research area

Human cognitive neuroscience


  • Motor Neurone Disease Association (MNDA)
  • MND Scotland

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