Edinburgh Cognitive and Behavioural ALS Screen (ECAS)

The ECAS was designed for ALS specifically, so tasks avoid the motor responses that ALS makes difficult. The ALS-specific section covers verbal fluency, executive function including social cognition, and language. The ALS-nonspecific section covers memory and visuospatial ability, the functions ALS usually spares. A separate carer interview covers behaviour change and psychotic symptoms across five domains associated with frontotemporal dementia.

Three numbers are reported, each higher-is-better. These are the original Edinburgh cut-offs, below which impairment is likely.

Cut-offs are population-specific. A Chinese validation set the total cut-off at 81.92, and the German, Swiss-German, and Italian versions publish age- and education-adjusted norms. On repeat testing with the alternate forms, a drop of 8 or more on ALS-Specific, 4 or more on ALS Non-specific, or 9 or more on the total counts as reliable change rather than measurement noise. Behavioural change on the carer interview is reported separately and is not added to the total.

The result is reference information that flags the need for a fuller assessment. It is not a diagnosis.

Administered by

A health care professional, such as a specialist nurse, preferably supervised by a neuropsychologist

Time to administer

15 to 20 minutes

Cost

Free to take here.

Published by

University of Edinburgh

Training required

Certification through the ECAS team at the University of Edinburgh

Repeat testing

Three alternate forms, A, B and C, with no significant practice effect

Available languages

26, including American English, Chinese, Dutch, French, German, Italian, Japanese, Korean, Polish, Portuguese, Spanish, and Welsh

• ALS→

• ALS Functional Rating Scale – Revised (ALSFRS-R)Physical function in ALS, the half the ECAS does not cover→
• Montreal Cognitive Assessment (MoCA)A general cognitive screen, for comparison outside ALS→
• EQ-5DGeneral health-related quality of life, comparable across conditions→

Created by Sharon Abrahams, Thomas Bak, and colleagues at the University of Edinburgh, and published in 2014. The University of Edinburgh holds the copyright and distributes the forms, guidelines, and translations.

Reliable change on retest

8 points ALS-Specific, 4 Non-specific, 9 total (Crockford, 2018)

Evidence base

Best-evidenced of six ALS cognitive screens in a 2024 systematic review

References

1. 1.Abrahams S, Newton J, Niven E, Foley J, Bak TH. Screening for cognition and behaviour changes in ALS. Amyotroph Lateral Scler Frontotemporal Degener. 2014;15(1-2):9-14.
2. 2.Niven E, Newton J, Foley J, et al. Validation of the Edinburgh Cognitive and Behavioural Amyotrophic Lateral Sclerosis Screen (ECAS): a cognitive tool for motor disorders. Amyotroph Lateral Scler Frontotemporal Degener. 2015;16(3-4):172-179.
3. 3.Crockford C, Newton J, Lonergan K, et al. Measuring reliable change in cognition using the Edinburgh Cognitive and Behavioural ALS Screen (ECAS). Amyotroph Lateral Scler Frontotemporal Degener. 2018;19(1-2):65-73.
4. 4.Ye S, Ji Y, Li C, He J, Liu X, Fan D. The Edinburgh Cognitive and Behavioural ALS Screen in a Chinese amyotrophic lateral sclerosis population. PLoS One. 2016;11(5):e0155496.
5. 5.Didcote L, Vitoratou S, Al-Chalabi A, Goldstein LH. What is the extent of reliability and validity evidence for screening tools for cognitive and behavioral change in people with ALS? A systematic review. Amyotroph Lateral Scler Frontotemporal Degener. 2024;25(5-6):437-451.
6. 6.Edinburgh Cognitive and Behavioural ALS Screen. University of Edinburgh, School of Philosophy, Psychology and Language Sciences. Forms, guidelines, international versions, and training.