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As the neuropsychological testing was not conducted prior to the year 2000, patients diagnosed before then were not included in the analysis of neuropsychological performance. A database of 2650 patients was searched for patients with sporadic ALS. Of them, 2457 of them had sporadic ALS. Those with familial ALS or another etiology for weakness were excluded. Then 37 were excluded because of missing data on more than one major outcome variable. Of the remaining, 49 patients were excluded because their symptom onset was before the age of 45?years. Thus, 2371 patients were enrolled. ALS-DM and ALS groups did not differ with regard to gender, education, ethnicity, or site of onset (Table?1). The ALS-DM group was found, however, to have significantly lower estimates of pre-morbid verbal IQ (AMNART score). The mean AMNART scores for both groups were classified within the average range. The age of ALS onset was earlier for men, non-Caucasians and patients with limb-onset ALS (Table?2). Age of onset for patients with ALS-DM was 4?years later than for the ALS group (60.3 vs. 56.3, P? and any of the four factors tested, including gender and site of onset (Table?3). Survival was significantly shorter in patients with bulbar-onset ALS in the bivariate analysis (2.73 vs. 3.47?years, P?=