{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T12:00:59Z","timestamp":1791892859477,"version":"4.3.4"},"reference-count":88,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T00:00:00Z","timestamp":1791590400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["NeuroRehabilitation"],"abstract":"<jats:p>Amyotrophic Lateral Sclerosis (ALS) is a very heterogeneous disease, yet some of the most common questions received by physicians in the ALS clinic are \u201chow much time do I have?\u201d and \u201cwhat can I expect to happen next?\u201d This line of inquiry is not strictly limited to patients; clinicians also need an idea of prognosis to appropriately plan for treatment decisions and prepare the patient and caregiver for future care needs. This narrative review synthesizes current evidence on prognostic indicators in ALS, organized across three temporal phases: factors preceding diagnosis, factors present at diagnosis, and factors emerging after diagnosis. Pre-diagnosis predictors include age at onset, sex, socioeconomic status, genetic background, premorbid Body Mass Index (BMI) and nutritional status, and comorbid disease. At diagnosis, clinical phenotype and site of onset, diagnostic delay, baseline Amyotrophic Lateral Sclerosis Functional Rating Score-Revised (ALSFRS-R) and forced vital capacity, cognitive involvement, fluid biomarkers, and electrophysiologic measures carry prognostic weight. Post-diagnosis, the trajectory is refined by the rate of ALSFRS-R decline, serial respiratory measures, and weight loss, and is actively modified by clinical interventions including noninvasive ventilation, enteral nutrition, disease-modifying therapy, and multidisciplinary care. Notably, quality of life does not track with physical decline, consistent with the disability paradox described in other severe neurological conditions. For neurorehabilitation, these indicators support a shift from reactive to anticipatory practice: timing equipment provision, communication support, respiratory intervention, and goals-of-care discussions to the predicted trajectory rather than to established deficit. Refinement of prognostic models may also improve stratification in ALS clinical trials.<\/jats:p>","DOI":"10.1177\/10538135261490936","type":"journal-article","created":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T13:54:47Z","timestamp":1791640487000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostication in Amyotrophic Lateral Sclerosis: A Narrative Review of Pre-Diagnosis and Functional Outcomes"],"prefix":"10.1177","author":[{"given":"Amber","family":"Vocelle","sequence":"first","affiliation":[{"name":"University of Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"Ensrud","sequence":"additional","affiliation":[{"name":"Stanford University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2498-7524","authenticated-orcid":false,"given":"Ileana M","family":"Howard","sequence":"additional","affiliation":[{"name":"Rehabilitation Care Services, VA Puget Sound, Seattle, WA, USA"},{"name":"University of Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,10]]},"reference":[{"key":"e_1_3_2_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-020-09761-z"},{"key":"e_1_3_2_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(16)30199-5"},{"key":"e_1_3_2_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0277-9536(98)00411-0"},{"key":"e_1_3_2_5_1","doi-asserted-by":"publisher","DOI":"10.1080\/21678421.2020.1771734"},{"key":"e_1_3_2_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebiom.2024.105323"},{"key":"e_1_3_2_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.25276"},{"key":"e_1_3_2_8_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnins.2019.00951"},{"key":"e_1_3_2_9_1","doi-asserted-by":"publisher","DOI":"10.1080\/21678421.2023.2165947"},{"key":"e_1_3_2_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2012.01.004"},{"key":"e_1_3_2_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awac470"},{"key":"e_1_3_2_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2005.083402"},{"key":"e_1_3_2_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2013-306589"},{"key":"e_1_3_2_14_1","doi-asserted-by":"publisher","DOI":"10.3109\/17482960802566824"},{"key":"e_1_3_2_15_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.06-2712"},{"issue":"12","key":"e_1_3_2_16_1","first-page":"1830","article-title":"Single fiber electromyography in 78 patients with amyotrophic lateral sclerosis","volume":"117","author":"Cui L.-Y.","year":"2004","unstructured":"Cui L.-Y., Liu M.-S., Tang X.-F. (2004). Single fiber electromyography in 78 patients with amyotrophic lateral sclerosis. Chinese Medical Journal, 117(12), 1830\u20131833.","journal-title":"Chinese Medical Journal"},{"key":"e_1_3_2_17_1","doi-asserted-by":"publisher","DOI":"10.3390\/cells13110928"},{"key":"e_1_3_2_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/braincomms\/fcad163"},{"key":"e_1_3_2_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awag159"},{"issue":"1","key":"e_1_3_2_20_1","first-page":"1","article-title":"Safety and efficacy of edaravone in well-defined Iranian patients with amyotrophic lateral sclerosis: A parallel-group single-blind trial","volume":"20","author":"Eishi-Oskouei A.","year":"2021","unstructured":"Eishi-Oskouei A., Basiri K. (2021). Safety and efficacy of edaravone in well-defined Iranian patients with amyotrophic lateral sclerosis: A parallel-group single-blind trial. Current Journal of Neurology, 20(1), 1. https:\/\/doi.org\/10.18502\/cjn.v20i1.6373","journal-title":"Current Journal of Neurology"},{"key":"e_1_3_2_21_1","doi-asserted-by":"publisher","DOI":"10.1080\/21678421.2016.1265565"},{"key":"e_1_3_2_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12890-019-0924-5"},{"key":"e_1_3_2_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.70290"},{"key":"e_1_3_2_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)01272-7"},{"key":"e_1_3_2_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcmm.16240"},{"key":"e_1_3_2_26_1","doi-asserted-by":"publisher","DOI":"10.1080\/21678421.2023.2297795"},{"key":"e_1_3_2_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2024.04.013"},{"key":"e_1_3_2_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.26875"},{"key":"e_1_3_2_29_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2017.71"},{"key":"e_1_3_2_30_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2019-322213"},{"key":"e_1_3_2_31_1","doi-asserted-by":"publisher","DOI":"10.1080\/21678421.2024.2304058"},{"key":"e_1_3_2_32_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13024-023-00685-6"},{"key":"e_1_3_2_33_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2020-322909"},{"issue":"9","key":"e_1_3_2_34_1","article-title":"Antisense oligonucleotide therapy for Amyotrophic Lateral Sclerosis (ALS): An umbrella review","volume":"17","author":"Jeong E.","year":"2025","unstructured":"Jeong E., Li D. (2025). Antisense oligonucleotide therapy for Amyotrophic Lateral Sclerosis (ALS): An umbrella review. Cureus, 17(9). https:\/\/doi.org\/10.7759\/cureus.93140","journal-title":"Cureus"},{"key":"e_1_3_2_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brainres.2026.150395"},{"key":"e_1_3_2_36_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-020-10354-z"},{"key":"e_1_3_2_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)61156-7"},{"key":"e_1_3_2_38_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41582-020-00434-z"},{"key":"e_1_3_2_39_1","doi-asserted-by":"publisher","DOI":"10.1080\/21678421.2024.2314064"},{"key":"e_1_3_2_40_1","doi-asserted-by":"publisher","DOI":"10.1177\/1545968305276583"},{"key":"e_1_3_2_41_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2009.183525"},{"key":"e_1_3_2_42_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000001642"},{"key":"e_1_3_2_43_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41582-023-00845-8"},{"issue":"23","key":"e_1_3_2_44_1","first-page":"397","article-title":"Depression and quality of life in patients with amyotrophic lateral sclerosis","volume":"105","author":"Lul\u00e9 D.","year":"2008","unstructured":"Lul\u00e9 D., H\u00e4cker S., Ludolph A., Birbaumer N., K\u00fcbler A. (2008). Depression and quality of life in patients with amyotrophic lateral sclerosis. Deutsches \u00c4rzteblatt International, 105(23), 397. https:\/\/doi.org\/10.3238\/arztebl.2008.0397","journal-title":"Deutsches \u00c4rzteblatt International"},{"key":"e_1_3_2_45_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41593-021-00936-z"},{"key":"e_1_3_2_46_1","doi-asserted-by":"publisher","DOI":"10.1080\/21678421.2017.1349151"},{"key":"e_1_3_2_47_1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.14393"},{"key":"e_1_3_2_48_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnins.2025.1536818"},{"key":"e_1_3_2_49_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2025.4946"},{"key":"e_1_3_2_50_1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00261-2019"},{"key":"e_1_3_2_51_1","doi-asserted-by":"publisher","DOI":"10.3390\/life14121664"},{"key":"e_1_3_2_52_1","doi-asserted-by":"publisher","DOI":"10.1177\/1359105314530453"},{"key":"e_1_3_2_53_1","doi-asserted-by":"publisher","DOI":"10.2147\/JMDH.S205313"},{"key":"e_1_3_2_54_1","doi-asserted-by":"publisher","DOI":"10.1080\/21678421.2021.1961805"},{"key":"e_1_3_2_55_1","doi-asserted-by":"publisher","DOI":"10.1017\/cjn.2025.10429"},{"key":"e_1_3_2_56_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14207351"},{"key":"e_1_3_2_57_1","doi-asserted-by":"publisher","DOI":"10.1080\/14660820600640596"},{"key":"e_1_3_2_58_1","doi-asserted-by":"publisher","DOI":"10.1080\/14660820500515021"},{"key":"e_1_3_2_59_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3181b6bbbd"},{"key":"e_1_3_2_60_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-021-10928-5"},{"key":"e_1_3_2_61_1","doi-asserted-by":"publisher","DOI":"10.1080\/21678421.2017.1288254"},{"key":"e_1_3_2_62_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12155036"},{"key":"e_1_3_2_63_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2014-309601"},{"key":"e_1_3_2_64_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2024.123112"},{"key":"e_1_3_2_65_1","doi-asserted-by":"publisher","DOI":"10.17161\/rrnmf.v5i1.20037"},{"key":"e_1_3_2_66_1","doi-asserted-by":"publisher","DOI":"10.1515\/med-2024-0990"},{"key":"e_1_3_2_67_1","doi-asserted-by":"publisher","DOI":"10.3233\/JND-221658"},{"key":"e_1_3_2_68_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-018-9008-3"},{"key":"e_1_3_2_69_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.55.3.388"},{"key":"e_1_3_2_70_1","doi-asserted-by":"publisher","DOI":"10.1002\/acn3.52264"},{"key":"e_1_3_2_71_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-56752-5"},{"key":"e_1_3_2_72_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2012.08.011"},{"key":"e_1_3_2_73_1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.14647"},{"key":"e_1_3_2_74_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-024-12201-x"},{"key":"e_1_3_2_75_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.74.9.1258"},{"key":"e_1_3_2_76_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2019-322541"},{"key":"e_1_3_2_77_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000209502"},{"key":"e_1_3_2_78_1","doi-asserted-by":"publisher","DOI":"10.1080\/21678421.2024.2443985"},{"key":"e_1_3_2_79_1","doi-asserted-by":"publisher","DOI":"10.1002\/acn3.70226"},{"key":"e_1_3_2_80_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnins.2021.679199"},{"key":"e_1_3_2_81_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2010.06.003"},{"key":"e_1_3_2_82_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2019-321916"},{"key":"e_1_3_2_83_1","doi-asserted-by":"publisher","DOI":"10.1001\/archneurol.2010.367"},{"key":"e_1_3_2_84_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(18)30089-9"},{"key":"e_1_3_2_85_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2021.4893"},{"key":"e_1_3_2_86_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2021.05.075"},{"issue":"5","key":"e_1_3_2_87_1","first-page":"777","article-title":"Brain stem glucose hypermetabolism in amyotrophic lateral sclerosis\/frontotemporal dementia and shortened survival: An 18F-FDG PET\/MRI study","volume":"63","author":"Zanovello M.","year":"2022","unstructured":"Zanovello M., Sorar\u00f9 G., Campi C., Anglani M., Spimpolo A., Berti S., Buss\u00e8 C., Mozzetta S., Cagnin A., Cecchin D. (2022). Brain stem glucose hypermetabolism in amyotrophic lateral sclerosis\/frontotemporal dementia and shortened survival: An 18F-FDG PET\/MRI study. Journal of Nuclear Medicine, 63(5), 777\u2013784. https:\/\/doi.org\/10.2967\/jnumed.121.262232","journal-title":"Journal of Nuclear Medicine"},{"key":"e_1_3_2_88_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-019-1448-9"},{"key":"e_1_3_2_89_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnagi.2022.919059"}],"container-title":["NeuroRehabilitation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10538135261490936","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10538135261490936","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10538135261490936","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T11:18:12Z","timestamp":1791890292000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10538135261490936"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,10]]},"references-count":88,"alternative-id":["10.1177\/10538135261490936"],"URL":"https:\/\/doi.org\/10.1177\/10538135261490936","relation":{},"ISSN":["1053-8135","1878-6448"],"issn-type":[{"value":"1053-8135","type":"print"},{"value":"1878-6448","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,10]]},"article-number":"10538135261490936"}}