Early psychiatric symptoms as an early indicator of amyotrophic lateral sclerosis: A case report

• Amyotrophic Lateral Sclerosis (ALS) is an incurable neurological disorder. • Emerging research has shown patients with ALS can develop psychiatric symptoms. • In this case report, a patient exhibited psychiatric symptoms decades before their diagnosis of ALS. • Understanding psychiatric symptoms as an early indicator for ALS may aid in screening and treatment. Amyotrophic Lateral Sclerosis (ALS) is a rare neurodegenerative disorder primarily characterized by the progressive loss of motor neurons, leading to muscle weakness and atrophy. Recent studies have highlighted the association between ALS and various neuropsychiatric comorbidities, including depression, schizophrenia, frontotemporal dementia, and Parkinson dementia. This case report presents a 63-year-old Hispanic male with a complex neuropsychiatric history, including schizoaffective disorder. The patient presented to the hospital following a fall from his mobility scooter, leading to the discovery of characteristic ALS symptoms during his inpatient hospital stay. The patient exhibited pseudobulbar affect, dysarthria, tongue fasciculations, and muscle atrophy, raising suspicion of ALS. A thorough review of his medical history revealed a pattern of neuropsychiatric symptoms that likely preceded his ALS diagnosis. Subsequent outpatient electromyography confirmed ALS, leading clinicians to believe his diagnosis of ALS was initially missed. This case report highlights the importance of a thorough physical examination and history in all patients regardless of presentation, and that neuropsychiatric symptoms can manifest before and after a diagnosis of ALS.