Yamakawa M, Dwyer S, Song X, et al. - This cohort demonstrated an older age at onset as well as more frequent bulbar onset compared with the National ALS (amyotrophic lateral sclerosis) Registry, likely indicating ascertainment biases in each registry. There is a requirement for prospective cohort studies with more clinical and functional data.

• In the US, the highest regional prevalence of self-reported ALS has been reported in the Midwest, but with limited epidemiological studies.

• A retrospective cohort study of 1,447 patients with ALS (registered with the ALS Association Mid-America Chapter), with a mean age at diagnosis of 65.7±11.9 years ( >60 years at diagnosis: 72%).

• From symptom onset, the median survival was 28.0 months; sample augmentation raised this to 41.0 months.

• Factors linked with a shorter survival were: bulbar onset disease and older age at diagnosis.

• Comparison of disease characteristics to the National ALS Registry was performed.

• Individuals not followed in ALS-Association registered clinics were more often male, had familial onset and tracheostomy.

• Older age at diagnosis was evident in veterans (N=298) but they experienced similar survival post-adjustment for age.