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Amyotrophic lateral sclerosis with depression, cognitive impairment, and mortality

De Marchi et al. conducted a prospective study to investigate the risk of cognitive impairment and mortality in patients with amyotrophic lateral sclerosis (ALS) having depression beforehand. Adjusted odds ratios (ORs) (95% confidence intervals [CIs]) of having depression beforehand for cognitive impairment was 1.46 (1.26-1.66). In addition, there was a significant increase of mortality in ALS patients with depression beforehand. I have two concerns about their study.