Amyotrophic Lateral Sclerosis (ALS) Symptoms
Neurological DisordersALS

Amyotrophic Lateral Sclerosis (ALS) Signs and Symptoms

Amyotrophic Lateral Sclerosis (ALS) Signs and Symptoms
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Updated on January 28, 2026
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The signs of amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease, often come on subtly or slowly over the course of several weeks or months.

 Symptoms usually start in the hands, feet, arms, or legs. Over time, other parts of the body become affected as more nerve cells deteriorate — the underlying cause of ALS symptoms — and more muscles weaken.

The exact cause of ALS is unknown, but genetics play a role in about 10 percent of cases.

 How quickly symptoms occur and progress varies for each person. There’s no cure for ALS, and eventually it leads to the inability to stand, walk, use your hands and arms, swallow, speak, and ultimately, breathe.

Symptoms of ALS

Some people first notice something is wrong when they can’t use their hands to do everyday activities like button a shirt or tie their shoes. Others notice that they are tripping more often.

Early signs and symptoms of ALS may include the following:

  • Tripping and falling or having a hard time walking
  • Feeling clumsy
  • Weakness in your hands, legs, feet, or ankles
  • Muscle cramps and tightness
  • Twitching in your arms, shoulders, and tongue
  • Inability to keep your head up or maintain a good posture
  • Slurred speech and having a hard time swallowing
  • Breathing difficulty
Bowel and bladder control are usually not affected by ALS. Additionally, most people’s sense of hearing, sight, smell, taste, and touch stay intact.

Medical Illustration of How Early Stage ALS Affects the Body, Man centered surrounded by symptoms including slurred speech, trouble breathing, twitching, lower limb weakness, tripping, muscle cramps, clumsy hands and fingers, trouble swallowing, posture
ALS symptoms usually begin in your hands, feet, arms, and legs.Everyday Health
While it was once believed that ALS doesn’t affect a person’s cognitive abilities to reason, remember, and solve problems, it’s now known that up to 50 percent of people with ALS develop cognitive or behavioral impairments of some kind.

Cognitive problems associated with ALS may show up as difficulties with these tasks:

  • Reasoning
  • Judgment
  • Planning
  • Regulating emotions
  • Self-awareness
Certain behaviors may pair with such cognitive concerns:

  • Pacing
  • Repeating actions or phrases
  • Ruminating
  • Expressing anxiety
  • Emotional reactivity
Additional abnormal behaviors associated with cognitive problems may include these reactions:

  • Social withdrawal
  • Indifference
  • Lack of empathy or understanding
Depression is also common with ALS, affecting up to 40 percent of people with the disease. While living with any chronic disease increases depression, researchers believe other factors may be at play with ALS, including disruption in the brain’s mood-control networks and dysregulation of the brain’s chemical signaling systems.

Complications of ALS

As ALS worsens, the following complications may develop.

Breathing Difficulty

ALS eventually paralyzes the muscles needed to breathe. When this happens, there are devices available to help with breathing that are similar to equipment used for sleep apnea. For instance, your doctor may recommend using a continuous positive airway pressure machine or a bilevel positive airway pressure machine to help you breathe at night.

In severe cases of ALS, you may opt for a tracheostomy, which is a surgically created hole in the front of your neck that leads to your windpipe, or trachea. A tracheostomy allows you to use a respirator to inflate and deflate your lungs around the clock.

Respiratory failure is the most common cause of death for people with ALS. Half of people with the disease don’t live beyond 18 months after diagnosis. But some people go on to live 10 years or more.

Speaking Challenges

At some point, speaking clearly becomes an issue for those with ALS. At first, you might periodically slur your words, but eventually, talking becomes harder, and it becomes more difficult for people to understand what you are saying.

 Technology, such as speech-generating devices and eye-gaze devices, can allow other ways to communicate.

Eating Issues

Because the muscles that control swallowing are affected, eating and drinking become difficult. As a result, people with ALS can develop malnutrition and dehydration and are at a greater risk of aspiration — or getting food, liquids, or saliva into the lungs — resulting in pneumonia. A feeding tube can ensure that you are getting enough food and hydration, and help avoid pneumonia.

Dementia

ALS can cause memory and decision-making complications. In some cases, people may develop a form of dementia called frontotemporal dementia. While population-based studies are limited, it’s believed that up to 20 percent of people with ALS have this type of dementia, which mainly affects behavior, personality, and language.

When to See a Doctor

Symptoms of ALS can be caused by other health conditions, so the only way to get an accurate diagnosis is to see a doctor.

If you notice these symptoms over time, whether in yourself or a loved one, it is imperative to seek evaluation with a neurologist specifically trained in ALS and neuromuscular medicine. (Ask your primary care doctor for help in finding a specialist if needed.

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Quickly establishing a diagnosis and then implementing the multidisciplinary care and services needed for patients with ALS can help preserve function for as long as possible and enhance quality of life.

The Takeaway

  • Early symptoms of ALS can be subtle and may include tripping, weakness in the hands or legs, muscle cramps, and slurred speech, which eventually progress to severe disability.
  • As ALS advances, most individuals will face challenges with breathing, talking, and swallowing, potentially leading to respiratory failure.
  • There is evidence that some people with ALS may also experience cognitive or behavioral problems, as well as depression.
  • It's critical for individuals noticing such symptoms to seek immediate evaluation with a neurologist to facilitate timely diagnosis and care that could enhance quality of life.

FAQ

What are some early signs and symptoms of ALS?
Early signs and symptoms of ALS may include tripping and falling, weakness in the hands and legs, muscle cramps and twitching, slurred speech, and difficulty swallowing.

While it was previously believed that ALS doesn’t affect cognitive abilities, newer research suggests that a significant percentage of people with ALS may experience cognitive or behavioral impairments.

Yes, receiving a diagnosis of ALS can lead to depression in some people. There’s an increased risk of depression before and after an ALS diagnosis, which may be a psychological reaction to the diagnosis or other early signs and symptoms.

As ALS progresses, complications such as breathing difficulty, speaking challenges, eating issues, and dementia can develop. Breathing difficulty is the most common cause of death for people with ALS.

Caregivers for patients with ALS can reach out to organizations such as the ALS Association and the National Family Caregivers Association for help and support. These organizations can offer tips, information on caregiving, and connect caregivers to resources for respite care, financial planning, and support services.

Resources We Trust

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. Amyotrophic Lateral Sclerosis (ALS). Johns Hopkins Medicine.
  2. Amyotrophic Lateral Sclerosis (ALS). Mayo Clinic. April 10, 2024.
  3. Amyotrophic Lateral Sclerosis (ALS). National Institute of Neurological Disorders and Stroke. March 26, 2025.
  4. Wang H et al. Recent Progress of the Genetics of Amyotrophic Lateral Sclerosis and Challenges of Gene Therapy. Frontiers in Neuroscience. May 11, 2023.
  5. FYI: ALS, Cognitive Impairment and Dementia. ALS Association. June 10, 2020.
  6. Jellinger KA. Understanding Depression With Amyotrophic Lateral Sclerosis: A Short Assessment of Facts and Perceptions. Journal of Neural Transmission. November 3, 2023.
  7. Augmentative and Alternative Communication. ALS Association.
  8. The Signs of ALS and Why Early Detection Matters. University Hospitals. August 19, 2025.
  9. Support for Caregivers. ALS Association.
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Jason Paul Chua, MD, PhD

Medical Reviewer
Castle Connolly Top Doctor

Jason Chua, MD, PhD, is an assistant professor in the Department of Neurology and Division of Movement Disorders at Johns Hopkins School of Medicine. He received his training at the University of Michigan, where he obtained medical and graduate degrees, then completed a residency in neurology and a combined clinical/research fellowship in movement disorders and neurodegeneration.

Dr. Chua’s primary research interests are in neurodegenerative disease, with a special focus on the cellular housekeeping pathway of autophagy and its impact on disease development in diseases such as Parkinson disease. His work has been supported by multiple research training and career development grants from the National Institute of Neurological Disorders and Stroke and the American Academy of Neurology. He is the primary or coauthor of 14 peer-reviewed scientific publications and two peer-reviewed online learning modules from the American Academy of Neurology. He is also a contributing author to The Little Black Book of Neurology by Osama Zaldat, MD and Alan Lerner, MD, and has peer reviewed for the scientific journals Autophagy, eLife, and Neurobiology of Disease.

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Cathy Cassata

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Cathy Cassata is a freelance writer who specializes in stories about health, mental health, medical news, and inspirational people. She writes with empathy and accuracy, and has a knack for connecting with readers in an insightful and engaging way. Cassata contributes to Healthline, Verywell, Yahoo, and more.

She previously worked for the American Association of Medical Assistants for eight years, writing and editing the magazine, marketing materials, and the website. Cassata completed the editing certificate program at the University of Chicago.

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