Dr. Heiman Patterson and her collaborators at Massachusetts General Hospital have been awarded a Clinical Management Grant from The ALS Association to study strategies that help caregivers deal with cognitive changes in ALS. While ALS primarily affects the motor system, up to 40% of PALS experience cognitive impairment, and approximately 20% PALS show behavioral changes, predominantly apathy and disinhibition. These cognitive and behavioral changes add significantly to the burden and distress of caregivers who have now to face the challenges of managing behavioral changes in addition to the physical disability. The overall goal of our study is to characterize the relationship of caregiver burden to cognitive and behavioral impairment in ALS and to develop and perform a feasibility study of a pilot individualized intervention as a way to reduce caregiver burden. Ultimately, this study will provide the necessary background to develop, inform, and guide future targeted and larger scale interventions directed to both PALS and caregivers.