Measurement of ALS impairment and progression is valuable for clinical trial design and understanding natural history. Mechanistic modeling of propagation of neurodegeneration in ALS progression may offer insights into pathophysiology. Neuropsychiatric manifestations of ALS (including cognitive loss, depression, pseudobulbar affect and apathy) are increasingly recognized and have prognostic significance. Patient-reported outcomes are important for health economic studies.

Our group includes individuals with diverse clinical and quantitative skills. We employ existing observational data from within Cleveland Clinic (Knowledge Program), and from external sources (such as the PROACT database) to address questions relating these areas.

Contact person

Nimish Thakore





Depression in ALS in a large self-reporting cohort. Kawada T, Thakore NJ, Pioro EP. Neurology. 97:1631-1632, 2016. doi: 10.1212/01.wnl.0000503501.75283.f1

Deconstructing progression of amyotrophic lateral sclerosis in states: a Markov modeling approach. Thakore NJ, Lapin BR, Kinzy TG, Pioro EP. Amyotroph Lateral Scler Frontotemporal Degener. (Published online June 12, 2018, doi: 10.1080/21678421.2018.1484925)

Trajectories of impairment in amyotrophic lateral sclerosis: Insights from the Pooled Resource Open-Access ALS Clinical Trials cohort. Thakore NJ, Lapin BR, Pioro EP. Muscle Nerve. 57(6):937-945, 2018. doi: 10.1002/mus.26042

Stage-specific riluzole effect in amyotrophic lateral sclerosis: a retrospective study. Thakore, N. J., Lapin, B. R., & Pioro, E. P. (2019). Amyotrophic Lateral Sclerosis & Frontotemporal Degeneration, 1-4. doi:10.1080/21678421.2019.1655060.

Variation in noninvasive ventilation use in amyotrophic lateral sclerosis.Thakore, N. J., Lapin, B. R., Pioro, E. P., & Aboussouan, L. S. (2019). Neurology, 93(3), e306-e316. doi:10.1212/WNL.0000000000007776.

Depression in ALS in a large self-reporting cohort.Thakore, N. J., & Pioro, E. P. (2016). Neurology, 86(11), 1031-1038. doi:10.1212/WNL.0000000000002465.

Laughter, crying and sadness in ALS. Thakore NJ, Pioro EP. J Neurol Neurosurg. 88:825-3, 2017. doi:10.1136/jnnp-2017-315622.

Depression in ALS in a large self-reporting cohort. Thakore NJ, Pioro EP. Neurology. 86:1031-8, 2016. doi: 10.1212/WNL.0000000000002465.

Members and Collaborations

Members and Collaborations

Within Cleveland Clinic

  • Erik Pioro, MD, PhD
  • Brittany Lapin, PhD, MPH

Collaborations outside Cleveland Clinic

  • John Ravits MD (Professor of Neurology, University of California, San Diego, CA)
  • Linda Petzold, PhD (Professor of Computer Science, University of California, Santa Barbara, CA)
  • Brian Drawert ,PhD (Assistant Professor, Computer Science, University of North Carolina, Asheville, NC)
  • David Schoenfeld, PhD (Professor of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA)
  • Alexander Sherman, PhD (Neurological Clinical Research Institute, Massachusetts General Hospital, Boston, MA)