A 55-year-old man dies of aspiration pneumonia after a 6-year illness, characterized by progressive, symmetric muscular weakness. At autopsy, the brain and spinal cord appear normal on gross examination. Microscopic sections show gliosis in the motor cortex, pallor of the lateral corticospinal tracts, and neuronal loss in the anterior horns of the spinal cord. Which of the following is the most likely underlying cause of death?
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