Neuropsychological assessment in mild cognitive impairment (MCI) increasingly includes executive functions evaluation to improve diagnostic accuracy. Handwriting analysis, though common in dementia studies, is less explored in MCI. This single-centre study aimed to compare neuropsychological tests and handwriting parameters, assessing their individual diagnostic value. The study included two groups: MCI (n = 46, female/male ratio 41/5, mean age 76.87 ± 5.08) and controls without cognitive impairment (n = 46, ratio 42/4, mean age 75.70 ± 5.97). The assessment included MoCA, MMSE, Comprehensive Trail Making Test (CTMT), verbal fluency test and handwriting analysis using Livescribe Echo Smartpen. Logistic Regression (LR), K-Nearest Neighbours (KNN) and Linear Discriminant Analysis (LDA) models were used to identify patients with MCI. Patients with MCI performed worse on neuropsychological tests, generating fewer words in verbal fluency (p < .01) and taking longer on CTMT (p < .01). Neuropsychological tests outperformed handwriting measures in MCI classification (AUC: CTMT = .81, semantic fluency = .76, phonemic fluency = .72). Among the handwriting measures, text height (AUC = .68) showed the best performance, while other kinematic features ranged from .63 to .64. After combining all neuropsychological tests, KNN achieved the best classification of MCI (AUC = .84, ACC = .82, MCC = .63), while handwriting-based models performed worse, with LR reaching the highest AUC (.64), ACC (.62) and MCC (.23). CTMT and verbal fluency tests are useful in diagnosing MCI, while handwriting measures showed limited classification value.

Reassessments with the Rey Auditory Verbal Learning Test (RAVLT) may generate learning effects, compromising the validity of the results. In Brazil, there are still no comparative studies between adapted versions of the test in healthy individuals. This study compared scores obtained on versions A and B of the RAVLT-A, routinely used in the neuropsychological assessment of patients with epilepsy and investigated the effects of age, education and version used. A prospective study with 188 cognitively healthy adults was randomly assigned to two groups (version A or B). Comparative analyses between groups and multivariate linear regression models were conducted to examine the impact of age, education and version on RAVLT-A scores. No significant differences were observed between versions A and B of the RAVLT-A (p > .05). Regression indicated a significant influence of age and, especially, education on performance on the test variables. The version used had no statistically relevant impact on the scores. This is the first Brazilian study to examine two adapted versions of the RAVLT-A in healthy adults. The findings demonstrate comparability between versions A and B, supporting their alternate use in reassessments to reduce practice effects. Age and, especially, education significantly influenced performance, emphasizing the need for normative data stratified by both variables, since those commonly used in Brazil are stratified only by age.

Following an increased need for remote cognitive screening solutions, we aimed to investigate the construct validity and determine initial sensitivity/specificity estimates of the Tele-OCS, a stroke-specific remotely administered cognitive screening tool. To this end, a secondary data analysis is presented from 98 stroke survivors from the OX-CHRONIC longitudinal study (average 4.5 years. post-stroke). Convergent validity was examined for overall Tele-OCS performance against MoCA total score, and separately for each of the subtasks against matched neuropsychological tasks. Divergent validity was examined against different neuropsychological tests and presumed to be unrelated self-reported anxiety, as measured with HADS-A. Overall, we found that the Tele-OCS subtasks had good convergent/divergent validity. All subtasks also showed excellent specificity (min 80%), and whilst the cancellation task also showed good sensitivity (80%), all other subtasks came at a cost of lower sensitivity, compared to a more sensitive neuropsychological assessment. The Tele-OCS provides a brief, remote, first-line cognitive screening tool that reliably detects cognitive changes where these are clearly present, specifically and validly measuring distinct cognitive domains, which contrasts with a domain-general cognitive screening approach.

Sleep plays a vital role in cognitive regulation, memory consolidation and brain health. In Colombia, sleep patterns may be influenced by cultural and socioeconomic factors such as co-sleeping, occupational stress and limited healthcare access, which can exacerbate sleep-related disorders like sleep apnoea. This study examined the relationship between objectively measured sleep quality and cognitive performance in Colombian adults with sleep apnoea. We hypothesised that poorer sleep quality, which is characterised by lower efficiency and more apnoea (hypopnoea events), would be associated with poorer memory and executive performance, and that age would intensify this effect. Thirty adults aged 30-59 years underwent overnight polysomnography and a comprehensive neuropsychological evaluation. A composite sleep quality index was derived through principal component analysis and analysed using gamma regression controlling for age and gender. Results showed that better sleep quality predicted superior performance on the Wisconsin Card Sorting Test (β = 4.04, p = .032) and the Wechsler Memory Scale (β = 4.43, p = .032), supporting the primary hypothesis. These findings suggest that disrupted sleep architecture selectively affects neural systems underlying executive control and memory. Integrating sleep assessments into neuropsychological evaluations may enhance diagnosis and guide interventions to improve cognitive resilience in Colombian adults with sleep-related disorders.

Interpreter-mediated assessments are increasingly common in paediatric neuropsychology, both globally and within the United Kingdom, due to the rising linguistic and cultural diversity of service users. However, limited research has examined how interpreters and clinicians navigate the complexities of delivering developmentally appropriate, culturally sensitive and psychometrically valid assessments. This qualitative study explored the experiences of 10 paediatric neuropsychologists and nine professional interpreters across NHS services in the United Kingdom. Semi-structured interviews examined the challenges, role expectations and collaborative practices within interpreter-mediated cognitive assessments. Data were analysed using reflexive thematic analysis, with key themes highlighting tensions between access and standardisation, differing interpretations of the interpreter's role and the unique demands of neuropsychological testing in children. Participants consistently emphasised the value of structured collaboration, such as pre-assessment briefings and post-assessment debriefs, though these practices were inconsistently applied. A two-round structured consensus-building exercise, informed by Delphi methodology but adapted for a smaller, profession-specific sample, was subsequently conducted with 13 participants to generate consensus-based recommendations. Nine statements reached an agreement of ≥80%, including the need for joint preparation, interpreter access to sample materials and tailored training for both interpreters and clinicians. These findings underscore the distinct cognitive, relational and linguistic challenges inherent to interpreter-mediated paediatric neuropsychological assessment and call for more explicit guidance and professional development. The study contributes to cross-cultural neuropsychology by providing practice-oriented recommendations to enhance the quality and equity of assessments. Future work should focus on implementation, particularly within resource-constrained or multilingual settings.

Reports of patients with impaired verbal short-term memory are central to the debate of whether there are independent short-term stores or whether immediate repetition is supported by activated long-term memory. Patients with selective impairments of verbal short-term memory support models with independent buffers. However, it has been argued that these patients were too rare to provide reliable data. Second, it has been suggested that these patients might suffer from subtle impairments of word perception, comprehension or production which previous studies had failed to notice. Ten neurological patients were assessed. Nine participants had impaired immediate spans for digits, letters and words whilst having unimpaired word perception, comprehension and production. Another patient exhibited better preserved immediate repetition despite severely impaired word perception, comprehension and production. This double dissociation provides unequivocal evidence for the functional independence of short- and long-term memory. The size of the present group of STM participants, the largest to date, makes it impossible to ignore data from neuropsychological patients.

Immersive virtual reality (VR) enhances ecological validity and facilitates intuitive and ergonomic hand interactions for performing neuropsychological assessments. However, its comparability to traditional computerized methods remains unclear. This study investigates the convergent validity, user experience and usability of VR-based versus PC-based assessments of short-term and working memory, as well as psychomotor skills, while also examining how demographic and IT-related skills influence performance in both modalities.

Psychometric properties of Tommy's Quest (TQ), a novel serious game to evaluate Theory of Mind (ToM) and the pen-and-paper Faux Pas Test (FPT) were assessed. Results from 67 cognitively unimpaired individuals indicated that TQ had adequate construct validity, internal consistency and test-retest reliability. Participants performed worse on TQ compared to the FPT, suggesting greater sensitivity to subtle deficits. These findings support serious games like TQ as a promising tool for ToM assessment, highlighting the need for clinical validation.

Obsessive-compulsive disorder (OCD) is a heterogeneous disorder, and approximately 70% of patients with OCD experience sensory phenomena (SP). Previous studies have revealed that patients with OCD exhibit a deficit in response inhibition (RI). However, few studies have investigated the relationship between SP and RI in patients with OCD. This study aimed to investigate differences in RI between non-comorbid, medication-free patients with OCD with and without SP. Thirty-seven patients with OCD with SP (OCD + SP), 27 without SP (OCD-noSP), and 50 controls (HCs) were compared in terms of RI using the stop-signal task. Both OCD groups had a deficit in RI compared with HCs, and no difference in RI was found between the OCD + SP and OCD-noSP groups. No correlation was observed between SP and stop-signal reaction time in the OCD + SP group. Our findings suggest that a deficit in RI is not related to SP in OCD.

The serial position effect is a well-established phenomenon characterised by better recall of items at the beginning and end of a list compared to those in the middle. A reduced primacy effect-reflected by diminished recall of items from the initial positions-has frequently been reported in individuals with Alzheimer's disease (AD) and Mild Cognitive Impairment (MCI). This study aimed to examine the serial position curve in the Prose Memory test and to assess whether recall accuracy from the primacy portion of the story can predict progression from MCI to AD. Sixty-two patients diagnosed with MCI were included. After 3 years, 30 patients progressed to AD (cMCI), while 32 remained stable (sMCI). Immediate and delayed recall performance for the three segments of the story (Primacy, Middle and Recency) was analysed. In the immediate recall trial, both MCI groups and healthy controls showed enhanced recall accuracy only for the Primacy portion of the story. In the delayed trial, a reduced primacy effect significantly distinguished cMCI from sMCI patients. Receiver Operating Characteristic (ROC) analysis indicated acceptable diagnostic accuracy of delayed Primacy recall in differentiating converters from stable MCI patients. Delayed Primacy recall in the Prose Memory test predicted conversion from MCI to AD. These results suggest that delayed Primacy recall in prose memory may serve as a non-invasive marker for identifying individuals at risk for AD progression.

There remains a lack of appropriately adapted neuropsychological tests for culturally, linguistically and educationally diverse populations, particularly for the evaluation of social cognition, as its assessment is essential for the early diagnosis of diseases such as frontotemporal dementia and Alzheimer's disease. To address this gap, we designed the TIE-93, an emotion recognition test based on Ekman's emotion recognition test, which was adapted to be better suited for culturally, linguistically and educationally diverse populations. However, in a previous study, we found that despite modifications to the test format, culture still had a significant effect on TIE-93 test performance. The present study aimed to further investigate this effect by comparing performances and analysing item-level accuracy and error patterns between participants from individualistic and collectivistic cultures. In total, 205 participants from individualistic countries and 91 participants from collectivistic countries, aged 50 to 90, were included in this study. Results were mostly consistent with existing research literature and showed that the individualistic group performed significantly better than the collectivistic group. However, unlike our previous findings, education-rather than culture-accounted for the largest proportion of variance (34.91%), followed by age (14.94%) and, finally, cultural group (4.2%). This study highlights the importance of considering both educational and cultural factors in the development of emotion recognition tests for diverse populations.

Dementia constitutes one of the most widespread neurological disorders, representing an important health concern due to its increasing prevalence. Among the various types of dementia, Alzheimer's disease (AD) is the most common in the elderly, characterized by episodic memory impairment and also a decline in executive functions. Mild cognitive impairment (MCI) is considered a transitional stage between normal ageing and dementia, often described as a pre-dementia state. Distinguishing between these states is of paramount importance for the detection and appropriate care of patients. Functional Assessment Battery (FAB) is a screening tool for assessing executive function. In this study, 36 healthy individuals (HC), 31 single-domain amnestic mild cognitive impairment (aMCI) patients, and 29 Alzheimer's disease (AD) patients were assessed using FAB to determine its reliability, validity, and discriminative validity in a Spanish sample. Results indicated a good internal consistency of FAB in the AD sample (α = .71), but not in the aMCI group (α = .49). Significant differences between HC and both aMCI and AD groups were observed in the total scores of FAB. The FAB also showed good accuracy in distinguishing between HC and patients (AUC = 0.85), with an estimated optimal cut-off point of 16.5. However, its ability to distinguish between aMCI and AD individuals was lower (AUC = 0.68). More studies are necessary to corroborate our results using larger samples.

Cognitive assessment and analysis of plasma biomarkers are lower-cost options for the early assessment of Alzheimer's disease (AD). In this study, we examined whether serial position markers in the Rey's AVLT were sensitive to plasma AD biomarkers in cognitively unimpaired older individuals. Participants (n = 327; mean age = 70.4, SD = 10.4) were free of dementia (MMSE = 24+) at baseline and recruited as part of the Memory Evaluation Research Initiative (MERI; Nathan Kline Institute, NY, USA). Data included plasma p-tau231, Aβ40 and Aβ42, AVLT scores and demographics. Bayesian linear and logistic regression analyses were carried out with plasma biomarkers as outcomes (including the Aβ42/40 ratio); memory scores, including traditional metrics and serial position scores, were predictors; and age, years of education, APOE ε4-status and reported gender were control variables. Results indicated that plasma p-tau231 was associated primarily with delayed primacy recall (first four words): the more primacy words were recalled, the lower the plasma p-tau231 levels were. This study confirms that serial position analysis of word-list recall data, and particularly delayed primacy, is a valuable tool for the identification of in vivo AD-related pathology in cognitively unimpaired individuals.

This study used fMRI to examine the effect that the abstract-concrete dimension may have on the thematic-taxonomic distinction. The dual hub theory (DHT) posits that left angular gyrus supports thematic relationships and left temporal pole supports taxonomic relationships; however, the DHT is largely based on evidence from concrete words. It is important that theories of semantic organization include abstract words as they are ubiquitous in everyday discourse (Lupyan & Winter, Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences, 2018, 373, 20170137). Additionally, there is reason to believe that there may bean interaction between the abstract-concrete dimension and the thematic-taxonomic distinction, based on the different representational frameworks (DRF) hypothesis, which posits that abstract concepts are primarily organized by association/theme, and that concrete concepts are primarily organized by similarity/taxonomy. However, there appears to be a mismatch among the DHT, predictions of the DRF hypothesis for brain activation, and existing neuroimaging data for the concreteness effect. Thus, we sought to include abstract words in a test of the DHT and determine whether any interactions exist between the abstract-concrete dimension and the thematic-taxonomic distinction. While we replicated the localization of abstract and concrete word processing, we did not extend the DHT to include abstract words, nor did we find an interaction that would support the DRF hypothesis. Rather, our results align more closely with the hub-and-spoke model (Patterson et al., Nature Reviews Neuroscience, 2007, 8, 976).

Transient global amnesia (TGA), a transient memory disorder in clinical neurology, is a unique clinical model for the study of hippocampal dysfunction and its implications for memory processes. While data are rather unequivocal concerning the relevance of the hippocampus for episodic memory, there is considerable dispute about its role for semantic memory. This study aimed at exploring how hippocampal impairment, which underlies the clinical presentation of TGA, affects semantic memory retrieval, particularly with regard to different retrieval strategies. Data from the acute and post-acute phase of 17 TGA patients and 17 healthy controls matched on socio-demographic factors were collected. Categorical word fluency tasks were differentiated into three retrieval strategies: first, with activation of episodic-spatial memory content; second, with novel and flexible linking of semantic memory content and third, with activation of overlearned semantic memory content. We find that hippocampal impairment during TGA significantly restricts semantic word fluency performance, with the degree of impairment depending on the retrieval strategy used and most pronounced when flexible relinking of semantic content is required. Our results suggest an important hippocampal contribution to semantic retrieval, especially in connection with novel and flexible linking of semantic content. They may furthermore be practically relevant for the early differential diagnosis and therapy of memory disorders.

Patients with dural arteriovenous fistulas (DAVF) suffer from cognitive impairments that go often unrecognized. This study aimed to explore the severity of cognitive impairment as well as specific cognitive domains affected in DAVF patients and to track its evolution over long-term follow-up after embolization. Consecutive DAVF patients (and an equal number of healthy controls) were prospectively enrolled and underwent a comprehensive baseline neuropsychological (NP) assessment. These patients were re-evaluated postembolization at a short-term follow-up of 1 month and long-term follow-up of 8-12 months. Thirty-one patients were included, with a male-to-female ratio of 5.2:1 and an average age of 45.1 years. NP assessments revealed significantly impaired cognitive scores across all domains (Addenbrooke's Cognitive Examination [m-ACE], the Rey Auditory Verbal Learning Test [RAVLT], the Wechsler Memory Scale, digit span forward and backward tests, and the Trail Making Test Parts A and B) in the DAVF group compared to healthy controls (p < .001). Post embolization, the m-ACE (p < .001), RAVLT (p = .04), WMS-verbal delay (p = .002) and Trail making test B (p = .019) scores showed statistically significant improvement compared to healthy controls at 1 month. However, the cognitive scores did not fully recover to the level of healthy controls at long-term follow-up. Though treatment leads to significant cognitive recovery, lasting residual cognitive deficits are persistent in DAVF patients compared to healthy controls. Inclusion of comprehensive NP evaluation in work up can unmask subtle cognitive deficits that may guide in therapeutic decision making especially in 'benign' DAVFs.

Faced with increasing diversity in Europe, a large body of research in neuropsychology has emerged to develop tools for the reliable detection of cognitive disorders in diverse older adults. Following this perspective, few tools have been validated, particularly for assessing episodic memory, such as the Nine Images Test (TNI-93). The aim of the present study was to test the interest of adding a delayed recall to the classic TNI-93 procedure for the detection of clinical Alzheimer's disease (AD) in diverse populations. A French retrospective analysis was conducted based on the clinical and neuropsychological data of 281 patients (111 who received a clinical diagnosis of AD; 101 with a cognitive profile not suggestive of AD and 70 patients with a subjective cognitive decline). The sample was mostly composed of people with a low level of education and non-French speakers. The TNI-93 data from the neuropsychological assessment, including a free and a cued recall after a 20 min delay, were analysed. First, AD patients performed more poorly than both other groups on all scores. However, performance decreased more significantly after a 20 min delay in AD patients than in the other groups. Second, the Receiver-Operating-Characteristic analysis showed that the higher diagnostic accuracy for the detection of AD patients was obtained for the 20 min free recall. These results confirm the relevance of the TNI-93 for the clinical detection of AD in diverse populations. The added delayed recall condition seems relevant to highlight the accelerated forgetting of AD patients in a 20 min time window following learning.

The 'KeyStrokes' test (KS) was created as an online and computerized neuropsychological assessment to assess simple attention, processing speed, and executive function. This pilot study aims to show proof of concept of the KS test as a computerized assessment. Building on a previous feasibility study, we assessed the KS test's internal consistency and correlations to other neurocognitive assessments. Participants were recruited from a clinical sample of patients referred for standard neuropsychological evaluation and were asked to perform several standard neurocognitive tests and six subtests of the KS: two response time trials (arrows, words), three inhibition trials (arrows, words, arrows/words) and one inhibition/switching trial (arrows/words). We assessed internal consistency; conducted correlation analyses between each KS subtest, standard neuropsychological tests, and demographic characteristics (age, education, ethnicity, and gender); and conducted multiple regression analyses to assess the relationship between test performance and age and education. We assessed 87 individuals with a mean age of 54.09 years. Correlations between KS subtests were positive and strong (all above ρ > .72, p < .001). Subtests were generally positively correlated with select WAIS-IV and Reynolds Interference Task subtests, and negatively correlated with trail making tests, the grooved pegboard test, and age. Age significantly predicted performance (p < .001), whereas education did not. Ethnicity appeared to correlate with certain subtests, whereas gender did not. Analysis of correlations between the KS subtests and multiple well-established neuropsychological tests showed the possible viability of the KS as a new neurocognitive measure assessing areas of attention, processing speed, and executive function. Additional study of the KS can provide more evidence for its use as a new computerized, and possible online neuropsychological assessment.

Harmonized neuropsychological assessment for neurocognitive disorders (NCDs) is an urgent priority in clinics. Neuropsychology assessments in NCDs seldom include tests exploring social cognitive skills. In 2022, we launched the SIGNATURE initiative to optimize socio-cognitive assessment in NCDs. Here, we report findings from the first initiative phase, including consortium creation and evaluation of the state of the art in socio-cognitive assessment in memory clinics. We developed an ad hoc online survey to explore practices and measures, relevance, and obstacles preventing the use of socio-cognitive testing in clinics. The survey was distributed within the SIGNATURE network. National coordinators were identified to disseminate the survey to local collaborators and scientific societies active in the field of dementia and/or neuropsychology. Data were analysed in aggregate form and stratified by geographical area and variables of interest. Four hundred and thirteen (413) responses from 10 European and Latin American geographical regions were recorded. Responders were balanced between physicians and psychologists. Seventy-eight (78) % of respondents reported no/limited experience with socio-cognitive measures; more than 85% agreed on their relevance in clinics. Ekman-60 faces was the most well-known and/or used task, followed by the Faux-Pas and Reading-the-Mind-in-the-Eyes tests. Lack of clinical measures, assessment time, guidelines, and education/training were reported as main obstacles. Real-life barriers prevent the adoption of socio-cognitive testing in clinics. Bidirectional collaboration between clinicians and researchers is required to address clinical needs and constraints and facilitate consistent socio-cognitive assessment.

Artificial intelligence (AI) and machine learning (ML) algorithms are revolutionising the world, and they have the potential to revolutionise neuropsychology as well. A particularly fruitful field for this revolution is the cognitive assessment of neurodegenerative disorders, such as Alzheimer's disease, Parkinson's disease, Mild Cognitive Impairment and Primary Progressive Aphasia. This narrative review explores the impact of ML and AI in classifying these patients by using biomarkers or neuropsychological tests, using vast amounts of data and providing previously unattainable insights. Additionally, the article will evaluate the accuracies of several ML algorithms, such as support vector machines, random forest or convolutional neural networks. The article will also discuss the challenges related to ML like the risk of overfitting and the need for ML algorithms to execute a differential analysis among several pathologies-a capability that current research has yet to achieve fully. Furthermore, it proposes new directions to improve the clinical utility and accuracy of ML classification algorithms in neuropsychology, underlining the possibility for theoretical advancements based on the results of these classifications.

Both Alzheimer's (AD) and Parkinson's disease (PD) are often associated with memory dysfunction, but their pathophysiological underpinnings differ. The current research aimed to differentiate specific profiles of memory impairment due to AD versus PD. We used controlled learning and cued recall paradigm based on the Memory Binding Test (MBT) in 'clinically cognitively normal' controls (CN; n = 161), in patients with amnestic mild cognitive impairment due to AD (AD-aMCI; n = 50) and due to PD (PD-MCI; n = 22), and in PD with normal cognition (n = 18) as based on performance in the neuropsychological battery to prevent circularity in diagnostic decision-making. We applied analysis of covariance (ANCOVA) and Receiver Operating Characteristic (ROC) analysis to determine between-group differences and detection potential of the MBT. We found statistically large between-group differences with worse memory performance in paired cued recall conditions in AD-aMCI .050). The detection potential of MBT paired cued recall for differentiating memory impairment in AD-aMCI from CN yielded an AUC of 90% (95% CI, 85-96) and an AUC of 91% (95% CI, 81->99) between AD-aMCI and PD-MCI. Associative memory and binding impairment are most pronounced in AD-aMCI in comparison to PD-MCI and controls. Overall, the MBT is an efficient tool for the differential diagnosis of memory impairment due to the two most common neurodegenerative diseases.

Neuropsychology's place in diagnosing dementia is still up for debate. With the advent of disease-modifying therapies, the optimisation of diagnostic pathways is increasingly urgent, particularly in the early stages of Alzheimer's disease. Yet, biomarker-driven frameworks eclipse neuropsychological testing as an ancillary tool rather than recognising it as a core component of clinical assessment. Emerging evidence indicates that relying solely on biomarkers does not provide a dependable forecast for the onset or progression of dementia. This drawback underscores how important neuropsychology is. Nonetheless, the clinical adoption of neuropsychological tests for diagnostic purposes requires a paradigm shift towards a more rigorous methodology. Despite its recognised diagnostic potential, the current neuropsychological framework is constrained by thresholds derived from normative distributions rather than Clinimetrics. Many existing tests rely on arbitrary cut-offs that do not account for disease prevalence, personological variability, or real-world cognitive performance. This oversimplified approach reduces the sensitivity of neuropsychological assessments and limits their integration into clinical practice. The development of population-specific clinimetric studies that establish weighted cut-offs for sensitivity and specificity based on clinical aims is crucial to ensure clinically meaningful decision-making.

This study investigated Theory of Mind (ToM) deficits in patients with suspected idiopathic normal pressure hydrocephalus (iNPH), a condition affecting motor, cognitive and autonomic functions. Given the overlap between ToM-related neural networks and those affected in iNPH, we examined whether ToM impairments are a feature of the disease. Thirty-eight patients with possible/probable iNPH and 25 healthy controls completed the Reading the Mind in the Eyes Test (RMET) along with typically administered neuropsychological tests in this population. Group differences were analysed while controlling for age and education. Pre- and post-lumbar puncture (LP) cognitive changes were also examined, and regression analyses explored cognitive and disease-specific predictors of ToM performance. Compared to the controls, patients performed significantly worse on all cognitive tests (p > .005), including the RMET [F(1, 59) = 7.209, p < .012, partial η = .102, 95% CI [0.009, 0.278])]. Evans Index and education were significant predictors of ToM performance (p =.005). Post-LP, while a subset of patients improved in gait and verbal fluency, their ToM scores remained unchanged. ToM deficits are part of the cognitive profile of iNPH. The association between ventricular enlargement and ToM impairment necessitates further research into the neural mechanisms underlying social cognitive dysfunction in iNPH. Incorporating ToM measures in neuropsychological evaluations may aid early identification of patients with social cognitive deficits and facilitate targeted interventions.

Depressive symptoms (DS) after stroke are associated with marked negative consequences for rehabilitation. Identifying determinants of DS is needed to enable prediction and develop psychological interventions. A promising candidate may be self-concept and changes thereof, so-called self-discrepancy. Consulting recent self-concept models, we investigated the role of self-concept subdomains and their individual importance. Within a prospective longitudinal study, 120 stroke survivors were interviewed via telephone 3 years post-ictus to assess present and past self-concept, self-discrepancy, self-concept subdomains and DS. The association of self-concept measures and DS was investigated using an ANCOVA. Controlling for established determinants (age, sex, history of depression, functional independence, social support), multiple regression analyses were used to examine the independent influence of self-concept measures and the role of subdomains and importance-weightings. Self-discrepancy showed a significant interaction with DS (F (1, 118) = 32.69, p < .001, η = .22). DS showed a stronger association with present (r = -.72) than with past self-concept (r = -.34) and self-discrepancy (r = -.47; all p < .001). Age, history of depression, social support and present self-concept were independent predictors of DS while functional independence was not (∆F (1, 113) = 48.04, p < .001). Importance-weighting of subdomains did not affect explained variance, though the number of self-concept subdomains showing significant association with DS increased. Findings propose appraisals of self-concept as independent predictors of DS after stroke. Considering individual importance of subdomains reveals their differential influence. The results suggest investigating the use of general self-concept for prediction and considering the individual relevance of subdomains in psychological interventions after stroke.

We investigated the course of recovery of emotion recognition impairments during the first year after mild stroke. Furthermore, we studied whether long-term emotion recognition impairments are related to behavioural problems and mood problems. Patient recruitment took place at the stroke unit of a general hospital. Fifty-eight mild ischaemic stroke patients underwent neuropsychological assessments of emotion recognition and overall cognition at 6-8 weeks and 1-year post-stroke. At follow-up, questionnaires were administered to identify behavioural problems and mood problems. Emotion recognition scores of patients were compared to scores of 109 healthy controls that were matched according to age, sex and educational level to identify impairments. Baseline patient emotion recognition scores were compared to the patient scores at follow-up to investigate recovery. In this group of mild stroke patients, emotion recognition was impaired compared with healthy controls, with no recovery over time. One year after stroke emotion recognition was impaired in 31% of the mild stroke participants. At 1-year post-stroke, impaired emotion recognition was associated with overall cognitive impairment and self-reported behavioural problems, but not with mood. Even in mild stroke, emotion recognition is on average impaired in the long term and related to behavioural problems. A substantial portion of mild stroke patients have impairments in emotion recognition both in the subacute phase as well as in the long term. Early assessment of emotion recognition is important to identify patients at risk of developing behavioural problems. Appropriate and early treatment might be necessary to prevent persisting problems.

We introduce a special issue of the Journal of Neuropsychology dedicated to a recent paradigm shift in Alzheimer's disease diagnosis. Joint workgroups from the (US) National Institute on Aging and the Alzheimer's Association (NIA-AA) recently issued policy guidelines reclassifying Alzheimer's disease as a biological entity. These guidelines shift the onus of diagnosis in favour of protein biomarkers, relegating cognitive symptoms (e.g. subjective memory and language disorders) as supportive rather than core features. We invited experts in the study of Alzheimer's disease and Related Disorders (ADRDs) to express their views on this paradigmatic shift in dementia management. In this editorial, we synthesize some of the main points advanced in the commentaries. Contributors identified the promise of blood-based biomarker testing for improving equitable detection of dementia in large swathes of the world population. This enthusiasm was tempered by concerns about the biomarker-only diagnostic approach, including the potential for significant harm (e.g. stigma, depression, suicide) caused by labelling asymptomatic older adults who might otherwise never behaviourally express the underlying disease pathology.

Updated criteria pertaining to the diagnosis of Alzheimer's disease (AD) have sparked debate over the reliance on biomarkers-particularly amyloid-β and phosphorylated tau. While biomarkers promise earlier detection and standardized criteria, the potential extension and interpretation of their use in asymptomatic individuals remains controversial. Many individuals with abnormal biomarker profiles never experience cognitive decline, raising concerns about overdiagnosis, unintended negative psychosocial consequences and the blurring line between risk and definitive diagnosis. We, and others, argue that biomarker positivity should be reframed not as a definitive diagnosis but rather as an indicator of elevated risk, particularly in the absence of cognitive symptoms. Doing so better aligns with current evidence, preserves clarity in diagnosis, and avoids unintended psychosocial consequences. Crucially, the role of cognitive reserve-influenced by education, other life experiences and structural inequities-must be considered, particularly among racially and ethnically diverse populations historically underrepresented in AD research. Biomarker thresholds (as well as neuropsychological tools) derived from predominantly non-Hispanic white cohorts may not generalize across groups, risking misclassification and inequity. As the field moves towards precision medicine and AI-driven risk models, inclusive data and culturally valid frameworks are essential. Ultimately, embracing a risk-based, multifactorial approach respects the complexity of AD and promotes equitable care. This perspective calls for interdisciplinary collaboration to refine diagnostic strategies that are scientifically grounded, socially conscious and responsive to the lived realities of diverse populations. Only then can we responsibly integrate biomarkers into practice without sacrificing nuance.

We aimed at validating the Mini Social Cognition and Emotional Assessment (Mini-SEA) in a German cohort of mildly impaired behavioural-variant frontotemporal dementia (bvFTD) patients and healthy controls. The Mini-SEA comprises the Facial Emotion Recognition Test (FERT) and the Faux Pas Test (FPT) measuring Theory of Mind (ToM) abilities in social norm-related real-life stories. We examined the diagnostic performance of the Mini-SEA alongside other neuropsychological assessments and investigated its structural neural correlates. We included 32 bvFTD patients and 54 controls in logistic regression models with forward-stepwise selection containing demographics, standard neuropsychological battery (CERAD-NAB+) and the Mini-SEA scores to identify the most relevant variables. Demographic, neuropsychological and daily-life activity associations were explored. Voxel-based morphometry analysis was conducted in a subsample (14 bvFTD and 14 controls) on regions previously linked to emotion processing and ToM functions. The Mini-SEA yielded a very good performance, being in the best-fitting model with a high odds ratio alongside the executive-language and memory measures. Specifically, the FERT indicated the strongest effect in the group differentiation. Mini-SEA showed significant associations with executive-language tests and daily-life activities. In canonical emotion processing brain regions, we found associations of the Mini-SEA composite and the FERT with grey matter volumes in the left insula and lentiform nucleus of putamen. Within ToM regions, associations were found for the Mini-SEA composite and the FPT in cerebellar regions. The German Mini-SEA discriminates well between mildly impaired bvFTD patients and controls. We also demonstrated its significant value for neuropsychological assessment and neuro-behavioural associations in regions underlying emotion processing and ToM.

Post-stroke fatigue (PSF) is a prevalent symptom associated with attention deficits. However, it is currently unclear what drives these. Here we applied Load Theory of Attention to investigate the role of perceptual load in the relationship between attention, distraction and fatigue levels in PSF. Thirty-two chronic stroke survivors performed a selective attention task of either low, medium or high perceptual load (varied through the number of relevant target features and their combinations). Neural responses to targets and distractor checkerboard flicker (vs. no flicker) were measured with frequency-tagged EEG responses. The results showed that fatigue severity scores were predictive of response slowing, and that this slowing was increased with higher levels of perceptual load. Fatigue severity was also associated with increased neural responsiveness to distractors, specifically: EEG 10 Hz (distractor flickering frequency) power was greater in the presence (vs. absence) of distractor flicker for participants with high (vs. low) fatigue-symptoms scores, across all levels of perceptual load in the later time period of each task trial. Overall, these results clarify the exacerbating effects of perceptual load on fatigue-related slowing, stressing the importance of cognitive, as opposed to purely motoric, deficits. Importantly, they demonstrate that increased fatigue severity involves reduced ability to suppress neural responses to irrelevant distractors, irrespective of perceptual load on attention. An account for attention in PSF based on a specific deficit in distractor suppression that is found irrespective of task demands can explain a myriad of PSF symptoms (e.g. sensory perceptual overload, difficulties to concentrate).

The neuropsychological assessment of executive functions is an important part of the diagnostic process for many neurological diseases and for predicting the ability of neurological patients to function independently. Unfortunately, for the majority of commonly used executive function tests there is a paucity of updated normative data, particularly for older adults. This complicates the process of a clinically meaningful assessment. To help address this, we provide normative data for three well-validated tests of executive functions, the Stroop Colour/Word Test, the Controlled Oral Word Association Test and the Hayling Sentence Completion Test, alongside scores from an estimate of general intellectual ability. These tests are sensitive to frontal lobe damage and provide clinicians with information about possible focal damage to the left and right frontal lobes. Percentiles are presented for five age cohorts across the adult lifespan (18-92 years). A regression equation with age and predicted full-scale IQ also allows for the categorisation of normal and defective performance on the Stroop and Hayling tests. Given the increasing proportion of older adults requiring neuropsychological assessment, we investigated separately two groups in the older adult range: 65-79 years and 80-92 years. We found a decline in performance for older adults on all three tests. This decline was more marked amongst lower scoring older adults. We did not find a significant relationship between sex and performance on any of the three tests. The findings are discussed in the light of the cognitive reserve theory of ageing.