Negative metacognitive bias, underestimating one’s abilities, is consistently linked to psychopathology, yet prior work has often collapsed anxiety/stress and depression or examined depression alone. We tested the unique associations of depression, anxiety/stress, and posttraumatic stress disorder (PTSD) with metacognitive bias in post-9/11 veterans.

Veterans from the Translational Research Center for TBI and Stress Disorders (TRACTS, N = 601; 90% male; M age = 34.31) completed 21-item Depression, Anxiety, and Stress Scale (depression, anxiety/stress), CAPS-IV (PTSD), WHODAS-II Understanding/Communicating (self-reported cognition), and an objective cognition composite (assessment of executive function, memory, and attention). Bias was computed as self-report minus objective cognition. A subsample (n = 239) repeated testing ∼2 years later.

At time 1, more negative metacognitive bias was associated with greater anxiety/stress (r = −.41), depressive (r = −.37), and PTSD symptoms (r = −.31) (all ps < .001). In a simultaneous model, anxiety/stress (β = −.29 p < .001) and depressive symptoms (β = −.12, p = .045) explained unique variance though PTSD symptoms did not (β = −.03, p = .524). Longitudinally, changes in bias were uniquely predicted by symptom changes in anxiety/stress (β = −.33, p < .001) and PTSD (β = −.16, p = .001), but not depression (β = −.10, p = .137).

Across cross-sectional and longitudinal models, anxiety/stress emerged as the most consistent correlate of metacognitive bias, with weaker contributions from depression and PTSD. These findings highlight the importance of assessing the self-report versus objective cognition gap and the need to further understand the temporal relationship between anxiety/stress and metacognitive bias.

While early-life adverse experiences have been linked to late-life cognitive decline, few studies have explored war exposure. Paradoxically, one study even indicated a late-life cognitive advantage of early-childhood war exposure. In the present study, we explored these associations.

We examined older adults exposed to World War II (1940–1944; n = 1179) and the subsequent Civil war (1946–1949; n = 962) in Greece during early and middle childhood with a comprehensive neuropsychological assessment and for ApoE-ε allele status, including demographic information and medical history.

Higher cognitive performance in language tasks predicted middle childhood, relative to early childhood, WWII-exposure group membership (B = .316, p = .038, OR:1.372, 95%CI:1.018–1.849), primarily for men, while higher attention/speed (B = .818, p = .002, OR:2.265, 95%CI:1.337–3.838) and total cognitive score (B = .536, p = .040, OR:1.709, 95%CI:1.026–2.849) were predictors of belonging to the middle-childhood group, only in men. Individuals who did not meet criteria for Mild Cognitive Impairment (MCI)/dementia were more likely to belong to the middle-childhood war-exposure group. Similarly, for the Civil war, higher cognitive scores and reduced likelihood to meet criteria for MCI/dementia were predictors of middle, relative to early childhood war exposure group membership (visuospatial score: B = .544, p = .001, OR:1.723, 95%CI:1.246–2.381, MMSE: B = .134, p = .020, OR:1.143, 95%CI:1.021–1.297), primarily for women. Results remained consistent when adjusting for multimorbidity, sex, education, current age, depression, and anxiety.

The present findings suggest that better cognitive performance and lower likelihood of MCI or dementia were associated with being exposed to significant hardships, such as war, during middle childhood, regardless of potentially confounding factors. Further studies are needed to shed light on this relationship.

Network modeling of post-concussion symptoms following mild traumatic brain injury (mTBI) has emerged as a promising tool for understanding how cognitive, emotional, and somatic symptoms co-occur and interact. However, the generalizability of networks developed in individual studies remains unclear. This study aimed to develop the first-ever meta-analytic pooled between-persons network structure of post-concussion symptoms and systematically examine the between-study heterogeneity of these symptom networks.

Using the Meta-Analytic Gaussian Network Aggregation (MAGNA) framework, a single pooled network model was developed by aggregating data from 6 distinct samples, comprising a total of 5,776 participants. Additionally, this study quantitatively assessed the degree of heterogeneity across these studies.

Strong symptom clusters between cognitive, emotional, and somatic symptoms were identified. Concentration difficulty and slowed thinking were the most central symptoms in the pooled MAGNA network. Large between-study heterogeneity was observed.

Findings from this meta-analysis highlight cognitive symptoms as most important for defining the network structure after mTBI at a group level, potentially perpetuating and/or being perpetuated by symptoms in other domains. The large heterogeneity observed between studies underscores the need for an idiographic (person-specific) approach to studying post-concussion symptom networks to inform precision rehabilitation.

Mild cognitive impairment (MCI) involves measurable cognitive decline that does not yet significantly disrupt daily functioning but may signal increased risk of dementia. Reliable prediction of dementia conversion in MCI is essential for early intervention and optimized clinical trial design. This study aimed to evaluate the predictive performance of various machine learning (ML) classification algorithms using clinical and neuropsychological data.

Data were drawn from the Gothenburg MCI Study and included 347 patients from a memory clinic, of whom 84 (24%) converted to dementia within two to six years. We applied 11 ML classification algorithms (logistic regression, linear discriminant analysis, naïve Bayes, k-nearest neighbors, LASSO, ridge regression, elastic net, decision tree, random forest, gradient boosting, and support vector machine (SVM)) to predict dementia conversion based on 54 clinical predictors (e.g., cerebrospinal fluid biomarkers, neuropsychological test scores, comorbidities, and demographics). In a second step, we included delta scores reflecting change in neuropsychological test performance from baseline to follow-up.

Without delta scores, LASSO, ridge, elastic net, random forest, and SVM performed best, achieving accuracy ≥0.87, kappa = 0.64, and AUC-ROC ≥0.90. These models demonstrated high specificity (0.94) but moderate sensitivity (0.68). Including delta scores improved performance, with ridge and elastic net achieving accuracy = 0.90, kappa = 0.73 and 0.72, AUC-ROC = 0.94, specificity = 0.96, and sensitivity = 0.73. The elastic net model yielded a positive predictive value of 0.85 and a negative predictive value of 0.92.

ML models incorporating clinical and cognitive change data can accurately predict dementia conversion in MCI, supporting their utility in clinical decision-making.

This study examines how multiple dimensions of socio-emotional well-being relate to cognitive functioning in older adults, and whether the associations vary by cognitive status, depression, and socio-demographic factors.

Data from the Harmonized Cognitive Assessment Protocol of the Survey of Health, Ageing and Retirement in Europe (n = 2,650; mean age = 76; 54.5% females) were used to test associations between life satisfaction, meaning in life, social connectedness, and loneliness with global, domain-specific cognitive performance, and informant-rated cognitive decline.

Linear mixed models, with individuals nested within five countries, found that higher life satisfaction, meaning in life, and social connectedness were associated with better cognitive outcomes, whereas greater loneliness was associated with worse performance and greater informant-rated decline. The largest effect sizes were observed for meaning in life (median β = .10) and loneliness (median β = −.09) across cognitive measures. The associations generally remained significant adjusting for well-known clinical (e.g., diabetes), behavioral (e.g., physical inactivity), and psychological (depressive symptomatology) risk factors for dementia. Moderation and sensitivity analyses suggested that associations with global cognition hinged on the inclusion of participants classified with cognitive impairment, while some domain-specific associations (e.g., loneliness and episodic memory) were observed only in individuals without cognitive impairment. Overall, evidence for moderation by cognitive status, depression and age was limited, and no moderation was observed for sex or education.

The results underscore the importance of socio-emotional well-being in cognitive aging and highlight the need for longitudinal research to clarify mechanistic pathways and inform targeted interventions.

This study investigated functional connectivity in the default mode, central executive, dorsal attention, and salience networks (SN) and its relation to executive function in youth with traumatic brain injury.

Twenty-three youth with traumatic brain injury (11 with moderate-to-severe injury (6 male, mage = 11.78 ± 2.68 years, mtimesinceinjury = 3.71 ± 2.43 years) and 12 with complicated-mild injury (9 male, mage = 12.59 ± 1.99 years, mtimesinceinjury = 4.55 ± 1.59 years) and 17 youth with orthopedic injury (11 male, mage = 11.75 ± 2.12 years, mtimesinceinjury = 3.95 ± 1.79 years)) completed resting-state functional magnetic resonance imaging and a parent rated their child’s executive function.

We found group differences in the strength of connectivity among four regions in the default mode network (DMN) and two regions of the SN, ps < .05, Eta2 = .151–.229. The orthopedic injury group demonstrated significant negative between-network connectivity, while brain injury groups had negligible negative or, in some cases, positive between-network associations. Groups did not differ on parent ratings of executive function, as all groups fell above the normative mean, reflecting poorer than expected everyday executive behavior. Attenuation of typical negative between-network association between the posterior cingulate in the DMN and two regions of the salience network was associated with worse parent-rated executive behavior (rs = .291–.317, ps < .05).

Findings illustrate the implications of disrupted downregulation of the default mode network by the SN following pediatric brain injury. They also demonstrate how disruption in functional connectivity may underlie poor executive function after childhood traumatic brain injury.

Evaluating pauses in natural speech is a promising strategy for improving reliability, validity, and efficiency in assessing cognitive functions in people with mild cognitive impairment (MCI) and Alzheimer’s dementia (AD).

We conducted a quantitative meta-analysis of studies employing automated pause analysis. We included measures of speaking rate for comparison.

We identified 13 studies evaluating pause measures and 8 studies of speaking rate in people with MCI (n’s = 276 & 109, respectively) and AD (n’s = 170 & 81, respectively) and healthy aged controls (n’s = 492 & 231, respectively). Studies evaluated speech across various tasks, including standard neuropsychological, reading, and free/conversational tasks. People with AD and MCI showed longer pauses than controls at approximately 1.20 and 0.62 standard deviations, respectively, though there was substantial heterogeneity across studies. A more modest effect, of 0.66 and 0.27 SDs, was observed between these groups in speech rate. The largest effects were observed for standardized memory tasks.

Of the many ways that speech can be objectified, pauses appear particularly important for understanding cognition in AD. Pause analysis has the benefit of being face valid, interpretable in ratio format as a reaction time, tied to known socio-cognitive functions, and relatively easy to measure, compute, and interpret. Automation of speech analysis can greatly expand the assessment of AD and potentially improve early identification of one of the most devastating and costly diseases affecting humans.

Neuropsychological (NP) tests are multi-domain in execution. Reliance on a single score representing specific domains obscures the detection of subtle cognitive changes and increases risk of inaccurate assessment. Rooted in the Boston Process Approach (BPA), the Framingham Heart Study (FHS) captures multi-dimensional errors and process features within and across NP tests. We examined these BPA variables in community-dwelling older adults.

We analyzed data from 2363 dementia-free participants aged 60 and above. Exploratory and confirmatory factor analyses used Kemeny covariance structures. Measurement invariance was estimated across age, sex, and education groups. We assessed the impact of demographics on latent factors, and the ability of these factors to predict future conversion to all-cause dementia. We trained machine learning (ML) models to compare NP and BPA data.

Participants were older adults (mean age 71.5 ± 8.7 years), primarily female (54.2%), and non-Hispanic White (96.5%). The bifactor model was the only model with adequate fit (CFI = 0.96, RMSEA = 0.03). General and specific factors captured ability for accurate and strategic responses, test-specific variance, and nuanced executive and semantic processes distributed across tests. Higher general ability and stronger verbatim story recall were associated with a reduced likelihood of developing all-cause dementia (general: OR = 0.15, 95% CI [0.12–0.86]; recall: OR = 0.24, 95% CI [0.23–0.90]) over a median of 5.2 years. With NP/BPA data, ML models identified >99% of 222 converters.

This study highlights the strengths of NP/BPA data. Multidimensional cognitive features may enhance sensitivity to early changes predictive of incipient dementia.

Subjective cognitive complaints (SCC) can precede cognitive decline and are associated with demographic, exposure, lifestyle, and psychological factors. Prevalences of SCC and their correlates in individuals with repetitive head impacts (RHI) are poorly understood. This study characterized SCC in former elite American football players by frequency, mood and behavioral correlates, concordance with informant reports, and associations with neuropsychological test performance, cerebrospinal fluid (CSF), and magnetic resonance imaging (MRI) markers of neurodegeneration.

Former American football players (n = 180) completed measures of global and domain-specific SCC, neuropsychiatric symptom questionnaires, neuropsychological testing, lumbar puncture, and MRI. Elastic net regression evaluated the relative importance of potential SCC correlates. Intraclass correlation coefficients measured concordance between self and informant reports. Multiple linear regressions tested associations between SCC and verbal memory and executive functioning scores. CSF Aβ1-42, p-tau181, t-tau, neurofilament light (NfL), hippocampal volume, and regional cortical thickness were examined for their potential associations with SCC.

Rates of SCC ranged from 43 to 77% depending on the domain. Symptoms of depression, impulsivity, and anxiety were strongly associated with SCC. Self- and informant-reported SCC showed moderate inter-rater agreement. Adjusting for age, race, education, APOE ϵ4 carrier status, and depressive symptoms, SCC were associated with lower objective verbal memory and executive functioning performance. SCC were associated with lower parahippocampal cortical thickness but not with hippocampal volume or any of the measured CSF tests.

SCC are strongly associated with neuropsychiatric factors in former American football players. SCC may also be a marker of cognitive decline and neurodegeneration.

Increasing survival probabilities among children and young adults with acute lymphoblastic leukemia (ALL) have led to a growing population at risk for long-term neurocognitive sequelae. This study investigated cognitive functioning among individuals treated for ALL under the Nordic Society of Paediatric Haematology and Oncology ALL2008 protocol in Eastern Denmark, including performance across multiple domains and associations with age at diagnosis, sex, time since end of treatment, hematopoietic stem cell transplantation (HSCT), and neurotoxic events during treatment.

Eighty-three survivors of ALL diagnosed before age 25 underwent neurocognitive testing at a median of 7.24 years post-treatment (interquartile range: 4.20–8.78). Performance was measured as age-standardized Z scores derived from normative data. Impairment was defined as Z ≤ −1.3 and severe impairment as Z ≤ −2.0. Multiple linear regression was used to investigate associations between cognitive outcomes and clinical risk factors.

Average performance was generally comparable to norms, but at least 38.6% of participants showed severe impairment in one or more domains, and at least 12% in two or more. Younger age at diagnosis was associated with poorer processing speed, executive functions, and non-verbal reasoning, while HSCT was associated with poorer processing speed and non-verbal reasoning.

Although average performance of the participants was generally comparable to norms, a notable proportion exhibited multi-domain, severe cognitive impairment. Associations with age at diagnosis and HSCT indicate potential for risk-stratified cognitive monitoring and targeted interventions.

The quest for non-invasive and cost-effective biomarkers for mild cognitive impairment (MCI) and Alzheimer’s disease (AD) has led to growing interest in resting-state functional magnetic resonance imaging (MRI). This study examined associations between whole-brain functional connectivity measures and cognitive performance across a spectrum of cognitive aging.

A total of 108 older adults (mean age 74.1 ± 5.7 years), comprised of cognitively intact individuals, participants with amnestic MCI, and those with mild dementia due to probable AD, underwent high-resolution structural MRI and resting-state functional MRI scans and cognitive testing with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Functional connectivity values were derived from a 17-network brain parcellation. Correlations were established between network connectivity values and RBANS Index scores.

Analyses revealed that lower RBANS Attention Index and Total Scale scores were significantly associated with increased connectivity between the ventral attention, central executive network, and limbic and default mode networks. Lower RBANS total scores were also associated with functional connectivity strength between the dorsal default mode networks and lateral frontoparietal regions of the central executive network, with increased connectivity observed across the dementia spectrum (Intact-MCI-AD).

These findings suggest that aberrant and potentially compensatory increases in functional connectivity may be linked to cognitive decline, supporting the utility of resting-state functional MRI as a promising biomarker for MCI and AD.

Spatial neglect is a heterogeneous post-stroke disorder with subtypes differing in reference frames, processing stages, and spatial domains. While egocentric peri-personal neglect recovery has been studied, recovery trajectories of allocentric peri-personal visuospatial and personal neglect remain unclear. This study investigated recovery time courses of egocentric and allocentric peri-personal visuospatial and personal neglect during the first 12 weeks post-stroke; whether initial severity predicts recovery and defines distinct patient clusters; and how subtypes interrelate over time.

Forty-one first-ever stroke patients were evaluated at weeks 3, 5, 8, and 12 post-stroke using the Broken Hearts Test, Line Bisection Test, Visuospatial Search Time Test, and Fluff Test. Recovery was analyzed using linear mixed models, clustering with Gaussian finite mixture models, and interrelationships using Spearman correlations.

Significant improvements occurred in egocentric and allocentric peri-personal visuospatial and personal neglect, primarily between weeks 3 and 5, followed by a plateau. The Line Bisection Test detected no changes. Higher initial severity predicted greater residual impairment. Cluster analysis identified near-normal, mild, and moderate-to-severe baseline subgroups with distinct recovery trajectories. Moderate-to-good correlations (ρ = 0.33 – 0.55) emerged between egocentric and allocentric neglect at week 3 and when timepoints were pooled.

Neglect improved mainly between weeks 3 and 5 after which recovery plateaued, mirroring motor and language recovery and suggesting a shared time-limited window. Initial severity was a determinant of recovery, highlighting the value of early severity stratification to monitor and support recovery potential after stroke. As subtypes are distinctive, assessment should include multiple neglect tests.

This study aimed to make a head-to-head comparison of the diagnostic accuracy and cross-cultural applicability of abbreviated 20-item versions of the Copenhagen Cross-Linguistic Naming Test (C-CLNT20) and Naming Assessment in Multicultural Europe (NAME20).

The present study was conducted in a multicultural and multilingual patient sample from memory clinics across five European countries. Receiver operating characteristic curve analysis was used to assess the diagnostic accuracy of C-CLNT20 and NAME20 in classifying dementia and mild cognitive impairment (MCI). Binary logistic regression analysis was performed to evaluate the influence of demographic and cultural factors on diagnostic accuracy.

C-CLNT20 and NAME20 showed acceptable diagnostic accuracy for dementia with areas under the curve (AUC) of .75 and .82, respectively, but had low accuracy for MCI (AUC of .64 and .62, respectively). Compared to C-CLNT20, NAME20 had slightly higher, but statistically non-significant, AUCs for dementia in both in the full sample and in participants with immigrant background. The diagnostic accuracy of the C-CLNT20 and NAME20 was not significantly influenced by education and immigrant status in the full sample, or by acculturation and use of an interpreter in participants with immigrant background.

Both C-CLNT20 and NAME20 are promising brief alternatives to the full versions of the naming tests when time is limited. They also present a promising alternative to other established naming tests by maintaining diagnostic accuracy while showing minimal cross-cultural and cross-linguistic bias.

This study aimed to explore the correlates of zero, one, and multiple performance validity test (PVT) failures on cognitive test performance in patients with various degrees of severity of traumatic brain injury.

306 participants completed the Trail Making Test as part of a neuropsychological evaluation within 1–36 months post-injury. They were assigned to zero, one, or ≥ two fail groups on the basis of at least two independent PVTs. Group differences in Trail Making Test performance were analyzed with analysis of variance, with post hoc contrasts with the Bonferroni correction for multiple comparisons. Groups were also compared on various background characteristics.

Participants who passed all PVTs had statistically significantly better performance on both parts of the Trail Making Test as compared to those who failed either one or multiple PVTs, with the latter two groups not differing statistically significantly from each other. PVT failure was relatively more common in participants who were female, had an uncomplicated mild TBI, were involved in financial compensation-seeking, and were seen at a longer time point since injury.

Failure of even only one PVT is associated with lower neuropsychological test performance in patients with traumatic brain injury, especially when empirically validated criteria are used that are stratified by injury severity. Such failure does not always reflect malingering but must be interpreted and addressed in the context of patient background characteristics.

Switching is one of three primary executive functions alongside inhibitory control and updating but remains relatively understudied in childhood attention-deficit/hyperactivity disorder (ADHD) compared to investigations into working memory and inhibitory control deficits. Where extant literature in adults suggests that switch costs are due to a combination of task set inertia and task set reconfiguration costs, it is not clear which of these is most relevant to explaining ADHD-related atypicalities in performance.

Children with (N = 34) and without ADHD (N = 28) aged 8–12 (average age = 9.45) completed a 192-trial computerized cued switching paradigm. Diffusion model decomposition of the data was performed to identify cognitive subprocesses responsible for the switch.

Consistent with the switching literature in adults, switch costs for children were due to a combination of both task set inertia (reduced drift rate) as well as slower task set reconfiguration (Ter) on switch versus repeat trials. Children with ADHD were less accurate than non-ADHD controls, but the ADHD × Switch interactions were not significant for any variable, indicating that the deficit was general and not switch-specific. Lower accuracy was in turn attributed to slower general drift rate among children with ADHD.

This study contributes to a growing literature finding that the performance deficits in children with ADHD across executive and non-executive function tasks are related to lower-level perceptual decision-making weaknesses that have downstream effects on higher-order processing.

The Rey–Osterrieth complex figure (ROCF) test is widely used to assess constructional praxis. Qualitative scoring methods, such as the Boston Qualitative Scoring System (BQSS), enable the detection of alterations in spatial organization, planning, and executive control during copying performance. While alterations in constructional abilities have been previously reported in Parkinson’s disease (PD), the possible presence of subtle qualitative modifications in PD patients without cognitive impairment (PD-CU) and their relationship with the cognitive functioning is still to be elucidated. This study evaluates differences in copying strategies and error patterns in PD patients with (PD-MCI) or without (PD-CU) mild cognitive impairment, assessing the link with the cognitive profile.

Seventy PD patients and 56 healthy controls (HC) were recruited. All participants underwent a neuropsychological assessment, including the ROCF. Their performance was assessed by standard quantitative scoring and qualitative rating scales (BQSS). Statistical analyses compared BQSS performance between groups and examined associations between qualitative visuo-constructional features and other cognitive domains.

Both PD-MCI and PD-CU groups showed qualitative alterations compared to HC, associated with executive dysfunctions. Qualitatively, PD-CU patients showed lower scores in neatness and planning measures compared to HC, the latter particularly associated with executive alterations. Notably, patients reporting a left or right asymmetric copy were characterized by different cognitive profiles.

The here-presented results support the importance of qualitative assessment in identifying early cognitive impairments in PD patients and suggest that BQSS parameters (i.e., planning) may offer complementary insights to standard quantitative assessments in detecting subthreshold executive impairments not yet captured by conventional tests.

Episodic memory decline is among the earliest and most prominent cognitive changes observed in both normal aging and Alzheimer’s disease. The Free and Cued Selective Reminding Test (FCSRT) enhances differentiation of memory deficits through controlled semantic encoding and cue-based retrieval. However, culturally appropriate normative data for Mandarin-speaking adult populations have been lacking. This study aimed to establish normative data for the Taiwan version of the FCSRT (T-FCSRT), examine demographic effects on test performance, and evaluate its psychometric properties and clinical applicability.

A total of 372 cognitively healthy adults aged 45–86 years were recruited using stratified sampling to reflect the Taiwanese population across sex, age, and education levels. Participants completed the T-FCSRT, and regression-based analyses were used to adjust for demographic effects. Reliability and validity were assessed using test–retest data and correlations with established neuropsychological measures.

All T-FCSRT core indices were significantly influenced by age and education level, whereas sex effects were confined to immediate and delayed free-recall measures. The T-FCSRT demonstrated good test–retest reliability, criterion-related and construct validity, and regression-based percentile norms that provide population-representative benchmarks.

The T-FCSRT demonstrates strong psychometric properties and provides culturally appropriate normative data for Mandarin-speaking adults in Taiwan. These findings support its utility for clinical assessment and research on episodic memory, enabling more accurate differentiation between normal and pathological aging.

Sensory burden, a momentary experience of being bothered by sensory stimuli, is a frequent challenge following acquired brain injury (ABI). This study quantitatively tested a theoretical model conceptualizing sensory burden as a dynamic interaction between situational triggers and an individual’s biopsychosocial resources using an experience sampling method.

41 individuals with ABI (median age = 59 years, median time since injury = 6.3 years) provided real-time data at seven semi-random intervals per day over seven consecutive days. Multilevel regression modeling assessed the influence of situational triggers (setting, company, effort, activity dissatisfaction, and negative affect) and individual resources (processing speed, fatigue, and sleep quality) on sensory burden.

Momentary fluctuations in sensory burden varied in severity and variability across individuals. Sensory burden was associated with higher levels of negative affect (β = .58, p < .01), activity dissatisfaction (β = .07, p < .01), effort (β = .09, p < .01), and being in company (β = .39, p < .01). Moreover, sensory burden was related to slower processing speed (β = −0.04, p = .02) and higher fatigue (β = .19, p < .01). However, no interaction effects were found. Effort was the only positive, significant between-person predictor (β = .56, p < .01).

These findings underscore the dynamic and individualized nature of sensory burden after ABI, emphasizing the need for personalized interventions targeting sensory hypersensitivity. Future research should explore additional triggers, resources, and causal pathways to further elucidate the proposed mechanisms and inform treatment development.

The clock drawing test is widely used in clinical neurological and neuropsychological assessment. We hypothesized that younger adults would have greater problems with clock drawing than older adults, perhaps due to decreasing analog clock use.

Cross-sectional study analyzing clock drawing performance and cognitive function across four generations (Gen Z, Millennials, Gen X, Baby Boomers). Participants included 92 adults divided into two generations (63 younger [18–42 years old] and 29 older [43–77 years old]) assessed between October 2022 and December 2024. Participants were screened to exclude conditions affecting cognition. The primary outcome was performance errors in clock drawing (e.g., writing “11:10” instead of drawing an analog clock, or placing hands incorrectly), assessed using standardized criteria. Cognitive function was assessed using eight computerized tests (CogState) measuring processing speed, attention, executive function, visuospatial memory, and verbal memory. Confirmatory factor analysis (CFA) validated three cognitive domain composites: Speed/Attention, Executive/Spatial, and Verbal Memory.

Performance errors were significantly more prevalent among younger participants compared with older participants (p = .016; risk ratio, 4.45). The effect size was large (Cohen’s h = .63). The generation effect was stronger (OR = 28.66, p = .003) after controlling for CFA-validated cognitive domain composites. This provides strong evidence that generational differences are independent of cognitive abilities.

Younger adults demonstrate significantly higher rates of clock drawing errors compared with older adults, independent of cognitive performance. These findings suggest a need for generation-specific or age adjusted norms in clock drawing test interpretation.

Assessment for children with acquired brain injury (ABI) often includes measures of preinjury functioning; however, there is limited understanding of how social determinants of health (SDOH) are associated with preinjury measures. This study investigated the association of the Area Deprivation Index (ADI) with measures of preinjury functioning.

196 caregivers of children with ABI completed the Adaptive Behavioral Assessment System-3rd Edition (ABAS-III), and 188 children with ABI completed the Wide Range Achievement Testing-4th Edition or 5th Edition word reading subtest (WRAT-Word Reading). Two linear regressions were performed: 1) ADI × WRAT-Reading and 2) ADI × ABAS-III.

The ADI demonstrated significant associations with the ABAS-III and WRAT-Reading scores. Children in lower deprivation areas demonstrated higher preinjury functioning and word reading scores.

These findings have implications for recovery from brain injury, considerations for incorporating social determinants of health into neuropsychological evaluations, and implications for clinician interpretation of a child’s testing.