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The International Conference on Cognitive Modeling brings together researchers from around the world whose main goal is to build computational systems that reflect the internal processes of the mind. In this issue, we present the five best representative papers on this work from our 19th meeting, ICCM 2021, which was held virtually from July 3 to July 9, 2021. Three of these papers provide new techniques for refining computational models, giving better methods for taking empirical data and producing accurate computational models of the cognitive systems that produce them. The other two papers focus on explanation: using models to elucidate the underlying processes affecting cognition in such diverse domains as logical reasoning and the effects of caffeine.

This study assessed classification accuracy of paper-and-pencil and computerized cognitive batteries at subacute (SA; 1-11 days) and early chronic (EC; ∼4 months) phases of pediatric mild traumatic brain injury (pmTBI). Two statistical approaches focused on single-subject performance (individual task scores, total impairments) were used to maximize clinical utility.Two hundred thirty-five pmTBI and 169 healthy controls (HC) participants aged 8-18 were enrolled, with a subset (190 pmTBI; 160 HC) returning for the EC visit. The paper-and-pencil battery included several neuropsychological tests selected from recommended common data elements, whereas computerized testing was performed with the Cogstate Brief Battery. Hierarchical logistic regressions (base model: Parental education and premorbid reading abilities; full model: Base model and cognitive testing variables) were used to examine sensitivity/specificity, with diagnosis as the dependent variable.Number Sequencing and Cogstate One-Card Learning accuracy significantly predicted SA diagnosis (full model accuracy = 71.6%-71.7%, sensitivity = 80.6%-80.8%, specificity = 59.1%-59.6%), while only immediate recall was significant at EC visit (accuracy = 68.5%, sensitivity = 74.6%, specificity = 61.5%). Other measures (Letter Fluency, Cogstate Detection, and One-Card Learning accuracy) demonstrated higher proportions of impairment for pmTBI subacutely (pmTBI: 11.5%-19.8%; HC: 3.7%-6.1%) but did not improve classification accuracy. Evidence of multiple impairments across the entire testing battery significantly predicted diagnosis at both visits (full model accuracy = 66.2%-68.6%, sensitivity = 71.2%-78.9%, specificity = 54.3%-61.5%).Current results suggest similar modest diagnostic accuracy for computerized and paper-and-pencil batteries across multiple pmTBI phases. Moreover, findings suggest the total number of impairments may be more clinically useful than any single test or cognitive domain in terms of diagnostic accuracy at both assessment points. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Spinocerebellar ataxias (SCAs) represent a large group of hereditary degenerative diseases of the nervous system, in particular the cerebellum, and other systems that manifest with a variety of progressive motor, cognitive, and behavioral deficits with the leading symptom of cerebellar ataxia. SCAs often lead to severe impairments of the patient's functioning, quality of life, and life expectancy. For SCAs, there are no proven effective pharmacotherapies that improve the symptoms or substantially delay disease progress, i.e., disease-modifying therapies. To study SCA pathogenesis and potential therapies, animal models have been widely used and are an essential part of pre-clinical research. They mainly include mice, but also other vertebrates and invertebrates. Each animal model has its strengths and weaknesses arising from model animal species, type of genetic manipulation, and similarity to human diseases. The types of murine and non-murine models of SCAs, their contribution to the investigation of SCA pathogenesis, pathological phenotype, and therapeutic approaches including their advantages and disadvantages are reviewed in this paper. There is a consensus among the panel of experts that (1) animal models represent valuable tools to improve our understanding of SCAs and discover and assess novel therapies for this group of neurological disorders characterized by diverse mechanisms and differential degenerative progressions, (2) thorough phenotypic assessment of individual animal models is required for studies addressing therapeutic approaches, (3) comparative studies are needed to bring pre-clinical research closer to clinical trials, and (4) mouse models complement cellular and invertebrate models which remain limited in terms of clinical translation for complex neurological disorders such as SCAs.

Cognitive deficits are a core feature of mental and behavioral disorders, leading to poor treatment adherence and functionality. Virtual reality (VR) methodologies are promising solutions for cognitive interventions in psychiatry once they provide greater ecological validity. This study assessed and compared two content-equivalent cognitive training (CT) interventions, delivered in desktop VR (Reh@City v2.0) and paper-and-pencil (Task Generator (TG)) formats, in patients with mental and behavioral disorders. 30 patients were randomly assigned to the Reh@City v2.0 group and the TG group. Both groups of patients underwent a time-matched 24-sessions intervention. Neuropsychological assessments were performed at baseline, post-intervention, and follow-up. A within-groups analysis revealed significant improvements in visual memory and depressive symptomatology after the Reh@City intervention. The TG group improved in processing speed, verbal memory, and quality of life (social relationships and environmental domains). Between groups, Reh@City led to a greater reduction in depressive symptomatology, whereas the TG group showed higher improvements in social relationships aspects of quality of life. At follow-up, previous gains were maintained and new improvements found in the Reh@City (global cognitive function, language, visuospatial and executive functions) and the TG groups (attention). The Reh@City significantly reduced depressive symptomatology, and the TG led to greater improvements in processing speed, abstraction, and social relationships domain of quality of life at follow-up. Both interventions were associated with important cognitive, emotional, and quality of life benefits, which were maintained after two months. Reh@City and TG should be considered as complementary CT methods for patients with mental and behavioral disorders. Trial registration The trial is registered at ClinicalTrials.gov, number NCT04291586.

The International Conference on Cognitive Modeling brings together researchers from around the world whose main goal is to build computational systems that reflect the internal processes of the mind. In this issue, we present the four best representative papers on this work from our 18th meeting, ICCM 2020, which was also the first meeting to be held virtually. Two of these papers develop novel techniques for building larger and more complex models using Reinforcement Learning and Learning By Instruction, respectively. The other two show how cognitive models connect to neuroscience, drawing on details of the hippocampus and cerebellum to constrain and explain the cognitive processes involved in memory and conditioning.

Background: Cognitive functions are mental series of activities that allow us to carry out any activity. The most important cognitive functions are orientation, attention, memory, executive functions, language, and visuospatial skills. Cognitive impairment is a prevalent consequence of stroke. The prognosis of stroke recovery can be estimated through the severity of cognitive impairment. The objective of this research work was to compare the changes in cognitive functions of post-stroke patients with the computerbased cognitive intervention (CBCI) using the PABLO system and conventional cognitive intervention (CCI) using the paper-pencil method. Methods: A total of 80 stroke patients with cognitive impairment were selected and divided into two groups. Group A received intervention through PABLO System (CBCI), and Group B received the cognitive intervention through the Paper Pencil method (CCI). Pre and post-assessment of cognitive functions like verbal fluency, language, orientation and attention, memory, visuospatial, and mini-mental state examination for both groups were done by Addenbrooke Cognitive Examination-revised (ACE-R) scale. Result: After the intervention of 4 weeks, patients of both groups showed improvement in cognitive functions. However, group A scored higher in comparison to group B. Conclusion: Data suggest that both the interventions will bring changes in cognitive functions of post-stroke patients, but CBCI may be much more effective in improving the cognitive functions of stroke patients.

Studying the human brain during interpersonal interaction allows us to answer many questions related to motor control and cognition. For instance, what happens in the brain when two people walking side by side begin to change their gait and match cadences? Adapted from the neuroimaging techniques used in single-brain measurements, hyperscanning (HS) is a technique used to measure brain activity from two or more individuals simultaneously. Thus far, HS has primarily focused on healthy participants during social interactions in order to characterize inter-brain dynamics. Here, we advocate for expanding the use of this electroencephalography hyperscanning (EEG-HS) technique to rehabilitation paradigms in individuals with neurological diagnoses, namely stroke, spinal cord injury (SCI), Parkinson’s disease (PD), and traumatic brain injury (TBI). We claim that EEG-HS in patient populations with impaired motor function is particularly relevant and could provide additional insight on neural dynamics, optimizing rehabilitation strategies for each individual patient. In addition, we discuss future technologies related to EEG-HS that could be developed for use in the clinic as well as technical limitations to be considered in these proposed settings.

Objective The National Academy of Neuropsychology (NAN), the American Academy of Clinical Neuropsychology (AACN), and the American College of Professional Neuropsychology (ACPN) collaborated to publish an update to their original position statements, confirming the organizations' opposition to third party observer (TPO). Method A review of literature addressing TPO effects, ethical standards, professional organization position statements, test publisher policies and new telemedicine developments was completed to obtain consensus on relevant issues in TPO and recording of neuropsychological evaluations. Results TPO has been shown to impact the cognitive functions most often assessed in forensic or medicolegal settings. Third party observation, whether in person, recorded or electronic, remains a potential threat to the validity and reliability of evaluation results, and violates test security guidelines, ethical principles and standards of conduct in the field. Demands for TPO in the context of medicolegal or forensic settings have become a tactic designed to limit the ability of the consulting neuropsychologist to perform assessment and provide information to the trier of fact. Conclusion The field of neuropsychology opposes the presence of TPO in the setting of medicolegal or forensic neuropsychological evaluations.

The aim of this paper is to disclose linguistic evidence of the use and function of metaphors in medical discourse, by comparing their incidence in two genres, namely research papers and press articles. For that purpose, a sample of texts in both genres is analysed. Four types of conceptual metaphorical projections are identified according to Conceptual Metaphor Theory (i.e. structural, image, ontological, and orientational). Subsequently, the relation of these mappings with cognitive functions – categorization and conceptualization – is described. The purpose is to explore the role these functions play in knowledge construction and their implications for communicative aspects of metaphor usage. The results suggest a characterization of metaphorical concepts in the two medical genres. The conclusions show divergent tendencies in the use of metaphor and its cognitive and communicative functions in the genres analysed.

This study deals with the alignment between National Curriculum, Textbooks, and Question papers of Board of Intermediate and Secondary Education (BISE) in the subject of English at secondary level. The purpose of the study was to check the alignment of National Curriculum for English Language, 2006 with the Textbooks of English for Grade IX-X, and to evaluate the Board of Intermediate and Secondary Education (BISE) question papers with reference to cognitive domain of Bloom’s taxonomy and with the corresponding textbooks. This study was done through document analysis. The documents analyzed for the study were the National Curriculum for English Language, Textbooks of English for Grade IX-X, and question papers of BISE of year 2014 and 2015. The instruments used for this study were the 1) Curriculum Textbook Alignment Framework and 2) Curriculum Textbook Alignment Rubric. The question papers of Board of Intermediate and Secondary Education were analyzed through the checklist developed by researcher. It was validated through expert opinion. Findings of the study depict that the SLOs stated in the textbooks of English were not completely matched with the SLOs narrated in National Curriculum Furthermore, the textbooks are not very helpful in achieving those SLOs with the help of the assessment exercises given in the textbook because most of the questions given in the textbook are not related to SLOs of National Curriculum. Findings further report that the all the question papers of Board of Intermediate and Secondary Education (BISE) for year 2014 and 2015 focused on knowledge and understanding level of Bloom’s taxonomy of cognitive domain and very less focus were given on application, analysis, synthesis and evaluation abilities. It was recommended that the same SLOs of National Curriculum of English Language for Grade IX-X should be included in the textbooks otherwise the alignment will suffer and the SLOs of higher order thinking skills should also be included in the textbooks. There should be a balance between the higher level and lower level cognitive skills Paper setters should be well aware of the Bloom’s taxonomy of cognitive domain and question papers should include items of all cognitive levels in accordance with assessment scheme of Board of Intermediate and Secondary Education, and specifications mentioned in the National Curriculum of English.

This study analyzed the current status, hotspots, and emerging trends of global research on cognitive frailty, in order to provide new research ideas for researchers. Articles and reviews related to cognitive frailty, published from 2013 to 2021, were retrieved from the Web of Science Core Collection (WoSCC) database on 26 November 2021. CiteSpace 5.8.R3 was employed for data analyses. A total of 2077 publications were included. There has been a rapid growth of publications on cognitive frailty research since 2016. The United States, Italy, England, and Australia have been the leading research centers of cognitive frailty; however, China has also recently focused on this topic. The National Center for Geriatrics and Gerontology, and Shimada H. were found to be the most prolific institution and author, respectively. Co-citation analysis identified 16 clusters, of which the largest was cognitive frailty. The keywords which occurred most frequently were “older adult”, followed by “cognitive impairment”, “frailty”, “risk”, “dementia”, “prevalence”, “mortality”, “health”, and “Alzheimer’s disease”. Burst keyword detection revealed a rising interest in cognitive frailty models. By analyzing these publications from recent years, this study provides a comprehensive analysis of cognitive frailty research.

Although executive function disorders are among the most prevalent cognitive impairments a consensus on diagnostic criteria has yet to be reached. With a view to harmonizing these criteria, the present position paper (i) focuses on the main dysexecutive disorders, (ii) examines recent approaches in both the behavioral and cognitive domains, (iii) defines diagnostic boundaries for frontal syndrome, (iv) reports on the frequency and profile of the executive function disorders observed in the main brain diseases, and (v) proposes an operationalization of diagnostic criteria. Future work must define the executive processes involved in human adaptive behavior, characterize their impairment in brain diseases, and improve the management of these conditions (including remediation strategies and rehabilitation).

Gamification is a marketing tool which has been deeply influential in recent years after catching the attention of marketers. Where, gamification creates a great value for businesses since it encourages the customer through entertainment and intelligent marketing messages (Yang et al., 2017). This study aims to develop a theoretical framework that focuses on investigating the effect of the direct relationship between gamification (as independent variable) and customer experience dimensions in terms of core experience (cognitive, affective, behavioral experience), sensory and relational experience (as dependent variable) in the context of e-banking in Washington DC, United states of America.

Developmental studies of brain volumes can reveal which portions of neural circuits are sensitive to environmental inputs. In social insects, differences in relative investment across brain regions emerge as behavioural repertoires change during ontogeny or as a result of experience. Here, we test the effects of maturation and social experience on morphological brain development inPolistes fuscatuspaper wasps,focusing on brain regions involved in visual and olfactory processing. We find that mature wasps regardless of social experience have relatively larger brains than newly emerged wasps and this difference is driven by changes to mushroom body calyx and visual regions but not olfactory processing neuropils. Notably, social wasps invest more in the anterior optic tubercle (AOT), a visual glomerulus involved in colour and object processing in other taxa, relative to other visual integration centres the mushroom body calyces compared with aged socially naive wasps. Differences in developmental plasticity between visual and olfactory neuropil volumes are discussed in light of behavioural maturation in paper wasps, especially as it relates to social recognition. Previous research has shown thatP. fuscatusneed social experience to develop specialized visual processing of faces, which is used to individually recognize conspecifics. The present study suggests that the AOT is a candidate brain region that could mediate facial processing in this species.

BackgroundDeveloping treatments for cognitive impairment is key to improving the functioning of people with mood disorders. Neuroimaging may assist in identifying brain-based efficacy markers. This systematic review and position paper by the International Society for Bipolar Disorders Targeting Cognition Task Force examines the evidence from neuroimaging studies of pro-cognitive interventions.MethodsWe included magnetic resonance imaging (MRI) studies of candidate interventions in people with mood disorders or healthy individuals, following the procedures of the Preferred Reporting Items for Systematic reviews and Meta-Analysis 2020 statement. Searches were conducted on PubMed/MEDLINE, PsycInfo, EMBASE, Cochrane Library, and Clinicaltrials.gov from inception to 30th April 2021. Two independent authors reviewed the studies using the National Heart, Lung, Blood Institutes of Health Quality Assessment Tool for Controlled Intervention Studies and the quality of neuroimaging methodology assessment checklist.ResultsWe identified 26 studies (N = 702). Six investigated cognitive remediation or pharmacological treatments in mood disorders (N = 190). In healthy individuals, 14 studies investigated pharmacological interventions (N = 319), 2 cognitive training (N = 73) and 4 neuromodulatory treatments (N = 120). Methodologies were mostly rated as ‘fair’. 77% of studies investigated effects with task-based fMRI. Findings varied but most consistently involved treatment-associated cognitive control network (CCN) activity increases with cognitive improvements, or CCN activity decreases with no cognitive change, and increased functional connectivity. In mood disorders, treatment-related default mode network suppression occurred.ConclusionsModulation of CCN and DMN activity is a putative efficacy biomarker. Methodological recommendations are to pre-declare intended analyses and use task-based fMRI, paradigms probing the CCN, longitudinal assessments, mock scanning, and out-of-scanner tests.

In psychological assessment, there is a tension between oral and written language. This tension is rarely troubled or even noted in clinical practice. For report writing purposes, psychologists routinely transform oral, socially embedded material into written texts. In this paper, I highlight three points in the psychological assessment process where this transformation occurs: one during testing, the second in the analysis and interpretation phase, and the third while writing the final report. As written language is not oral language put on paper, a conceptual linguistic leap is needed that has the potential to subtly distort how the minds of others are represented and constructed. Furthermore, there are literary aspects of scientific psychological report writing that are often invisible to both writers and readers, which leads to additional distortions. Underlying the above-noted conceptual leap is the assumption that the borderline between oral and written language is porous and the principles and rules of each are interchangeable. Some alternative approaches to psychological assessment are offered that acknowledge the specific nature of oral and written language.

Introduction: Assessment is a very important component of medical education and written examination is widely used tool of assessment. The instrument used in the written examination is the “Question Paper” (QP). The QP often lacks the validity, reliability, relevance and objectivity. 1,2 The present study is undertaken to assess the characteristics in construction of University question papers. Aim and Objectives: To analyze the theory question papers of Microbiology subject of Saurashtra University, with respect to; question form, learning objectives, relevance to core syllabus, relevance to teaching hours, and language and grammatical errors. Materials and Methods: Total 28 question papers of Saurashtra University of Microbiology subject (Mar-05 to Mar-15) were analyzed. The questions were analyzed with respect to types of question form and categorized in long answer type, short note type and short answer type. All questions were analyzed with respect to learning objectives and were classified in to three cognitive domains of learning knowledge, understanding and synthesis. All questions were analyzed to determine the focus of questions with respect to the syllabus and classified into must know, desirable to know and nice to know areas. Questions were analyzed to determine the weather questions cover the area of syllabus with regards to teaching hours dedicated. Questions were analyzed to identify the clarity and ambiguity in language, spelling and grammatical errors and scientific and taxonomic errors. Results: There were two paper styles noted. Question papers have long answer; short note and short answer questions. 95% questions were framed to test basic knowledge level of cognitive domain, and 5% question were framed to test the understanding level, while none of the questions were framed to test the synthesis level of cognitive domain. The majority of question were framed from must know area (97%) of syllabus, while less number of questions were from desirable to know (2%) and nice to know (1%) area. 30% of teaching hours were dedicated to bacteriology section and carried 22% weightage in examination. 6% of teaching hours were dedicated to mycology section which carried 11% weightage in examination. A balance was observed for General microbiology, Immunology and Virology sections with regards to teaching hours and weightage in examination. On an average of 11.1 errors per paper was noted. Spelling errors were common (8.8) followed by taxonomic errors (2.2) and grammatical errors (0.1). Conclusions: Major numbers of questions were subjective type than objective type. Majority of questions were framed to test basic knowledge level of cognitive domain. The majority of question were framed from must know area of syllabus which may have poor discriminatory ability between low and high achievers. A balance was observed for General microbiology, Immunology and Virology sections for dedicated teaching hours and its weightage in examination while Bacteriology has less and Parasitology and Mycology has more weightage in comparison to teaching hours. Many different types of errors were noted in question papers which include spelling errors, taxonomic errors and grammatical errors. A standard “Blue Print” is essential to bring the uniform standard in theory examination. Keywords: Question paper analysis, Blue-printing.

Background and objective The number of people suffering from dementia is increasing worldwide and so is the need for reliable and economical diagnostic instruments. Therefore, the aim of this study was to compare the processing times of the neuropsychological tests Trail Making Tests A and B (TMT-A/B) and Color-Word Interference Test (CWIT), which were performed in both digital and paper versions. Methods The pilot study was conducted among 50 healthy participants (age 65–83 years) using a randomized crossover design. The correlations and differences in the individual processing times of the two test versions were statistically analyzed. Further research questions concerned the influence of the individual usage of technology and the technology commitment of participants as well as the influence of the assessed usability on participants’ performance. Results Between the two versions (paper-based vs. digital) statistically significant correlations were found in all tests, e.g., TMT-A r(48) = 0.63, p rs(48) = 0.77, p t(49) = 11.24, p rs(48) = − 0.31) and smartphone (rs(48) = − 0.29) and between the processing times of the TMT-B and the usability (rs(48) = 0.29). Conclusions The high correlations between the test procedures appear promising. However, the differences found in the processing times of the two test versions require validation and standardization of digitized test procedures before they can be used in practice.

One of the satisfactions of publishing a paper in an academic journal is seeing the process reach closure after potentially weeks or months of peer review and editorial processing. Typically, in the latter step, a proof is developed and the paper stays in press until the paper is assigned to a journal issue, in the case of a print journal. In some cases, it is possible to find papers that are in press for years.Although it is unclear why this is the case, when a paper stays in an "in limbo" status for so long, it almost defeats the purpose of rapid proof and online publication.The date of the last "in press" article was manually extracted and compared in 23 medicine-related journals indexed in Elsevier's Science Direct.Among the 23 journals, "in press" articles ranged from less than one month to almost 16 years.Editors and publishers should endeavor to publish all "in press" papers within a reasonable amount of time. If not, they should rethink their publication process so as not to leave the intellect of some academics in a perpetual state of publishing "limbo".

Background The traditional informed consent (IC) process rarely emphasizes research participants’ comprehension of medical information, leaving them vulnerable to unknown risks and consequences associated with procedures or studies. Objective This paper explores how we evaluated the feasibility of a digital health tool called Virtual Multimedia Interactive Informed Consent (VIC) for advancing the IC process and compared the results with traditional paper-based methods of IC. Methods Using digital health and web-based coaching, we developed the VIC tool that uses multimedia and other digital features to improve the current IC process. The tool was developed on the basis of the user-centered design process and Mayer’s cognitive theory of multimedia learning. This study is a randomized controlled trial that compares the feasibility of VIC with standard paper consent to understand the impact of interactive digital consent. Participants were recruited from the Winchester Chest Clinic at Yale New Haven Hospital in New Haven, Connecticut, and healthy individuals were recruited from the community using fliers. In this coordinator-assisted trial, participants were randomized to complete the IC process using VIC on the iPad or with traditional paper consent. The study was conducted at the Winchester Chest Clinic, and the outcomes were self-assessed through coordinator-administered questionnaires. Results A total of 50 participants were recruited in the study (VIC, n=25; paper, n=25). The participants in both groups had high comprehension. VIC participants reported higher satisfaction, higher perceived ease of use, higher ability to complete the consent independently, and shorter perceived time to complete the consent process. Conclusions The use of dynamic, interactive audiovisual elements in VIC may improve participants’ satisfaction and facilitate the IC process. We believe that using VIC in an ongoing, real-world study rather than a hypothetical study improved the reliability of our findings, which demonstrates VIC’s potential to improve research participants’ comprehension and the overall process of IC. Trial Registration ClinicalTrials.gov NCT02537886; https://clinicaltrials.gov/ct2/show/NCT02537886

Traditional pen and paper based neuropsychological tests (NPT) for cognition assessment have several challenges limiting their use. They are time consuming, expensive, and require highly trained specialists to administer. This leads to testing being available to only a small portion of the population and often with wait times of several months. In clinical practice, we have found results tend not to be integrated effectively into assessment and plans of the ordering provider. Here we compared several tests using BrainCheck (BC), a computer-based NPT battery, to traditional paper-based NPT, by evaluating individual tests as well as comparing composite scores to scores on traditional screening tools. 26 volunteers took both paper-based tests and BC. We found scores of four assessments (Ravens Matrix, Digit Symbol Modulation, Stroop Color Word Test and Trails Making A&B Test) were highly correlated. The Balance Examination and Immediate/Delayed Hopkins Verbal Learning, however, were not correlated. The BC composite score was correlated to results of the Saint Louis University Mental Status (SLUMS) exam [1], the Mini-Mental State Examination (MMSE) [2], and the Montreal Cognitive Assessment (MoCA). Our results suggest BC may offer a computer-based avenue to address the gap between basic screening and formal neuropsychological testing.

The traditional view on the cerebellum is that it controls motor behavior. Although recent work has revealed that the cerebellum supports also nonmotor functions such as cognition and affect, only during the last 5 years it has become evident that the cerebellum also plays an important social role. This role is evident in social cognition based on interpreting goal-directed actions through the movements of individuals (social "mirroring") which is very close to its original role in motor learning, as well as in social understanding of other individuals' mental state, such as their intentions, beliefs, past behaviors, future aspirations, and personality traits (social "mentalizing"). Most of this mentalizing role is supported by the posterior cerebellum (e.g., Crus I and II). The most dominant hypothesis is that the cerebellum assists in learning and understanding social action sequences, and so facilitates social cognition by supporting optimal predictions about imminent or future social interaction and cooperation. This consensus paper brings together experts from different fields to discuss recent efforts in understanding the role of the cerebellum in social cognition, and the understanding of social behaviors and mental states by others, its effect on clinical impairments such as cerebellar ataxia and autism spectrum disorder, and how the cerebellum can become a potential target for noninvasive brain stimulation as a therapeutic intervention. We report on the most recent empirical findings and techniques for understanding and manipulating cerebellar circuits in humans. Cerebellar circuitry appears now as a key structure to elucidate social interactions. Frank Van Overwalle, Elien Heleven, Qianying Ma, and Min Pu were supported by an SRP57 grant from the Vrije Universiteit Brussel, and Elien Heleven was additionally supported by an FWO G002319N/AL907 grant from the Flemish government. Zaira Cattaneo was supported by a Bando Ricerca Finalizzata (GR2016-02363640) by the Italian Ministry of Health. Marco Michelutti and Arseny A. Sokolov were supported by aMille E Una Lode fellowship from the University of Padua to MM, and fellowships from the Leenaards Foundation and the Swiss National Science Foundation, and a grant from the Helmut Horten Foundation to AAS. Catherine Stoodley and Laura C. Rice were supported by an NIH R15MH106957 grant. Van Overwalle, F (corresponding author), Vrije Univ Brussel, Dept Psychol, Pl Laan 2, B-1050 Brussels, Belgium; Vrije Univ Brussel, Ctr Neurosci, Pl Laan 2, B-1050 Brussels, Belgium. Frank.VanOverwalle@vub.ac.be; mmanto@ulb.ac.be; zaira.cattaneo@unimib.it; silvia.clausi@uniroma1.it; chiara.ferrari@unipv.it; gabrieli@mit.edu; xguellparadis@mgh.harvard.edu; Elien.Heleven@vub.be; m.lupo@hsantalucia.it; Qianying.Ma@vub.be; michelutti.marco.m@gmail.com; g.olivito@hsantalucia.it; Min.Pu@vub.be; laura.blevins@student.american.edu; jschmahmann@mgh.harvard.edu; libera.siciliano@uniroma1.it; Arseny.Sokolov@chuv.ch; stoodley@american.edu; kim.vandun@uhasselt.be; LVandervert@aol.com; maria.leggio@uniroma1.it

Background: Utilizing information technology (IT) systems, for example in form of computerized cognitive screening or exergame-based (also called active videogames) training, has gained growing interest for supporting healthy aging and to detect, prevent and treat neurocognitive disorders (NCD). To ameliorate the effectiveness of exergaming, the neurobiological mechanisms as well as the most effective components for exergame-based training remain to be established. At the same time, it is important to account for the end-users’ capabilities, preferences, and therapeutic needs during the design and development process to foster the usability and acceptance of the resulting program in clinical practice. This will positively influence adherence to the resulting exergame-based training program, which, in turn, favors more distinct training-related neurobiological effects.Objectives and Methods: This methodological paper describes the design and development process of novel exergame-based training concepts guided by a recently proposed methodological framework: The ‘Multidisciplinary Iterative Design of Exergames (MIDE): A Framework for Supporting the Design, Development, and Evaluation of Exergames for Health’ (Li et al., 2020).Case Study: A step-by-step application of the MIDE-framework as a specific guidance in an ongoing project aiming to design, develop, and evaluate an exergame-based training concept with the aim to halt and/or reduce cognitive decline and improve quality of life in older adults with mild neurocognitive disorder (mNCD) is illustrated.Discussion and Conclusion: The development of novel exergame-based training concepts is greatly facilitated when it is based on a theoretical framework (e.g., the MIDE-framework). Applying this framework resulted in a structured, iterative, and evidence-based approach that led to the identification of multiple key requirements for the exergame design as well as the training components that otherwise may have been overlooked or neglected. This is expected to foster the usability and acceptance of the resulting exergame intervention in “real life” settings. Therefore, it is strongly recommended to implement a theoretical framework (e.g., the MIDE-framework) for future research projects in line with well-known checklists to improve completeness of reporting and replicability when serious games for motor-cognitive rehabilitation purposes are to be developed.

The discussion notes the extreme sensitivity of the technique with a despairing deprived girl with a deep dread of the future and of adulthood. Where defenses are identified, caring alternatives ar...

Education is a process of gaining knowledge and is important for all as it plays a vital role in shaping the life of a student. The knowledge that we gain through education is evaluated through examinations that the teachers conduct periodically. Performance in an examination is an indication of a student’s proficiency in a particular subject. Courses of an educational curriculum are defined with learning objectives. Question papers consist of questions belonging to different cognitive levels. Generation of a quality question paper is essential as performance in it can influence the career decisions the students take in their life. It is difficult for the teachers to maintain the same level of complexity across the set of question papers that are generated. In this paper, we present a model where the questions are tagged automatically to their respective cognitive levels. It also helps in creating different sets of question papers containing unique questions and also provides a pictorial representation of the percentage of various cognitive levels present in the question paper. The pictorial representation helps the evaluation panel to have an overview of the distribution of cognitive levels in the question paper.

School systems across the country are transitioning from paper-based testing (PBT) to computer-based testing (CBT). As this technological shift occurs, more research is necessary to understand the practical and performance implications of administering CBTs. Currently, there is a paucity of research using CBTs to examine working memory (WM) performance, even though CBTs may negatively influence performance. The present study compared a WM CBT and PBT and found enhanced WM performance on the PBT across several verbal and visuospatial WM tests. This pattern was evident even after age was controlled, indicating that test mode effects were persistent across ages (4-11 years). CBTs on WM performance may yield lower scores due to developmental WM differences, increased cognitive workload, test mode effects stemming from individual access to technology, and participant characteristics, such as developmental, biological, or gender differences. The presence of divergent WM in CBT and PBT indicates the need for additional options for children at risk of academic failure because of testing modality.

We identify useful functions and usability characteristics of a historical cognitive artifact used by nurses working in a hospital unit, the Kardex. By identifying aspects of a widely used artifact, we uncover opportunities to improve the usefulness of current systems for hospital nurses. We conducted semi-structured interviews with registered nurses about their prior experience with the Kardex. Questions included what elements of the Kardex are missing from their current electronic support. Memos were generated iteratively from interview transcript data and grouped into themes. Eighteen nurses from multiple clinical areas participated and had a median of 25–29 years of nursing experience. The themes were: (1) a status at a glance summary for each patient, (2) a prospective memory aid, (3) efficiency and ease of use, (4) updating information required to maintain value, (5) activity management, (6) verbal handover during shift-to-shift report, (7) narrative charting and personalized care, and (8) non-clinical care communication. Implications for digital support are to provide immediate, portable access to a standardized patient summary, support for nurses to manage their planned activities during a series of shifts, provide unstructured text fields for narrative charting, and to support adding informal notes for personalized care.

Social interactions have large effects on individual physiology and fitness. In the immediate sense, social stimuli are often highly salient and engaging. Over longer time scales, competitive interactions often lead to distinct social ranks and differences in physiology and behavior. Understanding how initial responses lead to longer-term effects of social interactions requires examining the changes in responses over time. Here we examined the effects of social interactions on transcriptomic signatures at two times, at the end of a 45-minute interaction and 4 hours later, in female Polistes fuscatus paper wasp foundresses. Female P. fuscatus have variable facial patterns that are used for visual individual recognition, so we separately examined the transcriptional dynamics in the optic lobe and the non-visual brain. Results demonstrate much stronger transcriptional responses to social interactions in the non-visual brain compared to the optic lobe. Differentially regulated genes in response to social interactions are enriched for memory-related transcripts. Comparisons between winners and losers of the encounters revealed similar overall transcriptional profiles at the end of an interaction, which significantly diverged over the course of 4 hours, with losers showing changes in expression levels of genes associated with aggression and reproduction in paper wasps. On nests, subordinate foundresses are less aggressive, do more foraging and lay fewer eggs compared to dominant foundresses and we find losers shift expression of many genes in the non-visual brain, including vitellogenin, related to aggression, worker behavior, and reproduction within hours of losing an encounter. These results highlight the early neurogenomic changes that likely contribute to behavioral and physiological effects of social status changes in a social insect., Author summary Aggressive interactions often create inequalities–some individuals win while others lose. Winning versus losing can lead to large physiological differences between individuals, including different neurogenomic profiles between winners and losers. How this information about contest outcome leads to distinct neurogenomic profiles is poorly understood. Here we examine gene expression in response to aggressive social encounters in paper wasps, which naturally form dominance hierarchies on their nests in the wild. Shortly following encounters winners and losers have similar expression profiles, likely because similar mechanisms are engaged by social experiences. Four hours later, we find divergent neurogenomic profiles between winners and losers, with losers showing larger shifts in expression compared to winners. Many of the most dynamically expressed genes have been previously associated with dominance and caste differences in paper wasps showing how a single interaction can engage many of the same genomic networks that are involved in mediating more dramatic differences in queen-worker behavioral differences are also involved in responses shortly following social interactions.

An assumption underlying replacing traditional paper-based (PB) writing tests with computer-based (CB) tests is that CB writing tests are more authentic than PB tests (Lessien, 2013). This study tested this assumption by examining the effect of test mode on the situational and interactive authenticity of English as a second language (ESL) writing assessments using an embedded correlational model of mixed-methods design. Sixty international ESL students enrolled at a university in the United States completed two writing tasks in the CB and PB modes. The participants then filled out cognitive processing questionnaires and participated in a post-test interview. All essays were scored by two raters both holistically and analytically. The results indicated higher authenticity for the CB test but also uncovered some concerns with the effect of typing skills on CB test performance. The findings have practical implications for test development, administration policies, and stakeholders in choosing delivery mode for ESL writing assessments.

Background: Utilizing information technology (IT) systems, for example in form of computerized cognitive screening or exergame-based (also called active videogames) training, has gained growing interest for supporting healthy aging and to detect, prevent and treat neurocognitive disorders (NCD). To ameliorate the effectiveness of exergaming, the neurobiological mechanisms as well as the most effective components for exergame-based training remain to be established. At the same time, it is important to account for the end-users’ capabilities, preferences, and therapeutic needs during the design and development process to foster the usability and acceptance of the resulting program in clinical practice. This will positively influence adherence to the resulting exergame-based training program, which, in turn, favors more distinct training-related neurobiological effects. Objectives and Methods: This methodological paper describes the design and development process of novel exergame-based training concepts guided by a recently proposed methodological framework: The ‘Multidisciplinary Iterative Design of Exergames (MIDE): A Framework for Supporting the Design, Development, and Evaluation of Exergames for Health’ (Li et al., 2020). Case Study: A step-by-step application of the MIDE-framework as a specific guidance in an ongoing project aiming to design, develop, and evaluate an exergame-based training concept with the aim to halt and/or reduce cognitive decline and improve quality of life in older adults with mild neurocognitive disorder (mNCD) is illustrated. Discussion and Conclusion: The development of novel exergame-based training concepts is greatly facilitated when it is based on a theoretical framework (e.g., the MIDE-framework). Applying this framework resulted in a structured, iterative, and evidence-based approach that led to the identification of multiple key requirements for the exergame design as well as the training components that otherwise may have been overlooked or neglected. This is expected to foster the usability and acceptance of the resulting exergame intervention in “real life” settings. Therefore, it is strongly recommended to implement a theoretical framework (e.g., the MIDE-framework) for future research projects in line with well-known checklists to improve completeness of reporting and replicability when serious games for motor-cognitive rehabilitation purposes are to be developed. ISSN:1663-4365

Objective To determine whether use of digital-based screening is a feasible approach to monitoring child development, it is necessary to assess young children's abilities to interface with touch screen technology. The primary objectives of this exploratory feasibility study with a randomized experimental design were to determine (1) whether young children respond differently to developmental tasks on paper versus tablet device and (2) whether responses to items presented digitally differed according to hours of weekly exposure to touch screen technology in the home. Methods Eighty children attending 18-, 24-, 36-, or 48-month pediatrician well-child checks were randomly assigned to complete a series of 70 examiner-facilitated, developmental tasks across 7 domains (receptive language, expressive language, early literacy, early numeracy, social emotional, cognition, and fine motor) presented either digitally or on paper. Parents provided information about use of technology in the home. A series of t tests assessed for main effects of presentation modality (digital vs paper) on each of the domains. Results Raw scores across the 7 domains did not differ by presentation modality. Hours of technology use per week was not related to raw scores among children in the digital condition. Conclusion Young children do not respond differentially to items when presented in a digital format in comparison to a paper-based format. Use of manipulatives for assessing developmental skills may be needed for children 2 years and younger, as they displayed a limited range of responses to items in both conditions at these age groups.

Contains fulltext : 201967.pdf (Publisher’s version ) (Open Access) Objective: In cognitive neuroscience, well-controlled and highly specific paradigms have been developed to measure cognitive processes over the last decades, often using computer-assisted presentation and response registration. This approach is in contrast with the traditional paper-and-pencil tests used in clinical neuropsychology, which typically assess cognitive function in a less specific manner, often even at the level of a cognitive domain. As a result, important aspects of cognitive (dys)function may be missed during a neuropsychological assessment. This paper focuses on the main challenges that need to be overcome in order to successfully integrate experimental paradigms from cognitive neuroscience into the clinical practice of neuropsychologists. Method: Six challenges are discussed: (i) experimental paradigms are often lengthy and may be overly specific; (ii) technical limitations even today hamper their application in clinics; (iii) the psychometric properties of methods used in cognitive neuroscience are under-examined or poor; (iv) many paradigms from cognitive neuroscience rely on reaction times rather than accuracy, limiting their use in the many brain-injured patients with processing speed deficits; (v) the predictive and ecological validity of these paradigms often unclear; (vi) technological progress (e.g. Moore's law) seriously affects the continuous availability of experimental computerized assessment methods. Conclusion: Both cognitive neuroscientists and clinical neuropsychologists should work together to develop and validate novel paradigms for use in clinical assessments that are platform-independent, reliable and valid, user friendly and easy to use in clinical practice. 12 p.

It remains to be determined how different inputs for memory-encoding, such as the use of paper notebooks or mobile devices, affect retrieval processes. We compared three groups of participants who read dialogues on personal schedules and wrote down the scheduled appointments on a calendar using a paper notebook (Note), an electronic tablet (Tablet), or a smartphone (Phone). After the retention period for an hour including an interference task, we tested recognition memory of those appointments with visually presented questions in a retrieval task, while scanned with functional magnetic resonance imaging. We obtained three major results. First, the duration of writing down schedules was significantly shorter for the Note group than the Tablet and Phone groups, and accuracy was much higher for the Note group in easier (i.e., more straightforward) questions. Because the input methods were equated as much as possible between the Note and Tablet groups, these results indicate that the cognitive processes for the Note group were deeper and more solid. Second, brain activations for all participants during the retrieval phase were localized in the bilateral hippocampus, precuneus, visual cortices, and language-related frontal regions, confirming the involvement of verbalized memory retrieval processes for appointments. Third, activations in these regions were significantly higher for the Note group than those for the Tablet and Phone groups. These enhanced activations for the Note group could not be explained by general cognitive loads or task difficulty, because overall task performances were similar among the groups. The significant superiority in both accuracy and activations for the Note group suggested that the use of a paper notebook promoted the acquisition of rich encoding information and/or spatial information of real papers and that this information could be utilized as effective retrieval clues, leading to higher activations in these specific regions.

Working memory training improves children’s cognitive performance on untrained tasks; however, little is known about the underlying neural mechanisms. We investigated this in 32 typically developing children aged 10-14 years (19 girls and 13 boys; Devon, UK) using a randomized controlled design and multi-modal MRI. Training improved working memory performance and increased intrinsic functional connectivity between the bilateral intraparietal sulci. Furthermore, improvements in working memory were associated with greater recruitment of the left middle frontal gyrus on a complex span task. The repeated engagement of fronto-parietal regions during training may increase their activity and functional connectivity over time, affording greater working memory performance. We discuss the plausibility of generalizable cognitive benefits from a neurobiological perspective and implications for neurodevelopmental theory. This is not the version of record.

This is a response to the papers in the special issue Logical Perspectives on Science and Cognition—The Philosophy of Gerhard Schurz.

The present study investigated the impact of the dominant hand on performance in two paper-and-pencil tests of visual selective attention (d2-R; FAIR-2). We hypothesized that preview benefits (i.e., preprocessing of stimuli located to the right of the currently fixated item) could improve test performance of left-handers as compared to right-handers because using the right hand could prevent preview benefits simply by covering subsequent stimuli. A group of left-handed students (n = 86) and a group of right-handed students (n = 90) completed both the test d2-R and the test FAIR-2 with their dominant (writing) hand. Results showed that left-handed participants outperformed right-handers in both tests. Hence, when the results of left-handers are to be compared to right-handers or to normative data (which are dominated by right-handers), the impact of preview benefits on left-hander performance should be taken into account.

The regulations for fitness to drive after a cerebrovascular accident in the German Driving License Regulations (FeV) and the German Evaluation Guidelines for Driving Ability (BGL). are not up to date with the current medical knowledge and not consistent with regulations regarding cardiovascular diseases. This position paper presented by six medical and neuropsychological societies in Germany provides a guideline for the assessment of driving ability after diagnosis of a cerebrovascular disease and addresses three major questions: If there is a functional limitation, how can it be compensated for? What is the risk of sudden loss of control while driving in the future? Are there behavioral or personality changes or cognitive deficiencies interfering with safety while driving? Recommendations for the assessment of driving ability in different cerebrovascular diseases are presented. This article is a translation of the position paper published in Nervenarzt: Marx, P., Hamann, G.F., Busse, O. et al. Nervenarzt 90(4): 388–398.

Drawing on a corpus of clickbait headlines ( Chakraborty et al., 2016 ) and using ideas from the relevance-theoretic pragmatic framework ( Sperber and Wilson, 1986/95 ), this paper examines some of the ways in which writers of clickbait headlines arouse the curiosity of their readers by creating an “information gap” ( Loewenstein, 1994 ). Comparative corpus analysis is combined with close analysis of illustrative examples to explore the contribution that particular parts-of-speech make to the creation of successful clickbait. I focus on two main categories that are overrepresented in clickbait headlines to a statistically significant degree: (i) definite referring expressions and (ii) superlatives and intensifiers. The results and analysis reveal that these parts-of-speech contribute to an information gap by encouraging readers to construct new conceptual files based on the terms used in the headline, while providing little or no content for those files. This then drives the reader to click on the associated link with the expectation that the article will contain relevant information with which he can enhance his conceptual files, and that this, in turn, will reward him with cognitive effects.

Traditional neuropsychological batteries may account for disparities in education and may produce testing anxiety, particularly for older Black adults. Computerized batteries may be more amenable to use. The current study used mixed-methods content analysis to explore the perceptions of middle-aged and older Black adults (N = 92) about the CogState Brief Battery (CSBB) and Joggle® computerized battery and a traditional paper-and-pencil neuropsychological battery. The data was analyzed using Atlas.ti. Themes were developed and qualitative responses were converted to quantitative counts to make comparisons to thematic differences based on demographics. Results: The majority of participants liked all three batteries. There were no differences based on demographics. Two prevalent themes across all three measures for what participants liked were 1) mental stimulation and memory, and 2) challenging. A disliked theme specific to the computerized batteries was personal competence. In summary, an array of accessible cognitive batteries is necessary to address individual preferences.

IntroductionAutism spectrum conditions (ASC) develop early in life and are thought to last a lifetime. However, ASC research has two major knowledge gaps that hinder progression in understanding the concept of ASC and in providing proper support for autistic adults: (1) the majority of knowledge about ASC mainly stems from childhood studies so little is known about older autistic adults and (2) while it is broadly recognised that ASC is a heterogeneous condition, we do not yet understand the differences in trajectories leading to their future outcome. We aim to fill both knowledge gaps.Methods and analysisA multistage overlapping cohort design assessing (cognitive) ageing in ASC is designed to obtain an accelerated longitudinal data set. Data, including a multitude of questionnaires, diagnostics and cognitive tests, are collected over four waves within a 10-year time frame. This will provide information regarding actual changes in quality of life, co-occurring health conditions and cognition as well as the possibility to test external validity and temporal stability in newly formed behavioural subtypes. Participants consist of three groups of adults aged 20–90 years: (1) with a clinical diagnosis of ASC, (2) with a clinical diagnosis of attention deficit hyperactivity disorder (ADHD) but no ASC, (3) no ASC/ADHD (ie, comparison group). The sample size differs between waves and instruments. Detailed analysis plans will be preregistered in AsPredicted or at the Open Science Framework.Ethics and disseminationEthical approval for this study was obtained from the ethical review board of the Department of Psychology of the University of Amsterdam (wave 1 2011-PN-1952 and 2013-PN-2668, wave 2 2015-BC-4270, waves 3 and 4 2018-BC-9285). In line with the funding policies of the grant organisation funding this study, future papers will be published open access.

In the view of Social Exchange Theory (SET), this article provides an insight into the knowledge sharing behavior of an employee in the organization. Trust is a core factor affecting knowledge shar...

Some animals are thought to exhibit cognitive specialization, as they have specialized cognitive modules that solve specific social or ecological problems instead of one general-purpose mechanism that addresses diverse problems. Although there are many examples of specialized cognition, little is known about whether specialization develops through experience or is produced by innate, species-specific differences. Previous work has shown that Polistes fuscatus wasps use face recognition to individually identify other wasps and that P. fuscatus are specialized for learning conspecific faces. Here, we test how experimentally altering face experience in three Polistes species influences the development of face specialization. We show face learning is influenced by both experience and innate, species-specific differences. In P. fuscatus, experience with conspecific faces is not required for the development of face specialization. In two related Polistes species that naturally lack individual face recognition, Polistes metricus and Polistes dominula, experience has different effects on specialization. Polistes metricus, a close relative of P. fuscatus, develops face specialization with experience. However, P. dominula, a more distant relative, uses general pattern recognition to learn faces regardless of experience. Therefore, some species have innate mechanistic architecture that facilitates the development of face specialization, while other species do not. These results suggest that selection shapes animal minds in a modular manner. The capacity for specialized cognitive skills evolves in response to specific ecological or social demands, such as social benefits associated with accurate individual face recognition.

Cognitive remediation is now widely recognized as an effective treatment for cognitive deficits in schizophrenia. Its effects are meaningful, durable, and related to improvements in everyday functional outcomes. As with many therapies, the evolution of cognitive remediation has resulted in treatment programs that use a variety of specific techniques, yet share common core principles. This paper is the product of a cognitive remediation expert working group consensus meeting to identify core features of the treatment and produce recommendations for its design, conduct, reporting, and implementation. Four techniques were identified as core features of cognitive remediation: facilitation by a therapist, cognitive exercise, procedures to develop problem-solving strategies, and procedures to facilitate transfer to real world functioning. Treatment techniques within each of these core features are presented to facilitate decisions for clinical trials and implementation in clinical settings.

Introduction: Although the effect of educational methods on executive function (EF) is well known, training this function by a playful method is debatable. The current study aimed at investigating if a play-based intervention is effective on metacognitive and behavioral skills of EF in students with specific learning disabilities. Methods: In the current randomized, clinical trial, 49 subjects within the age range of 7 to 11 years with specific learning disabilities were randomly assigned into the intervention (25 subjects; mean age 8.5±1.33 years) and control (24 subjects; mean age 8.7±1.03 years) groups. Subjects in the intervention group received EF group training based on playing activities; subjects in the control group received no intervention. The behavior rating inventory of executive function (BRIEF) was administered to evaluate the behavioral and cognitive aspects of EF. The duration of the intervention was 6 hours per week for 9 weeks. Multivariate analysis of covariance was used to compare mean changes (before and after) in the BRIEF scores between the groups. Results: The assumptions of multivariate analysis of covariance were examined. After controlling pre-test conditions, the intervention and control groups scored significantly differently on both the metacognition (P=0.002; effect size=0.20) and behavior regulation indices (P=0.01; effect size=0.12) of BRIEF. Conclusion: Play-based therapy is effective on the metacognitive and behavioral aspects of EF in students with specific learning disabilities. Professionals can use play-based therapy rather than educational approaches in clinical practice to enhance EF skills.

The International League Against Epilepsy (ILAE) presents a revised operational classification of seizure types. The purpose of such a revision is to recognize that some seizure types can have either a focal or generalized onset, to allow classification when the onset is unobserved, to include some missing seizure types, and to adopt more transparent names. Because current knowledge is insufficient to form a scientifically based classification, the 2017 Classification is operational (practical) and based on the 1981 Classification, extended in 2010. Changes include the following: (1) "partial" becomes "focal"; (2) awareness is used as a classifier of focal seizures; (3) the terms dyscognitive, simple partial, complex partial, psychic, and secondarily generalized are eliminated; (4) new focal seizure types include automatisms, behavior arrest, hyperkinetic, autonomic, cognitive, and emotional; (5) atonic, clonic, epileptic spasms, myoclonic, and tonic seizures can be of either focal or generalized onset; (6) focal to bilateral tonic-clonic seizure replaces secondarily generalized seizure; (7) new generalized seizure types are absence with eyelid myoclonia, myoclonic absence, myoclonic-atonic, myoclonic-tonic-clonic; and (8) seizures of unknown onset may have features that can still be classified. The new classification does not represent a fundamental change, but allows greater flexibility and transparency in naming seizure types.