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We studied the development of imitation ability in a cohort of 6-11-year-old children (N=174) with specific attention to error types and to their cognitive interpretation. Participants imitated meaningless actions as if they were in front of a mirror (specularly). Actions varied across three levels of complexity (movements of a single limb, of arm and leg of the same body side, or of arm and leg of opposite sides). Overall performance improved with age. Among the most frequent error categories, “side” errors (movement imitated with the left instead of the right limb or viceversa) paradoxically increased with age (from 9 years), but their sensitivity to complexity decreased with age. Thus, encoding two opposite body sides has high cognitive costs in younger children, and smaller or null costs in older children. We interpreted these results in terms of enhancement of Working Memory (WM) and body knowledge with age. When WM increases, it paradoxically drives older children to apply their superior body knowledge and imitate "anatomically", producing side errors. Younger children are free from such interference because they still lack the necessary body knowledge and WM capacity. The (fewer) side errors made by younger children would be due to failure to manage the conflict between opposite spatial codes, an effect of limited WM capacity witnessed by their sensitivity to action complexity. In conclusion, this study suggests that anatomical imitation becomes available in children’s cognitive repertoire from age 9, as an effect of increased body knowledge and WM capacity.

The present study exploited Left Neglect Dyslexia (ND) to investigate how prefixation is attended to in the process of reading. ND is an acquired reading disorder that impairs the apperception of the left side of words and sentences. Importantly, both orthographic and lexical factors have been shown to modulate the exploration of written material in this syndrome. Two main issues were addressed: whether the orthographic morphological structure of prefixed words influences attention in ND; whether, and how, higher level lexical information modulates these effects. A patient with ND was asked to read prefixed and pseudo-prefixed stimuli. The patterns of errors showed that ND is sensitive to the morphological structure of stimuli: the vast majority of left errors specifically affected prefixes, an effect that could not be explained by generic neglect of the leftmost portions of the words. Additionally, errors distributed unequally depending on higher level lexical factors like semantic transparency and stem boundedness. These results are consistent with dual-route models of morphological representation and processing.

Humor is a multifaceted function unique to human beings, like language and symbolic thought. Theories of humor propose different frameworks to investigate this function empirically; here, we applied a cognitive-psychology approach, focusing on a specific humor task. We asked 32 participants to listen to 30 jokes intermixed with 30 non-jokes that had an implausible ending, and to decide whether or not each stimulus was funny (Humor Decision Task, HDT). In a control task, 30 plausible stories were intermixed with 30 stories with an implausible ending and participants had to decide whether or not each stimulus was “strange” (Implausibility Decision Task, IDT). Response times (RT) in correct responses indicated that the two tasks involved different cognitive operations: while “yes, funny” responses were 256 ms faster than “no, not-funny” responses, “yes, strange” responses took the same time as “no, not-strange” ones. IDT results could be explained by assuming that participants used the degree of semantic overlap between the setup and the ending of the story to select a response. Two different cognitive accounts for the HDT results are offered, the “recognition” and the “sequential attempts” model. According to the “recognition” account,participants activate long-term memory (LTM) abstract representations of the semantic structure of jokes, while the “sequential attempts” account implies a trial-and-error strategy to find a solution to the puzzle posed by a punchline that is not already available in LTM. The RT pattern observed inincorrect responses led us to reject the “recognition” account and support the “sequential attempts” hypothesis.

We studied the development of imitation ability in a cohort of 6-11-year-old children (N=174) with specific attention to error types and their cognitive interpretation. Participants imitated meaningless actions as if they were in front of a mirror (specularly). Actions varied across three levels of complexity (movements of a single limb, arm and leg of the same body side, or arm and leg of opposite sides). Overall performance improved with age. Among the most frequent error categories, ‘side’ errors (movement imitated with the left instead of the right limb or vice-versa) paradoxically increased with age (from 9 years). Still, their sensitivity to complexity decreased with age. Thus, encoding two opposite body sides has high cognitive costs in younger children and smaller or null costs in older children. We interpreted these results in terms of the enhancement of Working Memory (WM) and body knowledge with age. When WM increases, it paradoxically drives older children to apply their superior body knowledge and imitate ‘anatomically’, producing side errors. Younger children are free from such interference because they still lack the necessary body knowledge and WM capacity. In conclusion, this study suggests that anatomical imitation becomes available in children’s cognitive repertoire from age nine due to increased body knowledge and WM capacity.Research HighlightsThe analysis of error types uncovers/illustrates the role of working memory and body knowledge in imitation.As an effect of little working memory capacity, younger children pay a cognitive cost to encode opposite body sides and make “side errors”.Imitation performance improves with age, but side errors paradoxically increase in frequency due to greater ability to master body knowledge bringing to anatomical imitation.Anatomical imitation is available in childrens’ cognitive repertoire from age 9, as an effect of the development of body knowledge and working memory capacity.

Introduction: Harmonized neuropsychological assessment for neurocognitive disorders, an international priority for valid and reliable diagnostic procedures, has been achieved only in specific countries or research contexts.Methods: To harmonize the assessment of mild cognitive impairment in Europe, a workshop (Geneva, May 2018) convened stakeholders, methodologists, academic, and non-academic clinicians and experts from European, US, and Australian harmonization initiatives.Results: With formal presentations and thematic working-groups we defined a standard battery consistent with the U.S. Uniform DataSet, version 3, and homogeneous methodology to obtain consistent normative data across tests and languages. Adaptations consist of including two tests specific to typical Alzheimer's disease and behavioral variant frontotemporal dementia. The methodology for harmonized normative data includes consensus definition of cognitively normal controls, classification of confounding factors (age, sex, and education), and calculation of minimum sample sizes.Discussion: This expert consensus allows harmonizing the diagnosis of neurocognitive disorders across European countries and possibly beyond.

We report the reading performance of an Italian speaker with egocentric Neglect Dyslexia on sentences with Negative Concord structures, which contain a linguistic cue to the presence of a preceding negative marker and compare it to sentences with no such cue. As predicted, the frequency of reading the whole sentence, including the initial negative marker non, was higher in Negative Concord structures than in sentences which also started with non, but crucially, lacked the medially positioned linguistic cue to the presence of non. These data support the claim that the presence of linguistic cues to sentence structure modulates attention during reading in Neglect Dyslexia.

Developmental dyslexia can be viewed as the result of the effects of single deficits or multiple deficits. This study presents a test of the applicability of a multifactor-interactive model (MFi-M) with a preliminary set of five variables corresponding to different neuropsychological functions involved in the reading process. The model has been tested on a sample of 55 school-age children with developmental dyslexia. The results show that the data fit a model in which each variable contributes to the reading ability in a non-additive but rather interactive way. These findings constitute a preliminary validation of the plausibility of the MFi-M, and encourage further research to add relevant factors and specify their relative weights. It is further discussed how subtype-based intervention approaches can be a suitable and advantageous framework for clinical intervention in a MFi-M perspective.

Background Growing evidence suggests that hyperhomocysteinemia (HHcy) constitutes a risk factor for Alzheimer’s Disease (AD). The impact of HHcy on cognitive functions has mainly been investigated using screening neuropsychological tests that provide general, unspecific measures of cognitive level. Since an association between HHcy and temporo-mesial atrophy has been documented, we predicted that a fine-grained analysis of neuropsychological performance should show stronger Hcy effects on memory scores than on other cognitive scores. Objective To determine the influence of Hcy level on cognitive profile evaluated with specific, sensitive neuropsychological tests in a wide AD cohort. Methods 323 patients with AD were enrolled in a cross-sectional study and underwent a neuropsychological examination exploring several cognitive domains (memory, language, visuoperception, visuospatial abilities, executive function, constructional praxis, ideomotor praxis). The effects of Hcy levels and other risk factors (including cholesterol, smoking habits, triglycerides, apoEe4 allele) were analysed. Results Generalized Linear Model detected a significant drop in performance with increasing Hcy in 6/19 measures of cognitive functions, namely, in memory performance tasks as well as in Luria’s motor planning test, with effect sizes ranging 1.4%–2.8% (Eta-squared), partialling out effects of other predictors. Conclusions HHcy was associated with poor performance in short and long-term spatial and verbal memory more than with other cognitive dysfunctions. These results support the hypothesis that medial temporal networks might be vulnerable to HHcy, consistently with data from neuroimaging studies suggesting a link in AD between temporal atrophy and HHcy; the effect on Luria’s motor planning task suggests further involvement of frontal structures.

A brief screening of the cognitive functions can be very useful in clinical practice. For instance, cognitive screening is often conducted to facilitate early detection of cognitive decline in adult and elderly patients. The Mini-Mental State Examination is broadly used worldwide; it addresses key cognitive functions and provides a global score, which may prompt the clinician (e.g., general doctor or neurologist) to refer the patient for further neuropsychological assessment. Similarly, in the developmental age, a screening test might be convenient to identify children with cognitive difficulties and delays, to monitor cognitive functions over time, to indicate whether a further neuropsychological assessment is needed. Over the past 20 years, a few attempts have been made to provide clinicians with a cognitive screening test targeting the pediatric age. We will review those attempts and present the Mini-Mental State Pediatric Examination, a cognitive screening test developed for the Italian population.

This work tackles the problem of whether the dissociation between two performances in a single-case study should be computed as the difference between the raw or between the standardized (e.g. z) scores. A wrong choice can lead to serious inflation of the probability of finding false dissociations and missing true dissociations. Two common misconceptions are that (i) standardized scores are a universally valid choice, or (ii) raw scores can be subtracted when the two performances concern the same "task/test", otherwise standardized scores are better. These and other rules are shown to fail in specific cases and a solution is proposed in terms of in-depth analysis of the meaning of each score. The scores that should be subtracted are those that better reflect "deficit severities" - the latent, unobservable degrees of damage to the cognitive systems that are being compared. Thus explicit theoretical modelling of the investigated cognitive function(s) - the "scenario" - is required. A flowchart is provided that guides such analysis, and shows how a given neuropsychological scenario leads to the selection of an appropriate statistical method for detecting dissociations, introducing the critical concept of "deficit equivalence criterion" - the definition of what exactly a non-dissociation should look like. One further, overlooked problem concerning standardized scores in general (as measures of effect size, of which neuropsychological dissociations are just one example) is that they cannot be meaningfully compared if they have different reliabilities. In conclusion, when studying dissociations, increases in false-positive and false-negative risks are likely to occur when no explicit neuropsychological theory is offered that justifies the definition of what are to be considered as equivalent deficit severities in both performances, and which would lead to appropriate selection of raw, standardized, or any other type of score. More generally, the choice of any measure in any research context needs explicit theoretical modelling, without which statistical risks cannot be controlled.

The Tower of London (ToL) test is traditionally used to assess strategical reasoning, problem-solving, and mental planning in clinical populations. Here, we provide the Italian standardization norms for the original, 12-problem version of the ToL test. The performance of 216 Italian individuals ranging 18 to 89 in age was scored in terms of both Time ( Speed) and Accuracy—the time, and the number of attempts, necessary to find a solution. We performed univariate analyses on separate Time and Accuracy scores, using Age in years, Education in years, and Sex (male vs. female) as predictors. z scores and equivalent scores were provided. Moreover, we performed a bivariate analysis for the assessment of individuals’ performance in terms of Time and Accuracy simultaneously. This standardization allows clinicians to use the original, most widespread version of ToL with the Italian population, thus optimizing comparability with other clinical and experimental research worldwide. Critically, this article offers a new statistical perspective on how Time and Accuracy scores, which are typically related to each other, can be combined to obtain a single, consistent clinical categorization that captures most of the information contained in the patient’s performance.

Unilateral neglect is usually investigated by adminstering stimuli (targets) in different positions, with targets being responded to by the patient (Hit) or omitted. In spite of this homogeneity of data type, neglect indices and diagnostic criteria vary considerably, causing inconsistencies in both clinical and experimental settings. We aimed at deriving a standard analysis which would apply to all tasks sharing this data form.A-priori theoretical reasoning demonstrated that the mean position of Hits in space (MPH) is an optimal index for correctly diagnosing and quantifying neglect. Crucially MPH eliminates the confounding effects of deficits that are different from neglect (non-lateral) but which decrease Hit rate. We ran a Monte Carlo study to assess MPH's (so far overlooked) statistical behavior as a function of numbers of targets and Hits.While average MPH was indeed insensitive to non-lateral deficits, MPH's variance (like that of all other neglect indices) increased dramatically with increasing non-lateral deficits. This instability would lead to alarmingly high false-positive rates (FPRs) when applying a classical diagnostic procedure that compares one patient with a control sample. We solved the problem by developing an equation that takes into account MPH instability and provides correct cut-offs and close-to-nominal FPRs, even without control subjects. We developed a computerized program which, given the raw data, yields the MPH, a z-score and a p-value.We provided a standard method that allows clinical and experimental neuropsychologists to diagnose and measure neglect in a consistent way across the vast majority of tasks.

ORCA.IT, a new online test of online research and comprehension was developed for the Italian population. A group of 183 students attending various types of upper secondary schools in Northern Italy were tested with the new tool and underwent further cognitive and neuropsychological assessment. The different school types involved in the study are representative of the school population in the Italian system, but can also be easily compared with the educational systems of other countries. The new test turned out to have good psychometric properties after accurate item construction and final selection. In particular, Version 1 showed better characteristics than Version 2. Subsequently, comparison with one-way ANOVAs were performed to test whether differences exist between different school types, between groups with and without reading difficulties, and between males and females. Such differences are sometimes reported in the literature, but many remain controversial. Further, Pearson's bivariate correlations were calculated to analyze associations between scores on the ORCA.IT and cognitive/neuropsychological variables. Finally, a stepwise regression analysis was performed on aggregated scores to identify the predictors of performance on each of the two versions. The test, especially in the most complete version (Version 1), appears to accurately and reliably capture students' web searching abilities and online reading comprehension. The tool could highlight differences in online search and comprehension ability between students with and without reading difficulties, not penalizing overall performance but allowing very specific weaknesses to be pointed out. Further, it seems to be able to capture differences due to both educational pathways (different school types) and social attitudes (differences between males and females). Most interestingly, it shows to be clearly resting on specific cognitive and neuropsychological abilities, including language, memory, and attentional skills, which explain a large portion of the total variance. Offline text reading comprehension is a crucial predictor of online reading performance, while decoding ability is not. Prior knowledge also influences the results, as expected. The new tool turns out to be rather independent of previous Internet experience and to measure more cognitively grounded processes related to information gathering, processing, and communicating.

We propose STIMA, a short test for ideo-motor apraxia, allowing us to quantify the apraxic deficit according to action meaning and affected body segment. STIMA is based on a neurocognitive model holding that there are two processes involved in action imitation (i.e., a semantic route for recognizing and imitating known gestures, and a direct route for reproducing new gestures). The test allows to identify which imitative process has been selectively impaired by brain damage (direct vs. semantic route) and possible deficits depending on the body segment involved (hand/limb vs. hand/fingers). N = 111 healthy participants were administered with an imitation task in two separated blocks of known and new gestures. In each block, half of the gestures were performed mainly with the proximal part of the upper limb and the remaining half with the distal one. It resulted in 18 known gestures (nine proximal and nine distal) and 18 new gestures (nine proximal and nine distal) for a total of 36. Each gesture was presented up to a maximum of two times. Detailed criteria are used to assign the final imitation score. Cut offs, equivalent scores and main percentile scores were computed for each subscale. Participants imitated better known than new gestures, and proximal better than distal gestures. Age influenced performance on all subscales, while education only affected one subscale. STIMA is easy and quick to administer, and compared to previous tests, it offers important information for planning adequate rehabilitation programs based on the functional locus of the deficit.

A pediatric cognitive screening tool has been shaped in three versions according to school class to assess spatial and temporal orientation, language, reading, writing, drawing, number knowledge, memory, praxis and executive functions in children aged 6-13. It has been standardized on an Italian sample of 807 children. Raw scores were adjusted for critical variables (child's age and parents' education) and a cut-off for the resulting global cognitive score was made available for clinical practice. In line with previous research, adapting the Mini-Mental State Examination to pediatric neuropsychological assessment turned out to be useful in estimating global cognitive functioning in children.

Neuropsychological assessment is critical in both diagnosis and prognosis of patients with epilepsy. Beyond electrophysiological and anatomical alterations, other factors including different ethnic-cultural and linguistic backgrounds might affect neuropsychological performance. Only a few studies considered migration and acculturation effects and they typically concerned nonclinical samples. The current study aimed at investigating the influence of ethnic background and time spent in Italy on a full neuropsychological battery administered to both Italian and foreign-born patients and at providing a brief interview for obtaining relevant information on each patient's transcultural and language-related history. Clinical reports from 43 foreign-born patients with drug-resistant epilepsy were collected from the archives of Milan Niguarda Hospital. Epileptogenic zone, age, education, profession, illness duration, seizure frequency, handedness, and gender were considered in selecting 43 Italian controls. Ethnicity (Italian/foreign-born) and years spent in Italy were analyzed as main predictors on 21 neuropsychological scales by means of General(ized) Linear Models. An additional analysis studied two composite scores of overall verbal and nonverbal abilities. Ethnicity significantly affected the following: the verbal overall score, Verbal Fluency, Naming, Token-test, Digit Span, Attentional Matrices, Trail-Making-Test, Line-Orientation-Test, and Raven matrices; no effects were found on the nonverbal overall score, Word Pairs Learning, Episodic Memory, reading accuracy, visual span, Bells test, Rey Figure, and face memory and recognition. No significant effects of years spent in Italy emerged. While years spent in Italy does not predict neuropsychological performance, linguistic background had a strong impact on it. With respect to Italian-speaking patients, those who were foreign-born showed large task-related variability, with an especially low performance on language-related tests. Hence, language tests should not be considered as valid measures of neuropsychological impairment in this population, not even in foreign-born patients with good Italian fluency. Clinicians should consider such asymmetries in order to improve the accuracy of neuropsychological assessment of foreign-born patients.

4 Neuromuscolar Omnicenter (NEMO), A.O. Niguarda Ca’ Granda, Piazza Ospedale Maggiore no. 3, 20162 Milan, MI, Italy Moreover, the authors also discovered three (3) typos in the reported Results (mixed ANOVA) on the hand laterality task (HLT): The paper reports 113.484 for the Angle of rotation by Stimulus view interaction, where the degrees of freedom should actually be 80.466. Secondly, the F for the factor Angle of rotation should be 33.669 and not 36.670. Finally, the t value of the Effect of stimulus orientation contains an inversion in digits: It should read 4.629 and not 4.692. Table 2 Average percentage of correct answers for control group and ALS patients