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Background Cognitive decline has been reported in premanifest and manifest Huntington’s disease but reliable biomarkers are lacking. Inner retinal layer thickness seems to be a good biomarker of cognition in other neurodegenerative diseases. Objective To explore the relationship between optical coherence tomography-derived metrics and global cognition in Huntington’s Disease. Methods Thirty-six patients with Huntington’s disease (16 premanifest and 20 manifest) and 36 controls matched by age, sex, smoking status, and hypertension status underwent macular volumetric and peripapillary optical coherence tomography scans. Disease duration, motor status, global cognition and CAG repeats were recorded in patients. Group differences in imaging parameters and their association with clinical outcomes were analyzed using linear mixed-effect models. Results Premanifest and manifest Huntington’s disease patients presented thinner retinal external limiting membrane-Bruch’s membrane complex, and manifest patients had thinner temporal peripapillary retinal nerve fiber layer compared to controls. In manifest Huntington’s disease, macular thickness was significantly associated with MoCA scores, inner nuclear layer showing the largest regression coefficients. This relationship was consistent after adjusting for age, sex, and education and p-value correction with False Discovery Rate. None of the retinal variables were related to Unified Huntington’s Disease Rating Scale score, disease duration, or disease burden. Premanifest patients did not show a significant association between OCT-derived parameters and clinical outcomes in corrected models. Conclusions In line with other neurodegenerative diseases, OCT is a potential biomarker of cognitive status in manifest HD. Future prospective studies are needed to evaluate OCT as a potential surrogate marker of cognitive decline in HD.

Non-motor manifestations of Parkinson’s disease (PD) appear early and have a significant impact on the quality of life of patients, but few studies have evaluated their predictive potential with machine learning algorithms. We evaluated 9 algorithms for discriminating PD patients from controls using a wide collection of non-motor clinical PD features from two databases: Biocruces (96 subjects) and PPMI (687 subjects). In addition, we evaluated whether the combination of both databases could improve the individual results. For each database 2 versions with different granularity were created and a feature selection process was performed. We observed that most of the algorithms were able to detect PD patients with high accuracy (>80%). Support Vector Machine and Multi-Layer Perceptron obtained the best performance, with an accuracy of 86.3% and 84.7%, respectively. Likewise, feature selection led to a significant reduction in the number of variables and to better performance. Besides, the enrichment of Biocruces database with data from PPMI moderately benefited the performance of the classification algorithms, especially the recall and to a lesser extent the accuracy, while the precision worsened slightly. The use of interpretable rules obtained by the RIPPER algorithm showed that simply using two variables (autonomic manifestations and olfactory dysfunction), it was possible to achieve an accuracy of 84.4%. Our study demonstrates that the analysis of non-motor parameters of PD through machine learning techniques can detect PD patients with high accuracy and recall, and allows us to select the most discriminative non-motor variables to create potential tools for PD screening. Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. This work was partially funded by the Department of Education, Universities and Research of the Basque Government (ADIAN, IT-980-16); by the Spanish Ministry of Science, Innovation and Universities - National Research Agency and the European Regional Development Fund - ERDF (PhysComp, TIN2017-85409-P), and from the State Research Agency (AEI, Spain) under grant agreement No RED2018-102312-T (IA-Biomed); by Michael J. Fox Foundation [RRIA 2014 (Rapid Response Innovation Awards) Program (Grant ID: 10189)]; by the Instituto de Salud Carlos III through the project “PI14/00679” and “PI16/00005”, the Juan Rodes grant “JR15/00008” (IG) (Co-funded by European Regional Development Fund/European Social Fund - “Investing in your future”); and by the Department of Health of the Basque Government through the projects “2016111009” and “2019111100”.

Introduction Visual dysfunction and cognitive impairment are common in Parkinson's disease (PD) but the precise contribution of lower-level visual impairment to visual-input based cognitive performance has not been extensively characterized in PD. Methods We included 49 PD patients and 22 healthy controls (HC). Lower-level visual function tests [high and low contrast visual acuity (HCVA and LCVA) and contrast sensitivity (CS)] and a neuropsychological battery (involving visual cognition) were performed. Pairwise correlations between lower-level visual functions and visual cognition were computed and stepwise linear regressions were fitted introducing age, Geriatric Depression Scale, and lower-level visual functions in the model to calculate their predicted effect on visual cognition. Results Compared to controls, patients presented a significant impairment in all cognitive domains (visual attention, visual processing speed and visual perception, visuospatial abilities, visuoconstructive abilities, and visual memory), and lower-level visual functions. HCVA and LCVA were significantly associated with visual cognition in PD. HCVA explained up to 49.3% and 34.2% of the variability in visual perception and visuospatial abilities, respectively, whereas LCVA was mainly associated with short- and long-term visual memory and visuospatial abilities. Conclusion Lower-level visual dysfunction is highly associated with cognitive performance in PD, when cognitive tests are based on visual input. Our results support that lower-level visual functions should be considered when assessing cognitive status of PD patients and might be useful for predicting cognitive deterioration.

Background: The estimation of premorbid intelligence (PI) is needed for an accurate diagnosis. Objective: This study aimed to estimate the cognitive performance taking into account the PI in Parkinson’s disease (PD) compared to healthy controls (HC); and to analyze the discrepancies between the current and the predicted cognitive performance based on the PI. Method: Semantic fluency, verbal and visual memory, and executive functions were assessed in 39 PD and 162 HC. A linear regression model was used to analyze the discrepancies between the predicted cognitive performance and the current raw scores through PI variables (Word Accentuation Test (WAT), Pseudo-Words (PW) Reading subtest from PROLEC-R, age, and years of education). ROC analyses were performed to assess their diagnostic properties. Results: Significant differences were found in the raw cognitive scores between patients and HC [semantic fluency (t = 6.07; p

This study aimed to analyze the association of autonomic dysfunction with cognition, depression, apathy, and fatigue in Lewy body disease (LBD). We included 61 patients [49 with idiopathic Parkinson’s disease, 7 with dementia with Lewy bodies, and 5 E46K-SNCA mutation carriers] and 22 healthy controls. All participants underwent a comprehensive battery of neuropsychological and clinical measures, autonomic symptom assessment with the SCOPA-AUT, analysis of non-invasive hemodynamic parameters during deep breathing, the Valsalva maneuver, and a 20-min tilt test, and electrochemical skin conductance measurement at rest (Sudoscan). Student’s t tests were used to assess group differences, and bivariate correlations and stepwise linear regressions to explore associations between autonomic function, cognition, depression, apathy, and fatigue. Compared to controls, patients who had significant impairment (p

Blood and cerebrospinal fluid represent emerging candidate fluids for biomarker identification in Parkinson's disease (PD).We studied 8 individuals carrying the E46K-SNCA mutation (3 PD dementia (PDD), 1 tremor-dominant PD, 2 young rigid-akinetic PD and 2 asymptomatic) and 8 age- and sex-matched healthy controls. We quantified the levels of total alpha-synuclein (a-syn), neurofilament light chain (NfL), glial fibrillary acidic protein (GFAP), Tau and ubiquitin carboxy-terminal hydrolase L1 (UCHL1) with SiMoA (Quanterix) in cerebrospinal fluid (CSF) of mutation carriers and in serum of all participants. The correlation between the concentration of biofluid markers and clinical outcomes was evaluated.Although based on a small number of cases, CSF a-syn was decreased in symptomatic E46K-SNCA carriers compared to the asymptomatic ones. Asymptomatic carriers exhibited similar serum biomarker levels as compared to matched controls, except for serum a-syn, which was higher in asymptomatic individuals. Carriers with PDD diagnosis displayed increased levels of serum NfL and GFAP compared to matched controls. These findings highly correlated with cognitive and motor status of E46K-SNCA carriers, but not with disease duration.Patients with familial forms of neurodegenerative disease exhibit variable penetrance of the phenotype and are exceptionally valuable for delineating biomarkers. Serum and CSF molecular biomarkers in E46K-SNCA mutation carriers show that a-syn might be suitable to track the conversion from asymptomatic to PD, whereas NfL and GFAP might serve to foresee the progression to PD dementia. These findings should be interpreted with caution and need to be replicated in other genetic synucleinopathy cohorts.

Background HD is an autosomal dominant, hereditary, and neurodegenerative disease that presents neurological, psychiatric, and cognitive impairment, with visual cognition being one of the affected areas. Aims This study aims to analyze the visual cognition profile of asymptomatic and symptomatic carriers of Huntington’s disease (HD), compared with healthy controls (HC), and to evaluate the differences between asymptomatic and symptomatic patients with different years of progression of HD. Methods We evaluated 99 participants, 51 HD carriers [17 asymptomatic, 13 symptomatic ( 5 years of evolution)] and 48 HC matched by sex and educational level. Motor function was rated with UHDRS scale, the general cognitive status was assessed with MoCA test, and a comprehensive battery of visual cognitive instruments was used. The following visual cognitive domains were assessed: visual memory, visuospatial skills and visuoconstructive abilities. One- way ANOVA and Tukey’s test for post hoc analysis were performed to analyze and compare the cognitive performance between the four groups. Results Statistically significant differences were found in the motor function (F(3.1)=14.129; p Conclusions Findings suggest that both symptomatic and asymptomatic HD patients present an increased visual cognitive impairment compared to HC. This impairment worsens with HD progression.

Background Retinal optical coherence tomography findings in Lewy body diseases and their implications for visual outcomes remain controversial. We investigated whether region-specific thickness analysis of retinal layers could improve the detection of macular atrophy and unravel its association with visual disability in Parkinson's disease. Methods Patients with idiopathic Parkinson's disease (n = 63), dementia with Lewy bodies (n = 8), and E46K mutation carriers in the alpha-synuclein gene (E46K-SNCA) (n = 4) and 34 controls underwent Spectralis optical coherence tomography macular scans and a comprehensive battery of visual function and cognition tests. We computed mean retinal layer thicknesses of both eyes within 1-, 2-, 3-, and 6-mm diameter macular discs and in concentric parafoveal (1- to 2-mm, 2- to 3-mm, 1- to 3-mm) and perifoveal (3- to 6-mm) rings. Group differences in imaging parameters and their relationship with visual outcomes were analyzed. A multivariate logistic model was developed to predict visual impairment from optical coherence tomography measurements in Parkinson's disease, and cutoff values were determined with receiver operating characteristic analysis. Results When compared with controls, patients with dementia with Lewy bodies had significant thinning of the ganglion cell-inner plexiform layer complex within the central 3-mm disc mainly because of differences in 1- to 3-mm parafoveal thickness. This parameter was strongly correlated in patients, but not in controls, with low contrast visual acuity and visual cognition outcomes (P < .05, False Discovery Rate), achieving 88% of accuracy in predicting visual impairment in Parkinson's disease. Conclusion Our findings support that parafoveal thinning of ganglion cell-inner plexiform complex is a sensitive and clinically relevant imaging biomarker for Lewy body diseases, specifically for Parkinson's disease. (c) 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society. This study was partially cofunded by the Michael J. Fox Foundation (2014 Rapid Response Innovation Awards; Grant 10189), by the Carlos III Health Institute through Projects PI14/00679 and PI16/00005, and Juan Rodes Grant JR15/00008 (I.G.) (cofunded by the European Regional Development Fund/European Social Fund "Investing in Your Future"), and by the Department of Health of the Basque Government through Project 2016111009

Autonomic dysreflexia (AD) is a life-threatening condition for individuals with cervical or high-thoracic spinal cord injury (SCI). The profile of autonomic dysfunction in AD using validated clinical autonomic tests has not been described so far, although it could be useful to identify SCI patients at greater risk of developing AD non-invasively. With this objective, 37 SCI patients (27% female) were recruited, and hemodynamic and cardiac parameters were continuously monitored to determine the presence of AD, defined as an increase of systolic blood pressure of 20 mmHg or higher after bladder filling with saline. Then, standard autonomic function testing was performed, including Deep Breathing, Valsalva Manoeuvre and Tilt Table Test. Finally, baroreflex sensitivity (BRS), and spectral analysis of heart rate and blood pressure variability were measured at rest. Catecholamines and vasopressin levels were also measured at supine and upright positions. The severity of SCI was assessed through clinical and radiological examinations. AD was observed in 73.3% of SCI patients, being 63.6% of them asymptomatic during the dysreflexive episode. AD patients displayed a drop in sympathetic outflow, as determined by decreased noradrenalin plasma levels, reduced sympathovagal balance and increased BRS. In line with decreased sympathetic activity, the incidence of neurogenic orthostatic hypotension was higher in AD patients. Our results provide novel evidence regarding the autonomic dysfunction in SCI patients with AD compared to non-AD patients, posing non-invasively measured autonomic parameters as a powerful clinical tool to predict AD in SCI patients.

Objective This study was undertaken to analyze longitudinal changes of retinal thickness and their predictive value as biomarkers of disease progression in idiopathic Parkinson's disease (iPD). Methods Patients with Lewy body diseases were enrolled and prospectively evaluated at 3 years, including patients with iPD (n = 42), dementia with Lewy bodies (n = 4), E46K-SNCA mutation carriers (n = 4), and controls (n = 17). All participants underwent Spectralis retinal optical coherence tomography and Montreal Cognitive Assessment, and Unified Parkinson's Disease Rating Scale score was obtained in patients. Macular ganglion cell-inner plexiform layer complex (GCIPL) and peripapillary retinal nerve fiber layer (pRNFL) thickness reduction rates were estimated with linear mixed models. Risk ratios were calculated to evaluate the association between baseline GCIPL and pRNFL thicknesses and the risk of subsequent cognitive and motor worsening, using clinically meaningful cutoffs. Results GCIPL thickness in the parafoveal region (1- to 3-mm ring) presented the largest reduction rate. The annualized atrophy rate was 0.63 mu m in iPD patients and 0.23 mu m in controls (p < 0.0001). iPD patients with lower parafoveal GCIPL and pRNFL thickness at baseline presented an increased risk of cognitive decline at 3 years (relative risk [RR] = 3.49, 95% confidence interval [CI] = 1.10-11.1, p = 0.03 and RR = 3.28, 95% CI = 1.03-10.45, p = 0.045, respectively). We did not identify significant associations between retinal thickness and motor deterioration. Interpretation Our results provide evidence of the potential use of optical coherence tomography-measured parafoveal GCIPL thickness to monitor neurodegeneration and to predict the risk of cognitive worsening over time in iPD This study was cofunded by the Michael J. Fox Foundation (RRIA [Rapid Response Innovation Awards] 2014 Program, grant ID: 10189), the Carlos III Health Institute, and the European Union (ERDF/ESF, "A Way to Make Europe"/"Investing in Your Future") through the projects PI14/00679 and PI16/00005; the Juan Rodes grant JR15/00008 (I.G.); and the Department of Health of the Basque Government through the projects 2016111009 and 2020333033. We thank all the patients and participants involved in the study.

Objective To prospectively evaluate nocturnal sleep problems and excessive daytime sleepiness (EDS) in Parkinson’s disease (PD) patients, and analyze the influence of motor symptoms, treatment, and sex differences on sleep problems in PD. Methods Sleep disturbances of 103 PD patients were assessed with Parkinson’s Disease Sleep Scale (PDSS) and the Epworth Sleepiness Scale (ESS). Student’s t-test for related samples, one-way ANOVA with Tukey’s HSD post hoc test were used to assess group differences. Bivariate correlations and mixed-effects linear regression models were used to analyze the association between clinical aspects and sleep disturbances over time. Results At baseline, 48.5% of PD patients presented nocturnal problems and 40% of patients presented EDS. The PDSS and ESS total score slightly improve over time. Nocturnal problems were associated with age and motor impartment, explaining the 51% of the variance of the PDSS model. Males presented less nocturnal disturbances and more EDS than females. Higher motor impairment and combined treatment (L-dopa and agonist) were related to more EDS, while disease duration and L-dopa in monotherapy were related to lower scores, explaining the 59% of the model. Conclusions Sleep disturbances changed over time and age, diseases duration, motor impairment, treatment and sex were associated with nocturnal sleep problems and EDS. Agonist treatment alone or in combination with L-dopa might predict worse daytime sleepiness, while L-dopa in monotherapy is related to lower EDS, which significantly affects the quality of life of PD patients.

Home-based rehabilitation after an acute episode or following an exacerbation of a chronic disease is often problematic with a clear lack of continuity of care between hospital and home care. Secondary prevention is an essential element of long-term rehabilitation where strategies oriented toward risk reduction, treatment adherence, and optimization of quality of life need to be applied. Frail and sometimes isolated, the patient fails to adhere to the proposed post-discharge clinical pathway due to lack of appropriate clinical, emotional, and informational support. Providing a suitable rehabilitation after an acute episode or a chronic disease is a major issue, as it helps people to live independently and enhance their quality of life. However, as the rehabilitation period usually lasts some months, the continuity of care is often interrupted in the transition from hospital to home. Virtual coaches could help these patients to engage in a personalized rehabilitation program that complies with age-related conditions. These coaches could be a key technology for empowering patients toward increasing their adherence to the care plan and to improve their secondary prevention measures. In this paper, we are presenting a novel virtual coaching system that will address these challenges by combining recent technological advances with clinical pathways, based on joint research and validation activities from researchers from the medical and information and communication technology (ICT) domains.

To identify myocardial sympathetic denervation patterns suggestive of Lewy body (LB) pathology in patients with genetic and idiopathic parkinsonisms by 123I-metaiodobenzylguanidine (MIBG) scintigraphy. We retrospectively analysed myocardial MIBG images acquired with a dual-head gamma camera and low-energy high-resolution collimator (LEHR) in 194 patients with suspected synucleinopathy or atypical parkinsonism, including 34 with genetic Parkinson’s disease (PD; 4 PARK1, 8 PARK2 and 22 PARK8), 85 with idiopathic PD (iPD), 6 with idiopathic REM sleep behaviour disorder (iRBD), 17 with dementia with LB (DLB), 40 with multiple system atrophy (MSA) and 12 with progressive supranuclear palsy (PSP), and in 45 healthy controls. We calculated heart-to-mediastinum MIBG uptake ratios (HMR) at 15 min and 4 h (HMR4H) for the LEHR and standardized medium-energy collimators, to obtain classification accuracies and optimal cut-off values for HMR using supervised classification and ROC analyses. While patients with LB disorders had markedly lower HMR4HLEHR than controls (controls 1.86 ± 0.26, iPD 1.38 ± 0.29, iRBD 1.23 ± 0.09, PARK1 1.20 ± 0.09, DLB 1.17 ± 0.11; p 0.05). The diagnostic accuracy of HMR4HLEHR was highest in patients with LB disorders (PARK1, iPD, DLB, iRBD; 89% to 97%) and lowest in those with PARK2, PARK8, PSP and MSA (65% to 76%), with an optimal HMR4HLEHR cut-off value of 1.72 for discriminating most patients with LB disorders including iPD and 1.40 for discriminating those with aggressive LB spectrum phenotypes (DLB, PARK1 and iRBD). Our study including patients with a wide spectrum of genetic and idiopathic parkinsonisms with different degrees of LB pathology further supports myocardial MIBG scintigraphy as an accurate tool for discriminating patients with LB spectrum disorders.

Two patients with a syndrome of pandisautonomia with clinical criteria of AAG are provided. Both patients present a similar clinical picture and response to immunosuppressive treatment. One of them has positive antibodies against the ganglionic nicotinic acetylcholine (gAChr) and the other does not. This brief article serves to reflect the spectrum of AAG, at a clinical level, in laboratory tests and in the response to immunotherapy, independently of the presence of positive gAChr antibodies.

IntroductionThe use of non-motor Parkinson’s disease (PD) features and genetic PD variants for clustering analyses may refine the phenotypic classification of idiopathic Lewy body (LB) diseases.MethodsOne-hundred participants [n=7 E46K-SNCA (n=5 symptomatic and n=2 asymptomatic), n=4 PARK2, n=3 LRRK2, n=8 dementia with Lewy bodies (DLB), n=48 idiopathic PD (iPD), n=30 healthy controls (HC)] underwent a comprehensive evaluation of non-motor and motor PD features. Non-motor features were used to perform a hierarchical clustering analysis with patients and HC using a Scikit-learn toolkit.ResultsClustering analysis suggested three clusters of subjects including Cluster 1 or “Normal-to-mild”: young iPD (< 60 years) classified together with most HC and the variable LB burden genetic PD variants (PARK2 and LRRK2) characterized by having normal-to-mild cognitive disabilities and mild-to-moderate motor disability with few axial symptoms; Cluster 2 or “Mild-to-moderate”: old iPD patients (>60 years) classified together with the lowest symptomatic E46K-SNCA, PARK2 carriers and HCs, characterizing by having mild-to-moderate cognitive and motor disabilities with few axial symptoms; and Cluster 3 or “Severe”: old iPD (>60 years) classified together with all DLB and the most symptomatic E46K-SNCA carriers, characterized by having severe pattern-specific cognitive disabilities (visual attention, perception, processing speed, memory and executive functions) and severe motor PD manifestations with marked axial symptoms.ConclusionsOur study supports the potential value of incorporating genetic PD variants in data-driven iPD classification algorithms and the usefulness of non-motor PD features, especially visual cognition abnormalities, to facilitate the identification of aggressive LB diseases.

Background and objective In 2004 we described the E46K mutation in alpha-synuclein gene (E46K-SNCA), a rare point mutation causing an aggressive Lewy body disease with early prominent non-motor features and small fiber denervation of myocardium. Considering the potential interest of the skin as a target for the development of biomarkers in Parkinson's Disease (PD), in this work we aimed to evaluate structural and functional integrity of small autonomic nerve fibers and phosphorylated alpha-synuclein (p-synuclein) deposition in the skin of E46K-SNCA carriers as compared to those observed in parkin gene mutation (PARK2) carriers and healthy controls. Patients and methods We studied 7 E46K-SNCA carriers (3 dementia with Lewy bodies, 2 pure autonomic failure, 1 PD and 1 asymptomatic), 2 PARK2 carriers and 2 healthy controls to quantify intraepidermal nerve fiber density and p-synuclein deposition with cervical skin punch biopsies (immunohistochemistry against anti PGP9.5/UCHL-1, TH and p-synuclein) and sudomotor function with electrochemical skin conductance (ESC) (SudoScan). Results All E46K-SNCA carriers had moderate to severe p-synuclein deposits and small fiber neurodegeneration in different epidermal and dermal structures including nerve fascicles and glands, especially in carriers with Pure Autonomic Failure, while p-synuclein aggregates where absent in healthy controls and in one of two PARK2 carriers. The severity of the latter skin abnormalities in E46K-SNCA were correlated with sudomotor dysfunction (lower ESC) in hands (p = 0.035). Interpretation These results together with our previous findings support the relevance of E46K-SNCA mutation as a suitable model to study small fiber neuropathy in Lewy body diseases.

Introduction. The Hopkins Verbal Learning Test-revised (HVLT-R) was originally created with the objective of providing a short verbal memory and learning test with six alternative forms that allow the re-administration. Aim. To obtain normative and standardized data for the HVLT-R taking into account the sociodemographic characteristics of the current Spanish population. Subjects and methods. The study is part of the Normacog Project. Seven hundred participants (18 to 90 years old) were assessed. The effect of age, level of education and gender on the performance of HVLT-R were analyzed, and percentiles and scalar scores adjusted by age and level of education were created. Results. A significant effect of age and educational level on the analyzed variables of the test was observed, explaining from 15% to 29% of the variance (trial 1, total recall, trial 4, discrimination index). As expected, the older and less educated obtained lower performance in all the analyzed variables of the HVLT-R. However, sex only had a significant effect on the variables trial 1, total recall and discrimination index. Conclusion. This study provides standardized and normalized data for the HVLT-R for the Spanish population, offering current norms to clinicians and researchers. The results confirm the influence of age and level of education on all the indicators of the test, so normative data are provided to correct the HVLT-R taking into account these characteristics.

The Normacog Brief Battery (NBB) provides a comprehensive overview of an individual’s cognitive functioning within a short amount of time. It was originally developed for the Spanish population in Spain. However, there is a considerable need for brief batteries in clinical neuropsychological assessment, especially in eastern European countries. Cultural background and other individual characteristics—such as age, level of education, and sex—are shown to influence both cognition and patients’ performance on neuropsychological tests. Therefore, it is important to develop understanding of how and why culture impacts on cognitive testing and determine which sociodemographic variables affect cognitive performance. The current study aims to translate, adapt, and standardize the NBB in Bulgaria, Croatia, and the Netherlands, and to analyze the effect of sex, age, and education level on cognitive performance between these three countries. This brief battery assesses eleven cognitive domains, including those most currently relevant in cognition such as premorbid intelligence, attention, executive function, processing speed, and memory. The translation and adaptation of the battery for different cultures will be done using the back-translation process. After exclusion criteria, the current study will include a total sample of three hundred participants (≥18 years old). The samples of 100 participants per country will be balanced through the consideration of their age and level of education. Effects of the sociodemographic variables (age, level of education, and sex) on cognitive performance are expected. Furthermore, this relationship is expected to differ across countries. A multivariate hierarchical linear regression will be used and exploratory analysis will be carried out to investigate further effects. The results will be particularly valuable for future research and assessment in cognitive performance. The growing demand for accurate and fast neuropsychological assessment shows the importance of creating a universal brief assessment tool for wider cross-cultural application.

The Modified Wisconsin Card Sorting Test (M-WCST) is a shorter, modified version of the WCST that assesses executive functioning and mental flexibility. The M-WCST presents some differences and advantages compared to other versions of the WCST, as previously described in the scientific literature.To standardize and develop demographically-calibrated norms for the M-WCST in a sample representing of the population of Spain.This study is part of the multisite Normacog project. Seven hundred participants from 18 to 90 years old were assessed using the M-WCST. The effects of age, sex, and educational level on M-WCST performance were analyzed, and demographically-calibrated percentiles and scaled scores corresponding to each raw score were created.The effect of age and level of education on the M-WCST variables analyzed (correct categories, perseverative errors and total errors) was statistically significant, whereas sex was not significant. Age and education explained 5.0-21.2% of the variance in M-WCST performance. Older participants with lower level of formal education completed fewer category sorts and made more errors than younger and more educated participants.This study reports the first normative data for the M-WCST in a contemporary Spanish sample, taking socio-demographic characteristics of the population into account. The influence of age and level of education on the M-WCST performance was confirmed.Test modificado de clasificacion de tarjetas de Wisconsin: normalizacion y estandarizacion de la prueba en poblacion española.Introduccion. El test modificado de clasificacion de tarjetas de Wisconsin (M-WCST) es una version breve y modificada del WCST que evalua las funciones ejecutivas y la flexibilidad mental. Presenta algunas diferencias y ventajas respecto a otras versiones del WCST que se han descrito en la bibliografia. Objetivo. Estandarizar y desarrollar datos normativos calibrados demograficamente para el M-WCST en una muestra representativa de la poblacion española. Sujetos y metodos. Como parte del proyecto multicentrico Normacog, se administro el M-WCST a 700 participantes (rango: 18-90 años). Se analizaron el efecto de la edad, el nivel educativo y el sexo sobre el M-WCST, y se crearon percentiles y puntuaciones escalares calibradas demograficamente para cada puntuacion directa. Resultados. Se observo un efecto significativo de la edad y del nivel educativo sobre las variables analizadas del M-WCST (categorias correctas, errores perseverativos y errores totales), pero no un efecto significativo del sexo en ninguna de las variables. La edad y la educacion explicaban un 5,0-21,2% de la varianza en el M-WCST y mostraron que, a mayor edad y menor nivel de educacion formal, el numero de categorias correctas disminuia y se cometian mayor cantidad de errores. Conclusion. El presente estudio aporta por primera vez los baremos normativos del M-WCST para la poblacion española teniendo en cuenta las caracteristicas sociodemograficas de nuestra sociedad. Se confirma la influencia de la edad y el nivel educativo sobre el rendimiento del M-WCST.

The Taylor Complex Figure (TCF) was created as an alternate form for the Rey-Osterrieth Complex Figure. Although both figures are widely used, to date, it has not been carried out the normalization of the TCF for Spanish population.To normalize and standardize the TCF taking into account the sociodemographic characteristics of the Spanish population.The present study is part of the Normacog Project. Seven hundred participants were recruited (18-90 years old), assessing the visuo-constructive ability and immediate visual memory by TCF. The effect of age, level of education and gender was analyzed on the performance of TCF and percentiles and scalar score for eight ranges of age and scalar score adjusted by the level of education.Results showed a significant effect of age and level of education on the performance in copy and memory of TCF, whereas gender was not significant. Age and education explained from 25.3% to 35.7% of the variance of TCF performance. The older and less educated, the worse performance shown in TCF. Percentiles, scalar score for each range of age and scalar score adjusted by the level of education were obtained.Administration instructions, scoring and the normative data of the TCF are provided taking into account the Spanish sociodemographic characteristics for adults in our country.Test de la figura compleja de Taylor: administracion y correccion segun un proceso de normalizacion y estandarizacion en poblacion española.Introduccion. La figura compleja de Taylor (FCT) fue creada como alternativa a la figura compleja de Rey-Osterrieth. Aunque ambas figuras son instrumentos ampliamente utilizados, no se ha realizado hasta la fecha la normalizacion de la FCT para poblacion española. Objetivo. Normalizar y estandarizar la FCT, considerando las caracteristicas sociodemograficas de la poblacion española. Sujetos y metodos. El presente estudio se enmarca dentro del proyecto Normacog. Se seleccionaron 700 participantes (rango: 18-90 años), y se evaluaron la capacidad visuoconstructiva y la memoria visual inmediata mediante la FCT. Se analizaron el efecto de la edad, el nivel educativo y el sexo sobre el rendimiento de la FCT, y se crearon los percentiles, las puntuaciones escalares para ocho rangos de edad y la puntuacion escalar ajustada por el nivel educativo. Resultados. Los resultados muestran un efecto significativo de la edad y el nivel educativo sobre el rendimiento en copia y memoria de la FCT, mientras que el sexo no influyo significativamente. La edad y la educacion explicaban el 25,3-35,7% de la varianza en la FCT. A mayor edad y menor nivel educativo, peor era el rendimiento obtenido en la FCT. Se obtienen los percentiles, las puntuaciones escalares para cada rango de edad y la puntuacion escalar individual ajustada por el nivel educativo. Conclusion. Se aportan los materiales para la administracion y correccion del test de FCT, asi como los datos normativos de la FCT teniendo en cuenta las caracteristicas sociodemograficas españolas para todo el rango adulto en nuestro pais.

Many neuropsychological tests used in Spain have been normed on Spanish-speaking persons in the USA and South America. In addition, the normative samples often span limited age or educational ranges, potentially decreasing their representativeness of the population, the interpretation of test results, and clinical decisions based on them. This study is part of the Normacog project which seeks to standardize neuropsychological instruments in a representative sample of Spanish society.To present the normalization methodology undertaken in the Normacog project and the sociodemographic characteristics of participants and Spanish population.Seven hundred and eleven participants aged 18-90 years were recruited from different geographical regions in Spain. Their sociodemographic characteristics, medical history, habits, native language, bilingualism and handedness were taken into account. Each participant completed 19 tests that assess a wide variety of cognitive domains such as verbal and visual memory, executive functions, processing speed or naming and verbal fluency.The final normative sample mirrors the population of Spain in age, education, and sex distributions.This article describes the normalization methodology and the characteristics of participants included in the multicenter Normacog study. This study seeks to standardize and normalize neuropsychological instruments, taking into account the sociodemographic characteristics of Spanish population. The Normacog project will provide normative data that are appropriate to our cultural environment, and essential for using these measures to form reliable clinical and diagnostic inferences.Estudio multicentrico de normalizacion y estandarizacion de instrumentos neuropsicologicos en personas sanas para poblacion española: metodologia y caracteristicas del proyecto Normacog.Introduccion. Muchos de los instrumentos neuropsicologicos utilizados en España se han normalizado en poblacion hispanohablante procedente de Estados Unidos y Sudamerica, con grupos de edad y caracteristicas restrictivas. Utilizar este tipo de normas disminuye potencialmente su representatividad, la interpretacion de los resultados y las decisiones clinicas. Este estudio se enmarca dentro del proyecto Normacog, con el fin de estandarizar instrumentos neuropsicologicos en una muestra representativa de la sociedad española. Objetivo. Presentar la metodologia de normalizacion llevada a cabo en el proyecto Normacog y las caracteristicas sociodemograficas de la poblacion española y de los participantes incluidos en el estudio. Sujetos y metodos. Se reclutaron 711 participantes (rango: 18-90 años) de diferentes areas geograficas de España, incluyendo los datos sociodemograficos, medicos, habitos habituales, lengua materna, bilinguismo y dominancia manual. Cada participante completo 19 instrumentos que evaluaban un amplio rango de dominios cognitivos, como memoria verbal y visual, atencion, funciones ejecutivas, velocidad de procesamiento o fluidez y denominacion verbal. Resultados. La muestra final normativa refleja las caracteristicas sociodemograficas y la representatividad de la poblacion española de acuerdo con los rangos de edad, educacion y sexo. Conclusiones. Se describe la metodologia de normalizacion y las caracteristicas de la muestra incluida en el estudio multicentrico Normacog, mediante el cual se llevara a cabo la estandarizacion y normalizacion de instrumentos neuropsicologicos, teniendo en cuenta las caracteristicas sociodemograficas propias de la poblacion española. El proyecto Normacog proporciona datos normativos adecuados a nuestro medio cultural, y es esencial para poder realizar un diagnostico clinico y neuropsicologico fiable.

Introduccion. El test modificado de clasificacion de tarjetas de Wisconsin (M-WCST) es una version breve y modificada del WCST que evalua las funciones ejecutivas y la flexibilidad mental. Presenta algunas diferencias y ventajas respecto a otras versiones del WCST que se han descrito en la bibliografia. Objetivo. Estandarizar y desarrollar datos normativos calibrados demograficamente para el M-WCST en una muestra representativa de la poblacion espanola. Sujetos y metodos. Como parte del proyecto multicentrico Normacog, se administro el M-WCST a 700 participantes (rango: 18-90 anos). Se analizaron el efecto de la edad, el nivel educativo y el sexo sobre el M-WCST, y se crearon percentiles y puntuaciones escalares calibradas demograficamente para cada puntuacion directa. Resultados. Se observo un efecto significativo de la edad y del nivel educativo sobre las variables analizadas del M-WCST (categorias correctas, errores perseverativos y errores totales), pero no un efecto significativo del sexo en ninguna de las variables. La edad y la educacion explicaban un 5,0-21,2% de la varianza en el M-WCST y mostraron que, a mayor edad y menor nivel de educacion formal, el numero de categorias correctas disminuia y se cometian mayor cantidad de errores. Conclusion. El presente estudio aporta por primera vez los baremos normativos del M-WCST para la poblacion espanola teniendo en cuenta las caracteristicas sociodemograficas de nuestra sociedad. Se confirma la influencia de la edad y el nivel educativo sobre el rendimiento del M-WCST.

Introduccion. La figura compleja de Taylor (FCT) fue creada como alternativa a la figura compleja de Rey-Osterrieth. Aunque ambas figuras son instrumentos ampliamente utilizados, no se ha realizado hasta la fecha la normalizacion de la FCT para poblacion espanola. Objetivo. Normalizar y estandarizar la FCT, considerando las caracteristicas sociodemograficas de la poblacion espanola. Sujetos y metodos. El presente estudio se enmarca dentro del proyecto Normacog. Se seleccionaron 700 participantes (rango: 18-90 anos), y se evaluaron la capacidad visuoconstructiva y la memoria visual inmediata mediante la FCT. Se analizaron el efecto de la edad, el nivel educativo y el sexo sobre el rendimiento de la FCT, y se crearon los percentiles, las puntuaciones escalares para ocho rangos de edad y la puntuacion escalar ajustada por el nivel educativo. Resultados. Los resultados muestran un efecto significativo de la edad y el nivel educativo sobre el rendimiento en copia y memoria de la FCT, mientras que el sexo no influyo significativamente. La edad y la educacion explicaban el 25,3-35,7% de la varianza en la FCT. A mayor edad y menor nivel educativo, peor era el rendimiento obtenido en la FCT. Se obtienen los percentiles, las puntuaciones escalares para cada rango de edad y la puntuacion escalar individual ajustada por el nivel educativo. Conclusion. Se aportan los materiales para la administracion y correccion del test de FCT, asi como los datos normativos de la FCT teniendo en cuenta las caracteristicas sociodemograficas espanolas para todo el rango adulto en nuestro pais.

Introduccion. Muchos de los instrumentos neuropsicologicos utilizados en Espana se han normalizado en poblacion hispanohablante procedente de Estados Unidos y Sudamerica, con grupos de edad y caracteristicas restrictivas. Utilizar este tipo de normas disminuye potencialmente su representatividad, la interpretacion de los resultados y las decisiones clinicas. Este estudio se enmarca dentro del proyecto Normacog, con el fin de estandarizar instrumentos neuropsicologicos en una muestra representativa de la sociedad espanola. Objetivo. Presentar la metodologia de normalizacion llevada a cabo en el proyecto Normacog y las caracteristicas sociodemograficas de la poblacion espanola y de los participantes incluidos en el estudio. Sujetos y metodos. Se reclutaron 711 participantes (rango: 18-90 anos) de diferentes areas geograficas de Espana, incluyendo los datos sociodemograficos, medicos, habitos habituales, lengua materna, bilinguismo y dominancia manual. Cada participante completo 19 instrumentos que evaluaban un amplio rango de dominios cognitivos, como memoria verbal y visual, atencion, funciones ejecutivas, velocidad de procesamiento o fluidez y denominacion verbal. Resultados. La muestra final normativa refleja las caracteristicas sociodemograficas y la representatividad de la poblacion espanola de acuerdo con los rangos de edad, educacion y sexo. Conclusiones. Se describe la metodologia de normalizacion y las caracteristicas de la muestra incluida en el estudio multicentrico Normacog, mediante el cual se llevara a cabo la estandarizacion y normalizacion de instrumentos neuropsicologicos, teniendo en cuenta las caracteristicas sociodemograficas propias de la poblacion espanola. El proyecto Normacog proporciona datos normativos adecuados a nuestro medio cultural, y es esencial para poder realizar un diagnostico clinico y neuropsicologico fiable.