Neuropsychological Tests - Science topic

Donald,

Thank you very much for your valuable answer.

Nicolò

I'm sorry I do not know

I think it depends on your goal in project,there are many option.

Actually it depends on variables you want to study on.

For example in our field of research mostly use Task are:

MT:multitasking

OTC:one touch stocking

SST:stop signal task

RVP:rapid visual information processing

So we can just provide these Tasks.

I need to device an experiment with the n-Back Pointing task without any hardware complement; e.g., no tablet to execute the reaching movements or ...

Teleneuropsychology: A model for clinical practice.

One more relevant publication for your reference:

Thibodaux, L. K., Breiger, D., Bledsoe, J., Sato, J., Hilsman, R., & Paolozzi, A. (2021). Teleneuropsychology: A model for clinical practice. Practice Innovations, 6(3), 189-198.

LEAP-Q is great for assessment of each of the multilingual’s languages, but w/out composite score.

Potential alternative instrument to consider for dominance score:

Bilingual Language Profile, BLP (Birdsong, Gertken, & Amengual, 2012)

YES NEPSY and WISC

Hi,

The p values from either of the sets are not significant at or below 0.05. The C.Is is not wide. The null hypothesis is accepted.

Two thoughts:

1. In order to combine results across tests that use different scales, one must place the results on the same metric. The easiest thing to do here would be to convert all standard scores to z scores. (You could probably do this starting with percentiles as well, but if possible, start with standard scores.)

2. I would not automatically lump all of these tests together as "executive function tests," because executive functions are complex, multifactorial in nature, and the tests are imperfect anyhow in that they also tap into other abilities (processing speed, memory, and so forth). So begin by analyzing each test separately. Then maybe do a meta-analysis of their correlations with one another (e.g., how closely related are Trails B and the Stroop?). Only if two measures are strongly related to each other should they then be combined into a higher-order meta-analysis.

You have your work cut out for you!

Also check https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6659169/

If you intend to use a paid software, then E-Prime would be helpful when used with Chronos and microphone.

E-Prime can record voice after each stimuli and keep it as separate recordings and it can get response times from the start of vocal responses.

You can use AudioInRecord Task Event, but have a look at their webinar on this topic for more information.

I don't think it can automatically convert the recording to text though.

I don't have a direct answer to your question, however the following may be of help:

Sci Rep. 2019 May 22;9(1):7688. doi: 10.1038/s41598-019-44082-w.

Influences of age, mental workload, and flight experience on cognitive performance and prefrontal activity in private pilots: a fNIRS study.

Causse M1, Chua ZK2, Rémy F3,4.

Author information

1ISAE-SUPAERO, Université de Toulouse, Toulouse, France. mickael.causse@isae.fr.2ISAE-SUPAERO, Université de Toulouse, Toulouse, France.3Université de Toulouse, UPS, Centre de Recherche Cerveau et Cognition, Toulouse, France.4CNRS, Cerco, Toulouse, France.

The effects of aging on cognitive performance must be better understood, especially to protect older individuals who are engaged in risky activities (e.g. aviation). Current literature on executive functions suggests that brain compensatory mechanisms may counter cognitive deterioration due to aging, at least up to certain task load levels. The present study assesses this hypothesis in private pilots engaged in two executive tasks from the standardized CANTAB battery, namely Spatial Working Memory (SWM) and  One Touch Stockings of Cambridge (OTS). Sixty-one pilots from three age groups (young, middle-aged, older) performed these two tasks from low to very high difficulty levels, beyond those reported in previous aging studies. A fNIRS headband measured changes in oxyhemoglobin (HbO2) in the prefrontal cortex. Results confirmed an overall effect of the difficulty level in the three age groups, with a decline in task performance and an increase in prefrontal HbO2 signal. Performance of older relative to younger pilots was impaired in both tasks, with the greatest impairment observed for the highest-load Spatial Working Memory task. Consistent with this behavioral deficit in older pilots, a plateau of prefrontal activity was observed at this highest-load level, suggesting that a ceiling in neural resources was reached. When behavioral performance was either equivalent between age groups or only slightly impaired in the older group, there were not any age-related differences in prefrontal activity. Finally, older pilots with extensive flying experience tend to show better preserved spatial working memory performance when compared to mildly-experienced of the same age group. The present findings are discussed in the frames of HAROLD and CRUNCH theoretical models of cognitive and neural aging, evoking the possibility that piloting expertise may contribute to preserve executive functions throughout adulthood.

PMID: 31118436 PMCID: PMC6531547 DOI: 10.1038/s41598-019-44082-wFree PMC Article

I had the same question years ago. I searched then and found an Apa article with adjustment of MMSE with age and level of education. I translated it in romanian for my supervised and attached it that way (“varsta“ = age). I’ll look for the paper and come back.

For testing satisfaction with life we used the following scale:

As Bonferroni correction relates only to the p-values per se, it does not matter if it is parametric or non-parametric clusters of p-values that are corrected. For Kruskal-Wallis can Dunn-Bonferroni be applied.

Dear Dr. Jan,

Thank you for your informatio. I completly agree that formal studies in this context are needed. However, such a study would be very difficult to perform from an ethical standpoin. The only way would perhaps be an interinstitutional comparison of medical care centers performing neuroimaging following different local strategies or standard operating procedures.

ICCs are like Pearson Correlations (when two variable are considered). Generally, using ICC for ordinal measurements are not correct. However, for ordinal measurement with more than 10-15 levels, ICCs are used.

Hi,

Maybe this article will interest you:

Article The Mindstreams MCI score: a practical clinical tool for ear...

Best regards,

Ya'akov

Assuming that your data are more or less normally distributed, you can convert to z scores as follows:

For each case, subtract the mean score for the sample from the score obtained by that individual. Then divide by the standard deviation for the sample. You can probably use the calculator at http://vassarstats.net/standard.html to make this happen quickly & easily.

The z score, of course, has a mean of 0 and a standard deviation of 1. To transform these into Wechsler-type scaled scores (mean of 10, SD of 3), I think you'd simply multiple by 3 and then add 10.

If the distribution is badly skewed or bimodal, you can still use this approach but you will not have the "expected" number of cases with each possible score. I haven't seen this issue discussed with regard to the Wechsler scaled scores, but it crops up in the literature on T Scores (more common in personality tests). The standard scores you get using the basic formula above preserve the original distribution of the data. If you want to force your scores to fall along a normal curve, there are extra steps to take. (The first approach yields a linear T Score; the second, a uniform or normalized T Score.) Erik Mortensen of the U. of Copenhagen (who is on ResearchGate) wrote a paper on normalized T scores, and Auke Tellegen (U. of Minnesota, now retired) wrote one on uniform T Scores, both in the 1990s.

Stephen, thank you for the reply. I didn't correctly express myself and have now corrected the question. I am not interested in one test which would merge all the functions but in all the tests available which cover the mentioned (not all in one test).

I am familiar with the Tower of Hanoi and I saw that the set can be bought online for a reasonable price, but was still hoping that other planning assessment tasks would be available.

Thank you for suggesting the Porteus Maze test, I will look into it.

I'll look into that, thanks :)

Without claiming to be a great statistician (I'm not), I've always suspected that the Bonferroni correction is mainly a way of discouraging researchers who might otherwise be inclined to "shotgun" data sets with lots of variables. But it accomplishes this by being excessively stringent. Take the case of a correlational study with 80 cases and 10 variables (this could be something as simple as the subtests of an ability measure or the scales on an omnibus personality test). The correlation matrix will have 50 entries. Using the conventional p<.05 standard, correlations of .217 or greater will be deemed "significant" and therefore interpretable. But if you apply the Bonferroni correction (.05 divided by 50) and demand a .001 level, then you would need r = .362 to proceed. Given how many actual correlations in personality, social, and clinical research hover in the low thirties, this would indeed mean skipping over lots of potentially important information - or even claiming that relationships did not exist when in fact they did (good old Type II error).

My recollection is that the Scheffe test is the most conservative of the post-hoc significance tests in that it controls for Type I error across all possible comparisons. So if, in an ANOVA, you had four groups (say, mild cognitive impairment, Alzheimer's, frontotemporal, and subcortical dementias), it would control not only for pairwise comparisons but also for combinations such as (MCI + FTD) vs. (ALZ + PAR). Sometimes this is an important set of comparisons, sometimes not.

The Tukey (not Turkey) HSD controls for all possible pairwise comparisons. So in the above example, your risk of Type I error could be set at five percent (.05) for MCI vs. ALZ, MCI vs. FTD, MCI vs. PAR, ALZ vs. FTD, ALZ vs. PAR, and FTD vs. PAR combined. Which, in that example, would probably be more than sufficient.

On the whole, I like to just use the Tukey test. And even if you do perform the occasional analysis combining groups, you're still being pretty conservative - and I've never had a reviewer or editor take me to task for it.

Please let me know if the following references/sites are useful to you:

1.  Neuropsychology in Epilepsy-Surgery - ta-service

Basic principle: comprehensive neuropsychological test inventory examining ... issues in surgical treatment of temporal lobe epilepsy. Neuropsychology in Epilepsy-Surgery ..... Verbal memory deficits in patients after dominant hemisphere.

2.  Neuropsychological outcomes after epilepsy surgery: Systematic ...

by E Sherman - ‎2011 - ‎Cited by 182 - ‎Related articles

Jan 20, 2011 - gains and losses after epilepsy surgery, and this varies across neuropsychological tests and cognitive domains. For these reasons, empirically ...

3.  Psychological and Neuropsychological Assessment Before and After ...

by GA Baker - ‎2001 - ‎Cited by 11 - ‎Related articles

Psychological and Neuropsychological Assessment Before and. After Surgery for Epilepsy: Implications for the Management of. Learning-Disabled People.

Dennis

Dennis Mazur

What about subtests from Wechsler battery?

Verbal fluency should be very informative. 

We used CANTAB for several years. We saw pros and cons. The pros were a wide range of tasks and when they worked, the system was pretty slick. I really like the reporting function although it took a few minutes to figure it out; it wasnt logical unless you were thinking like a programmer. The downside: some tasks would freeze in mid task and that was a recurring problem. The freeze would sometimes trash that participants file. THe help desk was...not helpful. Let me say that w e bought a turn key system from them; a laptop and the software and we installed no other apps on this system. After a lot of back and forth, they admitted to us that their system would never be failsafe on the hardware they sold us and so they suggested that the solution was to buy an all new system. Our response was to punt. I would say that they were very pleasant and tried to be helpful but for the licensing cost (not small) we felt we were 60%? 7-% satisfied. 

Your question contains links to the best sources. The tests will come with detailed Manuals. If you don't have a budget to purchase, then try contacting a Pearson Clinical representative; I know they want to facilitate research/publications regarding their products.

Another good source would be the Mental Measurements Yearbook, published by the Buros Institute. Your library may have a subscription; otherwise, you have to pay about $15 US per article. These are commissioned reviews by assessment experts. I know they published one about the Cambridge Prospective Memory Test in 2005, and I think the most recent review of the Rivermead was in 2008.

Hi Lara,

thank you very much for all the Information! It is very helpful!

Regards,

Sarah

@ jetty: Thank you too much for the important links mentioned above. The most NPH detailed was the third one which is giving precious comprehensive knowledge.

The problem is that the different testings available at the time being are crude and not sensitive enough to achieve optimal CSF pressure adjustment without possibility of serious risks. So most neurosurgeons would rationally prefer some under drainage which is safer. This compromise is not the optimal treatment as patients might suffer significant symptoms when adjusted above optimal. The dynamic changing nature of CSF is another problem they are facing. It looks as if the optimal point is escaping easily from them in some patients. Optimal adjustment would also logically help to prolong shunt life.

I am not denying the great researches which are going on to improve hydrocephalus understanding and management. Hydrocephalus researchers and experts have used to declare these problems and controversies very frankly and honestly. I am trying to share.

Dear Beatrice, 

Thank you very much for your answer. I want to test Y Maze, and Morris Maze ? 

How much time needed to separate between the two tests in aged mice ?

My e-mail is cecisierrae@live.com.mx

I'll join if it's possible, thank you

Trail Making Test B

the components of executives functions well as long-term episodic memory are not sufficiently contemplated no CAT3 . The instrument 's sensitivity to these cognitive functions is low and the atlhete can easily return to the cognitive base level. The evaluation through reaction time tests as well as larger list of words and Stroop test could provide more information.

thank you to everybody: the discussion has been pleasant; I could take advantage of many contributions, Mauro

Hi, maybe this can help:

Article: Neuropsychological Test Performance in Cognitively Normal Spanish-speaking Nonagenarians with Little Education

Elizabeth Guerrero-Berroa · James Schmeidler · Henriette Raventos · Daniel Valerio · Michal Schnaider Beeri · José R. Carrión-Baralt · Lara Mora-Villalobos · Patricia Bolaños · Mary Sano · Jeremy M. Silverman

Article: Heritability of cognitive functions in families of successful cognitive aging probands from the Central Valley of Costa Rica

Tiffany A Greenwood · Michal S Beeri · James Schmeidler · Daniel Valerio · Henriette Raventós · Lara Mora-Villalobos · Karla Camacho · José R Carrión-Baralt · Gary Angelo · Laura Almasy · Mary Sano · Jeremy M Silverman

To the best of my knowledge as a former EEG researcher, the EEG does not produce a reliable way to measure anxiety. As you may know, the EEG reflects only that part of the brain's electrical functioning that can cross the rather nonconductive skullbone. In addition, it reflects only a weak vector summation of millions of synapses. Finally, the signal is masked by the blood vessels of the head, large and small, which conduct various electrical signals (including Alpha waveforms) much better than bone due to their being filled with blood, which is electrically conductive due to its salt content.

While there is much controversial or fringe research that shows various EEG effects as a result of meditation, anxiety, and even thinking and task-solving, none of this research, to the best of my knowledge, is part of accepted medical knowledge. It cannot as yet be considered fact.

If you want a reliable measure of anxiety, you cannot do better than the State-Trait Anxiety Inventory for Adults (STAI Form Y), available at http://www4.parinc.com/Products/Product.aspx?ProductID=STAI . This is an accepted psychological instrument, having itself been validated in various human populations.

Research involving a measurement of anxiety that is based only on EEG readings may have only limited acceptance due to its dependence on the unreliability and lack of validation of the EEG as a measure of anxiety, to the best of my knowledge.

Olá Almir,

Look these papers which I sent to you. I think that you should find your response.

I hope this helps.

Dear Dr. Cheke and Dear Dr. Goettems-Bastos, 

Many thanks for your recommendations. I think that these papers will bew very useful to our purposes.

Best wishes, Esteve

thank youuuuuuuuuu

You may want to consider regressing  T1-T2 and T1+T2  for the two groups and test whether the slopes are significantly different.  Regressing T1-T2 with T1 has some inherent bias. See the article by Bland and Altman (1995) in Lancet: "Comparing methods of measurement: why plotting difference against standard method is misleading"

excellent Beatrice!! thanks!!

It seems unlikely, from a common sense point of view, from an evolutionary perspective, and from learning theoretical considerations, that the attenuation of the CS1 - UCS bond should affect the association between CS2 and UCS. If the first loses its predictive value, why should the second lose it as well? That would impair the organism's adaptation. Only if CS2 (plus context) resembles CS1 (plus context), or is otherwise related to CS1, it may lose somewhat of its predictive value.

Fernando, thanks for the references.

I have used a task of right-left orientation clinically for many years that I developed based on a British test using schematic human figures in four different orientations, half inverted, half upright, facing either forward or backward and holding a "large blue ball" in one hand only.  This task requires mental rotation and is described in my article in Developmental Neuropsychology, which I've attached in case it may prove of interest to you and your work.  Tom Snyder. 

Don't forget about a detailed clinical interview (i.e. assessing pre-morbid functioning and ADL decilne), interview of significant other, and a review of existing medical records. These are essential in the assessment process.

Ruling out emotional factors is also important in these types of evaluations.

We use a four hour battery that includes many of the above mentioned measures as well as an IQ measure, motor testing, and more detailed domain specific measures similar to those found in the RBANS that vary in complexity.

When time is a factor, such as on inpatient settings we often use the MOCA, RBANS, TMT, BNT, FAS+Animals, and a short emotional screener.

Well, I do not think it is possible, the full suite requires an usb key. Some simplier mental test runs in iPad.

Anyway, I purchased a Toshiba wt310 tablet (Core i5), it is all OK, except the occasional muted sound, which must be a docking problem.

I think you should not apply the test so early. Students don´t have to rebember nothing about it. I worked in a neuropsychology center and we applied the corresponding test once a year or more. Or when the patient had reach his goals. We never had any problem.

Dear Alexabdre,

You can ask it from E-mail: e.vandenberg-6@umcutrecht.nl

who wrote the paper:

The Brixton Spatial Anticipation Test as a test for executive function: Validity in patient groups and norms for older adults

ESTHER VAN DEN BERG et al. 2009

Correspondence and reprint requests: Esther van den Berg, University Medical Center Utrecht, Department of Neurology G03.228, P.O. Box 85500, 3508 GA Utrecht, The Netherlands. E-mail: e.vandenberg-6@umcutrecht.nl

You can try CANTAB - the tests are language-independent. An evaluation version of the tests is available on the web page. I suggest Spatial Working Memory test.

I believe Richard Frederick PhD in Missouri has that data.

There is also a Persian version of the NUCOG, our cognitive screening tool - I'd be happy to forward our validation paper or put you in touch with the author. 

Dear Roxana

As you know, during the memory procedure, some changes will occur in synaptic transmission in some brain areas which lead to increasing (or sometime decreasing) the activity of synapses, a process named synaptic plasticity. Occurance of synaptic plasticity, especiallt in the form of long-term potentiation (LTP)  is a necessary phenomenon in learning and memory.

When epileptic seizures happen, the hyperactivity of neural circuits will lead to a kind of synaptic plasticity in glutamatergic synapses which increases the synaptic strength. This kind of plasticity (which leads to increase in synaptic strength) is a kind of synaptic potentiation. Thus, in epileptic patients, the synapes are very potentiated, so that it is very difficult to induce a new LTP during learning and memory. Therefore, in these patients, the occurance of LTP is very difficult and this will result to impairement of LTP induction. Impairement of LTP induction will results to memory impairement per se. On the other hand, in epileptic patients, the synapses are so saturated that cannot undergo new potentiation. This is why memory function in epileptic patients is not similar to normal persons.

Of course, we have notice that some antiepileptic drugs can also affect learning and memory.

"For example, the symptom of impulsivity can be independently observed as an increase in commission errors."

Is there validation that the increase in commission errors in a neuropsych test is linked to the observed impulsive behaviors of the ADHD patient? If the behavior is observed to occur, what added value do you get from the test? If the patient is able to perform the test, does that negate the observation of behavior? And if someone is willing to be deceptive in reporting behavior, would they also be able to deceive on the test?

MANY TESTS THAT PRESUMABLY MEASURE "NON-VERBAL" INTELLIGENCE HAVE POOR REFERENCE POINTS, AND DO NOT CORRELATE WELL WITH RECOGNIZED "GENERAL ABILITY" MEASURES SUCH AS THE WECHSLER SCALES. THEREFORE, IT IS VERY DIFFICULT TO BE CONFIDENT ABOUT WHAT YOU ARE MEASURING. THAT SAID, THE RAVEN'S PROGRESSIVE MATRICES ARE ARGUABLY THE BEST MEASURE OF "g." THEY ARE AVAILABLE IN CHILD, ADULT, AND ADVANCED VERSIONS, SOLD BY A PUBLISHER IN THE UK. IMHO, THIS IS YOUR BEST BET; IT IS ALSO PRESUMABLY "CULTURE FREE," BUT I'M NOT SURE HOW THAT IS ESTABLISHED IF "TEST TAKING" IN GENERAL IS NOT PART OF ONE'S CULTURE.

AGAIN IMHO, I'M NOT SURE THAT "IQ" IS "THE" VARIABLE OF INTEREST IN EPILEPSY. I'M ASSUMING THAT YOU ARE EQUATING "NON-VERBAL" WITH NOT ORALLY EXPRESSIVE - A TEST THAT DOES NOT REQUIRE AN ACTIVE VERBAL REPLY. HOWEVER, THIS CAN BE MISLEADING, SINCE PEOPLE OFTEN USE VERBAL THINKING TO SOLVE PROBLEMS, EVEN WHEN NOT VERBALIZING A REPLY; STUDIES HAVE SHOWN THAT IN THE ABSENCE OF AN ACTIVE VERBAL REPLY, LANGUAGE NETWORKS ARE ACTIVATED ANYWAY; SIMILARLY, IT HAS BEEN DEMONSTRATED THAT ON WORD LIST LEARNING TASKS, THE BEST LEARNERS ACTIVATE ANTERIOR RIGHT HEMISPHERE BRAIN REGIONS. . MOST IQ TESTS HAVE SEVERAL/MANY SUBTESTS, AND THESE SUBTESTS ALMOST ALWAYS REQUIRE MULTIPLE COMPONENT COGNITIVE PROCESSES AND ACTIVATE WHATEVER BRAIN NETWORKS ARE REQUIRED, DEPENDENT UPON TASK DEMANDS. I AM TEMPTED TO THINK THAT IN SEIZURE DISORDERS, WITH A SPECIFIC FOCUS OF IMPAIRMENT, SELECTIVE BRAIN NETWORKS WOULD BE AFFECTED, SO INTELLIGENCE TEST SUBTESTS WILL NOT NECESSARILY SOLVE THE PROBLEM OF IDENTIFYING SPECIFIC REGIONAL NETWORK INVOLVEMENT.  YOUR BEST MEASURES MIGHT BE THOSE TESTS THAT ARE RELATIVELY "PURE," THOSE MEASURES THAT ARE INTERPRETED AS PATHOGNOMONIC SIGNS, OR PERHAPS THOSE TESTS WITH A SKEWED DISTRIBUTION, THOSE THAT DO NOT FOLLOW THE PERFORMANCE DISTRIBUTION OF A "BELL-SHAPED CURVE."  SEE LEZAK, ALMOST ANY EDITION, FOR FURTHER EXPLANATION. THIS WILL BE FOUND IN THE "BASIC CONCEPTS" CHAPTERS OF THE BOOK. - LK

Why did the patient start failing? did he forget the instructions? (then maybe memory is involved) Is he uncapable of inhibiting behaviour when he is not directly focused on doing so? How many time is allowed for him to respond? It's not the same when you have to act immediatly after the instruction than when you have some time to prepare. The meaning of behaviour is not the same, as other variables affect (e.g. speed of processing and psychomotor speed)

As far as I understand from your text is that the paper by Dubois states that 4 consecutive imitations = 0 score, so there you have your report.

What I wonder is why 3 errors are considered more impaired than 2 errors. I suppose that scaling scores is intended for grading severity, but I think that this kind of tests are usually performed close to ceiling, so any one or two errors indicate impairment. Does three errors reflect more inhibition impairments than two errors? Is it not reflected on daily behavior?

Dear Natasha,

Have you ever thought of performing a linear regression to find out how much each of the tasks load on the total score? It would be interesting to get those data and provide a simple algorithm for other researchers. Best.

There are many issues with using the MMSE as an outcome measure. First and foremost, if you are collecting multiple time points (e.g., pre, post, etc.), the MMSE has horrific practice effects. Scores will increase, particularly with relatively healthy older adults, simply by remembering the 30 items on the test. For example, it would not be uncommon to have an older adult in clinic tell you they went home and practiced WORLD backwards or serial 7s. They'll also practice all of the orientation questions with a caregiver/spouse on the way in. Finally, there are so many issues with with loading towards verbal strengths and not enough executive functioning assessment. I would stay away from it unless you are interested in a quick and dirty global functioning assessment. If you cannot construct a quick 30-40 minute neuropsych screening/assessment battery, I would recommend something a bit more comprehensive than the MMSE, such as the MOCA or Kokmen. Just my 2...

In Germany, testing on a computer is reimbursable.

Another test would be the TOMAL-R (Test of memory and learning) which has various verbal memory tasks. Also, some substest of the Woodckock Johnson Psychoeducational Battery. Finally, verbal reasoning from the FAVRES could be of use for some fucntional verbal problem solving... plus the BRIEF. The total loss of vision is not so frequent after a TBI. Is this due to bilateral damage to the primary visual cortex?

It is a great how hard question. For instance, we are working to developing a basic test for the evaluation of the memory / cognition of the space (Caffò et al. 2012 AJAAD, DOI: 10.1177/1533317512452035). We considered Petersen's criteria too strict at least for the people we work with, often with a very low level of education. For the definition of aMCI we established that at least two memory tests should be impaired. For the diagnosis of naMCI was necessary that at least two neuropsychological, not memory, tests showed to be impaired (usually those pertaining the area of ​​executive functions). For the diagnosis of multiple domains we set a criterion of four tests impaired. Obviously, any strategy seems to be too little or too severe. We had the feeling that even when patients failed to neuropsychological tests, their performance in daily activities wasn't so compromised. We also became convinced that major markers are those that indicate a change in habits: "I ​​do not drive anymore because I get lost in the streets", "I do not play more cards because I forget my previous hands." In other words, I believe that a well-motivated group of researchers could build a test/interview able to capture the change in daily life, before the deterioration is blown.