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Objective: Neuropsychological testing has traditionally been performed on site using standardized paper-pencil tests. Online platforms now offer the potential of conducting such testing at home but requires validation before widespread use. In this pilot study with healthy adults, we examine the convergent validity of the newly developed test battery Mindmore Remote.

Method: Fifty-two healthy participants were tested using both Mindmore Remote at home and traditional neuropsychological testing on site. The order of presentation was randomized. Associations between test performance on the two batteries were compared using Pearson and Spearman correlations.

Results: Results revealed significant correlations between all Mindmore Remote tests and traditional tests. Verbal tests showed stronger correlations (r = .71–.83) than non-verbal tests (r = .48–.71). Further, correlations were stronger for users who made responses using a computer mouse than for touch pad users.

Conclusions: Mindmore Remote tests that rely on verbal in-and output were comparable to traditional face-to-face neuropsychological tests. However, although promising, further validation is needed for tests that require visuo-motor interaction. In comparison with similar studies, the results indicate that test modification, rather than remote administration, is accountable for weaker correlations.

Background: Neuropsychological assessment traditionally requires physical meetings where patients meet psychologists on site at a clinic. This procedure may pose logistical challenges, for instance when patients are less mobile, or in sparsely populated areas where the distance to healthcare facilities may be considerable. Digital tests for remotely assessing cognitive functions may provide invaluable tools in these situations but need to be validated.

Objective: We aim to investigate to what degree the tests in a remote digital neuropsychological test-battery (Mindmore Remote) correspond to traditional neuropsychological tests.

Method: Fifty-two healthy participants between ages 19 and 89 years underwent both traditional neuropsychological testing procedures on site and remote testing on a computer at home. To avoid sequence effects, the order of testing (traditional / digital) was randomized. The tests examined (1) processing speed, (2) visual-scanning and attention, (3) visual short-term and working memory, (4) verbal learning, (5) episodic memory, (6) verbal production, (7) inhibition, and (8) cognitive flexibility. Associations between traditional and digital versions were assessed by correlations.

Results: Significant positive correlations were found for all tests. The strength of the relationship between the remote and traditional tests ranged from r = .36 to r = .83 in the following order: visual working memory (r = .36), visual short-term memory (r = .40), visual scanning (r = .45), visuomotor speed (r = .59), inhibition (r = .62), visual attention and processing speed (r = .65), cognitive flexibility (r = .71), verbal learning (r = .71), verbal production (r = .78) and episodic memory (r = .81-.83).

Conclusion: Several of the remote digital tests have the potential to be used in neuropsychological assessment. However, relatively weak relationships between tests that requires motor responses warrants further investigations before clinical implementation.

Gender differences in pain reporting and prevalence have been demonstrated. As gender of examiner also affects reporting of pain on palpation, the aim of this study was to evaluate the effects of examiner gender on palpation performance using three different palpation methods. Examiners of both genders were instructed on the correct technique for each palpation method by either a female or male instructor. The target was to achieve a pressure of 100 kPa, corresponding to the 1 kg of force for muscle palpation described in the diagnostic criteria for temporomandibular disorders (DC/TMD). All examiners performed traditional palpation with the index finger, palpation with a palpometer, and a novel bimanual palpation with visual feedback, in a randomized order. The examiner's gender, and its interaction with the gender of the instructor did not significantly affect magnitude, accuracy, or precision of the pressure applied. The method of palpation was the only factor that significantly impacted all metrics. The palpometer achieved the lowest palpation magnitude (mean pressure applied = 113.7  kPa, 95% CI: 109.8-117.6), the highest accuracy (absolute difference = 15.7  kPa, 95% CI: 12.3-19.1), and the highest precision (mean coefficient of variation = 6.8, 95% CI: 6.0-7.6), followed by bimanual palpation and traditional palpation. The results suggest that gender differences in pain reporting in patients are not likely to be a result of the technical aspects associated with the gender of the examiner. Instead, these differences may be attributed to other factors, such as sociocultural influences.

Background: Olfactory dysfunction together with neurological and cognitive symptoms are common after COVID-19. We aimed to study whether performance on olfactory and neuropsychological tests following infection predict post-COVID condition (PCC), persisting symptoms, and reduced health-related quality of life.

Methods: Both hospitalized (N = 10) and non-hospitalized individuals (N = 56) were enrolled in this prospective cohort study. Participants were evaluated 1–3 months after infection with an olfactory threshold test and neuropsychological tests, which was used as predictors of PCC. A questionnaire outlining persisting symptoms and the validated instrument EuroQol five-dimension five-level for health-related quality of life assessment were used as outcome data 1 year after infection (N = 59). Principal component analysis was used to identify relevant predictors for PCC at 1 year.

Results: Objectively assessed olfactory dysfunction at 1–3 months post infection, but not subjective olfactory symptoms, predicted post-COVID condition with reduced health-related quality of life (PCC+) at 1 year. The PCC+ group scored more often below the cut off for mild cognitive impairment on the Montreal Cognitive Assessment (61.5% vs. 21.7%) and higher on the Multidimensional Fatigue Inventory-20, compared to the group without PCC+.

Conclusion: Our results indicate that objectively assessed, olfactory dysfunction is a predictor for PCC+. These findings underscore the importance of objective olfactory testing. We propose that olfactory screening in the early post-acute phase of COVID-19 infection might identify individuals that are at higher risk of developing long-term health sequalae.

Introduction: There are great potential benefits of being able to conduct neuropsychological assessments remotely, especially for hard-to-reach or less mobile patient groups. Such tools need to be equivalent to standard tests done in the clinic and also easy to use in a variety of clinical populations.

Methods and analysis: This study protocol describes a cross-sectional study aimed at validating the newly developed digitalized neuropsychological test battery Mindmore Remote in patients with neurological disorders and injuries. Diagnoses comprise traumatic brain injury, stroke, Parkinson’s disease, multiple sclerosis, brain tumour and epilepsy. 50 patients in each patient group will be included. In addition, 50 healthy controls will be recruited. All participants will undergo both testing with Mindmore Remote at home and traditional neuropsychological assessment face-to-face in a randomised order. The primary outcome is the association between tests from the Mindmore Remote battery and their equivalent traditional neuropsychological tests. Further, bias between methods and differences between groups will also be investigated.

Ethics and dissemination: The study protocol has been approved by the Swedish Ethical Review Authority (2022-06230-01) and adheres to the declaration of Helsinki. All participants will be given oral and written information about the study and sign informed consent forms before entering the study. All participants are informed that they can terminate their participation in the study at any given time, without giving any explanation, and participating in the study or not will not affect their care at the clinic. Neither authors nor personnel involved in the research project are affiliated with Mindmore AB. The results from the study will be published in peer-reviewed scientific journals and presented at national and international conferences on the topic.

Trial registration number: NCT05819008.

The evidence for differences between women and men in terms of olfactory abilities is contradictory. We analyzed women and men's performance and reactions to a wider range of odour exposure outcomes than usually studied, to assess possible differences and similarities between sexes. Measures of sensitivity and sensory decision rule were established in 37 women and 39 men. Perceptual, cognitive, symptom-related and autonomic nervous system (skin conductance level and heart-rate variability) reactions were also assessed during extended ambient odour exposure, as well as participants' self-rated chemical intolerance. Bayesian analyses consistently revealed greater support for sex-related similarities than differences, suggesting that women and men perform and react comparably not only in terms of basic olfactory measures, but also to environmental odour exposure mimicking everyday situations.

Objective: To investigate the effects of sustained mental activity on perceptions of mental fatigue, cognitive performance, and autonomic response in patients with clinical burnout as compared to a healthy control group.

Methods: Patients with clinical burnout (n = 30) and healthy control participants (n = 30) completed a 3-hour test session, in which they were administered a set of cognitive tests before and after an effortful cognitive task with concurrent sound exposure. Perceptions of mental fatigue and task demands (mental effort and concentration difficulties) were assessed repeatedly over the course of the test session. Heart rate variability was recorded to index autonomic response.

Results: In comparison with controls, perceived mental fatigue increased earlier in the session for the clinical burnout group and did not recover following a short rest period. Throughout the session, patients rated the tasks as more demanding and showed less improvement on measures of attention and processing speed, inhibition and working memory. While autonomic responses were initially comparable, there was a unique decrease in high-frequency heart rate variability in the clinical burnout group after extended testing and exposure.

Conclusion: Patients with clinical burnout are affected differently than healthy controls by sustained mental activity, as reflected by ratings of perceived mental fatigue, aspects of cognitive performance and autonomic response. Further investigation into the role of autonomic regulation in relation to cognitive symptoms in clinical burnout is warranted.

Background: Multiple chemical sensitivity (MCS) is characterized by widespread symptoms attributed to exposure to airborne chemicals. MCS is categorized as a functional somatic syndrome (FSS), and MCS cases often meet the criteria for other types of FSS, e.g. fibromyalgia. The primary aim was to characterize MCS regarding symptom triggers, symptoms, lifestyle and describe demographics, socioeconomics and lifestyle factors associated with MCS. A secondary aim was to examine the implication of FSS comorbidity.

Methods: Data were derived from a random sample of the Danish adult population enrolled in the Danish Study of Functional Disorders (DanFunD; n = 9,656). Questionnaire data comprised information used to delimit MCS and four additional types of FSS, as well as data on demographics, socioeconomics and lifestyle. MCS cases (n = 188) was stratified into subgroups; MCS only (n = 109) and MCS with comorbid FSS (n = 73). Information regarding FSS comorbidities were missing for six MCS cases. MCS subgroups and controls without FSS comorbidities (n = 7,791) were compared by means of logistic regression analyses, adjusted for age and sex.

Results: MCS was associated with female sex, not being in occupation and low social status, but not with age or education. MCS cases reported normal dietary intake and smoking habits and lower alcohol consumption. Additional associations were found between MCS and low rate of cohabitation, sedentarism, daily physically limitations, and poor quality of sleep. However, subgroup analysis revealed that these findings were primarily associated with MCS with comorbid FSS.

Conclusions: MCS was associated with lower socioeconomic status, physically inactivity and poor quality of sleep. Subgroup analysis revealed that several associations was explained by FSS comorbidity, i.e. MCS cases with no comorbid FSS showed normal rate of cohabitation and did not report physical limitations or difficulties sleeping. Overall, our findings emphasise the importance of screening MCS cases for FSS comorbidity both in epidemiological and clinical settings.

Chemical intolerance is a surprisingly prevalent condition or affliction characterized by adverse reactions to low levels of chemical, often odorous stimulation. Sufferers often assume that their plight is due to an uncommon sensory acuteness, yet studies repeatedly fail to reveal altered detection thresholds. Here, we investigated whether self-reported chemical intolerance is associated with altered sensory sensitivity or response bias. The sensory acuity (sensitivity; A) and sensory decision rule (criterion; B) to n-butanol was assessed using the method of constant stimuli in 82 participants with different degrees of chemical intolerance (low to high). Higher self-reported chemical intolerance was associated with a lower criterion, but not with sensitivity.

Judging two events in combination (A&B) as more probable than one of the events (A) is known as a conjunction fallacy. According to dual-process explanations of human judgment and decision making, the fallacy is due to the application of a heuristic, associative cognitive process. Avoiding the fallacy has been suggested to require the recruitment of a separate process that can apply normative rules. We investigated these assumptions using functional magnetic resonance imaging (fMRI) during conjunction tasks. Judgments, whether correct or not, engaged a network of brain regions identical to that engaged during similarity judgments. Avoidance of the conjunction fallacy additionally, and uniquely, involved a fronto-parietal network previously linked to supervisory, analytic control processes. The results lend credibility to the idea that incorrect probability judgments are the result of a representativeness heuristic that requires additional neurocognitive resources to avoid.