An ecologically valid examination of event-based and time-based prospective memory using immersive virtual reality: The influence of attention, memory, and executive function processes on real-world prospective memory.

Studies on prospective memory (PM) predominantly assess either event- or time-based PM by implementing non-ecological laboratory-based tasks. The results deriving from these paradigms have provided findings that are discrepant with ecologically valid research paradigms that converge on the complexity and cognitive demands of everyday tasks. The Virtual Reality Everyday Assessment Lab (VR-EAL), an immersive virtual reality (VR) neuropsychological battery with enhanced ecological validity, was implemented to assess everyday event- and time-based PM, as well as the influence of other cognitive functions on everyday PM functioning. The results demonstrated the role of delayed recognition, planning, and visuospatial attention on everyday PM. Delayed recognition and planning ability were found to be central in event- and time-based PM respectively. In order of importance, delayed recognition, visuospatial attention speed, and planning ability were found to be involved in event-based PM functioning. Comparably, planning, visuospatial attention accuracy, delayed recognition, and multitasking/task-shifting ability were found to be involved in time-based PM functioning. These findings further suggest the importance of ecological validity in the study of PM, which may be achieved using immersive VR paradigms.

An Investigation of the Validity of the Edinburgh Social Cognition Test (ESCoT) in Acquired Brain Injury (ABI).

OBJECTIVES: Social cognition is frequently impaired following an acquired brain injury (ABI) but often overlooked in clinical assessments. There are few validated and appropriate measures of social cognitive abilities for ABI patients. The current study examined the validity of the Edinburgh Social Cognition Test (ESCoT, Baksh et al., ) in measuring social cognition following an ABI. METHODS: Forty-one patients with ABI were recruited from a rehabilitation service and completed measures of general ability, executive functions and social cognition (Faux Pas; FP, Reading the Mind in the Eyes; RME, Social Norms Questionnaire; SNQ and the ESCoT). Forty-one controls matched on age, sex and years of education also performed the RME, SNQ and ESCoT. RESULTS: A diagnosis of ABI was significantly associated with poorer performance on all ESCoT measures and RME while adjusting for age, sex and years of education. In ABI patients, the ESCoT showed good internal consistency with its subcomponents and performance correlated with the other measures of social cognition demonstrating convergent validity. Better Trail Making Test performance predicted better ESCoT total, RME and SNQ scores. Higher TOPF IQ was associated with higher RME scores, while higher WAIS-IV working memory predicted better FP performance. CONCLUSIONS: The ESCoT is a brief, valid and internally consistent assessment tool able to detect social cognition deficits in neurological patients. Given the prevalence of social cognition deficits in ABI and the marked impact these can have on an individual's recovery, this assessment can be a helpful addition to a comprehensive neuropsychological assessment.

Learning with friends and strangers: partner familiarity does not improve collaborative learning performance in younger and older adults.

Collaborative learning with a familiar partner can reduce age-related differences in learning and memory compared to learning alone. This study compares younger and older adults' learning with familiar and unfamiliar partners to determine whether familiarity is beneficial for collaborative learning. Twenty-four younger adults aged 18-28 years and 24 older adults aged 60-80 years participated in familiar and unfamiliar pairs. Participants were asked to arrange abstract tangram shapes in a specific order on a grid over multiple trials; the directors' tangram cards were arranged in a specific order on the grid and this order was communicated to the matcher. Older adults initially took longer to complete the task, using more words to correctly arrange the tangrams. Over multiple trials, a learning effect was observed in both groups, although older adults did not perform with similar efficiency to younger adults. Familiarity had no effect on performance. These findings suggest that the familiarity of a partner does not affect learning outcomes in younger or older adults when learning in a social context. Collaborative learning may be beneficial for older adults, even if they do not know their learning partner, which may have implications for adult education and lifelong learning.

Validation of the Virtual Reality Everyday Assessment Lab (VR-EAL): An Immersive Virtual Reality Neuropsychological Battery with Enhanced Ecological Validity.

OBJECTIVE: The assessment of cognitive functions such as prospective memory, episodic memory, attention, and executive functions benefits from an ecologically valid approach to better understand how performance outcomes generalize to everyday life. Immersive virtual reality (VR) is considered capable of simulating real-life situations to enhance ecological validity. The present study attempted to validate the Virtual Reality Everyday Assessment Lab (VR-EAL), an immersive VR neuropsychological battery, against an extensive paper-and-pencil neuropsychological battery. METHODS: Forty-one participants (21 females) were recruited: 18 gamers and 23 non-gamers who attended both an immersive VR and a paper-and-pencil testing session. Bayesian Pearson's correlation analyses were conducted to assess construct and convergent validity of the VR-EAL. Bayesian t-tests were performed to compare VR and paper-and-pencil testing in terms of administration time, similarity to real-life tasks (i.e., ecological validity), and pleasantness. RESULTS: VR-EAL scores were significantly correlated with their equivalent scores on the paper-and-pencil tests. The participants' reports indicated that the VR-EAL tasks were significantly more ecologically valid and pleasant than the paper-and-pencil neuropsychological battery. The VR-EAL battery also had a shorter administration time. CONCLUSION: The VR-EAL appears as an effective neuropsychological tool for the assessment of everyday cognitive functions, which has enhanced ecological validity, a highly pleasant testing experience, and does not induce cybersickness.

An ecologically valid examination of event-based and time-based prospective memory using immersive virtual reality: the effects of delay and task type on everyday prospective memory.

Recent research has focused on assessing either event- or time-based prospective memory (PM) using laboratory tasks. Yet, the findings pertaining to PM performance on laboratory tasks are often inconsistent with the findings on corresponding naturalistic experiments. Ecologically valid neuropsychological tasks resemble the complexity and cognitive demands of everyday tasks, offer an adequate level of experimental control, and allow a generalisation of the findings to everyday performance. The Virtual Reality Everyday Assessment Lab (VR-EAL), an immersive virtual reality neuropsychological battery with enhanced ecological validity, was implemented to comprehensively assess everyday PM (i.e., focal and non-focal event-based, and time-based). The effects of the length of delay between encoding and initiating the PM intention and the type of PM task on everyday PM performance were examined. The results revealed that everyday PM performance was affected by the length of delay rather than the type of PM task. The effect of the length of delay differentially affected performance on the focal, non-focal, and time-based tasks and was proportional to the PM cue focality (i.e., semantic relationship with the intended action). This study also highlighted methodological considerations such as the differentiation between functioning and ability, distinction of cue attributes, and the necessity of ecological validity.

Executive Functions do not Underlie Performance on the Edinburgh Social Cognition Test (ESCoT) in Healthy Younger and Older Adults.

OBJECTIVE: Current measures of social cognition have shown inconsistent findings regarding the effects of executive function (EF) abilities on social cognitive performance in older adults. The psychometric properties of the different social cognition tests may underlie the disproportional overlap with EF abilities. Our aim was to examine the relationship between social cognition and EF abilities using the Edinburgh Social Cognition Test (ESCoT; Baksh, R.A., Abrahams, S., Auyeung, B., & MacPherson, S.E. (2018). The Edinburgh Social Cognition Test (ESCoT): Examining the effects of age on a new measure of theory of mind and social norm understanding. PloS One, 13(4), e0195818.), a test assessing four different aspects of social cognition: cognitive theory of mind (ToM), affective ToM, interpersonal understanding of social norms, and intrapersonal understanding of social norms. METHOD: We administered the ESCoT, EF measures of inhibition, set shifting, updating, and a measure of processing speed to 30 younger and 31 older adults. We also administered the Visual Perspective Taking task (VPT) as a ToM test thought to be reliant on EF abilities. RESULTS: Better performance on cognitive ToM was significantly associated with younger age and slower processing speed. Better performance on affective ToM and ESCoT total score was associated with being younger and female. Better performance on interpersonal understanding of social norms was associated with being younger. EF abilities did not predict performance on any subtest of the ESCoT. In contrast, on the VPT, the relationship between age group and performance was fully or partially mediated by processing speed and updating. CONCLUSIONS: These findings show that the ESCoT is a valuable measure of different aspects of social cognition and, unlike many established tests of social cognition, performance is not predicted by EF abilities.

Cognitive Reserve Proxies Do Not Differentially Account for Cognitive Performance in Patients with Focal Frontal and Non-Frontal Lesions.

OBJECTIVE: Cognitive reserve (CR) suggests that premorbid efficacy, aptitude, and flexibility of cognitive processing can aid the brain's ability to cope with change or damage. Our previous work has shown that age and literacy attainment predict the cognitive performance of frontal patients on frontal-executive tests. However, it remains unknown whether CR also predicts the cognitive performance of non-frontal patients. METHOD: We investigated the independent effect of a CR proxy, National Adult Reading Test (NART) IQ, as well as age and lesion group (frontal vs. non-frontal) on measures of executive function, intelligence, processing speed, and naming in 166 patients with focal, unilateral frontal lesions; 91 patients with focal, unilateral non-frontal lesions; and 136 healthy controls. RESULTS: Fitting multiple linear regression models for each cognitive measure revealed that NART IQ predicted executive, intelligence, and naming performance. Age also significantly predicted performance on the executive and processing speed tests. Finally, belonging to the frontal group predicted executive and naming performance, while membership of the non-frontal group predicted intelligence. CONCLUSIONS: These findings suggest that age, lesion group, and literacy attainment play independent roles in predicting cognitive performance following stroke or brain tumour. However, the relationship between CR and focal brain damage does not differ in the context of frontal and non-frontal lesions.

Individual differences in cognitive processes underlying Trail Making Test-B performance in old age: The Lothian Birth Cohort 1936.

The Trail Making Test Part B (TMT-B) is commonly used as a brief and simple neuropsychological assessment of executive dysfunction. The TMT-B is thought to rely on a number of distinct cognitive processes that predict individual differences in performance. The current study examined the unique and shared contributions of latent component variables in a large cohort of older people. Five hundred and eighty-seven healthy, community-dwelling older adults who were all born in 1936 were assessed on the TMT-B and multiple tasks tapping cognitive domains of visuospatial ability, processing speed, memory and reading ability. Firstly, a first-order measurement model examining independent contributions of the four cognitive domains was fitted; a significant relationship between TMT-B completion times and processing speed was found (ß = -0.610, p < .001). Secondly, a bifactor model examined the unique influence of each cognitive ability when controlling for a general cognitive factor. Importantly, both a general cognitive factor (g; ß = -0.561, p < .001) and additional g-independent variance from processing speed (ß = -0.464, p < .001) contributed to successful TMT-B performance. These findings suggest that older adults' TMT-B performance is influenced by both general intelligence and processing speed, which may help understand poor performance on such tasks in clinical populations.

Corrigendum to Correlational structure of 'frontal' tests and intelligence tests indicates two components with asymmetrical neurostructural correlates in old age Intelligence 46 (2014) 94-106.

[This corrects the article DOI: 10.1016/j.intell.2014.05.006.].

Theory of mind and the Ultimatum Game in healthy adult aging.

BACKGROUND: The Ultimatum Game assesses decision-making involved in cooperative interactions with others. However, little is known about the role that the ability to understand other people's intentions plays in these interactions. METHODS: This study examined performance on the Ultimatum Game and theory of mind (ToM) tasks in younger and older adults. RESULTS: Age differences were not found on the ToM tasks, and a lack of variability in performance prevented analyses of the relationships between performance on the Ultimatum Game and ToM. However, age differences were found on the Ultimatum Game, with older adults accepting more unfair offers. Yet, the two age groups did not differ in their appreciation of fairness, as assessed using subjective fairness ratings. CONCLUSIONS: These findings suggest that older adults are more rational in their behavior, accepting unfair offers even when they know they are unfair, as it is in their self-interest to accept small monetary values rather than nothing at all.

A cluster-based approach to selecting representative stimuli from the International Affective Picture System (IAPS) database.

The International Affective Picture System (IAPS; Lang, Bradley, & Cuthbert, 2008) is a stimulus database that is frequently used to investigate various aspects of emotional processing. Despite its extensive use, selecting IAPS stimuli for a research project is not usually done according to an established strategy, but rather is tailored to individual studies. Here we propose a standard, replicable method for stimulus selection based on cluster analysis, which re-creates the group structure that is most likely to have produced the valence arousal, and dominance norms associated with the IAPS images. Our method includes screening the database for outliers, identifying a suitable clustering solution, and then extracting the desired number of stimuli on the basis of their level of certainty of belonging to the cluster they were assigned to. Our method preserves statistical power in studies by maximizing the likelihood that the stimuli belong to the cluster structure fitted to them, and by filtering stimuli according to their certainty of cluster membership. In addition, although our cluster-based method is illustrated using the IAPS, it can be extended to other stimulus databases.

Volumetric and Correlational Implications of Brain Parcellation Method Selection: A 3-Way Comparison in the Frontal Lobes.

OBJECTIVE: The aims of this study were to compare distinct brain frontal lobe parcellation methods across 90 brain magnetic resonance imaging scans and examine their associations with cognition in older age. METHODS: Three parcellation methods (Manual, FreeSurfer, and Stereology) were applied to T1-weighted magnetic resonance imaging of 90 older men, aged ∼ 73 years. A measure of general fluid intelligence (gf) associated with dorsolateral frontal regions was also derived from a contemporaneous psychological test battery. RESULTS: Despite highly discordant raw volumes for the same nominal regions, Manual and FreeSurfer (but not Stereology) left dorsolateral measures were significantly correlated with gf (r > 0.22), whereas orbital and inferior lateral volumes were not, consistent with the hypothesized frontal localization of gf. CONCLUSIONS: Individual differences in specific frontal lobe brain volumes--variously measured--show consistent associations with cognitive ability in older age. Importantly, differences in parcellation protocol for some regions that may impact the outcome of brain-cognition analyses are discussed.

Limitations of the trail making test part-B in assessing frontal executive dysfunction.

Part B of the Trail Making Test (TMT-B) is one of the most widely used neuropsychological tests of "executive" function. A commonly held assumption is that the TMT-B can be used to detect frontal executive dysfunction. However, so far, research evidence has been limited and somewhat inconclusive. In this retrospective study, performance on the TMT-B of 55 patients with known focal frontal lesions, 27 patients with focal non-frontal lesions and 70 healthy controls was compared. Completion time and the number of errors made were examined. Patients with frontal and non-frontal lesions performed significantly worse than healthy controls for both completion time and the number of errors. However, there was no significant difference for both completion time and the number of errors when patients with frontal and non-frontal lesions were compared. Performance was also not significantly different between patients with focal lesions within different regions of the frontal lobe (orbital, left lateral, right lateral, medial). Our findings suggest that the TMT-B is a robust test for detection of brain dysfunction. However, its capacity for detecting frontal executive dysfunction appears rather limited. Clinicians should be cautious when drawing conclusions from performance on the TMT-B alone.

How many segments are there in an orange: normative data for the new Cognitive Estimation Task in an Italian population.

The Cognitive Estimation Test (CET) is widely used by clinicians to assess frontal executive dysfunction. In the present work, the Italian standardization of a new version of the CET is provided. This version consists of two 9-item parallel forms (A and B) that were administered to two hundred and twenty-seven healthy Italian male and female participants aged between 19 and 91 years with 5-24 years of full-time education. Performance on the CET was not related to age or level of education; both forms showed a male CET advantage. The new CET is a useful tool for clinicians and researchers to administer the CET more than once without practice effects, which is considered important when assessing frontal executive abilities.

Correlational structure of 'frontal' tests and intelligence tests indicates two components with asymmetrical neurostructural correlates in old age.

Both general fluid intelligence (gf) and performance on some 'frontal tests' of cognition decline with age. Both types of ability are at least partially dependent on the integrity of the frontal lobes, which also deteriorate with age. Overlap between these two methods of assessing complex cognition in older age remains unclear. Such overlap could be investigated using inter-test correlations alone, as in previous studies, but this would be enhanced by ascertaining whether frontal test performance and gf share neurobiological variance. To this end, we examined relationships between gf and 6 frontal tests (Tower, Self-Ordered Pointing, Simon, Moral Dilemmas, Reversal Learning and Faux Pas tests) in 90 healthy males, aged ~ 73 years. We interpreted their correlational structure using principal component analysis, and in relation to MRI-derived regional frontal lobe volumes (relative to maximal healthy brain size). gf correlated significantly and positively (.24 ≤ r ≤ .53) with the majority of frontal test scores. Some frontal test scores also exhibited shared variance after controlling for gf. Principal component analysis of test scores identified units of gf-common and gf-independent variance. The former was associated with variance in the left dorsolateral (DL) and anterior cingulate (AC) regions, and the latter with variance in the right DL and AC regions. Thus, we identify two biologically-meaningful components of variance in complex cognitive performance in older age and suggest that age-related changes to DL and AC have the greatest cognitive impact.

The dog that didn't growl: the interactional negotiation of momentary confabulations.

We examine from a discursive perspective momentary confabulations generated by patients in clinical interviews based on confabulation questionnaires. Commonly, neuropsychology treats such confabulations solely as evidence of patients' inabilities or deficits. Here we argue that patients' descriptions indicate the interaction of memory deficits with preserved interactional skills. More than this, however, patients' descriptions can be seen in part to arise out of the interviews themselves, in that the interviewer's turns (a) signal agreement rather than disagreement or challenge, and (b) lead to further development of descriptions instead of marking these out as problematic. These features mark out the clinical interviews as different from (i) everyday conversation, and (ii) other clinical settings such as the administration of verbal memory tests, and as a result the interviews allow scope for patients to develop unchallenged autobiographical narratives. Thus, ironically, interviews that rely on the standard use of confabulation questionnaires can provide settings that are especially conducive to the generation of the momentary confabulations that they aim to study.

The influence of interruptions and planning on serial everyday multitasking in older adults.

Cognitive aging research has studied the influence of healthy aging on the ability to multitask. Yet, little is known about the factors that might improve or impair serial multitasking performance in older adults. Three experiments involving younger and older adults assessed the impact of interruptions and planning on a prop-based test of multitasking. In Experiment 1, 26 younger adults and 25 older adults' multitasking abilities were assessed; older adults performed significantly more poorly than younger adults. In Experiment 2, 19 younger and 22 older adults were randomly allocated to a group who experienced a one minute unexpected interruption while multitasking or a group with no interruption. The results showed that, when there was an interruption, the age difference disappeared. In Experiment 3, 32 younger and 30 older adults were randomly allocated to a group who were given 3 minutes to write an outline describing how they intended to approach the multitasking task, and another group who were given 3 minutes to label pictures of everyday objects prior to multitasking. Again, when participants were encouraged to plan, no age difference was found. These results highlight the advantage that interruptions and planning might have on serial everyday multitasking performance in older adults.

The Associations Between Camouflaging, Autistic Traits, and Mental Health in Nonautistic Adults.

Background: Camouflaging is frequently reported in autistic people and entails the disguising of autistic traits in social situations. Camouflaging is associated with poor mental health in autistic people. This study examined the manifestation of camouflaging in a nonautistic sample, examining the relationship between autistic traits, self-reported camouflaging, gender, and mental health. Method: In total 110 nonautistic adults completed standardized self-report questionnaires that measured autistic traits, mental health symptoms, and camouflaging behaviors. Hierarchical multiple linear regression models were used to analyze data and examine the unique contributions of autistic traits and camouflaging to mental health. Results: Self-reported autistic traits were associated with increased symptoms of poor mental health. However, autistic traits were not associated with mental health symptoms when controlling for self-reported camouflaging, and self-reported camouflaging predicted increased mental health symptoms over and above the effects of autistic traits. Women had poorer mental health than men in our sample, and in women there was a stronger relationship between camouflaging and mental health than in men. Conclusions: Camouflaging may contribute to poor mental health outcomes in the general population, just as it does for autistic people, to the extent that camouflaging more clearly relates to mental health profile than self-reported autism traits. This suggests camouflaging is an important construct for understanding mental health in general, and for exploring the complex relationship between autism and autistic traits.

Why was this study done?: Some autistic individuals report trying to hide their autistic traits to blend in with others, referring to this as "camouflaging" or "masking." Many autistic people who camouflage describe it as being a very difficult and distressing process, which can be harmful to their mental health. In nonautistic people, a higher level of autistic traits is related to poor mental health. Nonautistic people have also reported camouflaging autistic traits, but we know less about whether this might also impact their mental health. What was the purpose of this study?: We did this study to find out more about the relationship between mental health and camouflaging of autistic traits in nonautistic people. What did the researchers do?: We asked 110 nonautistic adults to complete a series of questionnaires. These questionnaires asked them about their autistic traits, their camouflaging behaviors, and their mental health. We then used statistical tests to look at the relationships between autistic traits, camouflaging, gender, and mental health. What were the results of the study?: We found that people who camouflaged more had poorer mental health, including symptoms of anxiety, depression, and stress. People with more autistic traits also had poorer mental health. When we looked at both of these relationships at the same time, only camouflaging was related to poor mental health, and not autistic traits. When we also looked at gender, we found that women in our study had poorer mental health than men, and the relationship between camouflaging and mental health was stronger for women. What do these findings add to what was already known?: These findings help us understand the relationship between autistic traits and mental health by demonstrating that it may be the camouflaging of autistic traits that is related to poorer mental health. These findings also help us better understand camouflaging by showing that the negative consequences of camouflaging for mental health may apply to both autistic and nonautistic people. What are the potential weaknesses in the study?: Our study only looked at the relationship between autistic traits, camouflaging, gender, and mental health. It is possible that there are other factors our study did not investigate, such as ethnicity or sexual identity, which also play an important role. Our study also cannot tell us whether or not camouflaging is the cause of poor mental health, only that there is a relationship between camouflaging and mental health. How will these findings help autistic adults now or in the future?: By studying camouflaging in different groups and seeing what is shared and what is unique between autistic and nonautistic people, we can develop a better understanding of camouflaging. Knowledge of the mental health consequences of camouflaging can help mental health services to reduce the negative impact of camouflaging for autistic and nonautistic people. Our findings also show an important similarity between autistic and nonautistic people, showing that both groups of people may camouflage, and this negatively impacts mental health. Acknowledgment of this shared experience may help to reduce the discrimination and stigma that autistic people face.

Prosocial speech acts: Links to pragmatics and aging.

This study investigated how adults over the lifespan flexibly adapt their use of prosocial speech acts when conveying bad news to communicative partners. Experiment 1a (N = 100 Scottish adults aged 18-72 years) assessed whether participants' use of prosocial speech acts varied according to audience design considerations (i.e., whether or not the recipient of the news was directly affected). Experiment 1b (N = 100 Scottish adults aged 19-70 years) assessed whether participants adjusted for whether the bad news was more or less severe (an index of general knowledge). Younger adults displayed more flexible adaptation to the recipient manipulation, while no age differences were found for severity. These findings are consistent with prior work showing age-related decline in audience design but not in the use of general knowledge during language production. Experiment 2 further probed younger adults (N = 40, Scottish, aged 18-37 years) and older adults' (N = 40, Scottish, aged 70-89 years) prosocial linguistic behavior by investigating whether health (vs. nonhealth-related) matters would affect responses. While older adults used prosocial speech acts to a greater extent than younger adults, they did not distinguish between conditions. Our results suggest that prosocial linguistic behavior is likely influenced by a combination of differences in audience design and communicative styles at different ages. Collectively, these findings highlight the importance of situating prosocial speech acts within the pragmatics and aging literature, allowing us to uncover the factors modulating prosocial linguistic behavior at different developmental stages. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The relationship between social cognitive processes and behavior changes in people with amnestic mild cognitive impairment or dementia using the Edinburgh Social Cognition Test (ESCoT).

OBJECTIVE: People with amnestic mild cognitive impairment (aMCI) or dementia often exhibit a decline in their social abilities, but few tests of social cognition exist that are suitable for clinical use. Moreover, the relationship between changes in behavior and impairments in social cognition is poorly understood. We examined the utility of the Edinburgh Social Cognition Test (ESCoT) in people with aMCI/dementia and explored associations between social cognition performance and behavior changes. METHOD: We administered the ESCoT and two established social cognition tests (the Reading the Mind in the Eyes and the Social Norms Questionnaire) to 28 people with aMCI or dementia and 28 age and sex matched cognitively healthy controls. Behavior change was measured using a semistructured interview which assesses behavioral abnormalities found in frontotemporal dementia. RESULTS: People with aMCI/dementia were impaired on the ESCoT affective theory of mind, ESCoT total score and the Reading the Mind in the Eyes. Behavior changes in the domains of apathy, loss of sympathy/empathy, perseveration, and psychotic symptoms were associated with poorer affective theory of mind scores. Disinhibition, loss of sympathy/empathy and hyperorality or altered food preferences were associated with cognitive theory of mind. All behaviors were significantly associated with poorer performance on ESCoT total score, but were not associated with performance on the Reading the Mind in the Eyes or the Social Norms Questionnaire. CONCLUSIONS: The ESCoT was sensitive to social cognition impairments in people with aMCI/dementia and it relates to behavior change in aMCI/dementia unlike established tests. Different subtests of the ESCoT were related to different behavior changes. These findings suggest that the ESCoT may be a clinically valuable tool when examining social cognition. (PsycInfo Database Record (c) 2024 APA, all rights reserved).