Longitudinal Effects of Asymptomatic C9orf72 Carriership on Brain Morphology.

OBJECTIVE: We investigated effects of C9orf72 repeat expansion and gene expression on longitudinal cerebral changes before symptom onset. METHODS: We enrolled 79 asymptomatic family members (AFMs) from 9 families with C9orf72 repeat expansion. Twenty-eight AFMs carried the mutation (C9+). Participants had up to 3 magnetic resonance imaging (MRI) scans, after which we compared motor cortex and motor tracts between C9+ and C9- AFMs using mixed effects models, incorporating kinship to correct for familial relations and lessen effects of other genetic factors. We also compared cortical, subcortical, cerebellar, and connectome structural measurements in a hypothesis-free analysis. We correlated regional C9orf72 expression in donor brains with the pattern of cortical thinning in C9+ AFMs using meta-regression. For comparison, we included 42 C9+ and 439 C9- patients with amyotrophic lateral sclerosis (ALS) in this analysis. RESULTS: C9+ AFM motor cortex had less gyrification and was thinner than in C9- AFMs, without differences in motor tracts. Whole brain analysis revealed thinner cortex and less gyrification in parietal, occipital, and temporal regions, smaller thalami and right hippocampus, and affected frontotemporal connections. Thinning of bilateral precentral, precuneus, and left superior parietal cortex was faster in C9+ than in C9- AFMs. Higher C9orf72 expression correlated with thinner cortex in both C9+ AFMs and C9+ ALS patients. INTERPRETATION: In asymptomatic C9orf72 repeat expansion carriers, brain MRI reveals widespread features suggestive of impaired neurodevelopment, along with faster decline of motor and parietal cortex than found in normal aging. C9orf72 expression might play a role in cortical development, and consequently explain the specific brain abnormalities of mutation carriers. ANN NEUROL 2023;93:668-680.

Zooming in on abnormal local and global processing biases after stroke: Frequency, lateralization, and associations with cognitive functions.

OBJECTIVES: The 'attentional spotlight' can be adjusted depending on the task requirements, resulting in processing information at either the local or global level. Stroke can lead to local or global processing biases, or the inability to simultaneously attend both levels. In this study, we assessed the (1) prevalence of abnormal local and global biases following stroke, (2) differences between left- and right-sided brain damaged patients, and (3) relations between local and global interference, the ability to attend local and global levels simultaneously, and lateralized attention, search organization, search speed, visuo-construction, executive functioning, and verbal (working) memory. METHODS: Stroke patients admitted for inpatient rehabilitation completed directed (N = 192 total; N = 46 left-sided/N = 48 right-sided lesion) and divided (N = 258 total; N = 67 left-sided/N = 66 right-sided lesion) local-global processing tasks, as well as a conventional neuropsychological assessment. Processing biases and interference effects were separately computed for directed and divided tasks. RESULTS: On the local-global tasks, 7.8-10.9% of patients showed an abnormal local bias and 6.3-8.3% an abnormal global bias for directed attention, and 5.4-10.1% an abnormal local bias and 6.6-15.9% an abnormal global bias for divided attention. There was no significant difference between patients with left- and right-sided brain damage. There was a moderate positive relation between local interference and search speed, and a small positive relation between global interference and neglect. CONCLUSIONS: Abnormal local and global biases can occur after stroke and might relate to a range of cognitive functions. A specific bias might require a different approach in assessment, psycho-education, and treatment.

Does visuospatial neglect contribute to standing balance within the first 12 weeks post-stroke? A prospective longitudinal cohort study.

BACKGROUND: Visuospatial neglect (VSN) has been suggested to limit standing balance improvement post-stroke. However, studies investigating this association longitudinally by means of repeated within-subject measurements early post-stroke are lacking. This prospective longitudinal cohort study evaluates the longitudinal association of egocentric and allocentric VSN severity with 1) standing balance independence and 2) postural control and weight-bearing asymmetry (WBA) during quiet standing, in the first 12 weeks post-stroke. METHODS: Thirty-six hemiplegic individuals after a first-ever unilateral stroke were evaluated at weeks 3, 5, 8 and 12 post-stroke. Egocentric and allocentric VSN severity were evaluated using the Broken Hearts Test. The standing unperturbed item of the Berg Balance Scale (BBS-s) was used to clinically evaluate standing independence. Posturographic measures included measures of postural control (mediolateral (ML)/anteroposterior (AP) net center-of-pressure velocities (COPvel)) and WBA during quiet standing. A linear mixed model was used to examine longitudinal associations between egocentric and allocentric VSN, and BBS-s, COPvel-ML, COPvel-AP and WBA within the first 12 weeks post-stroke. RESULTS: Egocentric (ß = -0.08, 95%CI[-0.15;-0.01], P = .029) and allocentric VSN severity (ß = -0.09, 95%CI[-0.15; -0.04], P = .002) were significant independent factors for BBS-s scores in the first 12 weeks post-stroke. Egocentric and allocentric VSN were no significant independent factors for COPvel-ML, COPvel-AP and WBA in the first 12 weeks post-stroke. CONCLUSIONS: Allocentric and egocentric VSN severity were significantly associated with decreased standing independence, but not impaired postural control or greater asymmetric weight-bearing, in the early subacute post-stroke phase. This may involve traditional VSN measures being not sensitive enough to detect fine-grained VSN deficits due to a ceiling effect between 5 and 8 weeks post-stroke, once the individual regains standing ability. Future studies may require more sensitive VSN measurements to detect such deficits. Trial registration Clinicaltrials.gov. unique identifier NCT05060458.

More (corrective) consecutive saccades after a lesion to the posterior parietal cortex.

To reach a target, primary saccades (S1s) are often followed by (corrective) consecutive saccades (S2, and potentially S3, S4, S5), which are based on retinal and extraretinal feedback. Processing these extraretinal signals was found to be significantly impaired by lesions to the posterior parietal cortex (PPC). Recent studies, however, added a more nuanced view to the role of the PPC, where patients with PPC lesions still used extraretinal signals for S2s and perceptual judgements (Fabius et al., 2020; Rath-Wilson & Guitton, 2015). Hence, it seems that a PPC lesion is not disrupting extraretinal processing per se. Yet, a lesion might still result in less reliable processing of extraretinal signals. Here, we investigated whether this lower reliability manifests as decreased or delayed S2 initiation. Patients with PPC lesions (n = 7) and controls (n = 26) performed a prosaccade task where the target either remained visible or was removed after S1 onset. When S1 is removed, accurate S2s (corrections of S1 error) rely solely on extraretinal signals. We analysed S2 quantity and timing using linear mixed-effects modelling and additive hazards analyses. Patients demonstrated slower S1 execution and lower S1 amplitudes than controls, but their S2s still compensated the S1 undershoot, also when they only relied on extraretinal information. Surprisingly, patients showed an increased amount of S2s. This deviation from control behaviour can be seen as suboptimal, but given the decreased accuracy of the primary saccade, it could be optimal for patients to employ more (corrective) consecutive saccades to overcome this inaccuracy.

Cognitive and Motor Therapy After Stroke Is Not Superior to Motor and Cognitive Therapy Alone to Improve Cognitive and Motor Outcomes: New Insights From a Meta-analysis.

OBJECTIVE: To evaluate whether cognitive and motor therapy (CMT) is more effective than no therapy, motor therapy, or cognitive therapy on motor and/or cognitive outcomes after stroke. Additionally, this study evaluates whether effects are lasting and which CMT approach is most effective. DATA SOURCES: AMED, EMBASE, MEDLINE/PubMed, and PsycINFO databases were searched in October 2022. STUDY SELECTION: Twenty-six studies fulfilled the inclusion criteria: randomized controlled trials published in peer-reviewed journals since 2010 that investigated adults with stroke, delivered CMT, and included at least 1 motor, cognitive, or cognitive-motor outcome. Two CMT approaches exist: CMT dual-task ("classical" dual-task where the secondary cognitive task has a distinct goal) and CMT integrated (where cognitive components of the task are integrated into the motor task). DATA EXTRACTION: Data on study design, participant characteristics, interventions, outcome measures (cognitive/motor/cognitive-motor), results and statistical analysis were extracted. Multilevel random effects meta-analysis was conducted. DATA SYNTHESIS: CMT demonstrated positive effects compared with no therapy on motor outcomes (g=0.49; 95% confidence interval [CI], 0.10, 0.88) and cognitive-motor outcomes (g=0.29; 95% CI, 0.03, 0.54). CMT showed no significant effects compared with motor therapy on motor, cognitive, and cognitive-motor outcomes. A small positive effect of CMT compared with cognitive therapy on cognitive outcomes (g=0.18; 95% CI, 0.01, 0.36) was found. CMT demonstrated no follow-up effect compared with motor therapy (g=0.07; 95% CI, -0.04, 0.18). Comparison of CMT dual-task and integrated revealed no significant difference for motor (F1,141=0.80; P=.371) or cognitive outcomes (F1,72=0.61, P=.439). CONCLUSIONS: CMT was not superior to monotherapies in improved outcomes after stroke. CMT approaches were equally effective, suggesting that training that enlists a cognitive load per se may benefit outcomes.

Don't hide the instruction manual: A dynamic trade-off between using internal and external templates during visual search.

Visual search is typically studied by requiring participants to memorize a template initially, for which they subsequently search in a crowded display. Search in daily life, however, often involves templates that remain accessible externally, and may therefore be (re)attended for just-in-time encoding or to refresh internal template representations. Here, we show that participants indeed use external templates during search when given the chance. This behavior was observed during both simple and complex search, scaled with task difficulty, and was associated with improved performance. Furthermore, we show that participants used external sampling not only to offload memory, but also as a means of verifying whether the template was remembered correctly at the end of trials. We conclude that the external world may not only provide the challenge (e.g., distractors), but may dynamically ease search. These results argue for extensions of state-of-the-art models of search, because external sampling seems to be used frequently, in at least two ways and is actually beneficial for task performance. Our findings support a model of visual working memory that emphasizes a resource-efficient trade-off between storing and (re)attending external information.

Time course of spatiotopic updating across saccades.

Humans move their eyes several times per second, yet we perceive the outside world as continuous despite the sudden disruptions created by each eye movement. To date, the mechanism that the brain employs to achieve visual continuity across eye movements remains unclear. While it has been proposed that the oculomotor system quickly updates and informs the visual system about the upcoming eye movement, behavioral studies investigating the time course of this updating suggest the involvement of a slow mechanism, estimated to take more than 500 ms to operate effectively. This is a surprisingly slow estimate, because both the visual system and the oculomotor system process information faster. If spatiotopic updating is indeed this slow, it cannot contribute to perceptual continuity, because it is outside the temporal regime of typical oculomotor behavior. Here, we argue that the behavioral paradigms that have been used previously are suboptimal to measure the speed of spatiotopic updating. In this study, we used a fast gaze-contingent paradigm, using high phi as a continuous stimulus across eye movements. We observed fast spatiotopic updating within 150 ms after stimulus onset. The results suggest the involvement of a fast updating mechanism that predictively influences visual perception after an eye movement. The temporal characteristics of this mechanism are compatible with the rate at which saccadic eye movements are typically observed in natural viewing.

Feasibility and user-experience of virtual reality in neuropsychological assessment following stroke.

Virtual Reality (VR) offers the possibility to assess cognitive functioning in a dynamic environment resembling daily life. In this cross-sectional study, we used two user interfaces, namely non-immersive VR by using a computer monitor (CM) and immersive VR by using a head-mounted display (HMD). We investigated (1) potential differences in feasibility, user-experience, and a potential preference for one user interface over another between stroke patients and healthy controls; (2) potential differences in feasibility, user-experience, and preference between patients referred for inpatient rehabilitation care and patients referred for outpatient rehabilitation care; and (3) potential demographic and clinical characteristics that were related to patients' preference for one user interface over another. Stroke patients (n = 88) and healthy controls (n = 66) performed a VR-task with a CM and HMD. Both user interfaces were feasible to use, irrespective of clinical referral (in- or outpatient rehabilitation care). Patients reported an enhanced feeling of engagement, transportation, flow, and presence, but more negative side effects when tested with a HMD, compared to a CM. The majority of stroke patients had no preference for one user interface over the other, yet younger patients tended to prefer a HMD. VR seems highly feasible in stroke patients.

CoCo - participation: The development and clinical use of a novel inventory measuring cognitive complaints in daily life.

Cognitive difficulties can be subtle and only come to light when patients return home from inpatient care and start to participate in society. Subjective cognitive complaints often interfere with participation, hence capturing cognitive complaints systematically is important. We developed a patient- and relative-reported measure to assess cognitive complaints during daily life activities across the memory, attention and executive domain for patients with acquired brain injury (ABI). The inventory Cognitive Complaints - Participation (CoCo-P) was created based on a literature review, consultations with experts, semi-structured interviews with patients, and a quantitative study. The inventory was administered to patients with ABI (n = 46), their relatives (n = 33) and healthy controls (n = 102) to finalize the inventory. We examined the reported complaints per daily life activity and cognitive domain of patients and healthy controls, and we compared the patients' and relatives' reports. The majority of patients (87-96%) experienced cognitive complaints, mostly related to attention, at work/education, during leisure activities, and in contact with family/friends and community. Patients reported more cognitive complaints than relatives. The CoCo-P seems appropriate to capture cognitive complaints in daily life in patients with mild ABI. Additional research is needed in terms of reliability and validity.

Impairments in Multisensory Integration after Stroke.

The integration of information from multiple senses leads to a plethora of behavioral benefits, most predominantly to faster and better detection, localization, and identification of events in the environment. Although previous studies of multisensory integration (MSI) in humans have provided insights into the neural underpinnings of MSI, studies of MSI at a behavioral level in individuals with brain damage are scarce. Here, a well-known psychophysical paradigm (the redundant target paradigm) was employed to quantify MSI in a group of stroke patients. The relation between MSI and lesion location was analyzed using lesion subtraction analysis. Twenty-one patients with ischemic infarctions and 14 healthy control participants responded to auditory, visual, and audiovisual targets in the left and right visual hemifield. Responses to audiovisual targets were faster than to unisensory targets. This could be due to MSI or statistical facilitation. Comparing the audiovisual RTs to the winner of a race between unisensory signals allowed us to determine whether participants could integrate auditory and visual information. The results indicated that (1) 33% of the patients showed an impairment in MSI; (2) patients with MSI impairment had left hemisphere and brainstem/cerebellar lesions; and (3) the left caudate, left pallidum, left putamen, left thalamus, left insula, left postcentral and precentral gyrus, left central opercular cortex, left amygdala, and left OFC were more often damaged in patients with MSI impairments. These results are the first to demonstrate the impact of brain damage on MSI in stroke patients using a well-established psychophysical paradigm.

Cognitive and behavioural changes in PLS and PMA:challenging the concept of restricted phenotypes.

OBJECTIVES: Cognitive and behavioural changes within the spectrum of frontotemporal dementia (FTD) are observed frequently in patients with amyotrophic lateral sclerosis (ALS). Whether these changes also occur in other forms of motor neuron disease (MND) is not well studied. We therefore systemically screened a large cohort of patients with primary lateral sclerosis (PLS) and progressive muscular atrophy (PMA) for cognitive and behavioural changes, and subsequently compared our findings with a cohort of patients with ALS. METHODS: Using a set of screening instruments (Edinburgh Cognitive and Behavioural ALS Screen, ALS and Frontotemporal Dementia Questionnaire, Frontal Assessment Battery, and Hospital Anxiety and Depression Scale), the presence of cognitive and behavioural changes as well as anxiety and depression in 277 patients with ALS, 75 patients with PLS and 143 patients with PMA was evaluated retrospectively. RESULTS: We found a high frequency of cognitive and behavioural abnormalities with similar profiles in all three groups. Subjects with behavioural variant FTD were identified in all groups. CONCLUSIONS: The percentage of patients with PLS and PMA with cognitive dysfunction was similar to patients with ALS, emphasising the importance for cognitive screening as part of routine clinical care in all three patient groups. With a similar cognitive profile, in line with genetic and clinical overlap between the MNDs, the view of PLS as an MND exclusively affecting upper motor neurons and PMA exclusively affecting lower motor neurons cannot be held. Therefore, our findings are in contrast to the recently revised El Escorial criteria of 2015, where PLS and PMA are described as restricted phenotypes. Our study favours a view of PLS and PMA as multidomain diseases similar to ALS.

Visuospatial declarative learning despite profound verbal declarative amnesia in Korsakoff's syndrome.

Korsakoff's syndrome (KS) is a neuropsychiatric disorder characterised by severe amnesia. Although the presence of impairments in memory has long been acknowledged, there is a lack of knowledge about the precise characteristics of declarative memory capacities in order to implement memory rehabilitation. In this study, we investigated the extent to which patients diagnosed with KS have preserved declarative memory capacities in working memory, long-term memory encoding or long-term memory recall operations, and whether these capacities are most preserved for verbal or visuospatial content. The results of this study demonstrate that patients with KS have compromised declarative memory functioning on all memory indices. Performance was lowest for the encoding operation compared to the working memory and delayed recall operation. With respect to the content, visuospatial memory was relatively better preserved than verbal memory. All memory operations functioned suboptimally, although the most pronounced disturbance was found in verbal memory encoding. Based on the preserved declarative memory capacities in patients, visuospatial memory can form a more promising target for compensatory memory rehabilitation than verbal memory. It is therefore relevant to increase the number of spatial cues in memory rehabilitation for KS patients.

Return to work after mild-to-moderate stroke: work satisfaction and predictive factors.

A large proportion of stroke patients are unable to return to work (RTW), although figures vary greatly. A total of 121 mild-to-moderate stroke patients, who had a paid job at the time of their stroke were included (a) to quantify RTW and work satisfaction one-year post-stroke (using the Utrecht Scale for Evaluation of Rehabilitation-Participation) and (b) to determine factors predicting RTW post-stroke, based on stroke-related, personal and neuropsychological variables. Half of the patients were not in work (28%) or were working less (22%) than pre-stroke. Ninety percent of those in fulltime employment post-stroke were satisfied with their occupational situation, against 36% of the unemployed participants. In regards to factors predicting RTW, global cognitive functioning (r = .19, Montreal Cognitive Assessment) and depressive symptoms (r = -.16, Hospital Anxiety and Depression Scale) at two months post-stroke onset were associated with return to work within one year. Only global cognitive functioning was an independent predictor of RTW (11.3% variance, p = .013). Although the explained variance was not that high, neuropsychological factors probably play a pivotal role in returning to work and should be taken into account during rehabilitation after mild and moderate stroke.

What Does It Take to Search Organized? The Cognitive Correlates of Search Organization During Cancellation After Stroke.

OBJECTIVES: Stroke could lead to deficits in organization of visual search. Cancellation tests are frequently used in standard neuropsychological assessment and appear suitable to measure search organization. The current aim was to evaluate which cognitive functions are associated with cancellation organization measures after stroke. METHODS: Stroke patients admitted to inpatient rehabilitation were included in this retrospective study. We performed exploratory factor analyses to explore cognitive domains. A digital shape cancellation test (SC) was administered, and measures of search organization (intersections rate and best r) were computed. The following cognitive functions were measured by neuropsychological testing: neglect (SC, line bisection; LB, Catherine Bergego Scale; CBS, and Balloons Test), visuospatial perception and construction (Rey Complex Figure Test, RCFT), psychomotor speed (Trail Making Test; TMT-A), executive functioning/working memory (TMT-B), spatial planning (Tower Test), rule learning (Brixton Test), short-term auditory memory (Digit Span Forward; DSF), and verbal working memory (Digit Span Backward; DSB). RESULTS: In total, 439 stroke patients were included in our analyses. Four clusters were separated: "Executive functioning" (TMT-A, TMT-B, Brixton Test, and Tower Test), "Verbal memory" (DSF and DSB), "Search organization" (intersections rate and best r), and "Neglect" (CBS, RCFT copy, Balloons Test, SC, and LB). CONCLUSIONS: Search organization during cancellation, as measured with intersections rate and best r, seems a distinct cognitive construct compared to existing cognitive domains that are tested during neuropsychological assessment. Administering cancellation tests and analyzing measures of search organization could provide useful additional insights into the visuospatial processes of stroke patients. (JINS, 2018, 24, 424-436).

Pharmacological Treatment of Visuospatial Neglect: A Systematic Review.

OBJECTIVES: The aims of the current review were (1) to give an overview of human studies investigating pharmacotherapy to ameliorate visuospatial neglect and (2) to evaluate the quality of those studies. METHODS: A systematic literature search using PubMed, Scopus, and ResearchGate was conducted in regard to studies that evaluated pharmacological interventions aiming to ameliorate poststroke visuospatial neglect. The search was limited in the following features: species (human), adults (≥18 years of age), language (English), and type of neglect (visuospatial). Two independent authors extracted data on study content and effectiveness and evaluated the quality of studies and methods. RESULTS: A total of 11 studies were identified. Three studies were considered to be of moderate quality, the others of low quality. Seven studies represented dopaminergic treatment; 3 studies represented cholinergic treatment; and 1 study represented noradrenergic treatment. Three dopaminergic studies showed primarily positive effects of dopaminergic stimulation on visuospatial neglect, whereas three others showed adverse effects. All 3 cholinergic studies found positive effects in some outcome measures concerning visuospatial neglect. Noradrenergic stimulation improved maintenance of attention when exploring space. CONCLUSIONS: Currently, cholinergic therapy might be the best option for future research. However, we must emphasize the explorative nature and the limited quality of the reviewed studies.

Procedural Learning and Memory Rehabilitation in Korsakoff's Syndrome - a Review of the Literature.

Korsakoff's syndrome (KS) is a chronic neuropsychiatric disorder caused by alcohol abuse and thiamine deficiency. Patients with KS show restricted autonomy due to their severe declarative amnesia and executive disorders. Recently, it has been suggested that procedural learning and memory are relatively preserved in KS and can effectively support autonomy in KS. In the present review we describe the available evidence on procedural learning and memory in KS and highlight advances in memory rehabilitation that have been demonstrated to support procedural memory. The specific purpose of this review was to increase insights in the available tools for successful memory rehabilitation and give suggestions how to apply these tools in clinical practice to increase procedural learning in KS. Current evidence suggests that when memory rehabilitation is adjusted to the specific needs of KS patients, this will increase their ability to learn procedures and their typically compromised autonomy gets enhanced.

Study protocol of 'Prism Adaptation in Rehabilitation': a randomized controlled trial in stroke patients with neglect.

BACKGROUND: A frequent disorder after stroke is neglect, resulting in a failure to report or respond to contralesional stimuli. Rehabilitation of neglect is important, given the negative influence on motor recovery, independence in self-care, transfers, and locomotion. Effects of prism adaptation (PA) to alleviate neglect have been reported. However, either small groups or no control group were included and few studies reported outcome measurements on the level of activities of daily living (ADL). The current ongoing RCT investigates the short- and long-term effects of PA in a large population in a realistic clinical setting. Measures range from the level of function to the level of ADL. METHODS/DESIGN: Neglect patients in the sub-acute phase after stroke are randomly assigned to PA (n = 35) or sham adaptation (SA; n = 35). Adaptation is performed for 10 consecutive weekdays. Patients are tested at start of the study, 1 and 2 weeks after starting, and 1, 2, 4 and 12 weeks after ending treatment. Primary objectives are changes in performance on neuropsychological tests and neglect in ADL. Secondary objectives are changes in simulated driving, eye movements, balance, visual scanning and mobility, subjective experience of neglect in ADL and independence during ADL. DISCUSSION: If effective, PA could be implemented as a treatment for neglect. TRIAL REGISTRATION: This trial is registered at the Dutch Trial Register # NTR3278 .

Cross-modal, bidirectional priming in grapheme-color synesthesia.

Grapheme-color synesthetes perceive achromatic graphemes to be inherently colored. In this study grapheme-color synesthetes and non-synesthetes discriminated (1) the color of visual targets presented along with aurally presented digit primes, and (2) the identity of aurally presented digit targets presented with visual color primes. Reaction times to visual color targets were longer when the color of the target was incongruent with the synesthetic percept reported for the prime. Likewise, discriminating aurally presented digit targets took longer when the color of the prime was incongruent with the synesthetic percept for the target. These priming effects were absent in non-synesthetes. We conclude that binding between digits and colors in grapheme-color synesthetes can occur bidirectionally across senses. The results are in line with the idea that synesthesia is the result of linking inducing stimuli (e.g. digits) to synesthetic percepts (colors) at an abstract - supra-modal - conceptual level of processing.

CancellationTools: All-in-one software for administration and analysis of cancellation tasks.

In a cancellation task, a participant is required to search for and cross out ("cancel") targets, which are usually embedded among distractor stimuli. The number of cancelled targets and their location can be used to diagnose the neglect syndrome after stroke. In addition, the organization of search provides a potentially useful way to measure executive control over multitarget search. Although many useful cancellation measures have been introduced, most fail to make their way into research studies and clinical practice due to the practical difficulty of acquiring such parameters from traditional pen-and-paper measures. Here we present new, open-source software that is freely available to all. It allows researchers and clinicians to flexibly administer computerized cancellation tasks using stimuli of their choice, and to directly analyze the data in a convenient manner. The automated analysis suite provides output that includes almost all of the currently existing measures, as well as several new ones introduced here. All tasks can be performed using either a computer mouse or a touchscreen as an input device, and an online version of the task runtime is available for tablet devices. A summary of the results is produced in a single A4-sized PDF document, including high quality data visualizations. For research purposes, batch analysis of large datasets is possible. In sum, CancellationTools allows users to employ a flexible, computerized cancellation task, which provides extensive benefits and ease of use.