The experience of pain, like other interoceptive processes, has recently been conceptualized in terms of predictive coding and free energy frameworks. In these views, the brain integrates sensory, proprioceptive, and interoceptive signals to generate probabilistic inferences about upcoming events, which shape both the state and the perception of our inner body. Here, we ask whether it is possible to induce pain expectations by providing false faster (vs. slower) acoustic cardiac feedback before administering electrical cutaneous shocks. We test whether these expectations will shape both the perception of pain and the body's physiological state toward prior predictions. Results confirmed that faster cardiac feedback elicited pain expectations that affected both perceptual pain judgments and the body's physiological response. Perceptual pain judgments were biased toward the expected level of pain, such that participants illusorily perceived identical noxious stimuli as more intense and unpleasant. Physiological changes mirrored the predicted level of pain, such that participants' actual cardiac response in anticipation of pain stimuli showed a deceleration in heart rate, in line with the well-known orienting cardiac response in anticipation of threatening stimuli (Experiment 1). In a control experiment, such perceptual and cardiac modulations were dramatically reduced when the feedback reproduced an exteroceptive, instead of interoceptive, cardiac feedback (Experiment 2). These findings show that cardiac perception can be understood as interoceptive inference that modulates both our perception and the physiological state of the body, thereby actively generating the interoceptive and autonomic consequences that have been predicted.

Background/Objectives: Attention-Deficit/Hyperactivity Disorder (ADHD) shows substantial cognitive heterogeneity, complicating individualized clinical formulation. This study examined whether Cognitive Disengagement Syndrome (CDS), anxiety, and ADHD symptom severity are associated with memory functions and visuospatial skills in children with ADHD. Methods: The sample included 120 children aged 6-12 years with ADHD (ADHD + CDS: n = 40; ADHD-only: n = 80). Memory was assessed with the Oktem Verbal Memory Processes Test (OVMPT) and Wechsler Memory Scale-Visual Reproduction (WMS-VR), and visuospatial skills with WISC-IV Block Design and Judgment of Line Orientation (JLO). ADHD symptoms were rated using combined parent-teacher Turgay-Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Based Disruptive Behavior Disorders Scale (T-DSM-IV-S) scores; CDS symptoms with the Barkley Child Attention Scale; and anxiety with the SCARED-Child Form. Group comparisons, correlation analyses, and multivariable linear regression models were conducted. Results: The ADHD + CDS group performed worse on WISC-IV Block Design than the ADHD-only group (p = 0.005). In the ADHD + CDS group, inattention severity showed a strong negative association with WMS-VR short-term memory (r = -0.560, p < 0.001). In the ADHD-only group, inattention severity was negatively associated with OVMPT Spontaneous Recall (ρ = -0.319, p = 0.004) and JLO total score (ρ = -0.348, p = 0.002). Anxiety severity in the ADHD-only group was positively associated with OVMPT Total Learning (ρ = 0.350, p = 0.001), Highest Learning (ρ = 0.370, p = 0.001), and WMS-VR short-term memory (ρ = 0.304, p = 0.006). In regression analyses, the presence of CDS independently and negatively predicted WMS-VR short-term memory (β = -0.187, p = 0.018) and Block Design performances (β = -0.226, p = 0.016). Inattention symptom severity was also independently and negatively associated with Block Design performance (β = -0.243, p = 0.013). Conclusions: CDS status and symptom dimensions contribute to cognitive variability in pediatric ADHD, with CDS showing independent associations with timed visuospatial construction and short-term visual memory. Inattention severity emerged as a robust dimensional predictor of cognitive inefficiency across domains, supporting the clinical utility of symptom-based cognitive profiling in ADHD diagnostic evaluations. In addition, mild anxiety symptoms demonstrated meaningful associations with some learning and memory performances within the ADHD-only group, indicating that affective factors may modulate cognitive outcomes in ADHD. Taken together, these findings support considering CDS status and symptom dimensions jointly when characterizing cognitive variability in ADHD.

The psychometric properties of the Benton Visual Form Discrimination Test, Matching (VFDT-MAT) subtest remain understudied. Preliminary evidence from dissertation research suggests that it involves intellectual (verbal and nonverbal ability and efficiency), visuospatial, and expressive language abilities, but these findings have not yet been empirically tested. To empirically test these findings, we conducted an exploratory principal component analysis of the Benton VFDT-MAT, using the Wechsler Adult Intelligence Scale, Fourth Edition (WAIS-IV; multidimensional intellect via its 4 indices), the Benton Judgment of Line Orientation (JLO; visuospatial), and the Boston Naming Test (BNT; expressive language). Under the supervision of a clinical neuropsychologist, neuropsychology trainees administered neuropsychological evaluations to a United States (U.S.) Military Veteran sample (n = 231; age = 52.71 years old ± .95 years). We conducted a series of principal component analyses (PCAs) to examine the dimensional relationships among the VFDT-MAT, WAIS-IV, JLO, and BNT. Our final descriptive component solution resulted in a high degree of test variance explained by the model (80.77%) and clear dimensionality among the four components produced. The first component produced in the final solution appeared to potentially be verbally mediated (29.18%), while components two (17.41%), three (17.25%), and four (16.93%) appeared to potentially be nonverbally mediated and shared similar variance. Results suggest that visual discrimination, as measured by the VFDT-MAT, requires verbal and nonverbal ability, cognitive efficiency, as well as visuospatial and expressive language skills. Accordingly, clinicians may be able to interpret item successes and failures on the VFDT-MAT through a process-based approach within the context of the aforementioned domain test performances.

ObjectiveThere are clinical and radiological sex differences in people with multiple sclerosis (pwMS); however, the influence of sex on the neuropsychiatric symptoms of MS remains unclear. This study aimed to clarify whether there are sex differences in the neuropsychiatric symptoms of MS.MethodA consecutive clinical cohort of 1530 pwMS completed the Hospital Anxiety and Depression Scale for symptoms of anxiety (HADS-A) and depression (HADS-D), the Modified Fatigue Impact Scale (MFIS), the Perceived Deficits Questionnaire (PDQ) for subjective cognitive concerns, and the Minimal Assessment of Cognitive Function in MS neurocognitive battery. Linear regression analyses were undertaken to predict neuropsychiatric raw scores from sex, adjusting for age, educational years, Expanded Disability Status Scale (EDSS) scores, disease duration, and disease subtype. The significance threshold was set at p < .01.ResultsMean age was 43.2 years (SD = 10.6), mean disease duration was 9.7 years (SD = 8.4), and median EDSS was 2.0 (IQR = 1.5-3.5). Seventy-three percent of participants were female. Controlling for covariates, females had higher MFIS, PDQ, California Verbal Learning Test, and Brief Visuospatial Memory Test total learning scores, and lower Judgment of Line Orientation and Paced Auditory Serial Addition Test scores than males, all p < .01. Sex was not independently predictive of scores on the HADS-A, HADS-D, Controlled Oral Word Association Test, Brief Visuospatial Memory Test delayed recall, Symbol Digit Modalities Test, or Delis-Kaplan Executive Function System.ConclusionsAmong pwMS, females experience greater fatigue, cognitive complaints, and dysfunction in spatial rotation and working memory than males, while males have elevated learning/memory difficulties. The absence of differences in symptoms of depression and anxiety between males and females contrasts with well-described sex differences in the general population. These data support future research that can explain sex-specific mechanisms of neuropsychiatric symptoms in pwMS.

Cognitive deficits often accompany brain structural changes, but the association between spinal cord atrophy and cognitive function remains unclear. Spastic paraplegia type 5 (SPG5) is a subtype of hereditary spastic paraplegias (HSPs), caused by mutations in cholesterol metabolism genes, with radiological features of spinal cord atrophy. Our study aims to explore cognitive impairment in SPG5 and its relation to spinal cord structure.

Anterior cruciate ligament reconstruction (ACLR) can result in persistent deficits in postural stability particularly under dual-task conditions involving cognitive demands. This study investigated the effects of cognitive tasks from different domains on postural control among individuals with ACLR compared with healthy controls. Twenty-five individuals with ACLR and 25 asymptomatic matched controls performed three cognitive tasks of backward counting (working memory), Stroop Color-Word Test (executive function), and Benton's Judgment of Line Orientation (visuospatial perception) under single- (seated) and dual-task (single-leg stance on rigid and foam surfaces) conditions. Postural stability was quantified by measuring center-of-pressure sway area and sway velocity in anterior-posterior and medial-lateral directions. Cognitive performance was evaluated by counting task errors. Results indicated significantly greater postural sway in the ACLR group compared with controls across all tasks (p < .01), with the Stroop Color-Word Test significantly increasing mean sway velocity compared with the no-task condition (p < .01) in only the ACLR group. ACLR participants also demonstrated consistently greater cognitive errors under all conditions. However, cognitive errors were not significantly affected by increased postural difficulty. Findings suggest that executive function tasks uniquely exacerbate postural control deficits following ACLR, highlighting the clinical importance of incorporating targeted cognitive-postural training focusing on executive control into rehabilitation protocols.

Sexual orientation is sometimes correlated to sexually polymorphic cognitive performance. Furthermore, hormones also modulate cognitive performance that may differ according to sexual orientation. Our study explores potential differences in cognitive performance and hormone levels across a diversity of sexual orientations that include sexually diverse (SD) people and those who identify as heterosexual. Participants were 332 healthy cisgender adults, who identified as SD women (n = 79), heterosexual women (n = 81), SD men (n = 81), and heterosexual men (n = 91). During the protocol, eight cognitive tasks were performed, and three saliva samples were collected at three time points to measure the levels of estradiol, progesterone, testosterone, dehydroepiandrosterone (DHEA) and cortisol. Socio-demographic questionnaires were used to measure sexual orientation and health status. Regressions controlling for key covariates revealed that sexual orientation influenced cognitive performance, particularly for women, with SD women outperforming heterosexual women on Digit Span, Judgment Line Orientation, and Purdue Pegboard tasks. In men, sexual orientation influenced cognitive performance on Digit Span, with heterosexual men outperforming SD men, but with SD men outperforming heterosexual men on the California Verbal Learning Test. Sexual orientation was also a significant predictor for DHEA levels in women, with SD women showing higher levels. Based on these results, sexual orientation appears to influence cognitive performance between SD and heterosexual individuals, but also DHEA levels between SD and heterosexual women.

The default mode network (DMN) is a collection of interconnected transmodal brain regions that is engaged during internally oriented thought processes. It has been linked with multiple functions, including self-referential judgment, social cognition, episodic memory, and semantic memory. In an effort to identify a unitary overarching purpose of the DMN, Menon [Menon, V. 20 years of the default mode network: A review and synthesis. Neuron, 111, 2469-2487, 2023] proposed that it uses its diverse capacities to create an "ongoing internal narrative" that represents dynamically shifting frames of thought and develops ontogenetically from self-directed overt speech during childhood. My aim was to evaluate this hypothesis. The core of the hypothesis is the notion of an ongoing internal narrative, but this is open to different interpretations. If it is interpreted rather narrowly as referring to a story-like stream of inner speech (IS), then Menon's hypothesis faces at least five challenges. First, regarding its developmental assumptions, research suggests that IS does not originate from self-directed overt speech. Second, there are huge individual differences in the frequency of IS, which implies that if the DMN does mediate an internal narrative, this narrative is not ongoing for everyone; instead, its rate of occurrence varies greatly across the population. Third, rodents and nonhuman primates possess a putative DMN, but they lack language and hence also IS, so the function of their DMN is left unclear. Fourth, IS often has a condensed, note-like form rather than being experienced as a full-fledged narrative. And fifth, so far only a couple neuroscientific studies support DMN engagement during IS. It is also possible, however, to interpret Menon's key notion of an ongoing internal narrative more broadly as involving a coherent sequence of situation models that are strongly influenced by language but not completely dependent on it. This interpretation not only obviates most of the problems just mentioned but also brings Menon's hypothesis more in line with other recent proposals regarding the DMN. Further work is needed, however, to refine and test this version of the hypothesis.

People with multiple sclerosis (pwMS) commonly describe cognitive decline later in the day, but few studies have evaluated this perception's validity. In a consecutive sample of 791 pwMS, this study evaluated whether time-of-testing predicted Minimal Assessment of Cognitive Function in MS raw scores, accounting for age, sex, educational years, disease duration, disability and disease-modifying therapy use. The mean age was 43.76 years (SD = 11.30), 76.74% were female and most had mild disability. Later time-of-testing independently predicted reduced Judgment of Line Orientation scores (p < 0.01), but not other cognitive variables. In pwMS, there is a diurnal decline in visuospatial cognitive test performance.

Aging in multiple sclerosis (MS) affects clinical and radiological disease activity. Yet, evidence is equivocal about the effects of aging on the neuropsychiatric sequelae of MS, including anxiety, depression, fatigue, and cognitive dysfunction. This study aimed to clarify how the neuropsychiatric symptoms of MS vary across ages. A consecutive cohort of 1194 people with MS (pwMS) underwent neuropsychological testing using the Minimal Assessment of Cognitive Function in MS, the Hospital Anxiety and Depression Scale sub-scales for anxiety (HADS-A) and depression (HADS-D), Modified Fatigue Impact Scale (MFIS), and the Perceived Deficits Questionnaire (PDQ) for cognitive complaints. Participants were stratified into age sub-groups: 18-29, 30-39, 40-49, 50-59 years. t-tests were undertaken to compare symptoms between the 18-29 and 50-59 sub-groups. Linear regression analyses, controlling for disability (Expanded Disability Status Scale; EDSS), sex, educational years, and high-efficacy disease-modifying therapy use, were used to evaluate whether age significantly predicted neuropsychiatric sequelae. Mean age was 42.15 years, 74.12% were female, and median EDSS was 2.00. Older pwMS had reduced HADS-A, PDQ, California Verbal Learning Test (CVLT), Brief Visuospatial Memory Test (BVMT), Symbol Digit Modalities Test (SDMT), and Delis-Kaplan Executive Function System (D-KEFS) scores, all p < 0.01. There were no age differences on the HADS-D, MFIS, Controlled Oral Word Association Test, Judgment of Line Orientation, or Paced Auditory Serial Addition Test. Controlling for covariates, older age independently predicted reduced HADS-A, CVLT, BVMT, SDMT, and D-KEFS scores, all p < 0.01. In summary, as pwMS age, anxiety declines and performance on learning, memory, processing speed, and executive function tests worsens.