The feasibility to assess sensory integration in ageing: beyond the cerebral cortex

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The evaluation of Sensory Integration (SI) beyond the cerebral cortex, focusing on subcortical sensory organization systems (tactile, vestibular, and proprioceptive), is fundamental for cognitive functioning (emotional regulation, awareness, attention, and memory). Objectives To adapt and validate the content of the Physical Assessment Scale from the Schoeder-Block-Campbell Psychiatric Sensory Integration Evaluation (SBC-PAS), to measure SI for older adults (OA), and to evaluate in a prospective pilot study its feasibility and safety for the aged population. Methods Based on the guidelines of the International Test Commission Guidelines for test translation and adaptation. The SBC-PAS scale was translated; its content was validated through an expert panel, and the feasibility and safety of its application were explored with an OA pilot study. Results Following the adaptation and validation, changes were made in 16 sections of the vestibular-proprioceptive dimension. The agreement percentages (67% - 89%) and concordance index (0.49 - 0.69) for the evaluated criteria ranged from moderate to substantial. After integrating the suggested changes, the feasibility study revealed that the SBC-PAS was applied within 90 to 190 minutes. We saw the need for specific spatial conditions, examiner training, and participant support. Conclusions We evaluated the adaptation, content validity, and feasibility of the SBC-PAS to assess SI in OA. Feasibility findings add evidence for its application in real-world settings. 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F1000Research 2025, 14 :859 ( https://doi.org/10.12688/f1000research.168955.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article The feasibility to assess sensory integration in ageing: beyond the cerebral cortex [version 1; peer review: awaiting peer review] Fabiola Tafoya-Ramos 1 , Gilberto Isaac Acosta-Castillo https://orcid.org/0000-0002-8664-9542 2 , Catalina Francisca González-Forteza 3 , Ana Luisa Sosa-Ortiz https://orcid.org/0000-0001-6919-6425 2 Fabiola Tafoya-Ramos 1 , Gilberto Isaac Acosta-Castillo https://orcid.org/0000-0002-8664-9542 2 , Catalina Francisca González-Forteza 3 , Ana Luisa Sosa-Ortiz https://orcid.org/0000-0001-6919-6425 2 PUBLISHED 02 Sep 2025 Author details Author details 1 Facultad de Medicina, Universidad Nacional Autónoma de México, México, Ciudad de México, 04360, Mexico 2 Laboratorio de Demencias, Instituto Nacional de Neurologia y Neurocirugia Manuel Velasco Suarez, Mexico City, Mexico City, 14269, Mexico 3 Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatria Ramon de la Fuente Muniz, Mexico City, Mexico City, 14370, Mexico Fabiola Tafoya-Ramos Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Resources, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Gilberto Isaac Acosta-Castillo Roles: Conceptualization, Methodology, Supervision, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Catalina Francisca González-Forteza Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing Ana Luisa Sosa-Ortiz Roles: Conceptualization, Methodology, Supervision, Validation, Writing – Review & Editing OPEN PEER REVIEW REVIEWER STATUS AWAITING PEER REVIEW Abstract Background The global aging population will continue, with significant implications as the growing numbers of people with neurocognitive disorders. The evaluation of Sensory Integration (SI) beyond the cerebral cortex, focusing on subcortical sensory organization systems (tactile, vestibular, and proprioceptive), is fundamental for cognitive functioning (emotional regulation, awareness, attention, and memory). Objectives To adapt and validate the content of the Physical Assessment Scale from the Schoeder-Block-Campbell Psychiatric Sensory Integration Evaluation (SBC-PAS), to measure SI for older adults (OA), and to evaluate in a prospective pilot study its feasibility and safety for the aged population. Methods Based on the guidelines of the International Test Commission Guidelines for test translation and adaptation. The SBC-PAS scale was translated; its content was validated through an expert panel, and the feasibility and safety of its application were explored with an OA pilot study. Results Following the adaptation and validation, changes were made in 16 sections of the vestibular-proprioceptive dimension. The agreement percentages (67% - 89%) and concordance index (0.49 - 0.69) for the evaluated criteria ranged from moderate to substantial. After integrating the suggested changes, the feasibility study revealed that the SBC-PAS was applied within 90 to 190 minutes. We saw the need for specific spatial conditions, examiner training, and participant support. Conclusions We evaluated the adaptation, content validity, and feasibility of the SBC-PAS to assess SI in OA. Feasibility findings add evidence for its application in real-world settings. READ ALL READ LESS Keywords Alzheimer Disease, dementia, older adults, sensory integration Corresponding Author(s) Fabiola Tafoya-Ramos ( [email protected] ) Close Corresponding author: Fabiola Tafoya-Ramos Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 Tafoya-Ramos F et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Tafoya-Ramos F, Acosta-Castillo GI, González-Forteza CF and Sosa-Ortiz AL. The feasibility to assess sensory integration in ageing: beyond the cerebral cortex [version 1; peer review: awaiting peer review] . F1000Research 2025, 14 :859 ( https://doi.org/10.12688/f1000research.168955.1 ) First published: 02 Sep 2025, 14 :859 ( https://doi.org/10.12688/f1000research.168955.1 ) Latest published: 02 Sep 2025, 14 :859 ( https://doi.org/10.12688/f1000research.168955.1 ) Introduction The global number of older adults (OA, aged ≥60 years) continues to experience accelerated growth, estimated to increase from 1 billion in 2020 to more than double in 2050. 1 In addition, there is growing evidence that the interaction of biological, psychological, and emotional factors accumulated across the lifetime contribute to an accelerated and highly heterogeneous aging process that includes variations in health and functional status of OA. 2 To better understand and focus on the needs of OA, it is crucial to examine fundamental elements related to their functioning. 3 Optimal brain functioning requires the integration of a constant and varied supply of sensory stimuli. 4 , 5 It is affected by the ageing process, as well as by the presence of many other conditions, which result in the impairment of Sensory Integration (SI) at different levels. 2 , 6 Some of the conditions that best illustrate this interaction are mild and major neurocognitive disorders. 2 , 6 , 7 This relationship has been studied in models that include cognitive and psychophysiological measures, demonstrating relationships in all three directions: SI, cognition and ageing. 6 , 7 The study of SI has been conceptualized using different terms, including ‘sensory processing’, 8 ‘multisensory integration’, 9 ‘sensorimotor integration’, 10 or ‘sensory diet’. 5 Some integrate to a greater or lesser extent cortical or higher cognitive functions as well as special senses such as touch, vision, taste, smell or hearing. 10 , 11 Among these approaches, the SI theory of Jane Ayres, 4 , 11 , 12 extends the analysis of how sensory modalities or inputs are processed beyond the special senses. 13 It considers main sensory integration systems at the subcortical level: tactile, vestibular and proprioceptive systems, 4 , 8 , 12 , 14 for the interpretation and response to external stimuli, in the cerebral cortex. 4 , 15 From this perspective the SI interacts with the environment to later modulate the responses generated in the cortex, even in the presence of anatomical, systemic or developmental alterations. 12 Although there is research that focused on the role of the special senses and cerebral cortex, the study of subcortical processes from the SI theory has been underestimated and little explored. 14 Subcortical structures contribute not only to the bottom-up processes of sensory input and information processing for emotional and behavioral regulation but also to the regulation of higher cognitive functions such as consciousness, alertness, selective attention, visuospatial processing, language, learning and memory, also known as top-down. 14 , 16 The study and assessment based on SI theory have primarily focused on developmental disorders, particularly in children 17 for cognitive and motor impairments, 12 some researchers have begun to apply this model to the ageing process, particularly in neurodegenerative disorders. 18 – 20 The SI assessment, adds particular and intrinsic challenges for OA as: (a) distinguishing changes in SI associated with aging from alterations in patients with possible neurodegenerative disorders (such as dementia syndromes) considering the deterioration of inputs from sensory systems, tissues and receptors due to aging is complex; (b) the instruments that assesses the main sensory integration systems based on SI theory, are in an incomplete 21 or shallow way 22 ; (c) most of the assessment methods are mediated by higher cortical functions such as language and reasoning 23 ; or (d) they infer SI indirectly, through the responses to sensory stimulation and their relationship to outcomes related to theoretical constructs such as functionality, cognitive functioning of specific tasks or global cognition. 24 To our knowledge, only one the Schoeder-Block-Campbell Psychiatric Sensory Integration Evaluation (SBC) assesses SI considering the main sensory integration systems, 25 – 27 and has evidence of acceptable reliability, concurrent and discriminant validity. 27 , 28 However, this instrument was developed and designed to assess SI in adults with mental health problems. 27 Considering challenges and the lack of specific methods to assess SI in OA, this research aims to adapt and validate the content of the Physical Assessment Scale from SBC (SBC-PAS) to Spanish, as a feasible method of assessing SI for OA from low-middle income countries. Methods Study design This was a prospective content validation 29 and feasibility study 30 , 31 of the SBC-PAS adapted for OA. Participants An expert panel collaborated in the content validation process of the SBC-PAS. Initially, three bilingual clinicians translated the SBC-PAS. Additionally, four professionals from different disciplines who provide written consent - neurology, neuropsychology, physiotherapy, and geriatrics - with extensive clinical experience in the care and attention of OA assess the content validity of the SBC-PAS. 32 , 33 Considering guidelines for test translation and adaptation, we also obtained information about feasibility 31 , 34 of applying the adapted SBC-PAS to OA. A convenience sample of OA was recruited. Eligibility criteria included providing written consent; being 60 years of age or older; and having no evidence of cognitive impairment: defined as a score >23/30 on the Mini Mental State Examination 35 ; or evident motor impairment: based on self-report and observation ability to walk across a small room without physical assistance. 36 Measurement instrument The Schoeder-Block-Campbell Adult Psychiatric Sensory Integration Evaluation (SBC) was developed to evaluate SI in adults with mental health problems. 26 The original structure consisted of three scales: the first considers clinical history, the second describes the side effects of psychiatric medication, and the SBC-PAS for the evaluation of the main sensory integration systems. For this research, we focus on the content adaptation of the SBC-PAS. The SBC-PAS comprises 25 sections organized in three dimensions: (a) vestibular-proprioceptive; (b) vestibular-visual; and (c) tactile-proprioceptive; which are related to sensory and motor responses necessary for performance in daily life activities such as balance, coordination, and hand functioning. 25 , 27 As the SBC-PAS focuses on the tactile dimension, it includes measures such as ‘Grip Strength’, ‘Fine Motor Control’, ‘Diadochokinesis’ and ‘Finger Thumb Opposition’. However, it does not assess other essential components of tactile perception, such as the ability to differentiate size, shape, texture or temperature, qualities necessary for functionality in daily life. To provide a more complete evaluation of the tactile-proprioceptive dimension, we added three sections: (I) Tactile analyzer of the Barcelona test, 37 (II) Tactile temperature, 38 and (III) Stereognosis. 39 The sections included are described in Table 1 . Table 1. Sections that integrate the SBC- Physical Assessment Scale (SBC-PAS) to evaluate sensory integration in older adults. Section Modification Vestibular-Proprioceptive 1.Dominance Foot dominance C hange [Standing, without support] [With walker or table support] ○ Hop on one foot three times • Lift one leg three times • Lift your leg again and draw a circle [Standing, without support] [Standing with support or seated] ○ Kick this ball gently to me • Kick this ball gently to me ○ Repeat two times • Kick the ball again, now to one side of me • Once again, kick the ball, but now on the other side that previously kicked it [indicate] 2. Posture N o C hange 3. Neck rotation C hange [Standing] [Standing with support or seated] 4. Gait N o C hange 5. Hand observation N o C hange 6. Bilateral coordination upper extremity N o C hange 7. Crossing the midline N o C hange 8. Stability upper extremity C hange [Standing] [Seated, without back support] 9. Stability trunk C hange [Standing] [Standing with the support of one assistant and the examiner] 10. Classical Romberg R eplaced [Short Physical Performance Battery [SPPB-Balance Test] 11. Sharpened Romberg R eplaced [Short Physical Performance Battery [SPPB-Balance Test] 12. Overflow movements N o C hange 13. Neck Righting C hange [Standing] [Seated, without back support -straight back-] 14. Rolling E liminated 15. Asymmetrical tonic neck reflex C hange [Hands and knees on the mat] [Seated, without back support -head and back slightly tilted forward-] 16. Symmetrical tonic neck reflex C hange [Hands and knees on the mat] [Seated, without back support -head and back slightly tilted forward-] 17. Tonic labyrinthine reflex C hange [Lying down on the mat on your stomach, bending elbows so that your hands are at shoulder level and your legs straight] [Sitting - back suspended with pillow support, lift arms and legs at the same time-] 18. Protective extension N o C hange 19. Seated equilibrium E liminated 20. Body image R eplaced [Proprioceptive tasks of the Barcelona Test] Vestibular-Visual 21.Visual Pursuits N o C hange Tactile-Proprioceptive 22.Grip Strength N o C hange 23. Fine motor control N o C hange 24. Diadochokinesis N o C hange 25. Finger thumb opposition N o C hange * 26. Tactile Analyzer A dded [The Barcelona Test -graphesthesia, morphogenesis, and denomination and recognition of shape-] * 27. Temperature discrimination A dded [Evaluation of tactile temperature recognition and discrimination] * 28. Stereognosis A dded [Recognition of relief, thickness, and space through palpation] * Sections added to the original SBC version. Procedure For the adaptation of the SBC-PAS, we considered the following five guidelines of the second edition of the International Test Commission Guidelines for Translating and Adapting Tests. 34 , 40 (I) Pre-Condition : to verify construct relevance to OA and original property rights; (II) Test development : to verify adaptation quality through an iterative process of independent translations, review by native speakers with clinical experience with OA, linguistic correction, suitability of the adapted version, and pilot testing for OA; (III) Confirmation: assessment of content validity by an expert panel; (IV) Administration : prepare administration materials, conditions and instructions to guide interaction during administration; and (V) Documentation : description of the adaptation process, modifications made and documentation to use the adapted test. The SBC is not listed in the World Intellectual Property Organization (WIPO) catalogue, 41 however the manual has a 1978 Copyright © registration (TXU12-812). 42 Since 2019, efforts have been made to reach out to the right holders and ask for official permission to translate and adapt the SBC-PAS, but no answer has been obtained. This research focuses on the adaptation of the SBC-PAS into Spanish only for academic and research purposes, without any commercial or profit-making interest, in accordance with the “fair use”, 43 and giving credit to the SBC right holders. This is done considering the interest in scientific progress and the significance of advancing knowledge about SI assessment, its applicability, and its safety for OA. The SBC manual was transcribed and double-checked for consistency. It was then translated into Spanish by a Master psychologist certified in SI and then revised by a bilingual clinical psychiatrist with a master’s degree in medical sciences. An English language expert with experience in clinical assessment of OA reviewed the translation to ensure semantic equivalence, operational consistency, and the appropriate use of medical terminology. After provided written consent and through an iterative process 34 , 40 the expert panel evaluated the linguistic and operational components of the SBC-PAS for OA as part of the content validity process, 32 using the following criteria 44 : relevance (Does the item measure the attribute of the specified dimension?); comprehensiveness or scope (Are the instructions for performing the activity clear to the target population?); application pertinence (Is the item appropriate for use with OA?); and additional observations or comments for each task. Finally, after adjusting and adapting the SBC-PAS, a feasibility study was conducted with five OA 31 , 45 without evidence of cognitive or motor impairment 46 who provided written consent to participate. Analysis The observations of the expert panel were reviewed, categorized, and compared to consider changes or deletion of sections. The percentage of agreement and the Gwet’s AC 1 concordance index 47 was calculated and interpreted according to the observed agreement proposed by Landis & Koch. 48 To assess the feasibility of the SBC-PAS, we examined the response of OA during its administration. Observations were recorded in a designated section of the answer sheet to gather information on human, logistical and procedures requirements, as well as potential implementation challenges. Specifically, the analysis focused on the clarity of instructions, the time needed for completion, the appropriateness and safety of tasks for the target population, and any difficulties encountered by participants or evaluators during the process. 30 , 31 Results The expert panel provided qualitative and quantitative data related to the four criteria evaluated 44 in the adapted version. Qualitative data identified 11 sections needing position changes or added task support. Substitute three sections from Vestibular-proprioceptive dimension: Short Physical Performance Battery [SPPB-Balance Test] instead of the two Romberg sections: Classical and Sharpened , and Proprioceptive task from Barcelona test instead Body image section. Also, two sections were removed from Vestibular-proprioceptive ( Rolling and Seated equilibrium ) ( Table 1 ). Some experts from the committee also recommended simplify ‘ Dominance’ and ‘ Grip Strength’ sections, and the use of images to illustrate each task and facilitate the comprehension of the SBC-PAS. Table 2 shows the percentage of agreements, which ranged between 67% to 79% and concordance agreements ranged from moderate to substantial. 48 As a result of the content validation process, the changes suggested by the expert committee evaluation were integrated into the SBC-PAS. The modified version of SBC-PAS was tested in five OA aged between 70 and 85 age years (three women and two men) without cognitive or motor impairment. Table 2. The percentage of agreement and the Gwet´s AC 1 coefficient for the criteria. Criteria Agreement % AC 1 ρ IC al 95% Relevance 72% 0.6196 <.001 0.4820-0.7572 Comprehensiveness 67% 0.4915 <.001 0.3221-0.6609 Pertinence 79% 0.6879 <.001 0.5468-0.8290 Based on the implementation of assessment, the following aspects were identified: (A) The organization and sequence of tasks in the SI measurement alternated between seated and standing activities, which prolonged the total administration time, ranging from 90 to 190 minutes. Three sections required more time on the assessment 1 : hand observation , by adjusting or changing hand or arm position to use the goniometer 2 ; fine motor control , for training prior to the execution of the activity; and 3 the tactile tasks adapted from the Barcelona test, which involved continuous switching between the right and left hands. (B) The performance of tasks, presentation of stimuli, and their organization required a physical space of at least 4 x 6 meters. (C) Instruments such as the dynamometer and the keyboard used to assess “Finger Tapping Test” required prior setup and calibration. Additionally, the timer needed to be set to silent mode to avoid disrupting task performance. (D) As a performance-based assessment for OA, at least two examiners were necessary: one to administer and score the test, and another to assist and ensure the safety and support of participants during task execution. Discussion The aim of this work was to adapt and validate the content of the SBC-PAS to assess SI in OA through the subcortical SI systems: tactile, vestibular and proprioceptive. The adaptation process also considered aspects of safety, feasibility and compliance with ethical principles for its application in OA. 49 Adaptation and content validation of SBC content in OA As a result of the adaptation and content validity process, the modification, replacement and deletion of sections was related to the vestibular and proprioceptive systems. The modified sections were related to changes in positioning and the use of supports to minimize the risk of injury or falls and ensure the safety of the OA by considering tasks more suitable for OA 50 , 51 Although the evaluation of balance can provide important information, we decided to eliminate two items from the scale, ‘Rolling’ (rolling on the floor on a soft surface), 52 and ‘Seated equilibrium’ (body control and balance), due to the risk associated with its execution. 31 , 45 However, sections such as ‘Dominance’ or ‘Grip strength’ could be simplified and reduced. It is necessary to highlight that for ‘Dominance’, crossed or mixed laterality is not an unidimensional trait, and the evaluation of visual preference is complemented with the evaluation of eye-foot motor coordination, 53 which gives information of the compensation mechanisms in their laterality 54 For ‘Grip Strength’, it was decided to keep the average of three measurements for both hands in order to have a more consistent measurement. 52 While the original version of the SBC focused on the assessment of the vestibular and proprioceptive systems, the SBC-PAS adapted for OA expanded the assessment of the tactile system by considering the qualities of shape, texture, size, hardness and temperature. 55 The evaluation of the tactile system is very important since these qualities have been related to manipulation and interaction with the environment, 56 the ability to identify nociceptive stimuli related to behavioral problems, 57 the expression of needs, interpersonal interaction and quality of life of OA with different cognitive functioning conditions, including OA with Alzheimer’s Disease. 58 Regarding the feasibility 31 , 45 it is important to consider that this is a detailed evaluation that requires: at least a rest period, a large space that allows the use and manipulation of the materials, the participation of the evaluator and an assistant. It is important to have training for getting the clinical and technical skills needed to use the evaluation tools properly. The importance of SI in OA Recent research has found that age-related sensory impairment may accelerate the pathogenesis of major cognitive impairment, the possibility of being a prodromal indicator in Alzheimer’s disease has been mainly pointed out. 7 Thus, evaluation and investigation of the brain structures involved in OA sensory functioning and integration is necessary to understand cognitive functioning. 6 The subcortical tactile, 59 vestibular 60 , 61 and proprioceptive systems 62 – 64 support their role in essential functions such as awareness, orientation, balance and body coordination. 65 Likewise, evidence on changes in the activity of subcortical structures is consistent as an indicator of risk for major cognitive impairment. 60 , 61 , 66 This is why the SBC-PAS for OA represents an enhanced neurocognitive assessment tool that allows the evaluation of SI from these three subcortical systems: tactile, vestibular and proprioceptive. To be able to distinguish changes in sensory functioning due to the process of aging, 67 or due to major cognitive impairment such as Alzheimer’s disease 68 , 69 could guide interventions targeted to preserve or address different cognitive functioning conditions 70 with non-pharmacological interventions 4 , 5 , 12 more accessible to low-middle income countries. 71 Physical and emotional well-being Evidence of non-pharmacological interventions for OA with major cognitive impairment such as stimulation of sensory systems separately or together such as SI, has been associated with benefits and improvements on passivity, social isolation, physical 72 and emotional wellbeing, behavioral agitation, 57 , 73 disruptive behaviors, 20 in addition to the inherent implications for their care and attention. 20 , 74 The evidence of interventions developed from SI is consistent on the benefit and improvement on disruptive behaviors, 20 cognitive abilities, self-expression, affect, social awareness, orientation, motor coordination, 18 independence in self-care tasks, 19 decreasing dependence, 20 and in the quality of life of OA and their caregivers. 19 However, since the first SI interventions with OA 18 , 20 the assessment of intervention effects has been measured based on variables related to improvements in the level of daily functioning (cognitive, behavioral, social and emotional). There is no documented instrument or scale such as the SBC-PAS that we have adapted to assess the behavioral outcome underlying sensory processing at the subcortical level in OA. Although the SBC-PAS adapted for OA provided evidence of its content validity by an expert panel and feasibility in a group of five OA, it is necessary to expand the evidence with different levels of cognitive functioning. Obtaining these data would allow gathering evidence on its predictive and discriminant validity, as well as strengthening its clinical value and utility. 75 Even if the percentage of agreement and concordance index was substantial for relevance and application pertinence, comprehensiveness or scope was moderated. This limitation could be explained by factors related to the assessment and background of experts: tasks evaluated could have biased the perception of the dimension, and knowledge or clinical experience may have influenced the identification of critical aspects. 76 Considering a new expert panel evaluation to review this adapted version will allow for a more precise and refined assessment and feedback of its comprehensiveness. 77 Likewise, concordance assessment could be more accurate if more clinical experts are included in the expert panel. 77 , 78 Among the strengths of this research is that the process for obtaining evidence of adaptation and content validity was rigorous and in accordance with the International Test Commission Guidelines. 34 The results obtained on content validity were moderate to substantial, 48 and are supported by a multidisciplinary clinical team specialized in OA and major cognitive impairment, which strengthens its content validity for assessing SI in OA. Another strength is related whit the organization and application format developed for the adapted version which included support images for categorizing response options and coding. 45 The final Spanish-adapted version of the SBC-PAS ‘Scoring guide’ for OA was structured in tables to identify and rate each section consistently, reflecting the overall score for each section. In the original version higher score reflects more limited SI so the instructions for the following sections: Diadochokinesis , Thumb Opposition , Upper Extremity Stability , Bilateral Coordination of the Upper Limbs , Line Crossing , and Trunk Stability were reversed to improve its comprehension 45 allowing for easier application and registration. This adaptation opens new possibilities for the evaluation and analysis of the subcortical systems that organize the SI in OA and transcends for those who experience alterations of these structures such as OA with major cognitive impairment. Considering the subcortical systems is a prior step to activating and facilitate cortical processing, 18 assessing the subcortical systems that organize SI in OA could be useful to identify sensory problems that are associated with cognitive impairment early, as well as to strengthen the design and implementation of accessible non-pharmacological interventions to preserve and promote autonomy, independence and general well-being of OA 5 as well as an alternative to improve their care and attention. Conclusions This study gathers evidence on the process of adaptation and content validity of the SBC-PAS to assess the subcortical systems that organize SI in OA. Being able to assess these systems together constitutes an advance for the neuropsychological assessment of OA, given its diagnostic potential in different cognitive functioning conditions. Furthermore, the feasibility results support the viability of using SBC-PAS in real-world contexts. This makes SBC-PAS a valuable initial approach for assessing SI in OA, with potential applications in the early identification of cognitive impairment, targeting non-pharmacological interventions, and the improvement of care and quality of life for OA, particularly in low-middle income countries. Ethical approval and informed consent The study was approved by the Ethics and Research Committee of the Manuel Velasco Suárez National Institute of Neurology and Neurosurgery, in letter No. CEI/028/2024, Protocol 001/2024. The expert panel assessment and pilot study was applied with the informed consent of the participants. Disclosure statement Fabiola Tafoya-Ramos is a Doctoral student at the UNAM and mentored in the Dementia’s laboratory of the Manuel Velasco Suárez National Institute of Neurology and Neurosurgery. This laboratory studies the process of Alzheimer’s disease and other dementias, as well as the development of psychosocial, non-pharmacological and pharmacological interventions, as part of its support and care strategies for the elderly population. The other authors have no conflicts of interest. Preregistered data analysis The research and analysis plan were not preregistered at an independent registry. Data availability statement The expert panel data supporting the findings on the concordance agreement are available at https://doi.org/10.5281/zenodo.16782260 79 ; Creative Commons Attribution 4.0 International (CC-BY). Access to the final Spanish-adapted version of the SBC-PAS ‘Scoring guide’ for OA is restricted to preserve the SBC right holders. Researchers or professionals with training and experience in neuropsychological assessment, who submit a declaration of intended use in accordance with Data Sharing Agreement to use it exclusively for non-commercial academic or research purposes may apply for access. Applications should be addressed to the corresponding author at [email protected] , who will review and respond to each request individually. Access to the document will be available at https://doi.org/10.5281/zenodo.16788053 . The access will be granted only for academic, non-commercial purposes; Creative Commons Attribution Non-Commercial 4.0 International (CC-BY-NC). Acknowledgements Fabiola Tafoya-Ramos would like to acknowledge the Universidad Nacional Autónoma de México (UNAM) Programa de Maestría y Doctorado en Ciencias Médicas, Odontológicas y de la Salud and Consejo Nacional de Ciencia y Tecnología (CONACYT) for their support in academic and research development during doctoral studies. 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Publisher Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 02 Sep 2025 ADD YOUR COMMENT Comment Author details Author details 1 Facultad de Medicina, Universidad Nacional Autónoma de México, México, Ciudad de México, 04360, Mexico 2 Laboratorio de Demencias, Instituto Nacional de Neurologia y Neurocirugia Manuel Velasco Suarez, Mexico City, Mexico City, 14269, Mexico 3 Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatria Ramon de la Fuente Muniz, Mexico City, Mexico City, 14370, Mexico Fabiola Tafoya-Ramos Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Resources, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Gilberto Isaac Acosta-Castillo Roles: Conceptualization, Methodology, Supervision, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Catalina Francisca González-Forteza Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing Ana Luisa Sosa-Ortiz Roles: Conceptualization, Methodology, Supervision, Validation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 02 Sep 2025, 14:859 https://doi.org/10.12688/f1000research.168955.1 Copyright © 2025 Tafoya-Ramos F et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Tafoya-Ramos F, Acosta-Castillo GI, González-Forteza CF and Sosa-Ortiz AL. The feasibility to assess sensory integration in ageing: beyond the cerebral cortex [version 1; peer review: awaiting peer review] . 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