International consensus for the assessment of social cognition in neurocognitive disorders: framework definition and clinical recommendations of the SIGNATURE initiative

International consensus for the assessment of social cognition in neurocognitive disorders: framework definition and clinical recommendations of the SIGNATURE initiative | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article International consensus for the assessment of social cognition in neurocognitive disorders: framework definition and clinical recommendations of the SIGNATURE initiative Alessandra Dodich, Andrea Panzavolta, Giulia Funghi, Claudia Meli, and 34 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6370459/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 06 Dec, 2025 Read the published version in Alzheimer's Research & Therapy → Version 1 posted 10 You are reading this latest preprint version Abstract BACKGROUND: Socio-cognitive assessment in neurocognitive disorders (NCDs) is rare in clinical practice and no consensus exists as to a uniform operationalization of socio-cognitive measures for neurocognitive disorders in memory clinics. The SIGNATURE initiative aims to optimize the use of socio-cognitive measures in memory clinics, defining expert recommendations. We report consortium guidelines for the use of socio-cognitive measures in NCDs based on available evidence from the literature and the current state of practices in memory clinics. METHODS: Using a Delphi consensus method supported by a literature review and the results of an international survey, 22 specialists defined recommendations for the context of use, relevance in NCD diagnosis, priorities for future research and facilitators/obstacles of socio-cognitive assessment in major and mild NCDs. RESULTS: Overall, panelists recommended social cognition testing in routine diagnostic assessment to evaluate both socio-cognitive and socio-behavioral alterations. A set of clinical, methodological, implementation and external factors facilitating or hampering the use of socio-cognitive tasks was identified. CONCLUSIONS: This is the first focused endeavor to favor the implementation of socio-cognitive assessment, which is required by DSM-5 but seldom performed despite clear evidence of its clinical relevance for diagnosis and care. Our results provide an initial set of recommendations, refinable through the future actions of the SIGNATURE initiative. Future collaborative clinical research projects should overcome current limitations and foster the use of ecological and cross-culturally validated measures in clinics. Cognitive Assessment Social cognition Recommendations Neurocognitive disorders Figures Figure 1 Figure 2 Figure 3 1. INTRODUCTION Social cognition, which encompasses the cognitive processes underlying social interactions, is a critical domain affected in various neurocognitive disorders (NCDs), including Alzheimer’s disease (AD) and related disorders (ADRD) [ 1 ]. Despite its recognized importance, assessment of the social cognition domain in clinical settings remains inconsistent and fragmented [ 2 – 5 ]. This variability hinders the ability to timely diagnose, monitor, and treat a considerable number of ADRD whose primary clinical profile differs from typical AD. Despite advancement in theoretical and clinical research, this knowledge has not effectively translated into improved expertise or familiarity with socio-cognitive assessments among clinicians in memory clinics, highlighting a persistent gap between research and clinical practice [ 6 , 7 ]. To address these challenges, the SIGNATURE initiative was launched in 2022, aiming to systematize and optimize the use of social cognition measures across different international clinical centers ( https://sites.google.com/unitn.it/signature-initiative/ ). The ultimate goal of the SIGNATURE initiative is to ensure that clinicians, regardless of their location or resources, have access to reliable and effective tools for assessing social cognition in case of cognitive and behavioral complaints associated with suspected NCDs. In light of this, in 2022 we launched a survey to gather information on the state-of-art clinical practices and needs [ 8 ], laying the foundation for the next phase of the SIGNATURE initiative. By providing clinical recommendations and suggestions on research priorities based on evidence from current literature and the state-of-the-art in clinics, the initiative seeks to promote consistency in clinical assessment, thereby improving the comparability of clinical research and findings across centers and the reliability of diagnoses. This ideally harmonized or at least consistent approach is expected to improve detection, patient care and care outcomes and to advance our understanding of social cognitive impairments in NCDs. The rationale for the SIGNATURE initiative is supported by analogous successful harmonization of socio-cognitive assessments in other clinical populations, such as autism spectrum disorders (ASD) and schizophrenia. Over 10 years ago, the “Social Cognition Psychometric Evaluation” (SCOPE) study was designed to identify not only the key dimensions of social cognition in schizophrenia but also the instruments best assessing these facets [ 9 ]. Alongside the growing understanding of social and non-social cognitive dysfunctions in this population [ 10 ], the SCOPE initiative has led to a set of cognitive assessment recommendations from the European Psychiatric Association, many of which focus on social cognition [ 11 ]. These recommendations aim to promote the use of standardized assessment protocols in both clinical trials and real-world clinical settings. Building from the experience of similar initiatives, applying standardized socio-cognitive assessments in NCDs holds significant promise. Ideally harmonized or at least consistent recommendations can enhance the early detection of social cognitive impairments, which are often present in the prodromal stages of NCDs [ 12 ]. Moreover, early identification can lead to timely interventions on patients and caregivers, which may slow the progression of the disease with positive outcomes on social functioning and quality of life. This paper describes the establishment of a task force with the objective of defining a framework and formulating a preliminary set of clinical recommendations pertaining to the context of use and the current relevance of socio-cognitive testing in the dementia context. Additionally, it addresses the facilitators and obstacles to implementing this framework in clinical settings and suggests research priorities to support the development and implementation of social cognition assessment in NCDs. 2. MATERIALS AND METHODS 2.1 Task force SIGNATURE Delphi team. The project task force included the Executive Board (EB), the Advisory Board (AB) and the panel (PA; details in Table 1 ). The EB included Delphi facilitators (C.C., A.D., G.F., C.M., A.P.) and one “external” reviewer (C.F.), one of the methodologists from the SIGNATURE initiative, who supervised the Delphi procedure. The AB included a scientific and methodological advisor (M.Bo.), 3 representatives from patient advocacy associations (L.I., M.P., M.T.) and an expert (M.T.) in neuropsychology practices in people with disabilities. Delphi panelist. The panel consists of specialists from different countries and scientific societies, i.e., 10 neurologists and 12 psychologists/neuropsychologists (Table 1 ). Thirteen experts are clinicians with both research and clinical experience in socio-cognitive assessment in NCDs and nine are researchers with world-renowned expertise in social cognition. Nine experts are national collaborators (representatives of countries participating in the SIGNATURE initiative) and three are advisors (M.Be., F.K., J.VdS.) of the SIGNATURE initiative (see Participant section of the SIGNATURE website; https://sites.google.com/unitn.it/signature-initiative/participants ). All have a long professional experience in NCDs and in the use of social cognitive tasks for diagnostic purposes in the clinical practice of their academic and high-level research institutions. Table 1 Participants and roles at the first SIGNATURE workshop (September 2023). Name, SURNAME Role in the Delphi Procedure Role in the SIGNATURE initiative The Executive Board Chiara CERAMI Delphi Facilitator Principal Investigator Alessandra DODICH Delphi Facilitator Principal Investigator Andrea PANZAVOLTA Project Manager Coordinating Team Giulia FUNGHI Delphi Facilitator Coordinating Team Claudia MELI Delphi Facilitator Coordinating Team Cristina FESTARI External Reviewer Methodologist The Panel Maxime BERTOUX France Representative, Psychologist, Social Cognition Expert Advisor Fiona KUMFOR Psychologist, Social Cognition Expert Advisor Jan VAN DEN STOCK Belgium Representative, Psychologist, Social Cognition Expert Advisor Christian CHICHERIO Switzerland-French section Representative, Psychologist, Clinical Researcher National Collaborator Florencia CLARENCE Argentina Representative, Psychologist, Clinical Researcher National Collaborator Fabricio Ferreira de OLIVEIRA Brazil Representative, Neurologist, Clinical Researcher National Collaborator Marco FILARDI Italy Representative, Psychologist, Clinical Researcher National Collaborator Sarah MACPHERSON UK Representative, Psychologist, Social Cognition Expert National Collaborator Jordi A. MATIAS-GUIU Spain Representative, Neurologist, Clinical Researcher National Collaborator Maxime MONTEMBEAULT Québec Representative, Psychologist, Clinical Researcher National Collaborator Leonardo SACCO Switzerland-Italian section Representative, Neurologist, Clinical Researcher National Collaborator Ann-Katrin SCHILD Germany Representative, Psychologist, Clinical Researcher National Collaborator Marc SOLLBERGER Switzerland-German section Representative, Neurologist, Clinical Researcher National Collaborator Miguel TABUAS-PEREIRA Portugal Representative, Neurologist, Clinical Researcher National Collaborator Esther VAN DEN BERG The Netherland Representative, Psychologist, Social Cognition Expert National Collaborator Stefano CAPPA Neurologist, Social Cognition Expert Member Agustin IBANEZ ReDLat Representative, Psychologist, Social Cognition Expert Member Giancarlo LOGROSCINO FRONTIERS Consortium Representative, Neurologist, Clinical Researcher Member Camillo MARRA Italian Association of Neurology for dementia Representative, Neurologist, Clinical Researcher Member Costanza PAPAGNO FESN Representative, Neurologist, Social Cognition Expert Member Olivier PIGUET Psychologist, Social Cognition Expert Member Simone POMATI INS cross-cultural needs working group Representative, Neurologist, Clinical Researcher Member The Advisory Board Marina BOCCARDI Scientific & Methodological Advisor Methodologist Laura INVERNIZZI FTD Caregiver Association Representative, World FTD United and Italian FTD Association Member Mario POSSENTI AD Caregiver Association Representative, Alzheimer Europe and Federazione Alzheimer Italia Member Magda TSOLAKI AD Caregiver Association Representative, Greek Federation of Alzheimer’s disease Member Marianna TSATALI Expert of Neuropsychology Practice in people with disabilities Member 2.2 Delphi methodology and procedure In this project, we applied the Delphi methodology according to previously reported procedures [ 12 , 13 ]. In detail, the EB reviewed the current literature and the results of the SIGNATURE clinical survey [ 8 ] and defined the panel for the Delphi procedure. Then, the facilitators drafted the first version of the Delphi questions, which was submitted to the external reviewer who assessed whether the items were sufficiently clear, neutral, informative, and complete. The Delphi questionnaire was then shared with all panelists via a web-based platform (i.e., Qualtrics) together with instructions to respond to each topic based on their expert opinion, experience, and evidence from the state-of-the-art. The Delphi procedure was performed during the 2-day hybrid First SIGNATURE Workshop held at the Scuola Universitaria Superiore IUSS in Pavia, Italy. Details of the event can be found at the following link https://sites.google.com/unitn.it/signature-initiative/events/ . See Fig. 1 for details on the Delphi approach including the preliminary activities and the Delphi procedure. Questionnaire definition. The EB identified four target topics for the Delphi consensus assumptions aimed at defining: Clinical context of use and practice in socio-cognitive testing for the diagnosis of NCDs in memory clinics by specialists in dementia (Section 1) ; Relevance of socio-cognitive assessment in cognitive decline and the dementia diagnostic framework (Section 2) ; Facilitators and obstacles for the implementation of socio-cognitive testing in clinics (Section 3) ; Priorities for future research on socio-cognitive testing in NCDs (Section 4) . See Supplementary Table 1 for details of the questions per section. Agreement, multiple choice, relevance and open text questions were used to assess consensus assumptions. See Supplementary Table 1 for the full list of questions. Panelists were allowed to abstain from voting when the topic of the question was outside their area of expertise. All responses were substantiated with justifications. Convergence threshold. For agreement and the multiple-choice questions, we established a predefined threshold of 70% of non-abstaining panelists for agreement in Round 1. Those questions for which no consensus was reached were then reformulated based on panelists’ comments and presented in Round 2. In this case, an absolute majority (50%+1) was sufficient for agreement. Responses to relevance questions were summed up into a single score and categorized according to the following range: ≥99 - Very Important (corresponding to a score of 'very important' assigned by at least half of the panelists, and the other half assigning a score of 'important’); 77 ≤ x < 99 - Important (corresponding to a score of 'important' assigned by at least half of the panelists, and the other half assigning a score of 'neutral’); 55 ≤ x < 77 - Neutral (corresponding to a score of 'neutral’ assigned by at least half of the panelists, and the other half assigning a score of 'not important'); 33 ≤ x < 55 - Not Important (corresponding to a score of 'not important' assigned by at least half of the panelists, and the other half assigning a score of 'not important at all'); < 33 - Not Important At All (when the majority of the panelists assigned a score of 'not important at all'). Open text questions were only used in Round 1 to derive a list of facilitators and obstacles that were voted on in terms of relevance in Round 2. 2.3 Evidence supporting the Delphi procedure To help the Delphi panelists to make informed decisions, we provided them with the following background information: a) top-down evidence from a literature review on available socio-cognitive measures for the early and differential diagnosis of mild and major NCDs; b) bottom-up evidence derived from results of our previous clinical survey [ 8 ]. Top-down evidence. For a), starting from a previous systematic review [ 14 ] that investigated clinically validated socio-cognitive measures for the diagnosis of behavioral variant of frontotemporal degeneration (bvFTD), we updated and expanded the literature review up to July 2023 according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement [ 15 ]. We considered only original studies published in English, excluding reviews, case reports, and guidelines. Search strings were harmonized across NCD syndromes (mild or major) and etiological diagnosis (e.g., AD, FTD, etc.). See Supplementary Table 2 for details on search strings. Relevant references from personal knowledge and citation-tracking articles were also included. Titles and abstracts were screened, and potentially relevant studies were then examined according to the following criteria: 1) use of either a clinical or biomarker-based diagnosis for patient classification, 2) quantitative scoring of a socio-cognitive measure or social cognition battery; 3) availability of diagnostic accuracy data for socio-cognitive tests, including metrics such as sensitivity, specificity, accuracy, positive/negative predictive value, or positive/negative likelihood ratios. The quality of evidence was rated by A.D., C.C., A.P. and C.M. using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2, [ 16 ]), a tool designed to provide a formal assessment of the quality of primary studies included in a review to avoid bias. Raters were trained in QUADAS-2 and had fine-tuning methodological meetings to ensure uniformity and reproducibility of data extraction. Data were recorded in an Excel spreadsheet, modified from Dodich et al., 2021[ 14 ]. Bottom-up evidence. The SIGNATURE clinical survey results [ 8 ] were presented during the workshop and provided on a dedicated Google Drive folder to all the panelists prior to the Delphi Round 1 to inform them on the clinical evidence regarding the state-of-the-art of socio-cognitive assessment in memory clinics, the best-known and used tools for assessing social-cognitive function across ten European and non-European geographical areas, the perceived relevance of assessing social cognition in NCDs, and the hurdles envisioned for the use of socio-cognitive measures in real-life clinical scenarios. 3. RESULTS 3.1 Top-down evidence An updated literature review of studies on socio-cognitive measures available in clinics identified a total of 971 papers that were screened for subsequent processing (see Supplementary Fig. 1). After excluding duplicate records, wrong publication type and off-topic and not-English papers, only 65 papers were assessed for eligibility. Forty-four papers were excluded because: 1) only the combined diagnostic accuracy of social and other cognitive measures was reported, without specific information on the accuracy of social tasks; 2) accuracy values were calculated using multifactorial models from which the exclusive weight of the social cognition measures was not obtainable; or 3) mixed samples of mild/major NCDs were included. The remaining 21 papers provided validated measures of the accuracy of single or combined socio-cognitive measures in major NCDs, two of them also including mild NCDs (see Supplementary Table 3). Of these, ten studies explored the accuracy of tests of emotion recognition using facial stimuli (e.g., Ekman 60 faces and its variants) [ 17 – 26 ], one test of emotional recognition using non-visual stimuli [ 27 ], eight using theory of mind tasks (Story-based Empathy Task, Reading the Mind in the Eyes test, the Faux-pas test, and experimental mentalizing music task) [ 19 – 22 , 25 , 28 – 30 ], eight using the Social Cognition and Emotional Assessment (SEA) battery or its short version (mini-SEA) [ 21 , 22 , 25 , 31 – 35 ], and six using other social cognition facets (e.g., empathy and socio-emotional sensitivity) [ 20 , 26 , 28 , 31 , 36 , 37 ]. These papers reported good to excellent accuracy values for emotion recognition and theory of mind tasks in the early and differential diagnosis of bvFTD and good clinical performance in differentiating amnestic mild cognitive impairment (MCI) and AD versus healthy control subjects (HC). Only one study explored the clinical diagnostic performance of emotion recognition and theory of mind in the differential diagnosis of frontotemporal lobar degeneration syndromes [ 19 ]. The quality of evidence assessed with QUADAS-2 was judged as strong in two studies [ 19 , 31 ] showing an overall judgment of low risk of bias or low concern regarding applicability. Ten studies showed low/moderate risk of bias [ 17 , 21 , 22 , 27 , 29 , 32 – 34 , 36 , 37 ]. The main methodological limitations were related to bias in: 1) patient selection (i.e., lack of consecutive, unspecified selection of subjects or inappropriate exclusions, n = 6); 2) reference standards (i.e., either possible inaccurate to classify the target condition or low availability of in vivo biomarkers, n = 4); and 3) flow and timing (i.e., unclear or inappropriate intervals between the index test(s) and the reference standard, and diagnoses not assessed against the same reference standard, n = 5). See Supplementary Table 4 for a summary of the QUADAS-2 assessment for all included studies. 3.2 Bottom-up evidence Results from the SIGNATURE survey data collection including 413 responses from 10 European and Latin America geographical regions reported the Ekman-60 faces (EK-60F; a well-known test for recognizing facial affect) test or its variants as the most well-known and used task overall, followed by two tests of theory of mind (i.e., the Faux-Pas and the Reading the Mind in the Eyes – RMET tests, or their variants) [ 8 ]. The EK-60F and the Faux-Pas tests were reported as known/used in 10/10 geographical regions, while the RMET in 8/10 [ 8 ]. In addition, the mini Social cognition & Emotional Assessment (Mini-SEA; a test combining facial emotion recognition and a selection of faux-pas) was known/used in 5/10 geographical regions and the Story-based Empathy task (SET; a test evaluating attribution of emotion and intention to others) in 6/10 [ 8 ]. 3.3 Results of Section 1 – Clinical context of use and practice Two Delphi runs were performed. Regarding recommendations for clinical use, the panelists agreed that social cognition testing should be routinely included in the assessment of every patient as part of the diagnostic definition for NCDs (Round 1, Q1; votes: 86.4% of agreement). However, social cognition assessment in follow-up evaluations was recommended only for selected cases based on the presence of socio-cognitive deficits at the first assessment or based on symptoms reported at the follow-up visit (Round 2, Q2r; votes: 95.5% of agreement). First-level evaluation was voted as the most appropriate context for the assessment of social cognition in major (Q3) and mild (Q4) NCDs (Round 1, Q3: votes 81.8% of agreement; Q4: 90.9%). Socio-cognitive assessment should include at least two tests evaluating different facets of social cognition (Round 1, Q5; votes: 95.4% of agreement) as well as a measure of social cognitive domain functioning (e.g., emotion recognition) and a measure to quantify changes in social behavior (e.g., sensitivity to social signals in real life) (Round 1, Q6; votes: 81.1% of agreement). See Fig. 2 for a summary of Section 1 recommendations and details on the agreement rates. The figure list recommendations for the clinical context of use and practice in socio-cognitive testing for the diagnosis of NCDs and on the relevance of socio-cognitive assessment in the different NCD diagnostic frameworks. See Supplementary Materials for details on the questions and agreement scores. RMET: Reading the Mind in the Eye Test; SET: Story-based Empathy task; Mini-SEA: mini-Social cognition & Emotional Assessment; IRI-EC: Interpersonal Reactivity Index – Empathic Concern; IRI-PT: Interpersonal Reactivity Index - Perspective Taking. 3.4 Results of Section 2 – Relevance in NCD diagnosis Panelists rated the assessment of emotion recognition in major NCDs (Round 1, Q7), and emotion recognition and cognitive ToM in mild NCDs (Round 1, Q8) as “very important”. The panel agreed on the use of the EK-60F test or its variants (Round 1, Q9; votes: 90% of agreement), the Faux-pas test (Round 2, Q10; votes 65% of agreement) and the Empathic Concern and Perspective Taking subscales of the Interpersonal Reactivity Index (IRI) questionnaire (Round 2, Q12r; votes: 57.9% of agreement) to assess emotion recognition, mentalizing, and empathy facets of social cognition respectively in major and mild NCDs. Panelists also agreed on using the RMET, the SET, and the mini-SEA as other tools to assess social cognition deficits in major and mild NCDs (Round 1, Q11; votes: 70% of agreement). No consensus was reached on using the revised version of the Self-monitoring Scale (r-SMS) to assess self-monitoring and awareness in NCDs. Specifically, the panelists recognized the evidence in favor of the use of r-SMS in frontotemporal dementia. However, based on the lack of information about the overall validity in mild and major NCDs, a consensus could not be found. Poor knowledge about the test and limited clinical data were raised as relevant points, which represent research priorities for its use in clinical practice. See Fig. 2 for a summary of the Section 2 recommendations and Supplementary Fig. 2 for details on agreement rates. 3.5 Results of Section 3 – Facilitators and obstacles Clinical and methodological obstacles (e.g., lack of validated standardized tools, lack of normative data) emerged as the most relevant factors influencing socio-cognitive measure use in clinical practice, together with implementation hurdles (e.g., lack of professional expertise and training for professionals, lack of time for the neuropsychological assessment) and external barriers (e.g., resistance to change in clinical practice, insufficient communication among research and clinical communities). Facilitators included the availability of tests without cognitive load in other domains, the availability of quick to administer cognitive tasks and the availability of cross-cultural and cross-language information. Automatization in data scoring and acquisition and lack of digital tools were rated only as marginal obstacles. See Fig. 3 for the full list of facilitators and obstacles. 3.6 Results of Section 4 – Priorities for future research Considering priorities for future research, the panel agreed that social cognition assessment should include a subset of cognitive screening tests administrable remotely using digital tools but only if an in-person assessment is not possible (Round 2, Q15r; votes: 54.6% of agreement). The panel rated either patient- or informant-administered measures with supervision (Round 1, Q16) as “Important”. Tasks or interview administration without supervision were rated overall as less relevant. Tablet-based neuropsychology platforms and teleneuropsychology via videoconferencing were considered relevant scenarios in the diagnostic framework (Round 2, Q17) and in the follow-up neuropsychological evaluation (Round 2, Q18). Other digital tools, such as wearables, virtual/augmented reality and eye-tracking, were rated as less important. The figure shows in bold the facilitators and obstacles rated as “Very Important”, and in nonbold those rated as “Important”. 4. DISCUSSION In this paper, we provide actionable recommendations to bridge the gap between research and clinical practice, advancing the implementation of socio-cognitive assessment within NCDs diagnostic procedures. As evidenced by the results of the SIGNATURE survey [ 8 ], the selection of social cognition measures is often influenced by individual clinical preferences, availability of measures, the level of expertise and local resources. This leads to significant differences in patient assessment and provision of care [ 38 ]. These recommendations aim to provide a general framework and guide the definition and implementation of social cognition assessment in NCDs. Socio-cognitive testing is recommended for all patients suspected of mild or major NCDs during the baseline assessment to facilitate more accurate diagnosis. Moreover, it should be included in the follow-up neuropsychological evaluation of selected patients for better monitoring of the disease progression, based on the presence of socio-cognitive deficits at their initial assessment or on symptomatology reported at the follow-up clinical visit. Indeed, the DSM-5 recommendations support the assessment of social cognition; however, no specific details are provided for major/mild NCDs or differential frameworks (i.e., diagnostic or follow-up). The results of this study help to operationalize the DSM-5 recommendations based on current evidence and expertise in the field to improve the detection rate in clinical practice of those patients not presenting with an AD phenotype. As suggested by the APA recommendations [ 39 ], which recommend that two tests provide a more comprehensive approach to accurately capture the multifaceted nature of cognitive domains, the panel agreed that socio-cognitive testing should include at least two tests that assess different facets of the social cognition domain, and that these should be complemented by a measure that quantifies changes in social behavior. Indeed, the use of a single test to evaluate the complexity of social cognition changes in NCDs poses significant risks for inaccuracy or misinterpretation and may fail to capture the breadth of impairments across the various subdomains of social cognition. It should be noted, however, that the use of more than one test per cognitive domain may be limited in some clinical settings for reasons of feasibility concerns (e.g., lack of resources or time constraint). Different tests available in clinics were considered by the panel in terms of their current utility for the detection of social deficits. However, as pointed out by the panelists, some tools pose significant challenges, such as inadequate psychometric properties [ 40 ], or lack normative data or the absence of cross-cultural validated tools that hamper their harmonized use in memory clinics (for a list of tests available in different countries see SIGNATURE website in measures subsection ). Future efforts should promote the development of more reliable tools, able to overcome these current limitations, possibly providing translations and cultural adaptations for different countries. This is a crucial point, as one could expect that social-cognitive measures - more than other cognitive domains - are heavily influenced by local specificities, social norms, and language nuances [ 41 ]. Variability in cultural contexts, characterized by different social norms, complex mental state definitions (e.g., schadenfreude) and non-verbal behaviors may lead to misinterpretations of individuals’ performance if a test is used in a context other than that for which it was designed [ 42 ]. In this regard, it is important to note that most neuropsychological tasks have been developed and validated in Western, educated, industrialized, higher socio-economic status, and largely democratic countries. Applying these norms to individuals from societies or countries with very different social contexts can lead to misinterpretation and misdiagnosis of cognitive impairments. The introduction of computerized adaptive testing through digital tools might advance the field of socio-cognitive testing by designing more flexible culture-broad tools able to capture deficits in social cognition [ 43 ]. In addition, more inclusive practices in clinical neuropsychology would improve appropriateness of cognitive testing in sexual and gender minorities [ 44 ], since they could express vulnerabilities in socio-cognitive functioning, which remain currently unexplored [ 45 , 46 ], as a consequence of specific environmental factors (e.g. stigma). Adapting socio-cognitive tools to reach a broader audience in clinics should also include populations with disabilities who have limited access to this type of evaluation [ 46 ]. Collaborative international participatory research, as also reported by the facilitators, is essential for addressing the challenges of social cognition assessment from a broad perspective, while also considering specific needs, such as those related to disabilities, and cultural differences. Another key facilitator of socio-cognitive assessment is the definition of a clear conceptual and theoretical framework of social cognition. Increasing knowledge of how subdomains of social cognition develop, function, and interact is a critical step in understanding the foundations of social behavior and how it can be measured in the clinical context of NCDs. Studies aimed at disentangling the interdependence of social cognition subdomains are needed to develop theoretical models from which neuropsychological batteries may be derived, as is already available for other cognitive domains (e.g., the Birmingham Object Recognition Battery for visuo-spatial assessment [ 47 ]). Recent efforts to promote the use of consensual terminology [ 48 ], and other initiatives could help ( https://shorturl.at/nzWQw ). In addition to the above-mentioned clinical, methodological (e.g., cross-culturally validated tests with good psychometric properties) and implementation (e.g., brief socio-cognitive tasks feasible in clinical settings) priorities, other relevant factors in the use of socio-cognitive testing in clinical scenarios have been identified by the panelists. These include the presence of external factors such as the resistance to changing clinical practice and the availability of copyright-free tools. These issues deserve special attention and can be addressed in the context of multicenter projects. Besides, the cross-cultural translation of these results in other socio-cultural settings is still untested. International networks, such as those promoted by the Cognition Professional Interest Area (PIA) of the International Society to Advance Alzheimer's Research and Treatment (ISTAART PIA-Cognition), can help to raise awareness among multiple stakeholders. Declarations Ethics Approval The study protocol was approved by the IUSS University Ethics Committee (IUSS-University of Pavia; Protocol 164/24). Consent for publication Not applicable Availability of data and materials Datasets generated and analyzed in this study are available from the corresponding author on request. Competing interests Chiara Cerami has been granted for consultancy by Newel Health srl, LinkForMed srl, Ethos srl. Stefano Cappa has received speaker honoraria from Biogen, Roche and Nutricia and is member of the Scientific Advisory Board of Brain Control. Alessandra Dodich has received funding through her institution from Associazione Alzheimer Trento ODV. Cristina Festari has received funding through her institution from the Alzheimer’s Association and Italian Ministry of Health. Giancarlo Logroscino has served as investigator for clinical trials sponsored by Biogen Pharmaceuticals, Axovant, Alector, Denali, Roche, Eisai, Genentech, Amylyx, Piam Farmaceutici SpA and has been granted for speech and consultancy by EISAI, Roche, Lilly, Piam Farmaceutici Spa, Biogen. Jordi Matias-Guiu has been granted for speech and consultancy by Almirall, Alter, Fujirebio, Esteve, KRKA and Schwabbe, Araclon, Eisai, and Schwabbe and is supported by grants from Instituto de Salud Carlos III and Fundacion Conocimiento Madri+D. Fabricio Ferreira de Oliveira has been granted for consultancy by Gerson Lehrman Group, Atheneum Partners, Guidepoint, Lionbridge. He is supported by FAPESP – The State of São Paulo Research Foundation (Grant #2015/10109-5) and is a board member of AAN Global Strategies Subcommittee, Awards Committee of the International Parkinson and Movement Society, ISTAART PIA Biofluid Based Biomarkers working group, ISTAART PIA Neuropsychiatric Syndromes and ESF Committee of Experts. Leonardo Sacco has served as investigator for clinical trials sponsored by Biogen and was member of the Advisory Board of Roche and Eisai. Marc Sollberger has been granted for speech and consultancy by Lilly, Eisai, OM Pharma. Katheen Welsh-Bohmer is a consultant to WCG, Senaptec, Jigsawdio. She serves on the U.S. POINTER data safety monitoring board and is unpaid board member for the nonprofit Dementia Alliance of NC (DANC). She is also funded through US Federal Grants (NIA/NIH), NC DHHS state funds, and private foundational support (National Philanthropic Trust/Gates to the Alzheimer’s Data Discovery Initiative ADDI). The other authors do not declare any conflict of interest. Funding SIGNATURE workshop activities were supported by JPND call for expert Working Groups "Concepts for health and social care research for neurodegenerative diseases" and by Associazione Alzheimer Trento ODV. Authors’ contributions All authors (C.C., A.D., G.F., C.M., A.P, C.F., T.C., C.C., F.C., F.F.O., M.F., A.I., L.I., T.L., G.L., S.E.M., R.M., C.M., J.A.M.G., M.M., C.P., S.P., M.P., O.P., L.S., A.K.S., M.S., M.T.P., M.T., E.V.B., S.F.C., M.B., F.K., J.V.S., M.B., and K.A.W.B) contributed to the study conception and design. Material preparation was performed by the Executive Board (C.C., A.D., G.F., C.M., A.P.). Data collection and analysis were performed by A.P, G.F., and C.M.. The first draft of the manuscript was written by A.D. and C.C. All authors (C.C., A.D., G.F., C.M., A.P, C.F., T.C., C.C., F.C., F.F.O., M.F., A.I., L.I., T.L., G.L., S.E.M., R.M., C.M., J.A.M.G., M.M., C.P., S.P., M.P., O.P., L.S., A.K.S., M.S., M.T.P., M.T., E.V.B., S.F.C., M.B., F.K., J.V.S., M.B., and K.A.W.B) reviewed the manuscript for content, read and approved the final version. Acknowledgment This manuscript was facilitated by the Alzheimer’s Association International Society to Advance Alzheimer's Research and Treatment (ISTAART), through the Cognition professional interest area (PIA). The views and opinions expressed by authors in this publication represent those of the authors and do not necessarily reflect those of the PIA membership, ISTAART or the Alzheimer's Association. SIGNATURE workshop activities were supported by JPND call for expert Working Groups "Concepts for health and social care research for neurodegenerative diseases" and by Associazione Alzheimer Trento ODV. LIST OF CONSORTIUM MEMBERS Dodich Alessandra 1 , Panzavolta Andrea 2 , Funghi Giulia 1 , Meli Claudia 1 , Festari Cristina 3 , Chatzikostopoulos Thanos 4 , Chicherio Christian 5 , Clarens Florencia 6 , de Oliveira Fabricio Ferreira 7 , Filardi Marco 8 , Ibanez Agustin 9 , Invernizzi Laura 10 , Lebouvier Thibaud 11 , Logroscino Giancarlo 12 , MacPherson Sarah E. 13 , Manca Riccardo 14 , Marra Camillo 15,16 , Matias-Guiu Jordi A. 17 , Montembeault Maxime 18 , Papagno Costanza 1 , Pomati Simone 19 , Possenti Mario 20 , Piguet Olivier 21 , Sacco Leonardo 22 , Schild Ann-Katrin 23 , Sollberger Marc 24 , Tábuas-Pereira Miguel 25,26 , Tsatali Marianna 4 ,Tsolaki Magda 4 , van den Berg Esther 27 , Cappa Stefano F. 2 , Bertoux Maxime 28 , Kumfor Fiona 29 , van den Stock Jan 30 , Boccardi Marina 31,32 , Welsh-Bohmer Kathleen Anne 33 , Cerami Chiara 2,34 , Federica Agosta 35 , Elisa Canu 35 , Ove Almkvist 36 , Goran Hagman 36 , Bengt Winblad 36 , Daniele Altomare 37 , Davide Angioni 38 , Jean-Marie Annoni 39 , Luca Beretta 40 , Manfred Berres 41 , Valentina Bessi 42 , Ingo Fimm 31 , Ingo Kilimann 31 , Emre Bora 43 , Andrea Brioschi-Guevara 44 , Andreas Buchmann 45,46 , Anton Gietl 45 , Cinzia Bussè 47 , Annachiara Cagnin 47 , Russell Chander 48 , Matthias Kliegel 49 , Nathalie Mella 49 , Alfredo Costa 50 , Camille Coulangers 38 , Pierre-Jean Ousset 38 , Chiara Cupidi 51 , Jean-François Démonet 52 , Mira Didic 53 , Francesco Di Lorenzo 54 , Bruno Dubois 55 , Alan Cronemberger Andrade 7 , Bruno Fimm 56 , Douglas Galasko 57 , Nicola Girtler 58 , Flavio Nobili 59 , Matteo Pardini 59 , Julie Henry 60 , Renelle Bourdage 61 , Lize Jiskoot 61 , Jackie Poos 27 , Haaro Seelaar 27 , Stefan Klöppel 46 , Christine Krebs 46 , Walter A. Kukull 62 , Richard Levy 63 , Marisa Lima 25 , Antonella Luca 64 , Simona Luzzi 65 , Marta Fernández Matarrubia 66 , Patrizia Mecocci 67 , Martina Pigliautile 67 , Alina Menichelli 68, Micaela Mitolo 69 , Andreas U. Monsch 24 , Despoina Moraitou 70 , Petr Novak 71 , Miriam E. Ortiz 72 , Sokratis Papageorgiou 73 , Nikolaos Scarmeas 73 , John Papatriantafyllou 74 , Andrea Plutino 75 , Davide Quaranta 76 , Inez Ramakers 77 , Stefania Rossi 78 , Mirella Russo 79 , Stefano Sensi 79 , Perminder Sachdev 48 , David P. Salmon 80 , Pilar Sanchez 81 , Florian Schöberl 82 , Steven D. Shirk 83 , Alessio Toraldo 84 , Annalena Venneri 85 , Dix Meiberth 23 , Maurizio Gallucci 86 , Fotini Kounti 87 , Silvia Rodrigo Herrero 88 , Pietro Marano 89 , Tommaso Piccoli 90 ,Samrah Ahmed 91 , Fabiola Böhm 92 , Matthias Schroeter 82 , Susanna Vestberg 9 3 , Marie Söntgerath 9 4 , Jennifer Thompson 9 5 , Tamlyn Watermeyer 96 , Hendrick-Jan van der Waal 9 7 , Lucy Chrisman-Russell 98 , Silvana Morson 10 , Lucas Wolski 82 , Renzo Dori 99 , Andrea Fabbo 100 , Chiara Galli 100 , Claudia Bartels 101 , Gert Geurtsen 102 , Francesca Baglio 103 , Sara Isernia 103 , Cem Dogdu 104 , Elisa Ruiu 105 , Fijanne Strijkert 106 , Nikki Zimmermann 107 , Wendy Weidner 108 , Helena Briales 109 , Rita Pezzati 110 , Anne Rita Oksengard 111 , Angela Bradshaw 112 1 Centre for Mind/Brain Sciences, University of Trento, Rovereto, Italy 2 IUSS Cognitive Neuroscience Center, Scuola Universitaria Superiore IUSS di Pavia, Pavia, Italy 3 Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy 4 Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece 5 Memory Center, Geneva University Hospitals, Geneva, Switzerland 6 Memory and Aging Center, Institute for Neurological Research, Buenos Aires, Argentina 7 Universidade Federal de São Paulo, São Paulo, Brazil 8 University for Foreigners of Perugia, Perugia, Italy 9 Latin American Brain Health Institute, Santiago, Santiago, Chile 10 Italian Frontotemporal Dementia Association, AIMFT, Brescia, Italy 11 Université de Lille, Inserm, Centre Hospitalier Universitaire de Lille, Lille Neuroscience & Cognition, Lille, France 12 Università degli Studi di Bari Aldo Moro, Bari, Italy 13 Department of Psychology, University of Edinburgh, Edinburgh, UK 14 Department of Medicine and Surgery, University of Parma, Parma, Italy 15 Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy 16 Department of Psychology – Catholic University of Sacred Heart – Milan, Italy 17 Department of Neurology, Hospital Clinico San Carlos. San Carlos Health Research Institute (IdISSC), Universidad Complutense, Madrid, Spain 18 Douglas Research Centre & Department of Psychiatry, McGill University, Montreal, Canada 19 Center for Cognitive Disorders and Dementia, Neurology Unit, Ospedale Luigi Sacco, Milan, Italy 20 Federazione Alzheimer Italia, Milan, Italy 21 School of Psychology and Brain & Mind Centre, University of Sydney, Sydney, Australia 22 Neuropsychological and Speech Therapy Unit, Neurocenter of Southern Switzerland, Lugano, Switzerland 23 Universitätsklinikum Köln, Köln, Germany 24 Memory Clinic, University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland 25 Memory Clinic, Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal 26 Faculty of Medicine, University of Coimbra, Coimbra, Portugal 27 Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, the Netherlands 28 Lille Neurosciences & Cognition, Inserm, Université de Lille, Centre Hospitalier Universitaire de Lille, Lille, France 29 School of Psychology, University of Sydney, Sydney, NSW, Australia 30 Neuropsychiatry, Leuven Brain Institute, KU Leuven, Leuven, Belgium 31 German Centre for Neurodegenerative Diseases, Rostock-Greifswald site, Rostock, Germany 32 Centre of Competence on Ageing, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland 33 Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States 34 Istituti Clinici Scientifici Maugeri IRCCS, Brain e-Health Aging Laboratory, Department of Neurorehabilitation, Milan, Italy 35 Vita-Salute San Raffaele University, Milan, Italy 36 Karolinska Institutet, Stockholm, Sweden 37 IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli di Brescia 38 Toulouse University Hospital, Toulouse, France 39 Université de Fribourg, Fribourg, Switzerland 40 Ospedale Valduce, Como, Italy 41 Koblenz University of Applied Sciences, Koblenz, Germany 42 Università degli Studi di Firenze, Firenze, Italy 43 Dokuz Eylul University, Izmir, Turkey 44 Université de Lausanne, Lausanne, Switzerland 45 Universität Zürich, Zürich, Switzerland 46 Universität Bern, Bern, Switzerland 47 Università di Padova, Padova, Italy 48 University of New South Wales – UNSW, Sydney, Australia 49 Université de Genève, Geneva, Switzerland 50 Fondazione Mondino IRCCS, Pavia, Italy 51 Fondazione Giglio Cefalù, Cefalù, Italy 52 Centre Leenaards de la Mémoire - CHUV, Lausanne University, Switzerland 53 Aix-Marseille Université, Marseille, France 54 IRCCS Fondazione Santa Lucia, Rome, Italy 55 Sorbonne Université, Paris, France 56 RWTH Aachen University, Aachen, Germany 57 UC San Diego Health, San Diego, USA 58 Department of Neuroscience (DINOGMI), Università degli Studi di Genova, Genoa, Italy 59 Università degli Studi di Genova, Genoa, Italy 60 University of Queensland (UQ) Australia, Brisbane, Australia 61 Erasmus MC University Medical Center, Rotterdam, the Netherlands 62 University of Washington 63 Hôpital Universitaire Pitié-Salpêtrière, Paris, France 64 Department of Medical, Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, Catania, Italy 65 Università Politecnica delle Marche, Ancona, Italy 66 Marqués de Valdecilla University Hospital, Santander, Spain 67 Università degli Studi di Perugia, Perugia, Italy 68 Azienda sanitaria universitaria Giuliano Isontina, Trieste, Italy 69 Università di Bologna, Bologna, Italy 70 Aristotle University of Thessaloniki, Thessaloniki, Greece 71 Slovak Academy of Sciences, Bratislava, Slovakia 72 Hospital de Torrejón, Madrid, Spain 73 National and Kapodistrian University of Athens, Athens, Greece 74 Third Age Center IASIS & Medical Center of Athens Hospital, Athens, Greece 75 Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Marche, Italy 76 Catholic University of Sacred Heart, Rome, Italy 77 Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands 78 Ente Ospedaliero Cantonale (EOC), Switzerland 79 G. D'Annunzio University of Chieti, Chieti, Italy 80 University of California San Diego, USA 81 Hospital Universitario Puerta de Hierro, Madrid, Spain 82 Technical University of Munich, School of Medicine, Munich, Germany 83 UMass Chan Medical School, Massachusetts, USA 84 Università degli Studi di Pavia, Pavia, Italy 85 University of Sheffield, Sheffield, UK 86 Azienda ULSS2 Marca Trevigiana, Treviso, Italy 87 Association for Alzheimer disease and healthy aging Herakleion, Crete, Greece 88 Hospital Universitario Juan Ramon Jimenez, Huelva, Spain 89 IRCCS Oasi Maria SS, Troina, Italy 90 Università degli Studi di Palermo, Palermo, Italy 91 University of Reading, Reading, UK 92 Martin Luther University Halle-Wittenberg 93 Department of Psychology, Lund University, Lund, Sweden 94 Klinik und Poliklinik für Neurologie, Universitätsklinikum Halle (Saale), Germany 95 Manchester Centre for Clinical Neurosciences, Manchester, UK 96 Department of Psychology,Northumbria University, Newcastle, UK 97 FTD Lotgenoten, Amsterdam, The Netherlands 98 University College London, London, UK 99 Associazione Alzheimer Trento, Trento, Italy 100 UOC di Geriatria- Disturbi Cognitivi e Demenze Dipartimento Cure Primarie AUSL Modena, Modena, Italy 101 Universitätsmedizin Göttingen, Göttingen, Germany 102 Department of Medical Psychology, Amsterdam Universitair Medische Centra, Amsterdam, The Netherlands 103 IRCCS Don Gnocchi Foundation of Milan, Milan, Italy 104 German Center for Neurodegenerative Diseases, Bonn, Germany 105 Azienda Ospedaliera Universitaria di Sassari, Sassari, Italy 106 Alzheimer's Center Groningen, Groningen, The Netherlands 107 World FTD United & Rare Dementia Support (RDS), UK 108 Alzheimer Disease International (ADI), London, UK 109 Aphasia Aid Association, Spain 110 Alzheimer Ticino, Switzerland 111 Associazione Alzheimer Norvegia 112 Alzheimer Europe, Luxembourg References Sachdev PS, Blacker D, Blazer DG, Ganguli M, Jeste DV, Paulsen JS, et al. Classifying neurocognitive disorders: the DSM-5 approach. Nat Rev Neurol. 2014;10:634–42. https://doi.org/10.1038/nrneurol.2014.181 . Van den Stock J. Social cognition assessment for mild neurocognitive disorders. Alzheimers Dement. 2022;18:1439–40. https://doi.org/10.1002/alz.12475 . Dodich A, Boccardi M, Sacco L, Monsch AU, Démonet J-F, Filardi M, et al. Answer to Social cognition assessment for mild neurocognitive disorders. Alzheimers Dement. 2022;18:1441–2. https://doi.org/10.1002/alz.12664 . Van den Stock J, Bertoux M, Diehl-Schmid J, Piguet O, Rankin KP, Pasquier F, et al. Current Potential for Clinical Optimization of Social Cognition Assessment for Frontotemporal Dementia and Primary Psychiatric Disorders. Neuropsychol Rev. 2022. https://doi.org/10.1007/s11065-022-09554-3 . Dodich A, Cerami C. Answer to Current Potential for Clinical Optimization of Social Cognition Assessment for Frontotemporal Dementia and Primary Psychiatric Disorders. Neuropsychol Rev. 2022. https://doi.org/10.1007/s11065-022-09556-1 . Jarsch M, Semenkova A, Monsch A, Kressig R, Sollberger M. Eine Lücke, die es zu schließen gilt: Die Untersuchung sozial-kognitiver Fähigkeiten an deutschsprachigen Memory-Kliniken A Gap that Needs to be Closed: The Assessment of Social-Cognitive Abilities in German-Speaking Memory Clinics. Z Für Neuropsychologie. 2022;33:129–37. https://doi.org/10.1024/1016-264X/a000358 . Quesque F, Nivet M, Etchepare A, Wauquiez G, Prouteau A, Desgranges B et al. Social cognition in neuropsychology: A nationwide survey revealing current representations and practices. Appl Neuropsychology: Adult 2022:1–14. https://doi.org/10.1080/23279095.2022.2061859 Cerami C, Boccardi M, Meli C, Panzavolta A, Funghi G, Festari C et al. Understanding barriers and optimizing socio-cognitive assessment in the diagnosis of neurocognitive disorders. Journal of neuropsychology, 2024. [Manuscript submitted for publication] . Pinkham AE, Penn DL, Green MF, Buck B, Healey K, Harvey PD. The Social Cognition Psychometric Evaluation Study: Results of the Expert Survey and RAND Panel. Schizophr Bull. 2014;40:813–23. https://doi.org/10.1093/schbul/sbt081 . Green MF, Penn DL, Bentall R, Carpenter WT, Gaebel W, Gur RC, et al. Social Cognition in Schizophrenia: An NIMH Workshop on Definitions, Assessment, and Research Opportunities. Schizophr Bull. 2008;34:1211–20. https://doi.org/10.1093/schbul/sbm145 . Vita A, Gaebel W, Mucci A, Sachs G, Erfurth A, Barlati S, et al. European Psychiatric Association guidance on assessment of cognitive impairment in schizophrenia. Eur Psychiatry. 2022;65:e58. https://doi.org/10.1192/j.eurpsy.2022.2316 . Murphy MK, Black NA, Lamping DL, McKee CM, Sanderson CF, Askham J, et al. Consensus development methods, and their use in clinical guideline development. Health Technol Assess. 1998;2:i–iv. Festari C, Massa F, Cotta Ramusino M, Gandolfo F, Nicolosi V, Orini S, et al. European consensus for the diagnosis of MCI and mild dementia: Preparatory phase. Alzheimers Dement. 2023;19:1729–41. https://doi.org/10.1002/alz.12798 . Dodich A, Crespi C, Santi GC, Cappa SF, Cerami C. Evaluation of Discriminative Detection Abilities of Social Cognition Measures for the Diagnosis of the Behavioral Variant of Frontotemporal Dementia: a Systematic Review. Neuropsychol Rev. 2021;31:251–66. https://doi.org/10.1007/s11065-020-09457-1 . Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev. 2021;10:89. https://doi.org/10.1186/s13643-021-01626-4 . Whiting PF, Rutjes AWS, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155:529–36. https://doi.org/10.7326/0003-4819-155-8-201110180-00009 . García-Casal JA, Martínez-Abad F, Cid-Bartolomé T, Smith SJ, Llano-Ordóñez K, Perea-Bartolomé MV, et al. Usability study and pilot validation of a computer-based emotion recognition test for older adults with Alzheimer’s disease and amnestic mild cognitive impairment. Aging Ment Health. 2019;23:365–75. https://doi.org/10.1080/13607863.2017.1423033 . Diehl-Schmid J, Pohl C, Ruprecht C, Wagenpfeil S, Foerstl H, Kurz A. The Ekman 60 Faces Test as a diagnostic instrument in frontotemporal dementia. Arch Clin Neuropsychol. 2007;22:459–64. https://doi.org/10.1016/j.acn.2007.01.024 . Dodich A, Crespi C, Santi GC, Luzzi S, Ranaldi V, Iannaccone S, et al. Diagnostic Accuracy of Affective Social Tasks in the Clinical Classification Between the Behavioral Variant of Frontotemporal Dementia and Other Neurodegenerative Disease. JAD. 2021;80:1401–11. https://doi.org/10.3233/JAD-201210 . Buhl C, Stokholm J, Gade A. Clinical Utility of Short Social Cognitive Tests in Early Differentiation of Behavioral Variant Frontotemporal Dementia from Alzheimer’s Disease. Dement Geriatr Cogn Dis Extra. 2013;3:376–85. https://doi.org/10.1159/000355123 . Mariano LI, Caramelli P, Guimarães HC, Gambogi LB, Moura MVB, Yassuda MS, et al. Regardless Apathy? JAD. 2020;74:817–27. https://doi.org/10.3233/JAD-190861 . Can Social Cognition Measurements Differentiate Behavioral Variant Frontotemporal Dementia from Alzheimer’s Disease. Moura MVB, Mariano LI, Teixeira AL, Caramelli P, De Souza LC. Social Cognition Tests Can Discriminate Behavioral Variant Frontotemporal Dementia From Alzheimer’s Disease Independently of Executive Functioning. Arch Clin Neuropsychol. 2021;36:831–7. https://doi.org/10.1093/arclin/acaa084 . Chiu I, Piguet O, Diehl-Schmid J, Riedl L, Beck J, Leyhe T, et al. Dissociation in Rating Negative Facial Emotions between Behavioral Variant Frontotemporal Dementia and Major Depressive Disorder. Am J Geriatric Psychiatry. 2016;24:1017–27. https://doi.org/10.1016/j.jagp.2016.06.011 . Chiu I, Piguet O, Diehl-Schmid J, Riedl L, Beck J, Leyhe T, et al. Facial Emotion Recognition Performance Differentiates Between Behavioral Variant Frontotemporal Dementia and Major Depressive Disorder. J Clin Psychiatry. 2018;79:16m11342. https://doi.org/10.4088/JCP.16m11342 . Barbosa IG, Leite FDMC, Bertoux M, Guimarães HC, Mariano LI, Gambogi LB, et al. Social cognition across bipolar disorder and behavioral variant frontotemporal dementia: an exploratory study. Brazilian J Psychiatry. 2023. https://doi.org/10.47626/1516-4446-2022-2935 . Lichtenstein ML, Stewart PV, Kirchner HL, Finney G, Feldman HH. Exploring Social Cognition Tests to Differentiate Frontotemporal Dementia from Depression: A Two-Step Pilot Study. Alzheimer Disease Assoc Disorders. 2023;37:145–8. https://doi.org/10.1097/WAD.0000000000000526 . Amlerova J, Laczó J, Nedelska Z, Laczó M, Vyhnálek M, Zhang B, et al. Emotional prosody recognition is impaired in Alzheimer’s disease. Alz Res Therapy. 2022;14:50. https://doi.org/10.1186/s13195-022-00989-7 . Gleichgerrcht E, Torralva T, Roca M, Manes F. Utility of an abbreviated version of the executive and social cognition battery in the detection of executive deficits in early behavioral variant frontotemporal dementia patients. J Int Neuropsychol Soc. 2010;16:687–94. https://doi.org/10.1017/S1355617710000482 . Downey LE, Blezat A, Nicholas J, Omar R, Golden HL, Mahoney CJ, et al. Mentalising music in frontotemporal dementia. Cortex. 2013;49:1844–55. https://doi.org/10.1016/j.cortex.2012.09.011 . Schroeter ML, Pawelke S, Bisenius S, Kynast J, Schuemberg K, Polyakova M, et al. A Modified Reading the Mind in the Eyes Test Predicts Behavioral Variant Frontotemporal Dementia Better Than Executive Function Tests. Front Aging Neurosci. 2018;10:11. https://doi.org/10.3389/fnagi.2018.00011 . Custodio N, Montesinos R, Cruzado L, Herrera-Perez E, Failoc-Rojas VE, Pintado-Caipa M, et al. Social Cognition and Behavioral Assessments Improve the Diagnosis of Behavioral Variant of Frontotemporal Dementia in Older Peruvians With Low Educational Levels. Front Neurol. 2021;12:704109. https://doi.org/10.3389/fneur.2021.704109 . Funkiewiez A, Bertoux M, de Souza LC, Lévy R, Dubois B. The SEA (Social cognition and Emotional Assessment): a clinical neuropsychological tool for early diagnosis of frontal variant of frontotemporal lobar degeneration. Neuropsychology. 2012;26:81–90. https://doi.org/10.1037/a0025318 . Bertoux M, Delavest M, de Souza LC, Funkiewiez A, Lépine J-P, Fossati P, et al. Social Cognition and Emotional Assessment differentiates frontotemporal dementia from depression. J Neurol Neurosurg Psychiatry. 2012;83:411–6. https://doi.org/10.1136/jnnp-2011-301849 . Bertoux M, Funkiewiez A, O’Callaghan C, Dubois B, Hornberger M. Sensitivity and specificity of ventromedial prefrontal cortex tests in behavioral variant frontotemporal dementia. Alzheimer’s Dement 2013;9. https://doi.org/10.1016/j.jalz.2012.09.010 Bertoux M, de Souza LC, O’Callaghan C, Greve A, Sarazin M, Dubois B, et al. Social Cognition Deficits: The Key to Discriminate Behavioral Variant Frontotemporal Dementia from Alzheimer’s Disease Regardless of Amnesia? J Alzheimers Dis. 2016;49:1065–74. https://doi.org/10.3233/JAD-150686 . Teichmann M, Daigmorte C, Funkiewiez A, Sanches C, Camus M, Mauras T, et al. Moral Emotions Frontotemporal Dement JAD. 2019;69:887–96. https://doi.org/10.3233/JAD-180991 . Carr AR, Samimi MS, Paholpak P, Jimenez EE, Mendez MF. Emotional quotient in frontotemporal dementia vs. Alzheimer’s disease: the role of socioemotional agnosia. Cogn Neuropsychiatry. 2017;22:28–38. https://doi.org/10.1080/13546805.2016.1259612 . Henry JD, von Hippel W, Molenberghs P, Lee T, Sachdev PS. Clinical assessment of social cognitive function in neurological disorders. Nat Rev Neurol. 2016;12:28–39. https://doi.org/10.1038/nrneurol.2015.229 . American Psychological Association. Guidelines for the evaluation of dementia and age-related cognitive change. Am Psychol. 2012;67(1):1–9. https://doi.org/10.1037/a0024643 . Higgins WC, Ross RM, Langdon R, Polito V. The Reading the Mind in the Eyes Test Shows Poor Psychometric Properties in a Large. Demographically Representative U S Sample Assess. 2023;30:1777–89. https://doi.org/10.1177/10731911221124342 . Quesque F, Coutrot A, Cox S, de Souza LC, Baez S, Cardona JF, et al. Does culture shape our understanding of others’ thoughts and emotions? An investigation across 12 countries. Neuropsychology. 2022;36:664–82. https://doi.org/10.1037/neu0000817 . Isernia S, MacPherson SE, Baksh RA, Bergsland N, Marchetti A, Baglio F, et al. Italian adaptation of the Edinburgh Social Cognition Test (ESCoT): A new tool for the assessment of theory of mind and social norm understanding. Front Psychol. 2022;13:971187. https://doi.org/10.3389/fpsyg.2022.971187 . Franzen S, European Consortium on Cross-Cultural Neuropsychology (ECCroN), Watermeyer TJ, Pomati S, Papma JM, Nielsen TR, et al. Cross-cultural neuropsychological assessment in Europe: Position statement of the European Consortium on Cross-Cultural Neuropsychology (ECCroN). Clin Neuropsychol. 2022;36:546–57. https://doi.org/10.1080/13854046.2021.1981456 . Anderson E, Eleazer J, Kristensen Z, St. Amand C, Baker A, Correro A et al. Affirmative neuropsychological practice with transgender and gender diverse individuals and communities. Clin Neuropsychol 2022:1–19. https://doi.org/10.1080/13854046.2022.2073915 Zeilinger EL, Stiehl KAM, Weber G. A systematic review on assessment instruments for dementia in persons with intellectual disabilities. Res Dev Disabil. 2013;34:3962–77. https://doi.org/10.1016/j.ridd.2013.08.013 . Manca R, Moreno JA, Nicoletti A, Henderson NJ, Flatt JD. Neurocognitive health in LGBTQIA + older adults: current state of research and recommendations. Front Hum Neurosci. 2024;18:1394374. https://doi.org/10.3389/fnhum.2024.1394374 . Riddoch JM, Humphreys GW. BORB: Birmingham Object Recognition Battery. London: Psychology; 2022. https://doi.org/10.4324/9781003069645 . Quesque F, Apperly I, Baillargeon R, Baron-Cohen S, Becchio C, Bekkering H, et al. Defining key concepts for mental state attribution. Commun Psychol. 2024;2:1–5. https://doi.org/10.1038/s44271-024-00077-6 . Additional Declarations Competing interest reported. Chiara Cerami has been granted for consultancy by Newel Health srl, LinkForMed srl, Ethos srl. Stefano Cappa has received speaker honoraria from Biogen, Roche and Nutricia and is member of the Scientific Advisory Board of Brain Control. Alessandra Dodich has received funding through her institution from Associazione Alzheimer Trento ODV. Cristina Festari has received funding through her institution from the Alzheimer’s Association and Italian Ministry of Health. Giancarlo Logroscino has served as investigator for clinical trials sponsored by Biogen Pharmaceuticals, Axovant, Alector, Denali, Roche, Eisai, Genentech, Amylyx, Piam Farmaceutici SpA and has been granted for speech and consultancy by EISAI, Roche, Lilly, Piam Farmaceutici Spa, Biogen. Jordi Matias-Guiu has been granted for speech and consultancy by Almirall, Alter, Fujirebio, Esteve, KRKA and Schwabbe, Araclon, Eisai, and Schwabbe and is supported by grants from Instituto de Salud Carlos III and Fundacion Conocimiento Madri+D. Fabricio Ferreira de Oliveira has been granted for consultancy by Gerson Lehrman Group, Atheneum Partners, Guidepoint, Lionbridge. He is supported by FAPESP – The State of São Paulo Research Foundation (Grant #2015/10109-5) and is a board member of AAN Global Strategies Subcommittee, Awards Committee of the International Parkinson and Movement Society, ISTAART PIA Biofluid Based Biomarkers working group, ISTAART PIA Neuropsychiatric Syndromes and ESF Committee of Experts. Leonardo Sacco has served as investigator for clinical trials sponsored by Biogen and was member of the Advisory Board of Roche and Eisai. Marc Sollberger has been granted for speech and consultancy by Lilly, Eisai, OM Pharma. Katheen Welsh-Bohmer is a consultant to WCG, Senaptec, Jigsawdio. She serves on the U.S. POINTER data safety monitoring board and is unpaid board member for the nonprofit Dementia Alliance of NC (DANC). She is also funded through US Federal Grants (NIA/NIH), NC DHHS state funds, and private foundational support (National Philanthropic Trust/Gates to the Alzheimer’s Data Discovery Initiative ADDI). The other authors do not declare any conflict of interest. Supplementary Files SignatureDelphiSupplementarymaterialAlzhResTerFinal.docx Cite Share Download PDF Status: Published Journal Publication published 06 Dec, 2025 Read the published version in Alzheimer's Research & Therapy → Version 1 posted Editorial decision: Revision requested 25 Sep, 2025 Reviews received at journal 25 Jul, 2025 Reviewers agreed at journal 01 Jul, 2025 Reviewers agreed at journal 26 Jun, 2025 Reviews received at journal 01 May, 2025 Reviewers agreed at journal 15 Apr, 2025 Reviewers invited by journal 10 Apr, 2025 Editor assigned by journal 07 Apr, 2025 Submission checks completed at journal 07 Apr, 2025 First submitted to journal 03 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6370459","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":467095916,"identity":"00f52516-ff66-4690-a5cb-ca4745d5fd75","order_by":0,"name":"Alessandra 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See Supplementary Materials for details on the questions and agreement scores.\u003cem\u003e RMET: Reading the Mind in the Eye Test; SET: Story-based Empathy task; Mini-SEA: mini-Social cognition \u0026amp; Emotional Assessment; IRI-EC: Interpersonal Reactivity Index – Empathic Concern; IRI-PT: Interpersonal Reactivity Index - Perspective Taking.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6370459/v1/780b8a6d82c69cd3defcc01d.jpeg"},{"id":85257823,"identity":"44a5f7ad-31a1-4d1b-8000-751977ffe875","added_by":"auto","created_at":"2025-06-24 03:11:57","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":178813,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSummary of the Delphi approach including preliminary activities (upper panel) and Delphi procedure (lower panel).\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6370459/v1/dd2031063b55355c25e4e7b2.png"},{"id":85258035,"identity":"73be491e-db50-47cd-aa4a-6e13016c4a33","added_by":"auto","created_at":"2025-06-24 03:19:57","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":209398,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eList of facilitators and obstacles identified with Section 3 questions.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6370459/v1/b400acc413ab156974e73614.jpeg"},{"id":97723899,"identity":"110ea7f9-3c92-48b2-9138-9153c2e4a61d","added_by":"auto","created_at":"2025-12-08 16:09:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1848833,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6370459/v1/5fad39de-7347-4b92-a068-5839a35391b8.pdf"},{"id":85258033,"identity":"8ec1dcb6-d6f4-499e-a301-09f5b2141e39","added_by":"auto","created_at":"2025-06-24 03:19:57","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":412667,"visible":true,"origin":"","legend":"","description":"","filename":"SignatureDelphiSupplementarymaterialAlzhResTerFinal.docx","url":"https://assets-eu.researchsquare.com/files/rs-6370459/v1/2deb37688dde688139f685d0.docx"}],"financialInterests":"Competing interest reported. Chiara Cerami has been granted for consultancy by Newel Health srl, LinkForMed srl, Ethos srl. Stefano Cappa has received speaker honoraria from Biogen, Roche and Nutricia and is member of the Scientific Advisory Board of Brain Control. Alessandra Dodich has received funding through her institution from Associazione Alzheimer Trento ODV. Cristina Festari has received funding through her institution from the Alzheimer’s Association and Italian Ministry of Health. Giancarlo Logroscino has served as investigator for clinical trials sponsored by Biogen Pharmaceuticals, Axovant, Alector, Denali, Roche, Eisai, Genentech, Amylyx, Piam Farmaceutici SpA and has been granted for speech and consultancy by EISAI, Roche, Lilly, Piam Farmaceutici Spa, Biogen. Jordi Matias-Guiu has been granted for speech and consultancy by Almirall, Alter, Fujirebio, Esteve, KRKA and Schwabbe, Araclon, Eisai, and Schwabbe and is supported by grants from Instituto de Salud Carlos III and Fundacion Conocimiento Madri+D. Fabricio Ferreira de Oliveira has been granted for consultancy by Gerson Lehrman Group, Atheneum Partners, Guidepoint, Lionbridge. He is supported by FAPESP – The State of São Paulo Research Foundation (Grant #2015/10109-5) and is a board member of AAN Global Strategies Subcommittee, Awards Committee of the International Parkinson and Movement Society, ISTAART PIA Biofluid Based Biomarkers working group, ISTAART PIA Neuropsychiatric Syndromes and ESF Committee of Experts. Leonardo Sacco has served as investigator for clinical trials sponsored by Biogen and was member of the Advisory Board of Roche and Eisai. Marc Sollberger has been granted for speech and consultancy by Lilly, Eisai, OM Pharma. Katheen Welsh-Bohmer is a consultant to WCG, Senaptec, Jigsawdio. She serves on the U.S. POINTER data safety monitoring board and is unpaid board member for the nonprofit Dementia Alliance of NC (DANC). She is also funded through US Federal Grants (NIA/NIH), NC DHHS state funds, and private foundational support (National Philanthropic Trust/Gates to the Alzheimer’s Data Discovery Initiative ADDI). The other authors do not declare any conflict of interest.","formattedTitle":"International consensus for the assessment of social cognition in neurocognitive disorders: framework definition and clinical recommendations of the SIGNATURE initiative","fulltext":[{"header":"1. INTRODUCTION","content":"\u003cp\u003eSocial cognition, which encompasses the cognitive processes underlying social interactions, is a critical domain affected in various neurocognitive disorders (NCDs), including Alzheimer\u0026rsquo;s disease (AD) and related disorders (ADRD) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Despite its recognized importance, assessment of the social cognition domain in clinical settings remains inconsistent and fragmented [\u003cspan additionalcitationids=\"CR3 CR4\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This variability hinders the ability to timely diagnose, monitor, and treat a considerable number of ADRD whose primary clinical profile differs from typical AD. Despite advancement in theoretical and clinical research, this knowledge has not effectively translated into improved expertise or familiarity with socio-cognitive assessments among clinicians in memory clinics, highlighting a persistent gap between research and clinical practice [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. To address these challenges, the \u003cem\u003eSIGNATURE\u003c/em\u003e initiative was launched in 2022, aiming to systematize and optimize the use of social cognition measures across different international clinical centers (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://sites.google.com/unitn.it/signature-initiative/\u003c/span\u003e\u003cspan address=\"https://sites.google.com/unitn.it/signature-initiative/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e).\u003c/span\u003e The ultimate goal of the \u003cem\u003eSIGNATURE\u003c/em\u003e initiative is to ensure that clinicians, regardless of their location or resources, have access to reliable and effective tools for assessing social cognition in case of cognitive and behavioral complaints associated with suspected NCDs. In light of this, in 2022 we launched a survey to gather information on the state-of-art clinical practices and needs [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], laying the foundation for the next phase of the \u003cem\u003eSIGNATURE\u003c/em\u003e initiative.\u003c/p\u003e \u003cp\u003eBy providing clinical recommendations and suggestions on research priorities based on evidence from current literature and the state-of-the-art in clinics, the initiative seeks to promote consistency in clinical assessment, thereby improving the comparability of clinical research and findings across centers and the reliability of diagnoses. This ideally harmonized or at least consistent approach is expected to improve detection, patient care and care outcomes and to advance our understanding of social cognitive impairments in NCDs. The rationale for the \u003cem\u003eSIGNATURE\u003c/em\u003e initiative is supported by analogous successful harmonization of socio-cognitive assessments in other clinical populations, such as autism spectrum disorders (ASD) and schizophrenia. Over 10 years ago, the \u0026ldquo;Social Cognition Psychometric Evaluation\u0026rdquo; (SCOPE) study was designed to identify not only the key dimensions of social cognition in schizophrenia but also the instruments best assessing these facets [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Alongside the growing understanding of social and non-social cognitive dysfunctions in this population [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], the SCOPE initiative has led to a set of cognitive assessment recommendations from the European Psychiatric Association, many of which focus on social cognition [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. These recommendations aim to promote the use of standardized assessment protocols in both clinical trials and real-world clinical settings. Building from the experience of similar initiatives, applying standardized socio-cognitive assessments in NCDs holds significant promise. Ideally harmonized or at least consistent recommendations can enhance the early detection of social cognitive impairments, which are often present in the prodromal stages of NCDs [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Moreover, early identification can lead to timely interventions on patients and caregivers, which may slow the progression of the disease with positive outcomes on social functioning and quality of life.\u003c/p\u003e \u003cp\u003eThis paper describes the establishment of a task force with the objective of defining a framework and formulating a preliminary set of clinical recommendations pertaining to the context of use and the current relevance of socio-cognitive testing in the dementia context. Additionally, it addresses the facilitators and obstacles to implementing this framework in clinical settings and suggests research priorities to support the development and implementation of social cognition assessment in NCDs.\u003c/p\u003e"},{"header":"2. MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Task force\u003c/h2\u003e \u003cp\u003e \u003cem\u003eSIGNATURE Delphi team.\u003c/em\u003e The project task force included the Executive Board (EB), the Advisory Board (AB) and the panel (PA; details in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The EB included Delphi facilitators (C.C., A.D., G.F., C.M., A.P.) and one \u0026ldquo;external\u0026rdquo; reviewer (C.F.), one of the methodologists from the \u003cem\u003eSIGNATURE\u003c/em\u003e initiative, who supervised the Delphi procedure. The AB included a scientific and methodological advisor (M.Bo.), 3 representatives from patient advocacy associations (L.I., M.P., M.T.) and an expert (M.T.) in neuropsychology practices in people with disabilities.\u003c/p\u003e \u003cp\u003e\u003cem\u003eDelphi panelist.\u003c/em\u003e The panel consists of specialists from different countries and scientific societies, i.e., 10 neurologists and 12 psychologists/neuropsychologists (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Thirteen experts are clinicians with both research and clinical experience in socio-cognitive assessment in NCDs and nine are researchers with world-renowned expertise in social cognition. Nine experts are national collaborators (representatives of countries participating in the SIGNATURE initiative) and three are advisors (M.Be., F.K., J.VdS.) of the \u003cem\u003eSIGNATURE\u003c/em\u003e initiative (see Participant section of the \u003cem\u003eSIGNATURE\u003c/em\u003e website; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://sites.google.com/unitn.it/signature-initiative/participants\u003c/span\u003e\u003cspan address=\"https://sites.google.com/unitn.it/signature-initiative/participants\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e).\u003c/span\u003e All have a long professional experience in NCDs and in the use of social cognitive tasks for diagnostic purposes in the clinical practice of their academic and high-level research institutions.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eParticipants and roles at the first \u003cem\u003eSIGNATURE\u003c/em\u003e workshop (September 2023).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eName, SURNAME\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eRole in the Delphi Procedure\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eRole in the SIGNATURE initiative\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eThe Executive Board\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChiara CERAMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDelphi Facilitator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePrincipal Investigator\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlessandra DODICH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDelphi Facilitator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePrincipal Investigator\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAndrea PANZAVOLTA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProject Manager\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCoordinating Team\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGiulia FUNGHI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDelphi Facilitator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCoordinating Team\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClaudia MELI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDelphi Facilitator\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCoordinating Team\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCristina FESTARI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExternal Reviewer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMethodologist\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eThe Panel\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaxime BERTOUX\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrance Representative, Psychologist, Social Cognition Expert\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdvisor\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFiona KUMFOR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePsychologist, Social Cognition Expert\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdvisor\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJan VAN DEN STOCK\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBelgium Representative, Psychologist, Social Cognition Expert\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdvisor\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChristian CHICHERIO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSwitzerland-French section Representative, Psychologist, Clinical Researcher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNational Collaborator\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFlorencia CLARENCE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eArgentina Representative, Psychologist, Clinical Researcher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNational Collaborator\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFabricio Ferreira de OLIVEIRA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBrazil Representative, Neurologist, Clinical Researcher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNational Collaborator\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarco FILARDI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItaly Representative, Psychologist, Clinical Researcher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNational Collaborator\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSarah MACPHERSON\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUK Representative, Psychologist, Social Cognition Expert\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNational Collaborator\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJordi A. MATIAS-GUIU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpain Representative, Neurologist, Clinical Researcher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNational Collaborator\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaxime MONTEMBEAULT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQu\u0026eacute;bec Representative, Psychologist, Clinical Researcher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNational Collaborator\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeonardo SACCO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSwitzerland-Italian section Representative, Neurologist, Clinical Researcher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNational Collaborator\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnn-Katrin SCHILD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGermany Representative, Psychologist, Clinical Researcher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNational Collaborator\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarc SOLLBERGER\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSwitzerland-German section Representative, Neurologist, Clinical Researcher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNational Collaborator\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiguel TABUAS-PEREIRA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePortugal Representative, Neurologist, Clinical Researcher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNational Collaborator\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEsther VAN DEN BERG\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eThe Netherland Representative, Psychologist, Social Cognition Expert\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNational Collaborator\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStefano CAPPA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeurologist, Social Cognition Expert\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMember\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAgustin IBANEZ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReDLat Representative, Psychologist, Social Cognition Expert\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMember\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGiancarlo LOGROSCINO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFRONTIERS Consortium Representative, Neurologist, Clinical Researcher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMember\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCamillo MARRA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItalian Association of Neurology for dementia Representative, Neurologist, Clinical Researcher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMember\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCostanza PAPAGNO\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFESN Representative, Neurologist, Social Cognition Expert\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMember\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOlivier PIGUET\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePsychologist, Social Cognition Expert\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMember\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSimone POMATI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eINS cross-cultural needs working group Representative, Neurologist, Clinical Researcher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMember\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eThe Advisory Board\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarina BOCCARDI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eScientific \u0026amp; Methodological Advisor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMethodologist\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLaura INVERNIZZI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFTD Caregiver Association Representative, World FTD United and Italian FTD Association\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMember\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMario POSSENTI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAD Caregiver Association Representative, Alzheimer Europe and Federazione Alzheimer Italia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMember\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMagda TSOLAKI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAD Caregiver Association Representative, Greek Federation of Alzheimer\u0026rsquo;s disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMember\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarianna TSATALI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExpert of Neuropsychology Practice in people with disabilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMember\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Delphi methodology and procedure\u003c/h2\u003e \u003cp\u003eIn this project, we applied the Delphi methodology according to previously reported procedures [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In detail, the EB reviewed the current literature and the results of the \u003cem\u003eSIGNATURE\u003c/em\u003e clinical survey [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] and defined the panel for the Delphi procedure. Then, the facilitators drafted the first version of the Delphi questions, which was submitted to the external reviewer who assessed whether the items were sufficiently clear, neutral, informative, and complete. The Delphi questionnaire was then shared with all panelists via a web-based platform (i.e., Qualtrics) together with instructions to respond to each topic based on their expert opinion, experience, and evidence from the state-of-the-art. The Delphi procedure was performed during the 2-day hybrid First \u003cem\u003eSIGNATURE\u003c/em\u003e Workshop held at the Scuola Universitaria Superiore IUSS in Pavia, Italy. Details of the event can be found at the following link \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://sites.google.com/unitn.it/signature-initiative/events/\u003c/span\u003e\u003cspan address=\"https://sites.google.com/unitn.it/signature-initiative/events/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. See Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e for details on the Delphi approach including the preliminary activities and the Delphi procedure.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eQuestionnaire definition.\u003c/em\u003e The EB identified four target topics for the Delphi consensus assumptions aimed at defining: Clinical context of use and practice in socio-cognitive testing for the diagnosis of NCDs in memory clinics by specialists in dementia \u003cem\u003e(Section 1)\u003c/em\u003e; Relevance of socio-cognitive assessment in cognitive decline and the dementia diagnostic framework \u003cem\u003e(Section 2)\u003c/em\u003e; Facilitators and obstacles for the implementation of socio-cognitive testing in clinics \u003cem\u003e(Section 3)\u003c/em\u003e; Priorities for future research on socio-cognitive testing in NCDs \u003cem\u003e(Section 4)\u003c/em\u003e. See Supplementary Table\u0026nbsp;1 for details of the questions per section.\u003c/p\u003e \u003cp\u003eAgreement, multiple choice, relevance and open text questions were used to assess consensus assumptions. See Supplementary Table\u0026nbsp;1 for the full list of questions. Panelists were allowed to abstain from voting when the topic of the question was outside their area of expertise. All responses were substantiated with justifications.\u003c/p\u003e \u003cp\u003e\u003cem\u003eConvergence threshold.\u003c/em\u003e For agreement and the multiple-choice questions, we established a predefined threshold of 70% of non-abstaining panelists for agreement in Round 1. Those questions for which no consensus was reached were then reformulated based on panelists\u0026rsquo; comments and presented in Round 2. In this case, an absolute majority (50%+1) was sufficient for agreement. Responses to relevance questions were summed up into a single score and categorized according to the following range: \u0026ge;99 - \u003cem\u003eVery Important\u003c/em\u003e (corresponding to a score of 'very important' assigned by at least half of the panelists, and the other half assigning a score of 'important\u0026rsquo;); 77\u0026thinsp;\u0026le;\u0026thinsp;x \u0026lt;\u0026thinsp;99 - \u003cem\u003eImportant\u003c/em\u003e (corresponding to a score of 'important' assigned by at least half of the panelists, and the other half assigning a score of 'neutral\u0026rsquo;); 55\u0026thinsp;\u0026le;\u0026thinsp;x \u0026lt;\u0026thinsp;77 - \u003cem\u003eNeutral\u003c/em\u003e (corresponding to a score of 'neutral\u0026rsquo; assigned by at least half of the panelists, and the other half assigning a score of 'not important'); 33\u0026thinsp;\u0026le;\u0026thinsp;x \u0026lt;\u0026thinsp;55 - \u003cem\u003eNot Important\u003c/em\u003e (corresponding to a score of 'not important' assigned by at least half of the panelists, and the other half assigning a score of 'not important at all'); \u0026lt; 33 - \u003cem\u003eNot Important At All\u003c/em\u003e (when the majority of the panelists assigned a score of 'not important at all'). Open text questions were only used in Round 1 to derive a list of facilitators and obstacles that were voted on in terms of relevance in Round 2.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Evidence supporting the Delphi procedure\u003c/h2\u003e \u003cp\u003eTo help the Delphi panelists to make informed decisions, we provided them with the following background information: a) top-down evidence from a literature review on available socio-cognitive measures for the early and differential diagnosis of mild and major NCDs; b) bottom-up evidence derived from results of our previous clinical survey [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e\u003cem\u003eTop-down evidence.\u003c/em\u003e For a), starting from a previous systematic review [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] that investigated clinically validated socio-cognitive measures for the diagnosis of behavioral variant of frontotemporal degeneration (bvFTD), we updated and expanded the literature review up to July 2023 according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. We considered only original studies published in English, excluding reviews, case reports, and guidelines. Search strings were harmonized across NCD syndromes (mild or major) and etiological diagnosis (e.g., AD, FTD, etc.). See Supplementary Table\u0026nbsp;2 for details on search strings. Relevant references from personal knowledge and citation-tracking articles were also included. Titles and abstracts were screened, and potentially relevant studies were then examined according to the following criteria: 1) use of either a clinical or biomarker-based diagnosis for patient classification, 2) quantitative scoring of a socio-cognitive measure or social cognition battery; 3) availability of diagnostic accuracy data for socio-cognitive tests, including metrics such as sensitivity, specificity, accuracy, positive/negative predictive value, or positive/negative likelihood ratios. The quality of evidence was rated by A.D., C.C., A.P. and C.M. using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2, [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]), a tool designed to provide a formal assessment of the quality of primary studies included in a review to avoid bias. Raters were trained in QUADAS-2 and had fine-tuning methodological meetings to ensure uniformity and reproducibility of data extraction. Data were recorded in an Excel spreadsheet, modified from Dodich et al., 2021[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cem\u003eBottom-up evidence.\u003c/em\u003e The SIGNATURE clinical survey results [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] were presented during the workshop and provided on a dedicated Google Drive folder to all the panelists prior to the Delphi Round 1 to inform them on the clinical evidence regarding the state-of-the-art of socio-cognitive assessment in memory clinics, the best-known and used tools for assessing social-cognitive function across ten European and non-European geographical areas, the perceived relevance of assessing social cognition in NCDs, and the hurdles envisioned for the use of socio-cognitive measures in real-life clinical scenarios.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. RESULTS","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Top-down evidence\u003c/h2\u003e \u003cp\u003eAn updated literature review of studies on socio-cognitive measures available in clinics identified a total of 971 papers that were screened for subsequent processing (see Supplementary Fig.\u0026nbsp;1). After excluding duplicate records, wrong publication type and off-topic and not-English papers, only 65 papers were assessed for eligibility. Forty-four papers were excluded because: 1) only the combined diagnostic accuracy of social and other cognitive measures was reported, without specific information on the accuracy of social tasks; 2) accuracy values were calculated using multifactorial models from which the exclusive weight of the social cognition measures was not obtainable; or 3) mixed samples of mild/major NCDs were included. The remaining 21 papers provided validated measures of the accuracy of single or combined socio-cognitive measures in major NCDs, two of them also including mild NCDs (see Supplementary Table\u0026nbsp;3). Of these, ten studies explored the accuracy of tests of emotion recognition using facial stimuli (e.g., Ekman 60 faces and its variants) [\u003cspan additionalcitationids=\"CR18 CR19 CR20 CR21 CR22 CR23 CR24 CR25\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], one test of emotional recognition using non-visual stimuli [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], eight using theory of mind tasks (Story-based Empathy Task, Reading the Mind in the Eyes test, the Faux-pas test, and experimental mentalizing music task) [\u003cspan additionalcitationids=\"CR20 CR21\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], eight using the Social Cognition and Emotional Assessment (SEA) battery or its short version (mini-SEA) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan additionalcitationids=\"CR32 CR33 CR34\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], and six using other social cognition facets (e.g., empathy and socio-emotional sensitivity) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. These papers reported good to excellent accuracy values for emotion recognition and theory of mind tasks in the early and differential diagnosis of bvFTD and good clinical performance in differentiating amnestic mild cognitive impairment (MCI) and AD versus healthy control subjects (HC). Only one study explored the clinical diagnostic performance of emotion recognition and theory of mind in the differential diagnosis of frontotemporal lobar degeneration syndromes [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. The quality of evidence assessed with QUADAS-2 was judged as strong in two studies [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] showing an overall judgment of low risk of bias or low concern regarding applicability. Ten studies showed low/moderate risk of bias [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan additionalcitationids=\"CR33\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. The main methodological limitations were related to bias in: 1) patient selection (i.e., lack of consecutive, unspecified selection of subjects or inappropriate exclusions, n\u0026thinsp;=\u0026thinsp;6); 2) reference standards (i.e., either possible inaccurate to classify the target condition or low availability of in vivo biomarkers, n\u0026thinsp;=\u0026thinsp;4); and 3) flow and timing (i.e., unclear or inappropriate intervals between the index test(s) and the reference standard, and diagnoses not assessed against the same reference standard, n\u0026thinsp;=\u0026thinsp;5). See Supplementary Table\u0026nbsp;4 for a summary of the QUADAS-2 assessment for all included studies.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Bottom-up evidence\u003c/h2\u003e \u003cp\u003eResults from the \u003cem\u003eSIGNATURE\u003c/em\u003e survey data collection including 413 responses from 10 European and Latin America geographical regions reported the Ekman-60 faces (EK-60F; a well-known test for recognizing facial affect) test or its variants as the most well-known and used task overall, followed by two tests of theory of mind (i.e., the Faux-Pas and the Reading the Mind in the Eyes \u0026ndash; RMET tests, or their variants) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The EK-60F and the Faux-Pas tests were reported as known/used in 10/10 geographical regions, while the RMET in 8/10 [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In addition, the mini Social cognition \u0026amp; Emotional Assessment (Mini-SEA; a test combining facial emotion recognition and a selection of faux-pas) was known/used in 5/10 geographical regions and the Story-based Empathy task (SET; a test evaluating attribution of emotion and intention to others) in 6/10 [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Results of Section 1 \u0026ndash; Clinical context of use and practice\u003c/h2\u003e \u003cp\u003eTwo Delphi runs were performed. Regarding recommendations for clinical use, the panelists agreed that social cognition testing should be routinely included in the assessment of every patient as part of the diagnostic definition for NCDs (Round 1, Q1; votes: 86.4% of agreement). However, social cognition assessment in follow-up evaluations was recommended only for selected cases based on the presence of socio-cognitive deficits at the first assessment or based on symptoms reported at the follow-up visit (Round 2, Q2r; votes: 95.5% of agreement). First-level evaluation was voted as the most appropriate context for the assessment of social cognition in major (Q3) and mild (Q4) NCDs (Round 1, Q3: votes 81.8% of agreement; Q4: 90.9%). Socio-cognitive assessment should include at least two tests evaluating different facets of social cognition (Round 1, Q5; votes: 95.4% of agreement) as well as a measure of social cognitive domain functioning (e.g., emotion recognition) and a measure to quantify changes in social behavior (e.g., sensitivity to social signals in real life) (Round 1, Q6; votes: 81.1% of agreement). See Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e for a summary of Section 1 recommendations and details on the agreement rates.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe figure list recommendations for the clinical context of use and practice in socio-cognitive testing for the diagnosis of NCDs and on the relevance of socio-cognitive assessment in the different NCD diagnostic frameworks. See Supplementary Materials for details on the questions and agreement scores. \u003cem\u003eRMET: Reading the Mind in the Eye Test; SET: Story-based Empathy task; Mini-SEA: mini-Social cognition \u0026amp; Emotional Assessment; IRI-EC: Interpersonal Reactivity Index \u0026ndash; Empathic Concern; IRI-PT: Interpersonal Reactivity Index - Perspective Taking.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Results of Section 2 \u0026ndash; Relevance in NCD diagnosis\u003c/h2\u003e \u003cp\u003ePanelists rated the assessment of emotion recognition in major NCDs (Round 1, Q7), and emotion recognition and cognitive ToM in mild NCDs (Round 1, Q8) as \u0026ldquo;very important\u0026rdquo;. The panel agreed on the use of the EK-60F test or its variants (Round 1, Q9; votes: 90% of agreement), the Faux-pas test (Round 2, Q10; votes 65% of agreement) and the Empathic Concern and Perspective Taking subscales of the Interpersonal Reactivity Index (IRI) questionnaire (Round 2, Q12r; votes: 57.9% of agreement) to assess emotion recognition, mentalizing, and empathy facets of social cognition respectively in major and mild NCDs. Panelists also agreed on using the RMET, the SET, and the mini-SEA as other tools to assess social cognition deficits in major and mild NCDs (Round 1, Q11; votes: 70% of agreement). No consensus was reached on using the revised version of the Self-monitoring Scale (r-SMS) to assess self-monitoring and awareness in NCDs. Specifically, the panelists recognized the evidence in favor of the use of r-SMS in frontotemporal dementia. However, based on the lack of information about the overall validity in mild and major NCDs, a consensus could not be found. Poor knowledge about the test and limited clinical data were raised as relevant points, which represent research priorities for its use in clinical practice. See Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e for a summary of the Section 2 recommendations and Supplementary Fig.\u0026nbsp;2 for details on agreement rates.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.5 Results of Section 3 \u0026ndash; Facilitators and obstacles\u003c/h2\u003e \u003cp\u003eClinical and methodological obstacles (e.g., lack of validated standardized tools, lack of normative data) emerged as the most relevant factors influencing socio-cognitive measure use in clinical practice, together with implementation hurdles (e.g., lack of professional expertise and training for professionals, lack of time for the neuropsychological assessment) and external barriers (e.g., resistance to change in clinical practice, insufficient communication among research and clinical communities). Facilitators included the availability of tests without cognitive load in other domains, the availability of quick to administer cognitive tasks and the availability of cross-cultural and cross-language information. Automatization in data scoring and acquisition and lack of digital tools were rated only as marginal obstacles. See Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e for the full list of facilitators and obstacles.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.6 Results of Section 4 \u0026ndash; Priorities for future research\u003c/h2\u003e \u003cp\u003eConsidering priorities for future research, the panel agreed that social cognition assessment should include a subset of cognitive screening tests administrable remotely using digital tools but only if an in-person assessment is not possible (Round 2, Q15r; votes: 54.6% of agreement). The panel rated either patient- or informant-administered measures with supervision (Round 1, Q16) as \u0026ldquo;Important\u0026rdquo;. Tasks or interview administration without supervision were rated overall as less relevant. Tablet-based neuropsychology platforms and teleneuropsychology via videoconferencing were considered relevant scenarios in the diagnostic framework (Round 2, Q17) and in the follow-up neuropsychological evaluation (Round 2, Q18). Other digital tools, such as wearables, virtual/augmented reality and eye-tracking, were rated as less important.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe figure shows in bold the facilitators and obstacles rated as \u0026ldquo;Very Important\u0026rdquo;, and in nonbold those rated as \u0026ldquo;Important\u0026rdquo;.\u003c/p\u003e \u003c/div\u003e"},{"header":"4. DISCUSSION","content":"\u003cp\u003eIn this paper, we provide actionable recommendations to bridge the gap between research and clinical practice, advancing the implementation of socio-cognitive assessment within NCDs diagnostic procedures. As evidenced by the results of the \u003cem\u003eSIGNATURE\u003c/em\u003e survey [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], the selection of social cognition measures is often influenced by individual clinical preferences, availability of measures, the level of expertise and local resources. This leads to significant differences in patient assessment and provision of care [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. These recommendations aim to provide a general framework and guide the definition and implementation of social cognition assessment in NCDs.\u003c/p\u003e \u003cp\u003eSocio-cognitive testing is recommended for all patients suspected of mild or major NCDs during the baseline assessment to facilitate more accurate diagnosis. Moreover, it should be included in the follow-up neuropsychological evaluation of selected patients for better monitoring of the disease progression, based on the presence of socio-cognitive deficits at their initial assessment or on symptomatology reported at the follow-up clinical visit. Indeed, the DSM-5 recommendations support the assessment of social cognition; however, no specific details are provided for major/mild NCDs or differential frameworks (i.e., diagnostic or follow-up). The results of this study help to operationalize the DSM-5 recommendations based on current evidence and expertise in the field to improve the detection rate in clinical practice of those patients not presenting with an AD phenotype. As suggested by the APA recommendations [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e], which recommend that two tests provide a more comprehensive approach to accurately capture the multifaceted nature of cognitive domains, the panel agreed that socio-cognitive testing should include at least two tests that assess different facets of the social cognition domain, and that these should be complemented by a measure that quantifies changes in social behavior. Indeed, the use of a single test to evaluate the complexity of social cognition changes in NCDs poses significant risks for inaccuracy or misinterpretation and may fail to capture the breadth of impairments across the various subdomains of social cognition. It should be noted, however, that the use of more than one test per cognitive domain may be limited in some clinical settings for reasons of feasibility concerns (e.g., lack of resources or time constraint).\u003c/p\u003e \u003cp\u003eDifferent tests available in clinics were considered by the panel in terms of their current utility for the detection of social deficits. However, as pointed out by the panelists, some tools pose significant challenges, such as inadequate psychometric properties [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e], or lack normative data or the absence of cross-cultural validated tools that hamper their harmonized use in memory clinics (for a list of tests available in different countries see \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eSIGNATURE website in measures subsection\u003c/span\u003e). Future efforts should promote the development of more reliable tools, able to overcome these current limitations, possibly providing translations and cultural adaptations for different countries. This is a crucial point, as one could expect that social-cognitive measures - more than other cognitive domains - are heavily influenced by local specificities, social norms, and language nuances [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Variability in cultural contexts, characterized by different social norms, complex mental state definitions (e.g., schadenfreude) and non-verbal behaviors may lead to misinterpretations of individuals\u0026rsquo; performance if a test is used in a context other than that for which it was designed [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn this regard, it is important to note that most neuropsychological tasks have been developed and validated in Western, educated, industrialized, higher socio-economic status, and largely democratic countries. Applying these norms to individuals from societies or countries with very different social contexts can lead to misinterpretation and misdiagnosis of cognitive impairments. The introduction of computerized adaptive testing through digital tools might advance the field of socio-cognitive testing by designing more flexible culture-broad tools able to capture deficits in social cognition [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. In addition, more inclusive practices in clinical neuropsychology would improve appropriateness of cognitive testing in sexual and gender minorities [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e], since they could express vulnerabilities in socio-cognitive functioning, which remain currently unexplored [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e], as a consequence of specific environmental factors (e.g. stigma). Adapting socio-cognitive tools to reach a broader audience in clinics should also include populations with disabilities who have limited access to this type of evaluation [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Collaborative international participatory research, as also reported by the facilitators, is essential for addressing the challenges of social cognition assessment from a broad perspective, while also considering specific needs, such as those related to disabilities, and cultural differences.\u003c/p\u003e \u003cp\u003eAnother key facilitator of socio-cognitive assessment is the definition of a clear conceptual and theoretical framework of social cognition. Increasing knowledge of how subdomains of social cognition develop, function, and interact is a critical step in understanding the foundations of social behavior and how it can be measured in the clinical context of NCDs. Studies aimed at disentangling the interdependence of social cognition subdomains are needed to develop theoretical models from which neuropsychological batteries may be derived, as is already available for other cognitive domains (e.g., the Birmingham Object Recognition Battery for visuo-spatial assessment [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]). Recent efforts to promote the use of consensual terminology [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e], and other initiatives could help (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://shorturl.at/nzWQw\u003c/span\u003e\u003cspan address=\"https://shorturl.at/nzWQw\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). In addition to the above-mentioned clinical, methodological (e.g., cross-culturally validated tests with good psychometric properties) and implementation (e.g., brief socio-cognitive tasks feasible in clinical settings) priorities, other relevant factors in the use of socio-cognitive testing in clinical scenarios have been identified by the panelists. These include the presence of external factors such as the resistance to changing clinical practice and the availability of copyright-free tools. These issues deserve special attention and can be addressed in the context of multicenter projects. Besides, the cross-cultural translation of these results in other socio-cultural settings is still untested. International networks, such as those promoted by the Cognition Professional Interest Area (PIA) of the International Society to Advance Alzheimer's Research and Treatment (ISTAART PIA-Cognition), can help to raise awareness among multiple stakeholders.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the IUSS University Ethics Committee (IUSS-University of Pavia; Protocol 164/24).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDatasets generated and analyzed in this study are available from the corresponding author on request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting\u0026nbsp;interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eChiara Cerami has been granted for consultancy by Newel Health srl, LinkForMed srl, Ethos srl. Stefano Cappa has received speaker honoraria from Biogen, Roche and Nutricia and is member of the Scientific Advisory Board of Brain Control. Alessandra Dodich has received funding through her institution from Associazione Alzheimer Trento ODV. Cristina Festari has received funding through her institution from the Alzheimer’s Association and Italian Ministry of Health. Giancarlo Logroscino has served as investigator for clinical trials sponsored by Biogen Pharmaceuticals, Axovant, Alector, Denali, Roche, Eisai, Genentech, Amylyx, Piam Farmaceutici SpA and has been granted for speech and consultancy by EISAI, Roche, Lilly, Piam Farmaceutici Spa, Biogen. Jordi Matias-Guiu has been granted for speech and consultancy by Almirall, Alter, Fujirebio, Esteve, KRKA and Schwabbe, Araclon, Eisai, and Schwabbe and is supported by grants from Instituto de Salud Carlos III and Fundacion Conocimiento Madri+D. Fabricio Ferreira de Oliveira has been granted for consultancy by Gerson Lehrman Group, Atheneum Partners, Guidepoint, Lionbridge. He is supported by FAPESP – The State of São Paulo Research Foundation (Grant #2015/10109-5) and is a board member of AAN Global Strategies Subcommittee, Awards Committee of the International Parkinson and Movement Society, ISTAART PIA Biofluid Based Biomarkers working group, ISTAART PIA Neuropsychiatric Syndromes and ESF Committee of Experts. Leonardo Sacco has served as investigator for clinical trials sponsored by Biogen and was member of the Advisory Board of Roche and Eisai. Marc Sollberger has been granted for speech and consultancy by Lilly, Eisai, OM Pharma. Katheen Welsh-Bohmer is a consultant to WCG, Senaptec, Jigsawdio. She serves on the U.S. POINTER data safety monitoring board and is unpaid board member for the nonprofit Dementia Alliance of NC (DANC). She is also funded through US Federal Grants (NIA/NIH), NC DHHS state funds, and private foundational support (National Philanthropic Trust/Gates to the Alzheimer’s Data Discovery Initiative ADDI). The other authors do not declare any conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSIGNATURE workshop activities were supported by JPND call for expert Working Groups \"Concepts for health and social care research for neurodegenerative diseases\" and by Associazione Alzheimer Trento ODV.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors (C.C., A.D., G.F., C.M., A.P, C.F., T.C., C.C., F.C., F.F.O., M.F., A.I., L.I., T.L., G.L., S.E.M., R.M., C.M., J.A.M.G., M.M., C.P., S.P., M.P., O.P., L.S., A.K.S., M.S., M.T.P., M.T., E.V.B., S.F.C., M.B., F.K., J.V.S., M.B., and K.A.W.B) contributed to the study conception and design. Material preparation was performed by the Executive Board (C.C., A.D., G.F., C.M., A.P.). Data collection and analysis were performed by A.P, G.F., and C.M.. The first draft of the manuscript was written by A.D. and C.C. All authors (C.C., A.D., G.F., C.M., A.P, C.F., T.C., C.C., F.C., F.F.O., M.F., A.I., L.I., T.L., G.L., S.E.M., R.M., C.M., J.A.M.G., M.M., C.P., S.P., M.P., O.P., L.S., A.K.S., M.S., M.T.P., M.T., E.V.B., S.F.C., M.B., F.K., J.V.S., M.B., and K.A.W.B) \u0026nbsp;reviewed the manuscript for content, read and approved the final version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis manuscript was facilitated by the Alzheimer’s Association International Society to Advance Alzheimer's Research and Treatment (ISTAART), through the Cognition professional interest area (PIA). The views and opinions expressed by authors in this publication represent those of the authors and do not necessarily reflect those of the PIA membership, ISTAART or the Alzheimer's Association.\u0026nbsp;SIGNATURE workshop activities were supported by JPND call for expert Working Groups \"Concepts for health and social care research for neurodegenerative diseases\" and by Associazione Alzheimer Trento ODV.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLIST OF CONSORTIUM MEMBERS\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDodich Alessandra\u003csup\u003e1\u003c/sup\u003e, Panzavolta Andrea\u003csup\u003e2\u003c/sup\u003e, Funghi Giulia\u003csup\u003e1\u003c/sup\u003e, Meli Claudia\u003csup\u003e1\u003c/sup\u003e, Festari Cristina\u003csup\u003e3\u003c/sup\u003e, Chatzikostopoulos Thanos\u003csup\u003e4\u003c/sup\u003e, Chicherio Christian\u003csup\u003e5\u003c/sup\u003e, Clarens Florencia\u003csup\u003e6\u003c/sup\u003e, de Oliveira Fabricio Ferreira\u003csup\u003e7\u003c/sup\u003e, Filardi Marco\u003csup\u003e8\u003c/sup\u003e, Ibanez Agustin\u003csup\u003e9\u003c/sup\u003e, Invernizzi Laura\u003csup\u003e10\u003c/sup\u003e, Lebouvier Thibaud\u003csup\u003e11\u003c/sup\u003e, Logroscino Giancarlo\u003csup\u003e12\u003c/sup\u003e, MacPherson Sarah E.\u003csup\u003e13\u003c/sup\u003e, Manca Riccardo\u003csup\u003e14\u003c/sup\u003e, Marra Camillo\u003csup\u003e15,16\u003c/sup\u003e, Matias-Guiu Jordi A.\u003csup\u003e17\u003c/sup\u003e, Montembeault Maxime\u003csup\u003e18\u003c/sup\u003e, Papagno Costanza\u003csup\u003e1\u003c/sup\u003e, Pomati Simone\u003csup\u003e19\u003c/sup\u003e, Possenti Mario\u003csup\u003e20\u003c/sup\u003e, Piguet Olivier\u003csup\u003e21\u003c/sup\u003e, Sacco Leonardo\u003csup\u003e22\u003c/sup\u003e, Schild Ann-Katrin\u003csup\u003e23\u003c/sup\u003e, Sollberger Marc\u003csup\u003e24\u003c/sup\u003e, Tábuas-Pereira Miguel\u003csup\u003e25,26\u003c/sup\u003e, Tsatali Marianna\u003csup\u003e4\u003c/sup\u003e,Tsolaki Magda\u003csup\u003e4\u003c/sup\u003e, van den Berg Esther \u003csup\u003e27\u003c/sup\u003e, Cappa Stefano F.\u003csup\u003e2\u003c/sup\u003e, Bertoux Maxime\u003csup\u003e28\u003c/sup\u003e, Kumfor Fiona\u003csup\u003e29\u003c/sup\u003e, van den Stock Jan\u003csup\u003e30\u003c/sup\u003e, Boccardi Marina\u003csup\u003e31,32\u003c/sup\u003e, Welsh-Bohmer Kathleen Anne\u003csup\u003e33\u003c/sup\u003e, Cerami Chiara\u003csup\u003e2,34\u003c/sup\u003e, Federica Agosta\u003csup\u003e35\u003c/sup\u003e, Elisa Canu\u003csup\u003e35\u003c/sup\u003e, Ove Almkvist\u003csup\u003e36\u003c/sup\u003e, Goran Hagman\u003csup\u003e36\u003c/sup\u003e, Bengt Winblad\u003csup\u003e36\u003c/sup\u003e, Daniele Altomare\u003csup\u003e37\u003c/sup\u003e, Davide Angioni\u003csup\u003e38\u003c/sup\u003e, Jean-Marie Annoni\u003csup\u003e39\u003c/sup\u003e, Luca Beretta\u003csup\u003e40\u003c/sup\u003e, Manfred Berres\u003csup\u003e41\u003c/sup\u003e, Valentina Bessi\u003csup\u003e42\u003c/sup\u003e, Ingo Fimm\u003csup\u003e31\u003c/sup\u003e, Ingo Kilimann\u003csup\u003e31\u003c/sup\u003e, Emre Bora\u003csup\u003e43\u003c/sup\u003e, Andrea Brioschi-Guevara\u003csup\u003e44\u003c/sup\u003e, Andreas Buchmann\u003csup\u003e45,46\u003c/sup\u003e, Anton Gietl\u003csup\u003e45\u003c/sup\u003e, Cinzia Bussè\u003csup\u003e47\u003c/sup\u003e, Annachiara Cagnin\u003csup\u003e47\u003c/sup\u003e, Russell Chander\u003csup\u003e48\u003c/sup\u003e, Matthias Kliegel\u003csup\u003e49\u003c/sup\u003e, Nathalie Mella\u003csup\u003e49\u003c/sup\u003e, Alfredo Costa\u003csup\u003e50\u003c/sup\u003e, Camille Coulangers\u003csup\u003e38\u003c/sup\u003e, Pierre-Jean Ousset\u003csup\u003e38\u003c/sup\u003e, Chiara Cupidi\u003csup\u003e51\u003c/sup\u003e, Jean-François Démonet\u003csup\u003e52\u003c/sup\u003e, Mira Didic\u003csup\u003e53\u003c/sup\u003e, Francesco Di Lorenzo\u003csup\u003e54\u003c/sup\u003e, Bruno Dubois\u003csup\u003e55\u003c/sup\u003e, Alan Cronemberger Andrade\u003csup\u003e7\u003c/sup\u003e, Bruno Fimm\u003csup\u003e56\u003c/sup\u003e, Douglas Galasko\u003csup\u003e57\u003c/sup\u003e, Nicola Girtler\u003csup\u003e58\u003c/sup\u003e, Flavio Nobili\u003csup\u003e59\u003c/sup\u003e, Matteo Pardini\u003csup\u003e59\u003c/sup\u003e, Julie Henry\u003csup\u003e60\u003c/sup\u003e, Renelle Bourdage\u003csup\u003e61\u003c/sup\u003e, Lize Jiskoot\u003csup\u003e61\u003c/sup\u003e, Jackie\u0026nbsp;Poos\u003csup\u003e27\u003c/sup\u003e, Haaro Seelaar\u003csup\u003e27\u003c/sup\u003e, Stefan Klöppel\u003csup\u003e46\u003c/sup\u003e, Christine Krebs\u003csup\u003e46\u003c/sup\u003e, Walter A. Kukull\u003csup\u003e62\u003c/sup\u003e, Richard Levy\u003csup\u003e63\u003c/sup\u003e, Marisa Lima\u003csup\u003e25\u003c/sup\u003e, Antonella Luca\u003csup\u003e64\u003c/sup\u003e, Simona Luzzi\u003csup\u003e65\u003c/sup\u003e, Marta Fernández Matarrubia\u003csup\u003e66\u003c/sup\u003e, Patrizia Mecocci\u003csup\u003e67\u003c/sup\u003e, Martina Pigliautile\u003csup\u003e67\u003c/sup\u003e, Alina Menichelli\u003csup\u003e68,\u003c/sup\u003e Micaela Mitolo\u003csup\u003e69\u003c/sup\u003e, Andreas U. Monsch\u003csup\u003e24\u003c/sup\u003e, Despoina Moraitou\u003csup\u003e70\u003c/sup\u003e, Petr Novak\u003csup\u003e71\u003c/sup\u003e, Miriam E. Ortiz\u003csup\u003e72\u003c/sup\u003e, Sokratis Papageorgiou\u003csup\u003e73\u003c/sup\u003e, Nikolaos Scarmeas\u003csup\u003e73\u003c/sup\u003e, John Papatriantafyllou\u003csup\u003e74\u003c/sup\u003e, Andrea Plutino\u003csup\u003e75\u003c/sup\u003e, Davide Quaranta\u003csup\u003e76\u003c/sup\u003e, Inez Ramakers\u003csup\u003e77\u003c/sup\u003e, Stefania Rossi\u003csup\u003e78\u003c/sup\u003e, Mirella Russo\u003csup\u003e79\u003c/sup\u003e, Stefano Sensi\u003csup\u003e79\u003c/sup\u003e, Perminder Sachdev\u003csup\u003e48\u003c/sup\u003e,\u0026nbsp;David P. Salmon\u003csup\u003e80\u003c/sup\u003e, Pilar Sanchez\u003csup\u003e81\u003c/sup\u003e, Florian Schöberl\u003csup\u003e82\u003c/sup\u003e, Steven D. Shirk\u003csup\u003e83\u003c/sup\u003e, Alessio Toraldo\u003csup\u003e84\u003c/sup\u003e, Annalena Venneri\u003csup\u003e85\u003c/sup\u003e, Dix Meiberth\u003csup\u003e23\u003c/sup\u003e, Maurizio Gallucci\u003csup\u003e86\u003c/sup\u003e, Fotini Kounti\u003csup\u003e87\u003c/sup\u003e, Silvia Rodrigo Herrero\u003csup\u003e88\u003c/sup\u003e, Pietro Marano\u003csup\u003e89\u003c/sup\u003e, Tommaso Piccoli\u003csup\u003e90\u003c/sup\u003e,Samrah Ahmed\u003csup\u003e91\u003c/sup\u003e, Fabiola Böhm\u003csup\u003e92\u003c/sup\u003e, Matthias Schroeter\u003csup\u003e82\u003c/sup\u003e, Susanna Vestberg\u003csup\u003e9\u003c/sup\u003e\u003csup\u003e3\u003c/sup\u003e, Marie Söntgerath\u003csup\u003e9\u003c/sup\u003e\u003csup\u003e4\u003c/sup\u003e, Jennifer Thompson\u003csup\u003e9\u003c/sup\u003e\u003csup\u003e5\u003c/sup\u003e, Tamlyn Watermeyer\u003csup\u003e96\u003c/sup\u003e, Hendrick-Jan\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;van der Waal\u003csup\u003e9\u003c/sup\u003e\u003csup\u003e7\u003c/sup\u003e, Lucy Chrisman-Russell\u003csup\u003e98\u003c/sup\u003e, Silvana Morson\u003csup\u003e10\u003c/sup\u003e,\u0026nbsp;Lucas Wolski\u003csup\u003e82\u003c/sup\u003e, Renzo Dori\u003csup\u003e99\u003c/sup\u003e, Andrea Fabbo\u003csup\u003e100\u003c/sup\u003e, Chiara Galli\u003csup\u003e100\u003c/sup\u003e, Claudia Bartels\u003csup\u003e101\u003c/sup\u003e, Gert\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Geurtsen\u003csup\u003e102\u003c/sup\u003e, Francesca Baglio\u003csup\u003e103\u003c/sup\u003e, Sara Isernia\u003csup\u003e103\u003c/sup\u003e, Cem Dogdu\u003csup\u003e104\u003c/sup\u003e, Elisa Ruiu\u003csup\u003e105\u003c/sup\u003e, Fijanne Strijkert\u003csup\u003e106\u003c/sup\u003e, Nikki Zimmermann\u003csup\u003e107\u003c/sup\u003e, Wendy Weidner\u003csup\u003e108\u003c/sup\u003e, Helena Briales\u003csup\u003e109\u003c/sup\u003e, Rita Pezzati\u003csup\u003e110\u003c/sup\u003e, Anne Rita Oksengard\u003csup\u003e111\u003c/sup\u003e, Angela Bradshaw\u003csup\u003e112\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003e Centre for Mind/Brain Sciences, University of Trento, Rovereto, Italy\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u003c/sup\u003e IUSS Cognitive Neuroscience Center, Scuola Universitaria Superiore IUSS di Pavia, Pavia, Italy\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e3\u003c/sup\u003e Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e4\u003c/sup\u003e Greek Association of Alzheimer's Disease and Related Disorders, Thessaloniki, Greece\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e5\u003c/sup\u003e Memory Center, Geneva University Hospitals, Geneva, Switzerland\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e6\u003c/sup\u003e Memory and Aging Center, Institute for Neurological Research, Buenos Aires, Argentina\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e7\u003c/sup\u003e Universidade Federal de São Paulo, São Paulo, Brazil\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e8\u003c/sup\u003e University for Foreigners of Perugia, Perugia, Italy\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e9\u003c/sup\u003e Latin American Brain Health Institute, Santiago, Santiago, Chile\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e10\u003c/sup\u003e Italian Frontotemporal Dementia Association, AIMFT, Brescia, Italy\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e11\u003c/sup\u003e Université de Lille, Inserm, Centre Hospitalier Universitaire de Lille, Lille Neuroscience \u0026amp; Cognition, Lille, France\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e12\u003c/sup\u003e Università degli Studi di Bari Aldo Moro, Bari, Italy\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e13\u0026nbsp;\u003c/sup\u003eDepartment of Psychology, University of Edinburgh, Edinburgh, UK\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e14\u003c/sup\u003e Department of Medicine and Surgery, University of Parma, Parma, Italy\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e15\u003c/sup\u003e Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e16\u003c/sup\u003e Department of Psychology – Catholic University of Sacred Heart – Milan, Italy\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e17\u0026nbsp;\u003c/sup\u003eDepartment of Neurology, Hospital Clinico San Carlos. San Carlos Health Research Institute (IdISSC), Universidad Complutense, Madrid, Spain\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e18\u0026nbsp;\u003c/sup\u003eDouglas Research Centre \u0026amp; Department of Psychiatry, McGill University, Montreal, Canada\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e19\u003c/sup\u003e Center for Cognitive Disorders and Dementia, Neurology Unit, Ospedale Luigi Sacco, Milan, Italy\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e20\u003c/sup\u003e Federazione Alzheimer Italia, Milan, Italy\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e21\u003c/sup\u003e School of Psychology and Brain \u0026amp; Mind Centre, University of Sydney, Sydney, Australia\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e22\u003c/sup\u003e Neuropsychological and Speech Therapy Unit, Neurocenter of Southern Switzerland, Lugano, Switzerland\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e23\u003c/sup\u003e Universitätsklinikum Köln, Köln, Germany\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e24\u003c/sup\u003e Memory Clinic, University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e25\u003c/sup\u003e Memory Clinic, Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e26\u0026nbsp;\u003c/sup\u003eFaculty of Medicine, University of Coimbra, Coimbra, Portugal\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e27\u003c/sup\u003e Department of Neurology and Alzheimer Center Erasmus MC, Erasmus MC University Medical Center, Rotterdam, the Netherlands\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e28\u003c/sup\u003e Lille Neurosciences \u0026amp; Cognition, Inserm, Université de Lille, Centre Hospitalier Universitaire de Lille, Lille, France\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e29\u003c/sup\u003e School of Psychology, University of Sydney, Sydney, NSW, Australia\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e30\u003c/sup\u003e Neuropsychiatry, Leuven Brain Institute, KU Leuven, Leuven, Belgium\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e31\u003c/sup\u003e German Centre for Neurodegenerative Diseases, Rostock-Greifswald site, Rostock, Germany\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e32\u0026nbsp;\u003c/sup\u003eCentre of Competence on Ageing, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e33\u003c/sup\u003eDepartment of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e34\u003c/sup\u003eIstituti Clinici Scientifici Maugeri IRCCS, Brain e-Health Aging Laboratory, Department of Neurorehabilitation, Milan, Italy\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e35\u003c/sup\u003eVita-Salute San Raffaele University, Milan, Italy\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e36\u003c/sup\u003eKarolinska Institutet, Stockholm, Sweden\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e37\u003c/sup\u003e IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli di Brescia\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e38\u003c/sup\u003e Toulouse University Hospital, Toulouse, France\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e39\u003c/sup\u003eUniversité de Fribourg, Fribourg, Switzerland\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e40\u003c/sup\u003eOspedale Valduce, Como, Italy\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e41\u0026nbsp;\u003c/sup\u003eKoblenz University of Applied Sciences, Koblenz, Germany\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e42\u0026nbsp;\u003c/sup\u003eUniversità degli Studi di Firenze, Firenze, Italy\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e43\u0026nbsp;\u003c/sup\u003eDokuz Eylul University, Izmir, Turkey\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e44\u0026nbsp;\u003c/sup\u003eUniversité de Lausanne, Lausanne, Switzerland\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e45\u0026nbsp;\u003c/sup\u003eUniversität Zürich, Zürich, Switzerland\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e46\u003c/sup\u003e Universität Bern, Bern, Switzerland\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e47\u003c/sup\u003e Università di Padova, Padova, Italy\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e48\u0026nbsp;\u003c/sup\u003eUniversity of New South Wales – UNSW, Sydney, Australia\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e49\u003c/sup\u003eUniversité de Genève, Geneva, Switzerland\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e50\u0026nbsp;\u003c/sup\u003eFondazione Mondino IRCCS, Pavia, Italy\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e51\u0026nbsp;\u003c/sup\u003eFondazione Giglio Cefalù, Cefalù, Italy\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e52\u0026nbsp;\u003c/sup\u003eCentre Leenaards de la Mémoire - CHUV, Lausanne University, Switzerland\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e53\u0026nbsp;\u003c/sup\u003eAix-Marseille Université, Marseille, France\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e54\u003c/sup\u003e IRCCS Fondazione Santa Lucia, Rome, Italy\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e55\u003c/sup\u003e Sorbonne Université, Paris, France\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e56\u003c/sup\u003e RWTH Aachen University, Aachen, Germany\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e57\u003c/sup\u003eUC San Diego Health, San Diego, USA\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e58\u003c/sup\u003eDepartment of Neuroscience (DINOGMI), Università degli Studi di Genova, Genoa, Italy\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e59\u0026nbsp;\u003c/sup\u003eUniversità degli Studi di Genova, Genoa, Italy\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e60\u0026nbsp;\u003c/sup\u003eUniversity of Queensland (UQ) Australia, Brisbane, Australia\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e61\u0026nbsp;\u003c/sup\u003eErasmus MC University Medical Center, Rotterdam, the Netherlands\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e62\u003c/sup\u003e University of Washington\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e63\u003c/sup\u003e Hôpital Universitaire Pitié-Salpêtrière, Paris, France\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e64\u0026nbsp;\u003c/sup\u003eDepartment of Medical, Surgical Sciences and Advanced Technologies \"GF Ingrassia\", University of Catania, Catania, Italy\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e65\u003c/sup\u003e Università Politecnica delle Marche, Ancona, Italy\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e66\u003c/sup\u003e Marqués de Valdecilla University Hospital, Santander, Spain\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e67\u0026nbsp;\u003c/sup\u003eUniversità degli Studi di Perugia, Perugia, Italy\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e68\u0026nbsp;\u003c/sup\u003eAzienda sanitaria universitaria Giuliano Isontina, Trieste, Italy\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e69\u0026nbsp;\u003c/sup\u003eUniversità di Bologna, Bologna, Italy\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e70\u003c/sup\u003e Aristotle University of Thessaloniki, Thessaloniki, Greece\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e71\u003c/sup\u003e Slovak Academy of Sciences, Bratislava, Slovakia\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e72\u003c/sup\u003e Hospital de Torrejón, Madrid, Spain\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e73\u0026nbsp;\u003c/sup\u003eNational and Kapodistrian University of Athens, Athens, Greece\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e74\u0026nbsp;\u003c/sup\u003eThird Age Center IASIS \u0026amp; Medical Center of Athens Hospital, Athens, Greece\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e75\u003c/sup\u003eAzienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Marche, Italy\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e76\u003c/sup\u003e Catholic University of Sacred Heart, Rome, Italy\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e77\u0026nbsp;\u003c/sup\u003eAlzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e78\u0026nbsp;\u003c/sup\u003eEnte Ospedaliero Cantonale (EOC), Switzerland\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e79\u0026nbsp;\u003c/sup\u003eG. D'Annunzio University of Chieti, Chieti, Italy\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e80\u0026nbsp;\u003c/sup\u003eUniversity of California San Diego, USA\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e81\u0026nbsp;\u003c/sup\u003eHospital Universitario Puerta de Hierro, Madrid, Spain\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e82\u0026nbsp;\u003c/sup\u003eTechnical University of Munich, School of Medicine, Munich, Germany\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e83\u003c/sup\u003e UMass Chan Medical School, Massachusetts, USA\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e84\u0026nbsp;\u003c/sup\u003eUniversità degli Studi di Pavia, Pavia, Italy\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e85\u0026nbsp;\u003c/sup\u003eUniversity of Sheffield, Sheffield, UK\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e86\u003c/sup\u003e Azienda ULSS2 Marca Trevigiana, Treviso, Italy\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e87\u0026nbsp;\u003c/sup\u003eAssociation for Alzheimer disease and healthy aging Herakleion, Crete, Greece\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e88\u003c/sup\u003e Hospital Universitario Juan Ramon Jimenez, Huelva, Spain\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e89\u0026nbsp;\u003c/sup\u003eIRCCS Oasi Maria SS, Troina, Italy\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e90\u0026nbsp;\u003c/sup\u003eUniversità degli Studi di Palermo, Palermo, Italy\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e91\u0026nbsp;\u003c/sup\u003eUniversity of Reading, Reading, UK\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e92\u003c/sup\u003e Martin Luther University Halle-Wittenberg\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e93\u003c/sup\u003e Department of Psychology, Lund University, Lund, Sweden\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e94\u0026nbsp;\u003c/sup\u003eKlinik und Poliklinik für Neurologie, Universitätsklinikum Halle (Saale), Germany\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e95\u0026nbsp;\u003c/sup\u003eManchester Centre for Clinical Neurosciences, Manchester, UK\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e96\u0026nbsp;\u003c/sup\u003eDepartment of Psychology,Northumbria University, Newcastle, UK\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e97\u0026nbsp;\u003c/sup\u003eFTD Lotgenoten, Amsterdam, The Netherlands\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e98\u003c/sup\u003e University College London, London, UK\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e99\u003c/sup\u003eAssociazione Alzheimer Trento, Trento, Italy\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e100\u0026nbsp;\u003c/sup\u003eUOC di Geriatria- Disturbi Cognitivi e Demenze Dipartimento Cure Primarie AUSL Modena, Modena, Italy\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e101\u0026nbsp;\u003c/sup\u003eUniversitätsmedizin Göttingen, Göttingen, Germany\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e102\u003c/sup\u003e Department of Medical Psychology, Amsterdam Universitair Medische Centra, Amsterdam, The Netherlands\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e103\u003c/sup\u003e IRCCS Don Gnocchi Foundation of Milan, Milan, Italy\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e104\u003c/sup\u003e German Center for Neurodegenerative Diseases, Bonn, Germany\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e105\u003c/sup\u003e Azienda Ospedaliera Universitaria di Sassari, Sassari, Italy\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e106\u0026nbsp;\u003c/sup\u003eAlzheimer's Center Groningen, Groningen, The Netherlands\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e107\u0026nbsp;\u003c/sup\u003eWorld FTD United \u0026amp; Rare Dementia Support (RDS), UK\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e108\u0026nbsp;\u003c/sup\u003eAlzheimer Disease International (ADI), London, UK\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e109\u0026nbsp;\u003c/sup\u003eAphasia Aid Association, Spain\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e110\u0026nbsp;\u003c/sup\u003eAlzheimer Ticino, Switzerland\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e111\u0026nbsp;\u003c/sup\u003eAssociazione Alzheimer Norvegia\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e112\u003c/sup\u003eAlzheimer Europe, Luxembourg\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSachdev PS, Blacker D, Blazer DG, Ganguli M, Jeste DV, Paulsen JS, et al. Classifying neurocognitive disorders: the DSM-5 approach. Nat Rev Neurol. 2014;10:634\u0026ndash;42. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/nrneurol.2014.181\u003c/span\u003e\u003cspan address=\"10.1038/nrneurol.2014.181\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVan den Stock J. Social cognition assessment for mild neurocognitive disorders. Alzheimers Dement. 2022;18:1439\u0026ndash;40. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/alz.12475\u003c/span\u003e\u003cspan address=\"10.1002/alz.12475\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDodich A, Boccardi M, Sacco L, Monsch AU, D\u0026eacute;monet J-F, Filardi M, et al. Answer to Social cognition assessment for mild neurocognitive disorders. Alzheimers Dement. 2022;18:1441\u0026ndash;2. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/alz.12664\u003c/span\u003e\u003cspan address=\"10.1002/alz.12664\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVan den Stock J, Bertoux M, Diehl-Schmid J, Piguet O, Rankin KP, Pasquier F, et al. Current Potential for Clinical Optimization of Social Cognition Assessment for Frontotemporal Dementia and Primary Psychiatric Disorders. Neuropsychol Rev. 2022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s11065-022-09554-3\u003c/span\u003e\u003cspan address=\"10.1007/s11065-022-09554-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDodich A, Cerami C. Answer to Current Potential for Clinical Optimization of Social Cognition Assessment for Frontotemporal Dementia and Primary Psychiatric Disorders. Neuropsychol Rev. 2022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s11065-022-09556-1\u003c/span\u003e\u003cspan address=\"10.1007/s11065-022-09556-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJarsch M, Semenkova A, Monsch A, Kressig R, Sollberger M. Eine L\u0026uuml;cke, die es zu schlie\u0026szlig;en gilt: Die Untersuchung sozial-kognitiver F\u0026auml;higkeiten an deutschsprachigen Memory-Kliniken A Gap that Needs to be Closed: The Assessment of Social-Cognitive Abilities in German-Speaking Memory Clinics. Z F\u0026uuml;r Neuropsychologie. 2022;33:129\u0026ndash;37. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1024/1016-264X/a000358\u003c/span\u003e\u003cspan address=\"10.1024/1016-264X/a000358\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQuesque F, Nivet M, Etchepare A, Wauquiez G, Prouteau A, Desgranges B et al. Social cognition in neuropsychology: A nationwide survey revealing current representations and practices. Appl Neuropsychology: Adult 2022:1\u0026ndash;14. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/23279095.2022.2061859\u003c/span\u003e\u003cspan address=\"10.1080/23279095.2022.2061859\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCerami C, Boccardi M, Meli C, Panzavolta A, Funghi G, Festari C et al. Understanding barriers and optimizing socio-cognitive assessment in the diagnosis of neurocognitive disorders. Journal of neuropsychology, 2024. \u003cem\u003e[Manuscript submitted for publication]\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePinkham AE, Penn DL, Green MF, Buck B, Healey K, Harvey PD. The Social Cognition Psychometric Evaluation Study: Results of the Expert Survey and RAND Panel. Schizophr Bull. 2014;40:813\u0026ndash;23. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/schbul/sbt081\u003c/span\u003e\u003cspan address=\"10.1093/schbul/sbt081\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGreen MF, Penn DL, Bentall R, Carpenter WT, Gaebel W, Gur RC, et al. Social Cognition in Schizophrenia: An NIMH Workshop on Definitions, Assessment, and Research Opportunities. Schizophr Bull. 2008;34:1211\u0026ndash;20. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/schbul/sbm145\u003c/span\u003e\u003cspan address=\"10.1093/schbul/sbm145\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVita A, Gaebel W, Mucci A, Sachs G, Erfurth A, Barlati S, et al. European Psychiatric Association guidance on assessment of cognitive impairment in schizophrenia. Eur Psychiatry. 2022;65:e58. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1192/j.eurpsy.2022.2316\u003c/span\u003e\u003cspan address=\"10.1192/j.eurpsy.2022.2316\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMurphy MK, Black NA, Lamping DL, McKee CM, Sanderson CF, Askham J, et al. Consensus development methods, and their use in clinical guideline development. Health Technol Assess. 1998;2:i\u0026ndash;iv.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFestari C, Massa F, Cotta Ramusino M, Gandolfo F, Nicolosi V, Orini S, et al. European consensus for the diagnosis of MCI and mild dementia: Preparatory phase. Alzheimers Dement. 2023;19:1729\u0026ndash;41. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/alz.12798\u003c/span\u003e\u003cspan address=\"10.1002/alz.12798\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDodich A, Crespi C, Santi GC, Cappa SF, Cerami C. Evaluation of Discriminative Detection Abilities of Social Cognition Measures for the Diagnosis of the Behavioral Variant of Frontotemporal Dementia: a Systematic Review. Neuropsychol Rev. 2021;31:251\u0026ndash;66. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s11065-020-09457-1\u003c/span\u003e\u003cspan address=\"10.1007/s11065-020-09457-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePage MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev. 2021;10:89. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s13643-021-01626-4\u003c/span\u003e\u003cspan address=\"10.1186/s13643-021-01626-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWhiting PF, Rutjes AWS, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155:529\u0026ndash;36. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.7326/0003-4819-155-8-201110180-00009\u003c/span\u003e\u003cspan address=\"10.7326/0003-4819-155-8-201110180-00009\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGarc\u0026iacute;a-Casal JA, Mart\u0026iacute;nez-Abad F, Cid-Bartolom\u0026eacute; T, Smith SJ, Llano-Ord\u0026oacute;\u0026ntilde;ez K, Perea-Bartolom\u0026eacute; MV, et al. Usability study and pilot validation of a computer-based emotion recognition test for older adults with Alzheimer\u0026rsquo;s disease and amnestic mild cognitive impairment. Aging Ment Health. 2019;23:365\u0026ndash;75. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/13607863.2017.1423033\u003c/span\u003e\u003cspan address=\"10.1080/13607863.2017.1423033\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDiehl-Schmid J, Pohl C, Ruprecht C, Wagenpfeil S, Foerstl H, Kurz A. The Ekman 60 Faces Test as a diagnostic instrument in frontotemporal dementia. Arch Clin Neuropsychol. 2007;22:459\u0026ndash;64. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.acn.2007.01.024\u003c/span\u003e\u003cspan address=\"10.1016/j.acn.2007.01.024\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDodich A, Crespi C, Santi GC, Luzzi S, Ranaldi V, Iannaccone S, et al. Diagnostic Accuracy of Affective Social Tasks in the Clinical Classification Between the Behavioral Variant of Frontotemporal Dementia and Other Neurodegenerative Disease. JAD. 2021;80:1401\u0026ndash;11. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3233/JAD-201210\u003c/span\u003e\u003cspan address=\"10.3233/JAD-201210\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBuhl C, Stokholm J, Gade A. Clinical Utility of Short Social Cognitive Tests in Early Differentiation of Behavioral Variant Frontotemporal Dementia from Alzheimer\u0026rsquo;s Disease. Dement Geriatr Cogn Dis Extra. 2013;3:376\u0026ndash;85. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1159/000355123\u003c/span\u003e\u003cspan address=\"10.1159/000355123\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMariano LI, Caramelli P, Guimar\u0026atilde;es HC, Gambogi LB, Moura MVB, Yassuda MS, et al. Regardless Apathy? JAD. 2020;74:817\u0026ndash;27. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3233/JAD-190861\u003c/span\u003e\u003cspan address=\"10.3233/JAD-190861\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Can Social Cognition Measurements Differentiate Behavioral Variant Frontotemporal Dementia from Alzheimer\u0026rsquo;s Disease.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoura MVB, Mariano LI, Teixeira AL, Caramelli P, De Souza LC. Social Cognition Tests Can Discriminate Behavioral Variant Frontotemporal Dementia From Alzheimer\u0026rsquo;s Disease Independently of Executive Functioning. Arch Clin Neuropsychol. 2021;36:831\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/arclin/acaa084\u003c/span\u003e\u003cspan address=\"10.1093/arclin/acaa084\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChiu I, Piguet O, Diehl-Schmid J, Riedl L, Beck J, Leyhe T, et al. Dissociation in Rating Negative Facial Emotions between Behavioral Variant Frontotemporal Dementia and Major Depressive Disorder. Am J Geriatric Psychiatry. 2016;24:1017\u0026ndash;27. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jagp.2016.06.011\u003c/span\u003e\u003cspan address=\"10.1016/j.jagp.2016.06.011\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChiu I, Piguet O, Diehl-Schmid J, Riedl L, Beck J, Leyhe T, et al. Facial Emotion Recognition Performance Differentiates Between Behavioral Variant Frontotemporal Dementia and Major Depressive Disorder. J Clin Psychiatry. 2018;79:16m11342. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4088/JCP.16m11342\u003c/span\u003e\u003cspan address=\"10.4088/JCP.16m11342\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarbosa IG, Leite FDMC, Bertoux M, Guimar\u0026atilde;es HC, Mariano LI, Gambogi LB, et al. Social cognition across bipolar disorder and behavioral variant frontotemporal dementia: an exploratory study. Brazilian J Psychiatry. 2023. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.47626/1516-4446-2022-2935\u003c/span\u003e\u003cspan address=\"10.47626/1516-4446-2022-2935\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLichtenstein ML, Stewart PV, Kirchner HL, Finney G, Feldman HH. Exploring Social Cognition Tests to Differentiate Frontotemporal Dementia from Depression: A Two-Step Pilot Study. Alzheimer Disease Assoc Disorders. 2023;37:145\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/WAD.0000000000000526\u003c/span\u003e\u003cspan address=\"10.1097/WAD.0000000000000526\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmlerova J, Lacz\u0026oacute; J, Nedelska Z, Lacz\u0026oacute; M, Vyhn\u0026aacute;lek M, Zhang B, et al. Emotional prosody recognition is impaired in Alzheimer\u0026rsquo;s disease. Alz Res Therapy. 2022;14:50. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s13195-022-00989-7\u003c/span\u003e\u003cspan address=\"10.1186/s13195-022-00989-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGleichgerrcht E, Torralva T, Roca M, Manes F. Utility of an abbreviated version of the executive and social cognition battery in the detection of executive deficits in early behavioral variant frontotemporal dementia patients. J Int Neuropsychol Soc. 2010;16:687\u0026ndash;94. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1017/S1355617710000482\u003c/span\u003e\u003cspan address=\"10.1017/S1355617710000482\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDowney LE, Blezat A, Nicholas J, Omar R, Golden HL, Mahoney CJ, et al. Mentalising music in frontotemporal dementia. Cortex. 2013;49:1844\u0026ndash;55. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.cortex.2012.09.011\u003c/span\u003e\u003cspan address=\"10.1016/j.cortex.2012.09.011\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchroeter ML, Pawelke S, Bisenius S, Kynast J, Schuemberg K, Polyakova M, et al. A Modified Reading the Mind in the Eyes Test Predicts Behavioral Variant Frontotemporal Dementia Better Than Executive Function Tests. Front Aging Neurosci. 2018;10:11. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fnagi.2018.00011\u003c/span\u003e\u003cspan address=\"10.3389/fnagi.2018.00011\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCustodio N, Montesinos R, Cruzado L, Herrera-Perez E, Failoc-Rojas VE, Pintado-Caipa M, et al. Social Cognition and Behavioral Assessments Improve the Diagnosis of Behavioral Variant of Frontotemporal Dementia in Older Peruvians With Low Educational Levels. Front Neurol. 2021;12:704109. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fneur.2021.704109\u003c/span\u003e\u003cspan address=\"10.3389/fneur.2021.704109\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFunkiewiez A, Bertoux M, de Souza LC, L\u0026eacute;vy R, Dubois B. The SEA (Social cognition and Emotional Assessment): a clinical neuropsychological tool for early diagnosis of frontal variant of frontotemporal lobar degeneration. Neuropsychology. 2012;26:81\u0026ndash;90. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1037/a0025318\u003c/span\u003e\u003cspan address=\"10.1037/a0025318\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBertoux M, Delavest M, de Souza LC, Funkiewiez A, L\u0026eacute;pine J-P, Fossati P, et al. Social Cognition and Emotional Assessment differentiates frontotemporal dementia from depression. J Neurol Neurosurg Psychiatry. 2012;83:411\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1136/jnnp-2011-301849\u003c/span\u003e\u003cspan address=\"10.1136/jnnp-2011-301849\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBertoux M, Funkiewiez A, O\u0026rsquo;Callaghan C, Dubois B, Hornberger M. Sensitivity and specificity of ventromedial prefrontal cortex tests in behavioral variant frontotemporal dementia. Alzheimer\u0026rsquo;s Dement 2013;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jalz.2012.09.010\u003c/span\u003e\u003cspan address=\"10.1016/j.jalz.2012.09.010\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBertoux M, de Souza LC, O\u0026rsquo;Callaghan C, Greve A, Sarazin M, Dubois B, et al. Social Cognition Deficits: The Key to Discriminate Behavioral Variant Frontotemporal Dementia from Alzheimer\u0026rsquo;s Disease Regardless of Amnesia? J Alzheimers Dis. 2016;49:1065\u0026ndash;74. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3233/JAD-150686\u003c/span\u003e\u003cspan address=\"10.3233/JAD-150686\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTeichmann M, Daigmorte C, Funkiewiez A, Sanches C, Camus M, Mauras T, et al. Moral Emotions Frontotemporal Dement JAD. 2019;69:887\u0026ndash;96. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3233/JAD-180991\u003c/span\u003e\u003cspan address=\"10.3233/JAD-180991\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarr AR, Samimi MS, Paholpak P, Jimenez EE, Mendez MF. Emotional quotient in frontotemporal dementia vs. Alzheimer\u0026rsquo;s disease: the role of socioemotional agnosia. Cogn Neuropsychiatry. 2017;22:28\u0026ndash;38. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/13546805.2016.1259612\u003c/span\u003e\u003cspan address=\"10.1080/13546805.2016.1259612\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHenry JD, von Hippel W, Molenberghs P, Lee T, Sachdev PS. Clinical assessment of social cognitive function in neurological disorders. Nat Rev Neurol. 2016;12:28\u0026ndash;39. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/nrneurol.2015.229\u003c/span\u003e\u003cspan address=\"10.1038/nrneurol.2015.229\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican Psychological Association. Guidelines for the evaluation of dementia and age-related cognitive change. Am Psychol. 2012;67(1):1\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1037/a0024643\u003c/span\u003e\u003cspan address=\"10.1037/a0024643\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHiggins WC, Ross RM, Langdon R, Polito V. The Reading the Mind in the Eyes Test Shows Poor Psychometric Properties in a Large. Demographically Representative U S Sample Assess. 2023;30:1777\u0026ndash;89. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/10731911221124342\u003c/span\u003e\u003cspan address=\"10.1177/10731911221124342\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQuesque F, Coutrot A, Cox S, de Souza LC, Baez S, Cardona JF, et al. Does culture shape our understanding of others\u0026rsquo; thoughts and emotions? An investigation across 12 countries. Neuropsychology. 2022;36:664\u0026ndash;82. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1037/neu0000817\u003c/span\u003e\u003cspan address=\"10.1037/neu0000817\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIsernia S, MacPherson SE, Baksh RA, Bergsland N, Marchetti A, Baglio F, et al. Italian adaptation of the Edinburgh Social Cognition Test (ESCoT): A new tool for the assessment of theory of mind and social norm understanding. Front Psychol. 2022;13:971187. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpsyg.2022.971187\u003c/span\u003e\u003cspan address=\"10.3389/fpsyg.2022.971187\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFranzen S, European Consortium on Cross-Cultural Neuropsychology (ECCroN), Watermeyer TJ, Pomati S, Papma JM, Nielsen TR, et al. Cross-cultural neuropsychological assessment in Europe: Position statement of the European Consortium on Cross-Cultural Neuropsychology (ECCroN). Clin Neuropsychol. 2022;36:546\u0026ndash;57. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/13854046.2021.1981456\u003c/span\u003e\u003cspan address=\"10.1080/13854046.2021.1981456\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnderson E, Eleazer J, Kristensen Z, St. Amand C, Baker A, Correro A et al. Affirmative neuropsychological practice with transgender and gender diverse individuals and communities. Clin Neuropsychol 2022:1\u0026ndash;19. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/13854046.2022.2073915\u003c/span\u003e\u003cspan address=\"10.1080/13854046.2022.2073915\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZeilinger EL, Stiehl KAM, Weber G. A systematic review on assessment instruments for dementia in persons with intellectual disabilities. Res Dev Disabil. 2013;34:3962\u0026ndash;77. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ridd.2013.08.013\u003c/span\u003e\u003cspan address=\"10.1016/j.ridd.2013.08.013\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eManca R, Moreno JA, Nicoletti A, Henderson NJ, Flatt JD. Neurocognitive health in LGBTQIA\u0026thinsp;+\u0026thinsp;older adults: current state of research and recommendations. Front Hum Neurosci. 2024;18:1394374. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fnhum.2024.1394374\u003c/span\u003e\u003cspan address=\"10.3389/fnhum.2024.1394374\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRiddoch JM, Humphreys GW. BORB: Birmingham Object Recognition Battery. London: Psychology; 2022. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.4324/9781003069645\u003c/span\u003e\u003cspan address=\"10.4324/9781003069645\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQuesque F, Apperly I, Baillargeon R, Baron-Cohen S, Becchio C, Bekkering H, et al. Defining key concepts for mental state attribution. Commun Psychol. 2024;2:1\u0026ndash;5. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/s44271-024-00077-6\u003c/span\u003e\u003cspan address=\"10.1038/s44271-024-00077-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":true,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"alzheimers-research-and-therapy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"azrt","sideBox":"Learn more about [Alzheimer's Research and Therapy](http://alzres.biomedcentral.com/)","snPcode":"13195","submissionUrl":"https://submission.nature.com/new-submission/13195/3","title":"Alzheimer's Research \u0026 Therapy","twitterHandle":"@AlzheimersRes","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cognitive Assessment, Social cognition, Recommendations, Neurocognitive disorders","lastPublishedDoi":"10.21203/rs.3.rs-6370459/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6370459/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBACKGROUND: \u003c/strong\u003eSocio-cognitive assessment in neurocognitive disorders (NCDs) is rare in clinical practice and no consensus exists as to a uniform operationalization of socio-cognitive measures for neurocognitive disorders in memory clinics. The \u003cem\u003eSIGNATURE\u003c/em\u003e initiative aims to optimize the use of socio-cognitive measures in memory clinics, defining expert recommendations. We report consortium guidelines for the use of socio-cognitive measures in NCDs based on available evidence from the literature and the current state of practices in memory clinics.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMETHODS: \u003c/strong\u003eUsing a Delphi consensus method supported by a literature review and the results of an international survey, 22 specialists defined recommendations for the context of use, relevance in NCD diagnosis, priorities for future research and facilitators/obstacles of socio-cognitive assessment in major and mild NCDs.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRESULTS: \u003c/strong\u003eOverall, panelists recommended social cognition testing in routine diagnostic assessment to evaluate both socio-cognitive and socio-behavioral alterations. A set of clinical, methodological, implementation and external factors facilitating or hampering the use of socio-cognitive tasks was identified.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCONCLUSIONS: \u003c/strong\u003eThis is the first focused endeavor to favor the implementation of socio-cognitive assessment, which is required by DSM-5 but seldom performed despite clear evidence of its clinical relevance for diagnosis and care. Our results provide an initial set of recommendations, refinable through the future actions of the \u003cem\u003eSIGNATURE \u003c/em\u003einitiative. Future collaborative clinical research projects should overcome current limitations and foster the use of ecological and cross-culturally validated measures in clinics.\u003c/p\u003e","manuscriptTitle":"International consensus for the assessment of social cognition in neurocognitive disorders: framework definition and clinical recommendations of the SIGNATURE initiative","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-24 03:11:52","doi":"10.21203/rs.3.rs-6370459/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-25T20:22:52+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-25T19:53:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"138417960912407212216323052742471644720","date":"2025-07-01T14:27:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"238577380401546454237963171238143932658","date":"2025-06-26T14:14:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-01T17:03:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"282862296860028935687568770481686965354","date":"2025-04-15T14:16:13+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-10T22:19:40+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-08T01:35:31+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-08T01:35:12+00:00","index":"","fulltext":""},{"type":"submitted","content":"Alzheimer's Research \u0026 Therapy","date":"2025-04-03T14:52:26+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"alzheimers-research-and-therapy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"azrt","sideBox":"Learn more about [Alzheimer's Research and Therapy](http://alzres.biomedcentral.com/)","snPcode":"13195","submissionUrl":"https://submission.nature.com/new-submission/13195/3","title":"Alzheimer's Research \u0026 Therapy","twitterHandle":"@AlzheimersRes","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6f7bea7c-08ab-4baa-bce7-3a75e26ee439","owner":[],"postedDate":"June 24th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-08T16:02:52+00:00","versionOfRecord":{"articleIdentity":"rs-6370459","link":"https://doi.org/10.1186/s13195-025-01908-2","journal":{"identity":"alzheimers-research-and-therapy","isVorOnly":false,"title":"Alzheimer's Research \u0026 Therapy"},"publishedOn":"2025-12-06 15:57:16","publishedOnDateReadable":"December 6th, 2025"},"versionCreatedAt":"2025-06-24 03:11:52","video":"","vorDoi":"10.1186/s13195-025-01908-2","vorDoiUrl":"https://doi.org/10.1186/s13195-025-01908-2","workflowStages":[]},"version":"v1","identity":"rs-6370459","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6370459","identity":"rs-6370459","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}