The Shoulder-Tapping Sign: A Highly Specific Indicator of Neurocognitive Disorders
Bibliographic record
Abstract
BACKGROUND: Perseveration, an inappropriate continuation of a response, is a well-established clinical sign of neurological dysfunction. The shoulder-tapping sign (STS) is a newly described and easily identified motor perseveration. OBJECTIVE: Investigate the diagnostic utility of the STS for identifying neurocognitive disorders in patients referred for neuropsychological evaluation. METHOD: We administered a five-step verbal command from the Commands subtest of the Boston Diagnostic Aphasia Examination ("Tap each shoulder twice with two fingers keeping your eyes shut") to 400 consecutive patients ( MAGE = 67.3, SD = 10.9) with suspected cognitive decline. The STS sign was considered positive if the patient tapped either shoulder more than twice. The STS was analyzed as a measure of neurocognitive disorder and compared with the final diagnosis. Analysis included calculations of sensitivity, specificity, and positive and negative likelihood ratios with 95% confidence intervals. RESULTS: The STS was positive in 23% of our sample, 96% of whom met criteria for a neurocognitive disorder. The STS was seen in 38% with dementia, 21% with mild neurocognitive disorder, and 4% with no neurocognitive diagnosis. As a diagnostic marker of neurocognitive disorders, the STS had a specificity of 0.96 and sensitivity of 0.28. Positive and negative likelihood ratios were 6.15 and 0.76, respectively. CONCLUSIONS: The STS is a highly specific indicator of neurocognitive disorders. Despite low sensitivity, the brevity and potential diagnostic yield make it a valuable addition to the cognitive assessment toolkit. When positive, the STS can be a defining feature of neurocognitive disorders in brief mental status examinations.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".