Scene Construction Theory suggests similar neural mechanisms for visual imagery and autobiographical memory, supporting the seeming scientific consensus that a loss of visual imagery affects autobiographical memory. Based on the Dual Coding Theory and the Reverse Hierarchy Model, we also assumed influences of visual imagery on recent visual memory and even verbal memory, although little evidence has been provided so far. Thus, in a sample of 67 congenital aphantasics (= persons without mental imagery) and 32 demographically matched controls, it was investigated whether deficits in visual imagery are associated with deficits in visual as well as verbal short‐term and long‐term memory. The memory tasks were theoretically selected based on task difficulty, retrieval condition, and subcategories of stimuli, as previous null findings were attributed to insensitive tasks that were solvable by aphantasics by means of non‐visual alternative strategies. Significant group differences were found in all memory components, with aphantasics performing worse than non‐aphantasics. Therefore, evidence was obtained for the influence of visual imagery on all memory components beyond autobiographical memory.

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Background: With regard to attitudes towards pain, many questionnaires have been developed. Although undoubtedly useful, they were specifically designed for the use in chronic pain and are less suitable for the assessment in the general population. The purpose of the present paper was to develop a measure for the assessment of general attitudes towards pain applicable in the general population, regardless of clinical condition, and to test its psychometric properties. Methods:We developed the General Attitudes Towards Pain Inventory and conducted two studies in order to provide psychometric data: In a general population sample (N = 362, study one), participants were asked to complete a questionnaire battery. To assess test-retest reliability, participants were contacted again after 4 weeks (retest sample: N = 101). For the evaluation of criterion validity (study two), a sample with sadomasochistic sexual preference (N = 68) was additionally recruited.Results: Statistical analyses revealed, overall, acceptable internal consistencies and test-retest reliabilities. A 10-factor model showed acceptable fit and was superior to alternative models. The inventory demonstrated convergent and divergent validity. In this context, we found pain sensitivity to be associated with pain attitudes. Finally, compared to the general population sample, individuals with sadomasochistic sexual preference showed significantly higher scores on fascination-pleasure and challenge subscales. Conclusions:In the present paper, we introduce a new and comprehensive instrument for pain research and provide evidence for its reliability and validity.In addition, we present new insights into how interindividual differences in pain sensitivity relate to pain attitudes. Statement of Significance:Acknowledging the lack of basic research on pain attitudes in the general population, we have developed and validated the first psychometric instrument to measure ten general attitudes towards pain. The

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Aphantasia and prosopagnosia are both rare conditions with impairments in visual cognition. While prosopagnosia refers to a face recognition deficit, aphantasics exhibit a lack of mental imagery. Current object recognition theories propose an interplay of perception and mental representations, making an association between recognition performance and visual imagery plausible. While the literature assumes a link between aphantasia and prosopagnosia, other impairments in aphantasia have been shown to be rather global. Therefore, we assumed that aphantasics do not solely exhibit impairments in face recognition but rather in general visual recognition performance, probably moderated by stimulus complexity. To test this hypothesis, 65 aphantasics were compared to 55 controls in a face recognition task, the Cambridge Face Memory Test, and a corresponding object recognition task, the Cambridge Car Memory Test. In both tasks, aphantasics performed worse than controls, indicating mild recognition deficits without face-specificity. Additional correlations between imagery vividness and performance in both tasks were found, suggesting that visual imagery influences visual recognition not only in imagery extremes. Stimulus complexity produced the expected moderation effect but only for the whole imagery-spectrum and only with face stimuli. Overall, the results imply that aphantasia is linked to a general but mild deficit in visual recognition.

As awareness of the phenomenon of aphantasia (= lack of voluntary imagery) has increased in recent years, many psychotherapists ponder its clinical implications. The present study investigates whether aphantasia meets the criteria for mental disorders, i.e. statistical rarity, impairment in activities of daily living, violation of social norms and inappropriate behavior and personal distress. Prevalence of aphantasia was determined meta-analytically based on 3,543 participants. An international sample of 156 participants with aphantasia (58.3% male; M age = 35.23) and 131 controls (65.6% male; M age = 28.88) was assessed with the Reading the Mind in the Eyes Test, the Questionnaire for the Assessment of Everyday Memory Performance and the Aphantasia Distress Questionnaire, as well as measures of depression, anxiety and well-being. The prevalence of aphantasia was estimated at 3.5 to 4.8%. Participants with aphantasia scored significantly lower than controls on every day and autobiographical memory, but not on theory of mind. A subgroup of 34.7% of participants with aphantasia reported distress significantly associated with lower well-being and high levels of anxiety and depression. The level of distress increased with poorer performance in autobiographical memory and theory of mind. Although aphantasia meets the criterion of statistical rarity, the impact on activities of daily living and personal distress is too weak to justify a classification as a mental disorder. In a subgroup, however, distress can reach clinically relevant levels. In individual cases, it is therefore advisable to conduct a psychological assessment, for example by means of the Aphantasia Distress Questionnaire.

Zusammenfassung Bei der Fahreignungsbeurteilung kommt Behandelnden in der ambulanten neurologischen Rehabilitation eine große Verantwortung zu, schließlich wirkt sich ihre Entscheidung sowohl auf die zukünftige Autonomie und Teilhabe der Patienten als auch auf die Sicherheit aller Verkehrsteilnehmer aus. Im Widerspruch dazu gibt es für die Fahreignungsbegutachtung von Patienten mit Hirngefäßerkrankungen bislang nur wenige eindeutige Bewertungskriterien. Die Begutachtungsleitlinien (BGL) zur Kraftfahreignung der Bundesanstalt für Straßenwesen (BASt), die dem Gutachter als Entscheidungshilfe dienen sollen, verzichten weitgehend auf klare Kriterien oder verneinen die Fahreignung bei bestimmten Führerscheingruppen ganz. Ein kürzlich erschienenes Positionspapier mehrerer Fachgesellschaften [5] ergänzt die BGL und bietet Ärzten ergänzende krankheitsspezifische Einschätzungsempfehlungen, die helfen sollen, jeden Einzelfall unter Berücksichtigung des individuellen Gefährdungspotenzials gesondert zu beurteilen. Das hier präsentierte Forschungsprojekt diente der Beantwortung der Frage, wie sich die Einschätzungsempfehlungen aus dem Positionspapier von Marx und Kollegen [5] rückblickend auf die Fahreignungsbegutachtung in unserer ambulanten neurologischen Rehabilitation ausgewirkt hätten. Die Fahreignungsempfehlungen von 162 Patienten mit Hirngefäßerkrankung, die 2019 eine Rehabilitationsmaßnahme im Neurologischen Therapiecentrum (NTC) Köln gGmbH in Anspruch genommen hatten, wurden im Rahmen einer retrospektiven Analyse hinsichtlich zweier Aspekte reevaluiert: (1) unserer eigenen therapeutischen Einschätzung unter Hinzunahme der Empfehlungen von Marx und Kollegen [5] sowie (2) einer Entscheidung allein auf Basis der Empfehlungen des Positionspapiers. Unter Hinzunahme der Empfehlungen nach Marx et al. [5] zu unserer bisherigen Fahreignungsbegutachtung zeigte sich keine Änderung in der Gesamtempfehlung, jedoch eine Änderung in der empfohlenen Karenzzeit. Die Beurteilung der Fahreignung allein auf Basis des Positionspapiers hätte hingegen signifikant häufiger zu einem positiven Ergebnis (»Fahreignung gegeben«) geführt (p < 0,001). Wäre die Begutachtung nur aus medizinischer Perspektive erfolgt, wäre 26,5 % der Patienten trotz signifikanter kognitiver Beeinträchtigungen empfohlen worden, weiterhin Auto zu fahren. Die Empfehlungen des Positionspapiers [5] erlauben durch die Kategorisierung zerebrovaskulärer Ereignisse in untergeordnete Risikoprofile sowie die daran orientierten Karenzzeiten eine differenziertere Einschätzung des individuellen Gefährdungspotentials. Sie bieten insbesondere Patienten mit unauffälliger medizinischer und neuropsychologischer Untersuchung eine fairere, einzelfallgerechte Begutachtung und können Gutachter bei der wichtigen und komplexen Aufgabe der Fahreignungsbegutachtung unterstützen. Als alleinige Entscheidungsgrundlage reichen die Empfehlungen unseren Daten nach jedoch nicht aus, da wichtige fahreignungsrelevante Aspekte vernachlässigt würden und die Fähigkeit von Patienten zum sicheren Führen von Fahrzeugen überschätzt würde. Unsere Ergebnisse unterstreichen den enormen Stellenwert der Neuropsychologie in der Fahreignungsbeurteilung. Schlüsselwörter: Fahreignung, Begutachtungsleitlinien, Hirngefäßerkrankungen, ambulante neurologische Rehabilitation Abstract When it comes to the assessment of the ability to drive, great responsibility rests with the treating physicians. Not only do their decisions affect the future autonomy and participation of the patient, but also road safety in general. In contrast, to date there are only a few explicit official regulations for patients suffering from cerebrovascular diseases. The German Guidelines for the Evaluation of Driving Ability of the Federal Highway Research Institute, which are meant to serve physicians as a decision-making tool, either omit clear criteria or, in some cases, rigorously deny the ability to drive. A recent position paper published by several expert associations [5] complements these guidelines and offers expert assessors additional disease-specific recommendations, which ought to help assess each case with regard to the individual risk potential. The research project presented here served to answer the question of how, in retrospect, the recommendations by Marx and colleagues [5] would have affected driving ability decisions in our neurological outpatient rehabilitation center. We re-evaluated the driving ability recommendations for 162 patients suffering from cerebrovascular diseases treated at the Neurologisches Therapiecentrum Köln gGmbH in 2019 with regard to two different aspects: (1) the recommendations of the position paper in addition to our standard driving ability assessment as well as (2) a decision made on the sole basis of these recommendations. The addition of the recommendations by Marx and colleagues [5] did not lead to any changes in the overall decisions. However, we found a change in the recommended waiting period. The assessment of the ability to drive on the sole basis of the recommendations by Marxand colleagues [5] would have led significantly more often to a positive decision (p < 0.001). If decisions would have been made by physicians alone, 26.5% of the patients would have received a recommendation to drive despite significant cognitive impairments. The recommendations as stated in the position paper allow a differentiated assessment of the individual risk potential through the categorization of cerebrovascular events into subordinate risk profiles and respective waiting periods. They offer a fairer assessment and do individual cases justice, especially in cases with clear medical and neuropsychological examination. The recommendations support expert assessors in the important yet complex task of assessing driving ability. Nonetheless, according to our data they cannot be used as isolated guidelines since essential factors would be neglected and thus, driving ability would be overestimated. Our results underscore the significance of neuropsychological driving ability assessments. Keywords: Driving ability, German Guidelines for the Evaluation of Driving Ability, cerebrovascular disease, outpatient neurological rehabilitation