Ageing Research Reviews 92 (2023) 102117

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Ageing Research Reviews

journal homepage: www.elsevier.com/locate/arr

ChatGPT’s dance with neuropsychological data: A case study in

Alzheimer’s disease
Mohamad El Haj a, b, *, Claire Boutoleau-Bretonnière c, Guillaume Chapelet b, d
a
Institut Universitaire de France, Paris, France
b
CHU Nantes, Clinical Gerontology Department, Bd Jacques Monod, F44093 Nantes, France
c
CHU Nantes, Inserm CIC04, Nantes, France
d
Université de Nantes, Inserm, TENS, The Enteric Nervous System in Gut and Brain Diseases, IMAD, Nantes, France

A R T I C L E I N F O A B S T R A C T

Keywords: Artificial intelligence continues to revolutionize the medical and scientific field, especially with the release of
Alzheimer’s disease ChatGPT. We assessed whether it provides an accurate interpretation of neuropsychological screening. We
Artificial intelligence provided ChatGPT with the neuropsychological data of a patient with mild Alzheimer’s Disease and invited it and
ChatGPT
two neuropsychologists to interpret the data. While ChatGPT provided an accurate interpretation of scores on
Neuropsychology
Neuropsychological testing
each of the neuropsychological tests, it did not use standardized scores and did not specify the cognitive domain
that may be most impaired. In contrast, the neuropsychologists used standardized scores to determine that the
patient was mainly suffering from memory decline. While ChatGPT may succeed in the general interpretation of
neuropsychological testing, at least in patients with Alzheimer’s Disease, it still cannot create a pattern of scores
across different tests to better specify the nature of cognitive impairment.

1. Introduction function, memory, attention, language, visuospatial skills and executive

Artificial intelligence continues to drive the medical and scientific
field forward, especially with the recent progress in natural language
processing tools, which use advanced machine learning algorithms to
generate human-like conversations. One of these very popular tools is
Chat-Generative Pre-Trained Transformer (ChatGPT). Released on 30
November 2022, ChatGPT was trained to perform on a broad range of
internet sources, including books, articles and websites. It fine-tunes its
conversational tasks based on reinforcement learning from human
feedback (Bhatia, 2023). This allows it to adapt to the complexity of user
demands and intentions, thus improving its response to complex tasks,
even those including medical queries. The use of ChatGPT in medicine is
currently under intense investigation, as it is believed to have promising
applications in the fields of clinical and laboratory diagnosis, as well as
in the planning and execution of medical research (Khan et al., 2023;
Ma, 2023). We thus investigated whether ChatGPT has the potential to
interpret scores in neuropsychological testing.
Neuropsychological testing in patients with dementia typically in­
volves a comprehensive evaluation, including a series of standardized
tests assessing various cognitive functions such as general cognitive
function. Scores on these tests are interpreted by neuropsychologists
who compare them to normative data to determine how patients’ per­
formances deviate from the expected average. Neuropsychologists
typically create a pattern of scores across different tests to better un­
derstand the nature of the patient’s cognitive impairment. Patients with
Alzheimer’s Disease (AD) typically demonstrate a prominent deficit on
the memory test, while patients with frontotemporal dementia typically
present a major deficit on tests of executive function. Neuropsycholo­
gists analyze scores and integrate them into a comprehensive under­
standing of the patients’ cognitive dysfunction. This neuropsychological
expertise is usually part of a broader clinical and geriatric/neurological
testing process to diagnose the patient’s medical condition and develop
a tailored care plan to support them and their families throughout the
course of the disease. One of the key steps in neuropsychological testing
is the interpretation of scores obtained on standardized tests. In this
paper, we assess whether ChatGPT can perform this interpretation.
Our study was not only inspired by the potential of artificial intel­
ligence in general but also by recent research revealing the potential of
ChatGPT in medical settings (Baumgartner, 2023; Biswas, 2023).
Research has demonstrated its ability to address complex rationality

* Correspondence to: Faculté de Psychologie, LPPL – Laboratoire de Psychologie des Pays de la Loire, Université de Nantes, Chemin de la Censive du Tertre, BP
81227, 44312 Nantes Cedex 3, France.
E-mail address: mohamad.elhaj@univ-nantes.fr (M. El Haj).

https://doi.org/10.1016/j.arr.2023.102117
Received 9 October 2023; Received in revised form 31 October 2023; Accepted 1 November 2023
Available online 4 November 2023
1568-1637/© 2023 Elsevier B.V. All rights reserved.

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M. El Haj et al.
problems in the field of human pathology (Sinha et al., 2023). Similarly,
ChatGPT can provide patients with valuable information about breast
cancer prevention and screening (Haver et al., 2023), as well as about
blepharoplasties (Cox et al., 2023). Other research has discussed the
potential of ChatGPT in various medical domains, including colorectal
surgery (Li et al., 2023), emergency surgery (Cheng et al., 2023),
arthroplasty (Cheng et al., 2023) and cardiopulmonary resuscitation
(Ahn, 2023; Ayers et al., 2023). Critically, ChatGPT has demonstrated a
certain level of accuracy in diagnosing medical conditions (Rao et al.,
2023), especially in ophthalmology (Balas and Ing, 2023; Delsoz et al.,
2023). There is also some recent research on the application of ChatGPT
in the field of diagnosis of mental disorders (Galido et al., 2023).
Based on the above-reviewed literature, one might expect ChatGPT
to improve the accuracy and efficiency of neuropsychological testing. It
may even make diagnostic suggestions based on the neuropsychological
testing scores of patients. Prior to addressing these assumptions,
research should first address a basic issue: can ChatGPT provide an ac­
curate interpretation of neuropsychological testing scores, especially
when those of patients suffering cognitive decline in AD? To answer this
question, we provided ChatGPT with the neuropsychological data of a
patient with AD and asked for its interpretation. We compared this
interpretation with that of neuropsychologists who were blind to the aim
to the study.
2. Method
2.1. Case study
We selected a patient from the database of the geriatric department
of the Hospital of Nantes. We were careful to choose a mild amnestic
form of AD, diagnosed by an experienced geriatrician based on the
criteria of the National Institute on Aging-Alzheimer’s Association
(McKhann et al., 2011). We simply selected the last patient in the
database who met this criterion (Mr L, 72 years old, 9 years of formal
education). This study was IRB-exempt as it involved only retrospective
data collection.
2.2. Procedures
The discussion with ChatGPT is provide din Appendix.
2.2.1. Blind assessment
We invited two independent neuropsychologists, who were blind to
the aims of the study, to interpret the patient’s scores. As with ChatGPT,
we only provided the demographic and neuropsychological data of the
patient, without mentioning the diagnosis. Using standardized scores,
especially Z scores of French norms (Van der Linden et al., 2004) for the
Free and Cued Selective Reminding Test and the French norms for the
Stroop task (Bayard et al., 2011), the two neuropsychologists suggested
that the patient suffered from cognitive impairment, especially in the
domain of memory.
2.3. Results
Regarding the scores of Mr L on each test, the interpretation of
ChatGPT was relatively accurate. However, this conclusion was not
supported by the use of standardized scores. While ChatGPT outlined
some cognitive impairments, it did not associate them with a specific
cognitive domain (e.g., memory, attention or executive function), unlike
the two neuropsychologists. Using standardized scores, they suggested
that the patient was primarily suffering from memory decline.
3. Discussion
We assessed whether ChatGPT can provide an accurate interpreta­
tion of neuropsychological screening. We provided it with the
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Ageing Research Reviews 92 (2023) 102117
neuropsychological data of a patient with mild AD and invited it to
interpret the data. The same request was made to two neuropsycholo­
gists. While ChatGPT provided an accurate interpretation of scores on
each of the neuropsychological tests, it did not use standardized scores
and did not specify the cognitive domain that might be most impaired. In
contrast, the neuropsychologists used standardized scores to predict that
the patient was mainly suffering from memory decline.
A key aspect of neuropsychological testing is score interpretation.
Our findings demonstrate how ChatGPT can achieve a certain level of
accuracy when interpreting the scores of a patient with AD on various
neuropsychological tests, including the Mini Mental State Examination,
spans, Free and Cued Selective Reminding Test, Rey test, Clock test,
Trail-Making Test and Stroop test. However, ChatGPT did not support its
interpretation with standardized scores. Furthermore, while ChatGPT
identified the patient’s cognitive impairments, it did not suggest any
specific cognitive domain that might be most impaired. In contrast, the
neuropsychologists specified that memory was the most impaired
function. These findings demonstrate that, while ChatGPT may succeed
in the general interpretation of scores on neuropsychological testing (at
least in patients with AD), it cannot yet create a pattern of scores across
different tests to better specify the nature of the cognitive impairment.
As the upcoming generation of neuropsychologists may naturally
resort to AI for neuropsychological tasks, it is essential to explore both
the advantages and limitations of using chatbots. While ChatGPT may be
a valuable tool, clinicians should remain cautious and acknowledge its
constraints in providing reliable information. While chatbots may be
efficient in performing automated tasks such as interpreting neuropsy­
chological test scores, they are not yet capable of replacing the
specialized expertise, innovative insights and diagnostic abilities of cli­
nicians, at least in their current state of development. However, one
advantage of using ChatGPT in neuropsychology and healthcare in
general is its capacity to analyze large datasets and derive insights from
them. ChatGPT can also undertake basic functions in clinical scenarios,
such as assisting in generating clinical notes, summaries and other
documentation, thereby enhancing efficiency and reducing the risk of
human errors. Although the ultimate decision in any medical matter
should always rest with a healthcare professional, ChatGPT may offer
additional support and recommendations based on patients’ symptoms
and medical history. ChatGPT may also prove beneficial in generating
automated responses to fundamental patient inquiries, such as sched­
uling appointments.
While ChatGPT can be helpful in certain automated clinical tasks, it
currently lacks the ability to address fundamental clinical features such
as therapeutic alliance, emotional intelligence and empathy. Its re­
sponses are based on the data it has been trained on and do not adapt to
user responses to provide emotional support. As they are based on sta­
tistical correlations between words, they may not fully grasp the nu­
ances of language, which may result in errors and misinterpretation in
complex conversations. Ethical and privacy considerations constitute
another prominent concern associated with ChatGPT. The interactions
between users and ChatGPT can potentially be utilized to enhance the
application, which raises privacy implications. Additionally, even when
data is anonymized, there is no foolproof assurance that ChatGPT has
robust data security protocols in place to deter unauthorized access,
breaches, or misuse. The matter of data ownership is also a topic of
ongoing debate since ChatGPT may employ data to refine its learning
process.
In summary, ChatGPT represents a significant milestone in AI
development. While it holds great promise for the future of neuropsy­
chology and health sciences, it has limitations in terms of neuropsy­
chological assessment, therapeutic alliance and privacy. However, as AI
continues to develop, it is likely to become integrated into the field of
clinical science. ChatGPT holds significant potential for use in neuro­
psychological applications, especially as an educational tool for both
patients and clinicians.
M. El Haj et al. Ageing Research Reviews 92 (2023) 102117

Declaration of Competing Interest Acknowledgements

The authors declare that they have no known competing financial Mohamad El Haj was supported by LABEX Distalz.
interests or personal relationships that could have appeared to influence
the work reported in this paper.

Appendix. : the discussion with ChatGPT

- Authors: “Hi, can you assist me with the interpretation of results of neuropsychological testing?”
- ChatGPT: “Of course, I’d be happy to help you interpret the results of neuropsychological testing. Neuropsychological
testing is a comprehensive assessment of cognitive and emotional functioning that can provide valuable insights into a
person’s brain and behavior. To help you interpret the results, I’ll need some specific information about the tests
conducted and the results obtained. If you can provide details such as the specific tests administered, the scores or
findings from those tests, and any relevant background information about the individual being tested, I can offer more
targeted assistance in interpreting the results. Please feel free to share as much information as you’re comfortable with,
and I’ll do my best to assist you.”
- Authors: “ok, here is the neuropsychological data, which concerns a 72-year-old male with nine years of formal
education.
1- Mini Mental Stat Examination score: 24/30 Spatio temporal Orientation: 8/10, Immediate recall: 2/3, Calculation: 5/5,
Delayed recall: 1/3, Language: 7/8, Construct ability: 1/1
2- Working memory spans, Forward: 5, Backward: 4
3- Verbal episodic memory, The Free and Cued Selective Reminding Test
Immediate Free Recall: 5/16, Free Recall after Semantic Cueing 8/16, Total: 13/16, Intrusions: 1
4- Visual memory, Rey test: Immediate copy 12/36, Delayed 6/365- Clock test: 6/7
6- Flexibility, Trait Making Test A: 135 s & 2 errors
7- Inhibition, Stroop test: Color naming: 28 s, Word naming: 46 s, Incongruous condition: 83 s, Self-corrected errors: 2,
Uncorrected errors: 5″

- ChatGPT: Thank you for providing the neuropsychological data. I can offer some general interpretations based on the
information you provided. Please remember that these interpretations are not a substitute for a thorough evaluation by a
qualified neuropsychologist, and individual results can vary.
1- Mini-Mental State Examination (MMSE): The MMSE score of 24/30 suggests some cognitive impairment. Scores below
24 often indicate potential cognitive deficits, but it’s essential to consider other factors such as the individual’s baseline
score and educational level.
Spatio-temporal Orientation: A score of 8/10 indicates some difficulty with spatial and temporal awareness but is rela­
tively within the normal range.
Immediate Recall: A score of 2/3 suggests mild difficulty with immediate memory.
Calculation: A score of 5/5 indicates intact calculation abilities.
Delayed Recall: A score of 1/3 indicates difficulty with delayed recall.
Language: A score of 7/8 suggests relatively intact language skills.
Construct Ability: A score of 1/1 indicates intact ability in constructing a design.
2-Working Memory Spans:
Forward: A score of 5 suggests that the individual can maintain a sequence of numbers in forward order with relatively
good working memory.
Backward: A score of 4 indicates some difficulty in maintaining a sequence of numbers in reverse order.
3- Verbal Episodic Memory (Free and Cued Selective Reminding Test): The total score of 13/16 suggests difficulty in
immediate and free recall, but improvement with semantic cueing. The presence of intrusions (i.e., recalling unrelated
information) may be indicative of memory issues.
4- Visual Memory (Rey Test): The scores of 12/36 for immediate copy and 6/36 for delayed recall suggest significant
difficulties in visual memory tasks.
5- Clock Test: A score of 6/7 indicates relatively intact visuospatial and executive functioning in the context of drawing a
clock.
6- Flexibility (Trail Making Test A): Completing the test in 135 s with 2 errors may suggest some difficulties with cognitive
flexibility and processing speed. It could indicate issues with attention and executive function.
7- Inhibition (Stroop Test): Longer times and errors in naming colors and words, especially in the incongruous condition,
suggest difficulties in inhibiting automatic responses and may be indicative of executive function deficits. The presence of
self-corrected and uncorrected errors further supports this.
Overall, the neuropsychological data you provided suggests some cognitive impairments, particularly in memory,
attention and executive function domains. These findings can be indicative of various conditions, including mild cognitive
impairment (MCI) or early-stage dementia. However, it’s crucial to consult with a neuropsychologist or healthcare pro­
fessional who can conduct a more comprehensive assessment, review the medical history and perform additional tests to
make a formal diagnosis and develop an appropriate treatment plan if necessary.

References Balas, M., Ing, E.B., 2023. Conversational AI models for ophthalmic diagnosis:
comparison of ChatGPT and the isabel pro differential diagnosis generator. JFO
Open Ophthalmol. 1, 100005 https://doi.org/10.1016/j.jfop.2023.100005.
Ahn, C., 2023. Exploring ChatGPT for information of cardiopulmonary resuscitation.
Baumgartner, C., 2023. The potential impact of ChatGPT in. Clin. Transl. Med. Clin.
Resuscitation 185. https://doi.org/10.1016/j.resuscitation.2023.109729.
Transl. Med. 13 (3), e1206 https://doi.org/10.1002/ctm2.1206.
Ayers, J.W., Poliak, A., Dredze, M., Leas, E.C., Zhu, Z., Kelley, J.B., Faix, D.J.,
Bayard, S., Erkes, J., Moroni, C., 2011. Victoria stroop test: normative data in a sample
Goodman, A.M., Longhurst, C.A., Hogarth, M., Smith, D.M., 2023. Comparing
group of older people and the study of their clinical applications in the assessment of
physician and artificial intelligence chatbot responses to patient questions posted to
inhibition in Alzheimer’s disease. Arch. Clin. Neuropsychol. 26 (7), 653–661.
a public social media forum. JAMA Intern. Med. 183 (6), 589–596. https://doi.org/
https://doi.org/10.1093/arclin/acr053.
10.1001/jamainternmed.2023.1838.

Downloaded for Anonymous User (n/a) at University of the Andes from ClinicalKey.com by Elsevier on April 29,
2024. For personal use only. No other uses without permission. Copyright ©2024. Elsevier Inc. All rights reserved.
M. El Haj et al.
Bhatia, P., 2023. ChatGPT for academic writing: a game changer or a disruptive tool.
J. Anaesthesiol. Clin. Pharm. 39 (1), 1–2. https://doi.org/10.4103/joacp.joacp_84_
23.
Biswas, S.S., 2023. Role of Chat GPT in public health. Ann. Biomed. Eng. 51 (5),
868–869. https://doi.org/10.1007/s10439-023-03172-7.
Cheng, K., Li, Z., Li, C., Xie, R., Guo, Q., He, Y., Wu, H., 2023. The potential of GPT-4 as
an AI-powered virtual assistant for surgeons specialized in joint arthroplasty. Ann.
Biomed. Eng. 51 (7), 1366–1370. https://doi.org/10.1007/s10439-023-03207-z.
Cheng, K., Li, Z., Guo, Q., Sun, Z., Wu, H., Li, C., 2023. Emergency surgery in the era of
artificial intelligence: ChatGPT could be the doctor’s right-hand man. Int. J. Surg.
109 (6), 1816–1818. https://doi.org/10.1097/js9.0000000000000410.
Cox, A., Seth, I., Xie, Y., Hunter-Smith, D.J., Rozen, W.M., 2023. Utilizing ChatGPT-4 for
providing medical information on blepharoplasties to patients. Aesthetic Surg. J. 43
(8), NP658–NP662. https://doi.org/10.1093/asj/sjad096.
Delsoz, M., Raja, H., Madadi, Y., Tang, A.A., Wirostko, B.M., Kahook, M.Y., Yousefi, S.,
2023. The use of ChatGPT to assist in diagnosing glaucoma based on clinical case
reports. Ophthalmol. Ther. https://doi.org/10.1007/s40123-023-00805-x.
Galido, P.V., Butala, S., Chakerian, M., Agustines, D., 2023. A case study demonstrating
applications of ChatGPT in the clinical management of treatment-resistant
schizophrenia. Cureus 15 (4), e38166. https://doi.org/10.7759/cureus.38166.
Haver, H.L., Ambinder, E.B., Bahl, M., Oluyemi, E.T., Jeudy, J., Yi, P.H., 2023.
Appropriateness of breast cancer prevention and screening recommendations
provided by ChatGPT. Radiology 307 (4), e230424. https://doi.org/10.1148/
radiol.230424.
Khan, R.A., Jawaid, M., Khan, A.R., Sajjad, M., 2023. ChatGPT - reshaping medical
education and clinical management. Pak. J. Med Sci. 39 (2), 605–607. https://doi.
org/10.12669/pjms.39.2.7653.
Downloaded for Anonymous User (n/a) at University of the Andes from ClinicalKey.com by Elsevier on April 29,
2024. For personal use only. No other uses without permission. Copyright ©2024. Elsevier Inc. All rights reserved.
Ageing Research Reviews 92 (2023) 102117
Li, W., Zhang, Y., Chen, F., 2023. ChatGPT in colorectal surgery: a promising tool or a
passing fad. Ann. Biomed. Eng. 51 (9), 1892–1897. https://doi.org/10.1007/
s10439-023-03232-y.
Ma, Y., 2023. The potential application of ChatGPT in gastrointestinal pathology.
Gastroenterol. Endosc. 1 (3), 130–131. https://doi.org/10.1016/j.
gande.2023.05.002.
McKhann, G., Knopman, D.S., Chertkow, H., Hyman, B.T., Jack Jr., C.R., Kawas, C.H.,
Klunk, W.E., Koroshetz, W.J., Manly, J.J., Mayeux, R., Mohs, R.C., Morris, J.C.,
Rossor, M.N., Scheltens, P., Carrillo, M.C., Thies, B., Weintraub, S., Phelps, C.H.,
2011. The diagnosis of dementia due to Alzheimer’s disease: recommendations from
the National Institute on Aging-Alzheimer’s association workgroups on diagnostic
guidelines for Alzheimer’s disease. Alzheimers Dement 7 (3), 263–269. https://doi.
org/10.1016/j.jalz.2011.03.005.
Rao, A., Pang, M., Kim, J., Kamineni, M., Lie, W., Prasad, A.K., Landman, A., Dreyer, K.,
Succi, M.D., 2023. Assessing the utility of ChatGPT throughout the entire clinical
workflow: development and usability study. J. Med Internet Res 25, e48659. https://
doi.org/10.2196/48659.
Sinha, R.K., Deb Roy, A., Kumar, N., Mondal, H., 2023. Applicability of ChatGPT in
assisting to solve higher order problems in pathology. Cureus 15 (2), e35237.
https://doi.org/10.7759/cureus.35237.
Van der Linden, M., Adam, S., Agniel, A., Baisset- Mouly, C., Bardet, F., & Coyette, F.
(2004). L′évaluation des troubles de la mémoire: Présentation de quatre tests de mémoire
épisodique (avec leur étalonnage) [Evaluation of memory deficits: Presentation of four
tests of episodic memory (with standardization)]. Solal Editeurs.