Modeling metacognition and executive functions in the metacognitive wisconsin card sorting test using the neuropsychological digital-twin method

Executive functions rely on goal-directed manipulation of representations, while metacognition reflects the evaluation and control of one’s own representations. Several studies have examined these processes separately, but none formalise the neuro-representational computations underlying their interaction during goal-directed behaviour. This gap prevents comprehensive frameworks and extended model-based neuropsychological investigations. Here we address these issues by introducing a neuropsychological digital-twin method - a translational modelling framework that integrates clinical and experimental data, theoretical formalisation, and computational modelling for neuropsychological profiling and prediction. We formalised the three-component theory of metacognitive and flexible goal-directed cognition - grounded in theoretical and neuroscientific literature - and developed a neuro-inspired computational model tested with a standard neuropsychological task (Metacognitive Wisconsin Card Sorting Test, Meta-WCST). We further corroborated the proposal by reproducing experimental data from healthy controls and psychiatric populations (Anorexia Nervosa and Schizophrenia). Finally, we generated three digital-twins - computational models fitted to human data and reproducing behavioural and neuro-cognitive features - for neuropsychological profiling and intervention prediction. Our results support an integrated framework of executive functions and metacognition in healthy and pathological goal-directed behaviour and provide the first theory-based computational model of the Meta-WCST. They also reveal that Anorexia Nervosa and Schizophrenia share hidden cognitive and metacognitive similarities (motivational impairment and over-confidence) alongside differences (perseveration and poor self-improvement in the former; distraction and poor self-evaluation in the latter). Consistently, simulations predict differential benefits from metacognitive-based psychotherapy, highlighting the importance of personalised interventions. Finally, our contributions have implications for cognitive science (e.g., consciousness studies) and emerging technologies (digital-twin healthcare and autonomous robotics).