# Towards Synthesizing Normative Data for Cognitive Assessments Using Generative Multimodal Large Language Models

arXiv: https://arxiv.org/abs/2508.17675 · HTML: https://mlsanity.com/paper/2508.17675/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in MLLM training and visual instruction tuning, one of 16 directions in Multimodal LLMs / vision-language models.
- Builds on 6 of its 19 references that are in the map.
- First posted on arXiv 25 Aug 2025.

## Placed in

- Multimodal LLMs / vision-language models / [MLLM training and visual instruction tuning](https://mlsanity.com/mllm/mllm-training-and-visual-instruction-tuning/)

## Builds on (most cited first, 6 of 6)

- [GPT-4 Technical Report](https://mlsanity.com/paper/2303.08774/) (2023)
- [Sentence-BERT: Sentence Embeddings using Siamese BERT-Networks](https://mlsanity.com/paper/1908.10084/) (2019)
- [Judging LLM-as-a-Judge with MT-Bench and Chatbot Arena](https://mlsanity.com/paper/2306.05685/) (2023)
- [BERTScore: Evaluating Text Generation with BERT](https://mlsanity.com/paper/1904.09675/) (2019)
- [A Survey on LLM-as-a-Judge](https://mlsanity.com/paper/2411.15594/) (2024)
- [A Survey on Multimodal Large Language Models](https://mlsanity.com/paper/2306.13549/) (2023)

## Abstract (arXiv)

Cognitive assessments require normative data as essential benchmarks for evaluating individual performance. Hence, developing new cognitive tests based on novel image stimuli is challenging due to the lack of readily available normative data. Traditional data collection methods are costly, time-consuming, and infrequently updated, limiting their practical utility. Recent advancements in generative multimodal large language models (MLLMs) offer a new approach to generate synthetic normative data from existing cognitive test images. We investigated the feasibility of using MLLMs, specifically GPT-4o and GPT-4o-mini, to synthesize normative textual responses for established image-based cognitive assessments, such as the "Cookie Theft" picture description task. Two distinct prompting strategies-naive prompts with basic instructions and advanced prompts enriched with contextual guidance-were evaluated. Responses were analyzed using embeddings to assess their capacity to distinguish diagnostic groups and demographic variations. Performance metrics included BLEU, ROUGE, BERTScore, and an LLM-as-a-judge evaluation. Advanced prompting strategies produced synthetic responses that more effectively distinguished between diagnostic groups and captured demographic diversity compared to naive prompts. Superior models generated responses exhibiting higher realism and diversity. BERTScore emerged as the most reliable metric for contextual similarity assessment, while BLEU was less effective for evaluating creative outputs. The LLM-as-a-judge approach provided promising preliminary validation results. Our study demonstrates that generative multimodal LLMs, guided by refined prompting methods, can feasibly generate robust synthetic normative data for existing cognitive tests, thereby laying the groundwork for developing novel image-based cognitive assessments without the traditional limitations.