American Clinical Neurophysiology Society Technical Standards for Electrical Stimulation With Intracranial Electrodes for Functional Brain Mapping and Seizure Induction

PURPOSE

These American Clinical Neurophysiology Society technical standards suggest best practices for electrical stimulation mapping (ESM) with subdural and stereotactic depth electrodes for seizure induction and mapping of brain function.

METHODS

A working group was convened from American Clinical Neurophysiology Society membership with expertise in ESM. PubMed searches were performed to identify pertinent peer-reviewed literature. Recurrent meetings reviewed progress, built consensus by discussion, and developed evidence-based recommendations to the extent possible.

RECOMMENDATIONS

Stimulators used for ESM should have sufficient dynamic range, ability to interrupt a stimulus train, and ictal disrupt mechanism(s). Charge density should be calculated for the specific electrodes and ESM settings, the maximum safe limits being 52 to 57 μC/cm 2 /phase for subdural electrodes and not established for stereotactic depth electrodes. Subdural ESM for functional mapping is typically performed at 50-Hz pulse frequency, 200- to 300-µs pulse width, 2- to 8-s train duration, and 1- to 20-mA current strength. Stereo ESM is commonly performed using 2 different pulse frequencies: 1 Hz (300-500 µs pulse width, train duration up to 30 s, and often a constant current of 3-5 mA), and 50 Hz (100-500 µs pulse width, train duration 2-8 s, and 0.5-10 mA current intensity).

CONCLUSIONS

This guideline provides technical standards for the performance of ESM, which will likely evolve over time with advances in technology and additional evidence (also see Graphical Abstract).

Characteristics of patients diagnosed with psychogenic non-epileptic seizures (PNES) who request reinstatement of their driving privileges

RATIONALE

Patients who experience seizures, including PNES, are usually advised to discontinue driving, or have their driving privileges revoked until a determined period of seizure-freedom is achieved. In this retrospective study, patients with PNES who requested driving privileges or reported having resumed driving were compared to those who did not on measures of depression, anxiety, PTSD, and cognitive flexibility/motor speed.

METHODS

DiagnosisofPNESwasconfirmedwithvideo-EEG.Demographicand clinical dataand requests for reinstatement of driving privileges (requiring 6 or more months seizure freedom) and reports of decisions to resume driving were noted. Tests of motor speed and hand eye coordination and self-report questionnaires of depression, anxiety and PTSD administered as part of neuropsychological assessment were analyzed.

RESULTS

A total of 403 patients with PNES evaluated in 2010-2020 were identified. Of those, 365 patients were eligible for inclusion, and of those, 60 applied for driving privileges or reported that they resumed driving. When the two groups were compared, the group that applied for driving privileges or decided to resume driving was significantly less depressed (p = 0.001) when tested than the group that did not. Furthermore, a significant difference was seen in measures of motor performance between those who requested to resume driving and those who did not (DKEFS T1, p = 0.006, DKEFS T2, p = 0.001, DKEFS T3, p = 0.002, DKEFS T4, p = 0.001; GPT dominant, p = 0.05, GPT non-dominant, p = 0.003).

CONCLUSION

Driving a motor vehicle is a useful measure of improvement for PNES because patients with seizures are required to discontinue driving until seizure-freedom is achieved. This study revealed that lower levels of depression and better fine motor functioning were associated with reported seizure-freedom and driving resumption. Depression is commonly associated with diminished performance (slower motor response times and impaired fine motor movements) on tests of motor functioning, both of which may result in less interest in pursuing permission to resume driving. These findings suggest that mood symptoms (and associated performance on measures of motor speed and coordination) may have prognostic significance in patients diagnosed with PNES. This also suggests that timely treatment of depression in newly diagnosed patients with PNES may be indicated.

CD8+T cells and monocytes were associated with brain alterations in human immunodeficiency virus-infected individuals with cognitive impairment

Cognitive impairment (CI) continues to be a concern for people living with HIV-1 (PLWH) in the era of antiretroviral therapy (ART), yet the underlying mechanisms remain unclear. We aimed to elucidate the structural and functional brain alterations and peripheral immune profile of PLWH with CI, as well as the correlation between them. PLWH were divided into CI (n = 30) and cognitive normal (CN, n = 59) groups based on the Montreal Cognitive Assessment, and underwent multi-modal magnetic resonance imaging. Mass cytometry was utilized to profile immune cells, while the liquid chip technique was employed to measure plasma levels of cytokines and chemokines. Spearman correlation analyses were conducted for correlation analysis. Here, we found that the gray matter volume in left supramarginal gyrus was reduced, and the ReHo in the right middle frontal gyrus and the functional connectivity between right middle frontal gyrus and left postcentral gyrus were enhanced in CI group compared to CN group. Additionally, the frequencies of naïve CD8+T cells (Tn) and CD31lowCD8+ Tn were significantly correlated with gray matter volume in the left supramarginal gyrus. The amplitude of low frequency fluctuations in a specific brain region of frontal-middle lobe was negatively correlated with the frequencies of non-classical monocytes (nCM) and their subpopulations (CCR2lownCM, CD57lownCM and CD127+nCM), and positively associated with the plasma interleukin 25 and transforming growth factor-α levels. These findings suggest the association between peripheral immunity and the brain abnormalities in PLWH, highlighting a potential role of the immune-brain-cognition axis in the pathogenesis of CI in Chinese PLWH.

Brain-Charting Autism and Attention-Deficit/Hyperactivity Disorder Reveals Distinct and Overlapping Neurobiology

BACKGROUND

Autism and attention-deficit/hyperactivity disorder (ADHD) are heterogeneous neurodevelopmental conditions with complex underlying neurobiology that is still poorly understood. Despite overlapping presentation and sex-biased prevalence, autism and ADHD are rarely studied together and sex differences are often overlooked. Population modeling, often referred to as normative modeling, provides a unified framework for studying age-specific and sex-specific divergences in brain development.

METHODS

Here, we used population modeling and a large, multisite neuroimaging dataset (N = 4255 after quality control) to characterize cortical anatomy associated with autism and ADHD, benchmarked against models of average brain development based on a sample of more than 75,000 individuals. We also examined sex and age differences and relationship with autistic traits and explored the co-occurrence of autism and ADHD.

RESULTS

We observed robust neuroanatomical signatures of both autism and ADHD. Overall, autistic individuals showed greater cortical thickness and volume that was localized to the superior temporal cortex, whereas individuals with ADHD showed more global increases in cortical thickness but lower cortical volume and surface area across much of the cortex. The co-occurring autism+ADHD group showed a unique pattern of widespread increases in cortical thickness and certain decreases in surface area. We also found that sex modulated the neuroanatomy of autism but not ADHD, and there was an age-by-diagnosis interaction for ADHD only.

CONCLUSIONS

These results indicate distinct cortical differences in autism and ADHD that are differentially affected by age and sex as well as potentially unique patterns related to their co-occurrence.

The impact of linguistic complexity on feasibility and reliability of language mapping in aphasic glioma patients

BACKGROUND

Reliable language mappings require sufficient language skills. This study evaluated whether linguistic task properties impact feasibility and reliability of navigated transcranial magnetic stimulation (nTMS)-based language mappings in aphasic glioma patients.

METHODS

The effect of linguistic complexity on naming accuracy during baseline testing without stimulation and on the number of errors during nTMS was evaluated for 16 moderately and 4 severely expressive aphasic patients.

RESULT

During baseline, items acquired later in life and used less frequently, a higher amount of multisyllabic, compound, and inanimate items were named inaccurately. Even after removing these more complex items, less frequent and multisyllabic items were more error-prone during stimulation.

CONCLUSION

Higher linguistic item complexity was associated with decreased naming accuracy during baseline and resulted in a potentially higher false positive rate during nTMS in aphasic glioma patients. Thus, tailoring task complexity to individual performance capabilities may considerably support the preservation of residual functionality.

Recent advances in nanotherapeutics for HIV-associated neurocognitive disorders and substance use disorders

Substance use disorders (SUD) and HIV-associated neurocognitive disorders (HAND) work synergistically as a significant cause of cognitive decline in adults and adolescents globally. Current therapies continue to be limited due to difficulties crossing the blood-brain barrier (BBB) leading to limited precision and effectiveness, neurotoxicity, and lack of co-treatment options for both HAND and SUD. Nanoparticle-based therapeutics have several advantages over conventional therapies including more precise targeting, the ability to cross the BBB, and high biocompatibility which decreases toxicity and optimizes sustainability. These advantages extend to other neurological disorders such as Alzheimer's disease (AD) and amyotrophic lateral sclerosis (ALS). This review summarizes recent advances in nanotechnology for application to HAND, SUD, and co-treatment, as well as other neurological disorders. This review also highlights the potential challenges these therapies face in clinical translation and long-term safety.

Depressive Symptoms and Amyloid Pathology

Importance

Depressive symptoms are associated with cognitive decline in older individuals. Uncertainty about underlying mechanisms hampers diagnostic and therapeutic efforts. This large-scale study aimed to elucidate the association between depressive symptoms and amyloid pathology.

Objective

To examine the association between depressive symptoms and amyloid pathology and its dependency on age, sex, education, and APOE genotype in older individuals without dementia.

Design, Setting, and Participants

Cross-sectional analyses were performed using data from the Amyloid Biomarker Study data pooling initiative. Data from 49 research, population-based, and memory clinic studies were pooled and harmonized. The Amyloid Biomarker Study has been collecting data since 2012 and data collection is ongoing. At the time of analysis, 95 centers were included in the Amyloid Biomarker Study. The study included 9746 individuals with normal cognition (NC) and 3023 participants with mild cognitive impairment (MCI) aged between 34 and 100 years for whom data on amyloid biomarkers, presence of depressive symptoms, and age were available. Data were analyzed from December 2022 to February 2024.

Main Outcomes and Measures

Amyloid-β1-42 levels in cerebrospinal fluid or amyloid positron emission tomography scans were used to determine presence or absence of amyloid pathology. Presence of depressive symptoms was determined on the basis of validated depression rating scale scores, evidence of a current clinical diagnosis of depression, or self-reported depressive symptoms.

Results

In individuals with NC (mean [SD] age, 68.6 [8.9] years; 5664 [58.2%] female; 3002 [34.0%] APOE ε4 carriers; 937 [9.6%] had depressive symptoms; 2648 [27.2%] had amyloid pathology), the presence of depressive symptoms was not associated with amyloid pathology (odds ratio [OR], 1.13; 95% CI, 0.90-1.40; P = .29). In individuals with MCI (mean [SD] age, 70.2 [8.7] years; 1481 [49.0%] female; 1046 [44.8%] APOE ε4 carriers; 824 [27.3%] had depressive symptoms; 1668 [55.8%] had amyloid pathology), the presence of depressive symptoms was associated with a lower likelihood of amyloid pathology (OR, 0.73; 95% CI 0.61-0.89; P = .001). When considering subgroup effects, in individuals with NC, the presence of depressive symptoms was associated with a higher frequency of amyloid pathology in APOE ε4 noncarriers (mean difference, 5.0%; 95% CI 1.0-9.0; P = .02) but not in APOE ε4 carriers. This was not the case in individuals with MCI.

Conclusions and Relevance

Depressive symptoms were not consistently associated with a higher frequency of amyloid pathology in participants with NC and were associated with a lower likelihood of amyloid pathology in participants with MCI. These findings were not influenced by age, sex, or education level. Mechanisms other than amyloid accumulation may commonly underlie depressive symptoms in late life.

Cognitive Effects of Heading in Professional Football: A Systematic Review

Large cohort studies have reported that former professional football players have an increased risk of mortality from neurodegenerative disease. Due to emerging concerns regarding the safety of heading the technique is now banned for players under 12. The aim of this systematic review was to evaluate the association between heading exposure and cognitive function in professional football players. A search strategy was devised and entered into seven electronic databases: MEDLINE, Embase, Web of Science, PsycINFO, CENTRAL, SportDiscus and PEDro. The search identified 563 records. After screening records and applying the eligibility criteria, nine cross-sectional studies (n=925) were included in the review, investigating 452 current and 473 former players (859 males, 66 females). Six studies (n=595) reported evidence for an association between heading and impaired cognitive function, while three studies (n=330) reported no association. Diverse cognitive domains were investigated, which might underline the disparity in these results. The association between heading and cognitive function in professional football appears likely but remains inconclusive. Methodological heterogeneity and variability in the presentation of results limits the conclusions drawn. Prospective longitudinal studies using standardised methods, and including females, are required to provide evidence to support or refute an association.

Effect of serum antioxidants on cognitive dysfunction in first-episode and drug-naïve patients with major depressive disorder

BACKGROUND

Cognitive dysfunction is a persistent and difficult-to-treat symptom of major depressive disorder (MDD) and is receiving increasing attention. A balanced state of oxidative stress sustained by antioxidants is essential for normal functioning of brain, including learning capacity, emotional regulation, and cognitive function. The correlation between cognition and oxidative stress may also be altered in patients with mental disorders. This study aimed to explore the relationship between serum antioxidant levels and cognitive dysfunction in patients with MDD.

METHODS

We collected and matched cognitive performance data using the Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery (MCCB), serum antioxidants, and demographic and clinical characteristics of 105 first-episode drug-naïve patients with MDD and 53 healthy controls (HC) from February 2022 to October 2023, and then analyzed the differences between the two groups. HamiltonDepressionScale-17 and Young Mania Rating Scale (YMRS) were used to evaluate the clinical symptoms of the participants with MDD. Serum antioxidants, including albumin (ALB), uric acid (UA), and superoxide dismutase (SOD) were used to detect the level of oxidative stress in participants and its correlation with cognitive function. We then used a threshold for cognitive dysfunction of 1.5 standard deviations below the mean of the standard score to divide the participants with MDD into two groups to detect the relevant elements of the five different domains of cognitive dysfunction in MDD.

RESULTS

ALB levels were significantly lower in the MDD group (p = 0.001) after adjusting for years of education. The performance in all five domains of cognitive function was significantly worse in the MDD group than in the HC group (p < 0.001). Speed of processing (SOP) in the MDD group correlated with ALB (r = 0.261, p = 0.008), and UA (r = 0.295, p = 0.002) levels. We also explored the correlation between the attention/vigilance (AV) domain and the UA (r = 0.239, p = 0.015). YMRS score was risk factor of impairment of SOP domain in patients with MDD. Yet UA was a protective factor against SOP impairment, with a 0.006-fold reduction in the risk of SOP impairment for each 1-unit increase in UA.

CONCLUSIONS

As serum antioxidants, ALB and UA may serve as biomarkers of cognitive function in patients with MDD. Our findings contribute to the understanding of the potential ability of serum antioxidants to predict cognitive decline in patients with MDD.

Pain Perception Threshold in Young High-Altitude Natives After Acute Exposure to Severe Hypoxic Conditions

Previous studies indicate that individuals at high altitudes have a lower pain threshold than those living at sea level. This study evaluates the differences in pain perception among young people living at an altitude of 3800 m and after acute exposure to a severe hypoxic environment at more than 5100 m. Fourteen people (BMI of 22.6 ± 1.2 and age of 23.3 ± 1.9 years) residing in the city of Puno (3825 m) participated in an ascent to the Populated Center of La Rinconada (>5100 m). The unilateral ischemia pain provocation test was used, applying pressure with a manual sphygmomanometer to generate transient ischemia in the arm while the patient opens and closes their hand. Onset, peak, and resolution times of pain, heart rate, and oxygen saturation were recorded. At their residence altitude of 3828 m, the mean hemoglobin was 16.16 ± 2.29, while at 5100 m, mean hemoglobin increased to 17.57 ± 1.74. The average time to pain onset in the right arm was 30.43 s ± 14.15 at 3828 m, whereas at 5100 m above sea level, the pain perception was at 31.00 s ± 19.01. At 3828 m, the average time until pain sensation in the left arm was 19.93 s ± 9.44 and increased to 23.07 s ± 10.83 at 5100 m. During exposure to a severe hypoxic environment, the pain perception threshold was similar between 3828 m and 5100 m above sea level.

Mild behavioral impairment and its relation to amyloid load in isolated REM sleep behavior disorder

INTRODUCTION

In isolated REM sleep behavior disorder (iRBD), the evidence of cognitive impairment and co-existing amyloid pathology suggests that mild behavioral impairment (MBI) may be associated with disease progression. In this study, we investigated MBI and its association with cognitive function, brain amyloid load and glucose metabolism in iRBD patients to evaluate the utility of MBI as a predictive marker of disease progression.

METHODS

Patients with iRBD underwent a neuropsychological evaluation, 18F-florbetaben (FBB) PET, and 18F-fluorodeoxyglucose (FDG) PET. MBI was evaluated using the MBI-checklist (MBI-C). Comparisons between MBI-positive and MBI-negative groups and correlations with MBI-C total scores were examined on neuropsychological performances and PET regional standardized uptake value ratios (SUVRs). Additionally, associations between regional amyloid burden and glucose metabolism and mediating role of MBI status on these associations were evaluated in all iRBD patients.

RESULTS

Of 36 iRBD patients, about one-third were classified as MBI-positive. Although we did not find the differences between the MBI groups and correlations with MBI-C total scores in neuropsychological performances and brain glucose metabolism, the MBI-positive group revealed higher FBB SUVRs in the anterior cingulate cortex, prefrontal cortex, caudate nucleus, and putamen than the MBI-negative group. The FBB SUVR of caudate nucleus was negatively correlated with glucose metabolism in the precuneus, which was not directly mediated by the MBI.

CONCLUSION

Characteristic amyloid accumulation in prefrontal and subcortical structures in MBI-positive iRBD patients suggests that MBI may be associated with early amyloid pathology that can be an integral role in disease progression.

Patterns of cortical thickness in MCI patients with and without semantic impairment

BACKGROUND

About half of MCI patients experience semantic deficits, which may predict progression to Alzheimer's disease (AD). The neural basis of these deficits in MCI is not well understood. This study aimed to examine the relationship between semantic memory performance and cortical thickness in MCI patients.

METHODS

Using FreeSurfer, T1-weighted MRI scans were analyzed from MCI patients with (MCIsem+) and without (MCIsem-) semantic deficits. Correlation analyses across all participants, including healthy controls, examined the link between semantic memory and cortical thickness, controlling for age and education. Group comparisons of cortical thickness were also conducted between MCIsem+ and MCIsem- groups.

RESULTS

Significant correlations emerged between semantic memory performance and cortical thickness in the left medial temporal lobe, right temporal pole, and bilateral frontal regions-areas involved in central semantic and executive processes. Additionally, MCIsem + patients showed reduced cortical thickness in frontal, parietal, and occipital areas compared to MCIsem- patients.

CONCLUSION

Semantic memory performance in MCI patients is associated with structural differences in regions supporting both central and executive aspects of semantic processing. Given that MCIsem + patients may face higher risk of AD progression, longitudinal studies should investigate these cortical markers' predictive value.

The evolution of subjective cognition after meditation training in older people: a secondary analysis of the three-arm age-well randomized controlled trial

Aging is associated with cognitive changes, even in the absence of brain pathology. This study aimed to determine if meditation training, by comparison to active and passive control groups, is linked to changes in the perception of cognitive functioning in older adults. One hundred thirty-four healthy older participants from the Age-Well Randomized Clinical Trial were included: 45 followed a meditation training, 45 a non-native language training and 44 had no intervention. Subjective cognition was assessed at baseline and following the 18-month intervention period. Perception of attentional efficiency was assessed using internal and external Attentional Style Questionnaire (ASQ) subscale scores. Perception of global cognitive capacities was measured via the total score of Cognitive Difficulties Scale (CDS). Deltas ([posttest minus pretest scores]/standard deviation at pretest) were calculated for the analyses. Generalized mixed effects models controlling for age, sex, education and baseline scores revealed that meditation training decreased the vulnerability score toward external distractors measured by the ASQ compared to non-native language training. However, no between-groups differences on ASQ internal or CDS total scores were observed. Results suggest a beneficial effect of meditation practice on perceived management of external distracting information in daily life. Meditation training may cultivate the ability to focus on specific information (e.g., breath) and ignore stimulation from other kinds of stimuli (e.g., noise).

Critical appraisal of methodological quality and completeness of reporting in Chinese social science systematic reviews with meta-analysis: A systematic review

Background

A systematic review is a type of literature review that uses rigorous methods to synthesize evidence from multiple studies on a specific topic. It is widely used in academia, including medical and social science research. Social science is an academic discipline that focuses on human behaviour and society. However, consensus regarding the standards and criteria for conducting and reporting systematic reviews in social science is lacking. Previous studies have found that the quality of systematic reviews in social science varies depending on the topic, database, and country.

Objectives

This study evaluates the completeness of reporting and methodological quality of intervention and non-intervention systematic reviews in social science in China. Additionally, we explore factors that may influence quality.

Search Methods

We searched three major Chinese electronic databases-CNKI, VIP, and Wangfang-for intervention and non-intervention reviews in social science published in Chinese journals from 1 January 2009 to 2 December 2022.

Selection Criteria

We included intervention and non-intervention reviews; however, we excluded overviews, qualitative syntheses, integrative reviews, rapid reviews, and evidence syntheses/summaries. We also excluded meta-analyses that used advanced methods (e.g., cross-sectional, cumulative, Bayesian, structural equation, or network meta-analyses) or that focused on instrument validation.

Data Collection and Analysis

We extracted data using a coding form with publication information and study content characteristics. This study conducted pilot extraction and quality assessment with four authors and formal extraction and assessment with two groups of four authors each. PRISMA2020 and MOOSE were used to evaluate the reporting completeness of intervention and non-intervention reviews. AMSTAR-2 and DART tools were adopted to assess their methodological quality. We described the characteristics of the included reviews with frequencies and percentages. We used SPSS (version 26.0) to conduct a linear regression analysis and ANOVA to explore the factors that may influence both completeness of reporting and methodological quality.

Main Results

We included 1176 systematic reviews with meta-analyses published in Chinese journals between 2009 and 2022. The top three fields of publication were psychology (417, 35.5%), education (388, 33.0%), and management science (264, 22.4%). Four hundred and thirty-two intervention reviews were included. The overall completeness of reporting in PRISMA and compliance rate of the methodological process in AMSTAT-2 were 49.9% and 45.5%, respectively. Intervention reviews published in Chinese Social Science Citation Index (CSSCI) journals had lower reporting completeness than those published in non-CSSCI journals (46.7% vs. 51.1%), similar to methodological quality (39.6% vs. 47.9%). A few reviews reported the details on registration (0.2%), rationality of study selection criteria (1.6%), sources of funding for primary studies (0.2%), reporting bias assessment (2.8%), certainty of evidence assessment (1.2%), and sensitivity analysis (107, 24.8%). Seven hundred and forty-four non-intervention reviews were included. The overall completeness of reporting in MOOSE and compliance rate of the methodological process in DART were 51.8% and 50.5%, respectively. Non-intervention reviews published in CSSCI journals had higher reporting completeness than those published in non-CSSCI journals (53.3% vs. 50.3%); however, there was no difference in methodological quality (51.0% vs. 50.0%). Most reviews did not report the process and results of selection (80.8%), and 58.9% of reviews did not describe the process of data extraction; only 9.5% assessed the quality of included studies; while none of the reviews examined bias by confounding, outcome reporting bias, and loss to follow-up. An improving trend over time was observed for both intervention and non-intervention reviews in completeness of reporting and methodological quality (PRISMA: β = 0.24, p < 0.01; AMSTAR-2: β = 0.17, p < 0.01; MOOSE: β = 0.34, p < 0.01; DART: β = 0.30, p < 0.01). The number of authors and financial support also have a positive effect on quality.

Authors' Conclusions

Completeness of reporting and methodological quality were low in both intervention and non-intervention reviews in Chinese social sciences, especially regarding registration, protocol, risk of bias assessment, and data and code sharing. The sources of literature, number of authors, publication year, and funding source declarations were identified as factors that may influence the quality of reviews. More rigorous standards and guidelines for conducting and reporting reviews are required in social science research as well as more support and incentives for reviewers to adhere to them.

Aging with HIV and HIV-associated neurocognitive impairment

Antiretroviral therapy (ART) is the most effective therapeutic intervention for HIV infection. With improved survival, comorbidities, including neuropsychiatric and HIV-associated neurocognitive impairment (NCI) are of increasing concern to aging people with HIV (PWH). The clinical features and the inter-individual variability of the aging process confound the elucidation of the diagnosis and underlying mechanisms of cognitive dysfunction in aging PWH. Herein, we review the clinical aspects of HIV-associated NCI in the aging PWH contrasting to the normative neuro-aging seen in people without HIV (PWoH) and address the growing role of biomarkers to predict the onset of age-related diseases in PWH and their clinical significance. There is an urgent need for further research into the role of specific immune brain biomarkers in predicting the aging process and how these biomarkers may assist in understanding the mechanisms and possible prognosis of age-related neurocognitive comorbidities in aging PWH as an endpoint for interventional studies.

How spatial-cue reliability affects navigational performance in young and older adults

Navigational abilities decline with age, but the cognitive underpinnings of this cognitive decline remain partially understood. Navigation is guided by landmarks and self-motion cues, that we address when estimating our location. These sources of spatial information are often associated with noise and uncertainty, thus posing a challenge during navigation. To overcome this challenge, humans and other species rely on navigational cues according to their reliability: reliable cues are highly weighted and therefore strongly influence our spatial behavior, compared to less reliable ones. We hypothesize that older adults do not efficiently weigh spatial cues, and accordingly, the reliability levels of navigational cues may not modulate their spatial behavior, as with younger adults. To test this, younger and older adults performed a virtual navigational task, subject to modified reliability of landmarks and self-motion cues. The findings revealed that while increased reliability of spatial cues improved navigational performance across both age groups, older adults exhibited diminished sensitivity to changes in landmark reliability. The findings demonstrate a cognitive mechanism that could lead to impaired navigation abilities in older adults.

Examining Health Behaviors as Mechanisms Linking Earlier Pubertal Timing with Accelerated Epigenetic Aging in Late Adolescence

Earlier pubertal timing is associated with accelerated epigenetic aging, but the underlying mechanisms are not well understood. This three-wave longitudinal study examined negative health behaviors, specifically substance use, short sleep duration, and poor diet quality in middle adolescence, as mediators of links between earlier phenotypic and perceived pubertal timing measured in early adolescence and epigenetic aging on three epigenetic clocks in late adolescence (GrimAge, DunedinPACE, and PhenoAge). Phenotypic pubertal timing measured physical pubertal maturation relative to chronological age, whereas perceived pubertal timing was based on adolescents' subjective interpretation of their pubertal timing relative to their peers. Participants included 1213 youth (51% female, 49% male; 62% Black, 34% White) who participated during early adolescence (mean age = 13.10 years), middle adolescence (mean age = 16.1 years) and late adolescence (mean age = 19.7 years). Results from a mediation model revealed a mediation effect of earlier phenotypic pubertal timing on accelerated GrimAge in late adolescence through higher substance use during middle adolescence. There was also a direct effect of earlier phenotypic pubertal timing on accelerated DunedinPACE in males. Sleep duration and diet quality did not emerge as mediators but shorter sleep duration predicted accelerated GrimAge in females. These findings suggest that higher substance use presents a mechanism through which earlier maturing youth experience faster epigenetic aging that puts them at risk for poorer health across the lifespan.

Neural effects of memory training to reduce false memories in older adults: Univariate and multivariate analyses

The growing population of older adults emphasizes the need to develop interventions that prevent or delay some of the cognitive decline that accompanies aging. In particular, as memory impairment is the foremost cognitive deficit affecting older adults, it is vital to develop interventions that improve memory function. This study addressed the problem of false memories in aging by training older adults to use details of past events during memory retrieval to distinguish targets from related lures. We examined the neural basis of a retrieval-based monitoring strategy by assessing changes in univariate BOLD activity and discriminability of targets and lures pre and post training. Results showed training-related decreases in false memory rates with no alterations to hit rates. Both training and practice were associated with altered recruitment of a frontoparietal monitoring network as well as benefits to neural discriminability within network regions. Participants with lower baseline neural discriminability between target and lure items exhibited the largest changes in neural discriminability. Collectively, our results highlight the benefits of training for reductions of false memories in aging. They also provide an understanding of the neural mechanisms that support these reductions.

Age-related contextual cueing features are more evident in reaction variability than in reaction time

Visual-spatial contextual cueing learning underpins the daily lives of older adults, enabling them to navigate their surroundings, perform daily activities, and maintain cognitive function. While the contextual cueing effect has received increasing attention from researchers, the relationship between this cognitive ability and healthy ageing remains controversial. To investigate whether visual-spatial contextual cueing learning declines with age, we examined the contextual learning patterns of older (60-71 years old) and younger adults (18-26 years old) using a contextual-guided visual search paradigm and response variability measurements. We observed significant contextual learning effects in both age groups, impacting response speed and variability, with these effects persisting for at least 24 days. However, older adults required more repetitions and memorised fewer repeated stimuli during initial learning. Interestingly, their long-term memory maintenance appeared stronger, as their contextual facilitation persisted in both response speed and variability, while younger adults only persisted in response speed but not variability. Overall, our results suggest an age-related complex and diverse contextual cueing pattern, with older adults showing weaker learning but stronger long-term memory maintenance compared with younger adults.

Cigarette smoking is associated with reduced neuroinflammation and better cognitive control in people living with HIV

People living with HIV (HIV+) are roughly twice as likely to smoke cigarettes (Smok+) as the general population. With the advent of effective antiretroviral therapies, it is increasingly important to understand the effects of chronic HIV infection and cigarette smoking on brain function and cognition since HIV+ individuals have heightened neuroinflammation and cognitive deficits even with such therapies. Based on prior studies demonstrating that smoking reduces a marker for neuroinflammation in HIV- individuals, we hypothesized that HIV+/Smok+ individuals would have less neuroinflammation and better cognitive control than HIV+/Smok- individuals. Fifty-nine participants (HIV-/Smok- [n = 16], HIV-/Smok+ [n=14], HIV+/Smok- [n = 18], and HIV+/Smok+ [n = 11]) underwent baseline eligibility tests, positron emission tomography (PET) scanning to determine levels of a marker for neuroinflammation, and assessment of cognitive control with the reverse-translated 5-choice continuous performance test (5C-CPT), with smokers having smoked to satiety prior to testing. For the PET data, a significant effect of smoking status on whole brain (WB) standardized uptake value (SUV) was found between HIV+/Smok+ and HIV+/Smok- participants (due to 18.8% lower WB SUV in the HIV+/Smok+ group). HIV+/Smok- participants exhibited a mean 13.5% higher WB SUV than HIV-/Smok- participants. For the 5C-CPT, HIV+/Smok+ participants performed significantly better than HIV+/Smok- participants (d prime), and HIV+/Smok- participants performed worse than HIV-/Smok- participants. Thus, HIV+/Smok+ individuals demonstrated lower levels of the neuroinflammation marker and better cognitive control than HIV+/Smok- individuals. Given that HIV+ individuals whose HIV is well-controlled can still have chronic neurocognitive complications, study results suggest possible paths for future research into nicotine-related treatments to prevent such complications.

Interrelationships between polygenic risk scores, cognition, symptoms, and functioning in first-episode psychosis: A network analysis approach

Psychopathological manifestations and cognitive impairments are core features of psychotic disorders. Polygenic risk scores (PRS) offer insights into the relationships between genetic vulnerability, symptomatology, and cognitive impairments. This study used a network analysis to explore the connections between PRS, cognition, psychopathology, and overall functional outcomes in individuals experiencing a first episode of psychosis (FEP). The study sample comprised 132 patients with FEP. Genetic data were used to construct PRS for mental disorders and cognitive traits via PRS-continuous shrinkage. We conducted comprehensive clinical and neuropsychological assessments at 2 months post-diagnosis and again at a 2-year follow-up. A network analysis was performed to generate two distinct networks and their centrality indices, encompassing 19 variables across domains such as symptoms, cognition, functioning, and PRS. Variables were grouped within related domains, and stronger relationships were observed within domains than between them. PRS for schizophrenia showed weak negative associations with attention, working memory, and verbal memory, while PRS for cognitive performance showed weak positive associations with attention. Negative symptoms were negatively associated with functioning and verbal memory at both the 2-month and 2-year assessments, as well as with social cognition at 2 years. Poor functioning was moderately related to greater severity of Positive and Negative Syndrome Scale dimensions. This study identified pathways linking PRS, cognition, symptoms, and functioning, suggesting that genetic risk may serve as a marker of vulnerability and disorder progression. The findings also highlight the importance of considering genetic predispositions alongside clinical and cognitive factors to better understand the heterogeneity of psychotic disorders.

Microstructural lateralization of thalamocortical connections in individuals with a history of reading difficulties

Previous research has shown that the thalamus is crucial in reading, with its function depending largely on its connections with the cortex. However, the relationship between the lateralization of thalamocortical connections and reading has not been well-explored. This study investigates the microstructure and its lateralization differences in thalamocortical white matter fiber tracts in individuals with varying reading abilities and explores their relationship with reading skills and early reading performances. The study involved 26 Mandarin-speaking adults with a history of reading difficulties and 35 typically developing Mandarin-speaking adults. Severity of reading difficulties were accessed via the Chinese Adult Reading History Questionnaire (C-ARHQ) self-reported by participants. Reading-related abilities including reading accuracy, phonological awareness, and rapid automatized naming were assessed. Neuroimaging data, including T1-weighted and diffusion-weighted images, were collected. Thalamocortical white matter fiber tracts were reconstructed using the constrained spherical deconvolution (CSD) model and grouped into six regions based on connections with bilateral brain areas. The Neurite Orientation Dispersion and Density Imaging (NODDI) model was employed to evaluate the microstructural properties of these tracts, calculating lateralization indices for the orientation dispersion index (ODI), neurite density index (NDI), and isotropic volume fraction (VISO). Results revealed that individuals with reading difficulties had significantly lower NDI values in the left and right frontal-thalamic and occipital-thalamic fiber tracts compared to good readers. Additionally, greater rightward lateralization of frontal-thalamic white matter fiber tracts was linked to poorer early reading performance in those with reading difficulties. Our study reveals atypical thalamocortical white matter connections in adults with a history of reading difficulties, and the lateralization of these connections is influenced by severity of early reading difficulties.

The effect of implicit and explicit motor learning on a targeting task in children with autism spectrum disorder (ASD)

This study aims to investigate the effect of different implicit and explicit instructions on learning a fundamental motor skill (throwing task) in autistic children with a high propensity for reinvestment. A total of 48 male volunteer students with special educational needs aged between 7 and 9 years old were conveniently selected to practice a novel throwing motor task (slingerball). The study includes a 1-week the acquisition phase with five phases of measurements involving four groups: a) analogy, b) explicit instruction, c) errorless, and d) errorful paradigms. It was conducted in five phases: pre-test, acquisition, retention, transfer, and dual-task, using a quasi-experimental design. The task in this study was to throw a slingerball' towards a horizontal target on the ground. Mixed-design analysis of variance (ANOVA) and LSD post-hoc test performed to determine the interaction and main effects on throwing accuracy. The results indicated that participants in the analogy and errorless instruction groups had higher throwing accuracy in all phases of acquisition, retention, transfer and dual task compared to the explicit and errorful instruction groups (P ≤ 0.05). Moreover, both implicit learning groups performed more accurately in the dual task test than the explicit group (P ≤ 0.05). The results of this study support the theoretical framework that implicit practice can improve motor skill learning in children with autism spectrum disorder more than explicit practice. So, the application of errorless learning and analogy instruction is recommended for developing of motor performance and learning as implicit learning methods in educational environments.

Repeatability of diffusion kurtosis tensor parameters in muscles of the lower legs

PURPOSE

The aim of this study was to provide measurements from and investigate the repeatability of diffusion kurtosis tensor parameters in the muscles of the lower legs.

METHODS

Test-retest acquisition of a kurtosis tensor sequence was performed in 13 healthy volunteers. Quantitative kurtosis tensor parameters were derived, and repeatability of each parameter was evaluated by muscle group and over the whole muscle through intraclass correlation coefficient (ICC) and within-subject coefficient of variation (wsCV). Bland-Altman analysis was also conducted. Differences in parameter values by muscle group were investigated through an analysis of variance.

RESULTS

Axial kurtosis and radial kurtosis values from the test data were 0.63 ± 0.04 and 0.70 ± 0.05, respectively. Kurtosis tensor parameters from all muscle groups and over the whole muscle had wsCV below 15%. ICC for the parameters from most muscle groups was above 85%, with the lowest ICC over the whole muscle being 88.39%. The medial gastrocnemius and extensor digitorum longus showed highest repeatability. Mean, axial, and radial diffusivity had higher wsCV despite being lower-order terms than kurtosis.

CONCLUSION

This study sought to examine the repeatability of diffusion kurtosis tensor-derived parameters in the legs and verify that they could potentially be used as longitudinal imaging metrics. wsCV values from test-retest data indicated high repeatability throughout all examined muscle groups. There were minimal differences in kurtosis and diffusivity parameters between muscle groups in this healthy volunteer cohort.

Understanding Sensory-Motor Disorders in Autism Spectrum Disorders by Extending Hebbian Theory: Formation of a Rigid-Autonomous Phase Sequence

Autism spectrum disorder is a neuropsychiatric disorder characterized by persistent deficits in social communication and social interaction and restricted, repetitive patterns of behavior, interests, or activities. The symptoms invariably appear in early childhood and cause significant impairment in social, occupational, and other important functions. Various abnormalities in the genetic, neurological, and endocrine systems of patients with autism spectrum disorder have been reported as the etiology; however, no clear factor leading to the onset of the disease has been identified. Additionally, higher order cognitive dysfunctions, which are represented by a lack of theory of mind, sensorimotor disorders, and memory-related disorders (e.g., flashbacks), have been reported in recent years, but no theoretical framework has been proposed to explain these behavioral abnormalities. In this study, we extended Hebb's biopsychology theory to provide a theoretical framework that comprehensively explains the various behavioral abnormalities observed in autism spectrum disorder. Specifically, we propose that a wide range of symptoms in autism spectrum disorder may be caused by the formation of a rigid-autonomous phase sequence (RAPS) in the brain. Using the RAPS formation theory, we propose a biopsychological mechanism that could be a target for the treatment of autism spectrum disorders.

Challenges and Research Opportunities for Integrating Quantitative Electroencephalography Into Sports Concussion Rehabilitation

Although concussion management and return to play/learn decision making focuses on reducing symptoms, there is growing interest in objective physiological approaches to treatment. Clinical and technological advancements have aided concussion management; however, the scientific study of the neurophysiology of concussion has not translated into its standard of care. This expert commentary is motivated by novel clinical applications of electroencephalographic-based neurofeedback approaches (eg, quantitative electroencephalography [QEEG]) for treating traumatic brain injury and emerging research interest in its translation for treating concussion. QEEG's low-cost relative to other brain recording/imaging techniques and precedent in clinical and medical care makes it a potential tool for concussion rehabilitation. Although uncommon, licensed and certified clinicians and medical professionals are implementing QEEG neurofeedback for concussion management within their score of practice. These approaches are not widely adopted nor recommended by professional medical societies, likely because of a limited evidence base of well-designed studies with available standard protocols. Thus, the potential efficacy of QEEG neurofeedback for treating persistent symptoms or cognitive dysfunction after sports-related concussion is unknown. This commentary will update the concussion clinician-scientist on the emerging research, techniques, and disagreements pertaining to the translation of QEEG neurofeedback for concussion management, particularly in the treatment of persistent cognitive difficulties. This commentary will also introduce to readers the fundamentals of how the electroencephalogram may be acquired, measured, and implemented during QEEG neurofeedback. An evidence base of supportive findings from well-designed studies, including those that are retrospective, outcomes-based, and, ultimately, placebo/sham-controlled is recommended prior to considering more widespread adoption of QEEG neurofeedback approaches for treating persistent symptoms or cognitive deficits after sports-related concussion. We review the considerable barriers to this research and clinical implementation, and conclude with opportunities for future research, which will be necessary for establishing the quality and efficacy of QEEG neurofeedback for concussion care.

Paediatric traumatic brain injuries: A descriptive analysis of incidence, visits, cause, and admission rates in Iceland from 2010 to 2021

BACKGROUND

Traumatic brain injuries (TBI) are common in emergency departments (ED) and may cause long-term negative outcomes but knowledge on how the first assessment of children with TBI may predict outcomes is lacking. This study aimed to expand the knowledge by describing the incidence, visits, causes, and outcomes of TBI in children in Iceland.

METHODS

A retrospective descriptive data analysis was conducted on electronic medical records of children aged 0-17 that visited Landspitali EDs due to a traumatic head injury in 2010-2021. Cases were based on registered ICD-10 diagnosis and data was collected on demographics, causes, triage, length of stay (LOS), admissions and mortality rates. Descriptive statistics were calculated, and associations of variables tested for significance.

RESULTS

The study sample included 30,014 emergency visits. The majority involved boys (61.21 %) and children under 6 years old (57.99 %, M = 5.98 years). Girls had a significantly lower mean age (5.75 years vs 6.13 years, p < 0.001). The highest incidence was in one-year olds (729 per 100,000) and was on average 310 per 100,000 children of all ages. Total yearly visits decreased throughout the study period (M = 2,501). Emergency Severity Index (ESI) of 4 (50.77 %) was the most common, with 59.6 % of ESI = 1 cases admitted (p < 0.001). The average LOS was 2.2 h and 1.05 % were admitted. Falls (43.62 %) and soft tissue injuries (73.68 %) were the most common, with intracranial injuries (42.57 %) being the most common in ED observations and admissions. Throughout the study period, 30 (0.10 %) died, thereof three within a week post-injury. In total, 26.64 % of children had at least one revisit to the ED with a traumatic head injury.

CONCLUSIONS

Children commonly visit EDs due to TBI, mostly with mild injuries but one fourth revisited with a new head injury. There may be groups of children that require specialised follow-up care and assessment to detect and prevent further complications of TBI. Paediatric emergency nurses may be in a key position in identifying children in need of follow-up care. Further research is needed to enhance knowledge of outcomes of TBI in children and to reflect the important role of nurses in paediatric TBI care.

Alexithymia Prevalence, Characterization, and Associations With Emotional Functioning and Life Satisfaction: A Traumatic Brain Injury Model System Study

OBJECTIVES

Alexithymia an emotional processing deficit that interferes with a person's ability to recognize, express, and differentiate emotional states. Study objectives were to (1) determine rates of elevated alexithymia among people with moderate-to-severe traumatic brain injury (TBI) 1-year post-injury, (2) identify demographic and injury-related variables associated with high versus low-average levels of alexithymia, and (3) examine associations among alexithymia with other aspects of emotional functioning and life satisfaction.

SETTING

Data were collected during follow-up interviews across four TBI Model System (TBIMS) centers.

PARTICIPANTS

The sample consisted of 196 participants with moderate-to-severe TBI enrolled in the TBIMS. They were predominately male (77%), White (69%), and had no history of pre-injury mental health treatment (66.3%).

DESIGN

Cross-sectional survey data were obtained at study enrollment and 1-year post-injury.

MAIN MEASURES

Toronto Alexithymia Scale-20 (TAS-20) as well as measures of anger, aggression, hostility, emotional dysregulation, post-traumatic stress, anxiety, depression, resilience and life satisfaction. Sociodemographic information, behavioral health history and injury-related variables were also included.

RESULTS

High levels of alexithymia (TAS-20 score > 1.5 standard deviation above the normative mean) were observed for 14.3%. Compared to individuals with low/average levels of alexithymia, the high alexithymia group tended to have lower levels of education. At 1-year follow-up, high TAS-20 scores were strongly associated with emotional dysregulation and post-traumatic stress; moderately associated with anger, hostility, depression, anxiety, lower resilience and lower satisfaction with life; and weakly associated with aggression.

CONCLUSION

These findings provide further evidence that alexithymia is associated with poor emotional functioning and life satisfaction after TBI. Longitudinal studies are needed to determine if alexithymia is a risk factor that precipitates and predicts worse emotional outcomes in the TBI population. This line of work is important for informing treatment targets that could prevent or reduce of psychological distress after TBI.

Cognitive disorders in patients with neuroimmunological disease

PURPOSE OF REVIEW

Autoimmune diseases such as systemic lupus erythematosus (SLE), multiple sclerosis (MS), and autoimmune encephalitis can directly and indirectly affect brain function, leading to cognitive dysfunction or well characterized neurocognitive syndromes. However, these are often poorly characterized in the literature. Here, we review evidence on clinical manifestations, risk factors, their assessment and outcomes, and evidence for underlying mechanisms and associated biomarkers, if available.

RECENT FINDINGS

Significant advances have been made in neurocognitive disorders associated with four categories of autoimmune disease: neurocognitive disorders due to autoimmune connective tissue diseases, neurocognitive disorders due to autoimmune demyelinating diseases of the CNS, neurocognitive disorders due to autoimmune encephalitis, and neurocognitive disorders due to cerebrovascular disease of autoimmune origin.

SUMMARY

Autoimmune diseases should be considered as critical causal factors underlying new cases of neurocognitive disorder, especially in young patients. These diseases are mediated by immune system reactions involving antibody production, T-cell-mediated damage, and demyelination. Although the prognosis seems favourable in most conditions after immunotherapy, the magnitude of the therapeutic effect of immunotherapy on cognitive functioning remains unclear.

Perceived stress in adults with epilepsy: A systematic review

This systematic review summarizes evidence about perceived stress in adults with epilepsy to clarify the particularities and potential effects on the prognosis and consequences of the disease. This review follows the recommendations of the PRISMA statement and was registered in PROSPERO. Thirty-four articles were selected. In 89 % of the studies, stress in epilepsy was conceptualized as a process in which the demands of the environment exceed the organism's ability to cope. Stressful life events related to perceived stress in epilepsy included the COVID-19 pandemic and work-related problems. Perceived stress was identified as a seizure precipitant in 85 % of studies. In 67 % of studies, patients with epilepsy had higher perceived stress than healthy people. Female gender, youth, low educational levels, unemployment, poor social support, less than five years suffering the disorder, temporal lobe epilepsy, depression, poor seizure control, and polytherapy were identified as risk factors for increased stress. These studies highlight the need for the conceptualization of epilepsy within a chronic stress framework which could facilitate more appropriate clinical management.

Manganese exposure and sleep quality in iron and steel industry workers

Manganese (Mn) is an essential element crucial for the proper functioning of the human body. However, excessive exposure to manganese can lead to complications, particularly neurotoxicity. Among the health issues associated with exposure to heavy metals, one of the major concerns in the adverse effect on sleep quality. A total of 189 employees from a steel factory were divided into two groups: exposed (149 people) and non-exposed (40 people). Air samples were collected using the NIOSH 7300 method, and blood samples were obtained at the end of each shift. The samples underwent analysis by ICP-OES after preparation using the acid-thermal digestion method. To gather information on sleep quality, the Petersburg Sleep Questionnaire (PSQI) was used. The data collected in this study showed abnormal conditions, leading to the inclusion of medians alongside averages. The participants had an average age of 35 and an average work experience of 6 years. The exposed group had a significantly higher median respiratory exposure to manganese (1.32 mg/m3) compared with the non-exposed group (0.20 mg/m3). The average sleep quality score in the exposed group was significantly worse (score of 7) compared with the non-exposed group (score of 4). In addition, there was a significant relationship between the quality of sleep and the level of manganese in the air, so that the quality of sleep decreases with the increase in the level of manganese in the air (p-value = .005). However, no significant relationship was observed between blood manganese level and air manganese level in the exposed group (p-value = .06).

Multidisciplinary approach to optimizing long-term outcomes in pediatric kidney transplant recipients: multifaceted needs, risk assessment strategies, and potential interventions

The post-transplant course of pediatric kidney transplant recipients is marked by a myriad of challenges, encompassing medical complications, recurrent hospitalizations, physical and dietary restrictions, and mental health concerns such as depression, anxiety, and post-traumatic stress disorder. Moreover, pediatric recipients are at risk of neurodevelopmental impairment, which may result in neurocognitive deficits and pose significant psychosocial obstacles. Addressing these multifaceted demands necessitates a multidisciplinary approach to pediatric kidney transplant care. However, the existing literature on the effective implementation of such a model remains scarce. This review examines the psychosocial and neurodevelopmental challenges faced by pediatric kidney transplant recipients and their families, discussing their impact on long-term transplant outcomes. Furthermore, it provides insights into risk assessment strategies and potential interventions within a multidisciplinary framework, aiming to enhance patient care and optimize post-transplant outcomes.

Aging Impacts Basic Auditory and Timing Processes

Deterioration in the peripheral and central auditory systems is common in older adults and often leads to hearing and speech comprehension difficulties. Even when hearing remains intact, electrophysiological data of older adults frequently exhibit altered neural responses along the auditory pathway, reflected in variability in phase alignment of neural activity to speech sound onsets. However, it remains unclear whether challenges in speech processing in aging stem from more fundamental deficits in auditory and timing processes. Here, we investigated if and how aging individuals encoded temporal regularities in isochronous auditory sequences presented at 1.5Hz, and if they employed adaptive mechanisms of neural phase alignment in anticipation of next sound onsets. We recorded EEG in older and young individuals listening to simple isochronous tone sequences. We show that aging individuals displayed larger event-related neural responses, an increased 1/F slope, but reduced phase-coherence at the stimulation frequency (1.5Hz) and a reduced slope of phase-coherence over time in the delta and theta frequency-bands. These observations suggest altered top-down modulatory inhibition when processing repeated and predictable sounds in a sequence and altered mechanisms of continuous phase-alignment to expected sound onsets in aging. Given that deteriorations in these basic timing capacities may affect other higher-order cognitive processes (e.g., attention, perception, and action), these results underscore the need for future research examining the link between basic timing abilities and general cognition across the lifespan.

Hiding in Plain Sight: A case of post ictal psychosis with suicidal behavior

Postictal psychosis (PIP) is a serious, often unrecognized complication of epilepsy. Early diagnosis and intervention can prevent life-threatening outcomes. We report the case of a 26-year-old woman with childhood-onset frontal lobe epilepsy who attempted suicide, during a postictal psychotic episode, several days after undergoing inpatient video-EEG monitoring. This case presents a real-world scenario with clear guidelines for the on-call neurologist who will need to accurately diagnose and confidently manage PIP with psychotropic medications. Moreover, this case may stimulate discussion about the complex relationship between epilepsy and psychosis.

Neural circuits and therapeutic mechanisms of empathic pain

Empathy is the capacity to understand and share the experiences of others. This ability fosters connections between individuals, enriching the fabric of our shared world. One notable example is empathy for the pain of others. Such experiences facilitate the identification of potential dangers, both for oneself and for others. Neuroimaging studies have helped to pinpoint brain regions that modulate empathic pain. Recently, there has also been a surge in studies exploring the neural mechanisms of empathic pain in rodent models. Neuropsychiatric disorders such as autism, psychosis, and schizophrenia often exhibit empathy deficits. Targeting the modulation of empathic pain holds potential for alleviating core symptoms in these patients. Interestingly, empathy research may also benefit pain management, leading to new approaches for understanding the negative emotions associated with pain. This review summarizes recent advances in neuroimaging for the study of empathic pain, outlines the underlying neurocircuit mechanisms, describes therapeutic strategies, and explores promising avenues for future research. This article is part of the Special Issue on "Empathic Pain".

Decoding Brain Development and Aging: Pioneering Insights From MRI Techniques

ABSTRACT

The aging process induces a variety of changes in the brain detectable by magnetic resonance imaging (MRI). These changes include alterations in brain volume, fluid-attenuated inversion recovery (FLAIR) white matter hyperintense lesions, and variations in tissue properties such as relaxivity, myelin, iron content, neurite density, and other microstructures. Each MRI technique offers unique insights into the structural and compositional changes occurring in the brain due to normal aging or neurodegenerative diseases. Age-related brain volume changes encompass a decrease in gray matter and an increase in ventricular volume, associated with cognitive decline. White matter hyperintensities, detected by FLAIR, are common and linked to cognitive impairments and increased risk of stroke and dementia. Tissue relaxometry reveals age-related changes in relaxivity, aiding the distinction between normal aging and pathological conditions. Myelin content, measurable by MRI, changes with age and is associated with cognitive and motor function alterations. Iron accumulation, detected by susceptibility-sensitive MRI, increases in certain brain regions with age, potentially contributing to neurodegenerative processes. Diffusion MRI provides detailed insights into microstructural changes such as neurite density and orientation. Neurofluid imaging, using techniques like gadolinium-based contrast agents and diffusion MRI, reveals age-related changes in cerebrospinal and interstitial fluid dynamics, crucial for brain health and waste clearance. This review offers a comprehensive overview of age-related brain changes revealed by various MRI techniques. Understanding these changes helps differentiate between normal aging and pathological conditions, aiding the development of interventions to mitigate age-related cognitive decline and other symptoms. Recent advances in machine learning and artificial intelligence have enabled novel methods for estimating brain age, offering also potential biomarkers for neurological and psychiatric disorders.

Related factors of cognitive frailty among older adults with type 2 diabetes: a cross-sectional study

BACKGROUND

The correlation between diabetes and cognitive frailty is still controversial. The purpose of this study was to explore the related factors of cognitive frailty in older adults with type 2 diabetes, and to provide new ideas for realising healthy ageing of diabetic patients.

METHODS

The survey was conducted at Mianyang Central Hospital affiliated to University of Electronic Science and Technology of China from January 15 to June 30, 2024. The subjects were older adults with type 2 diabetes aged 60 years or older. Cognitive frailty was assessed using Fried's phenotype and Mini-Mental State Examination. Statistical analysis and plotting were conducted using SPSS 25.0 and R 4.3.3. Least absolute shrinkage and selection operator (LASSO) regression was used to reduce the dimensionality of 30 clinical features collected, and the unimportant factors were initially screened out. The important factors with non-zero coefficients identified by LASSO regression were included in a multivariate logistic regression analysis to explore the factors influencing cognitive frailty in older diabetic patients.

RESULTS

This study included 301 older persons with type 2 diabetes. Among them, 91 (30.2%) cases of cognitive frailty occurred. Related factors for cognitive frailty in older adults with type 2 diabetes include: age (odds ratio (OR) = 6.417, 95% CI: 1.882-21.876, P = 0.003), hypomnesia (OR = 2,985, 95%CI: 1.143-7.797, P = 0.026), depression (OR = 9.926, 95%CI: 4.117-23.934, P < 0.001), diabetic retinopathy (OR = 6.489, 95%CI: 1.969-21.384, P = 0.002), history of diabetic ketoacidosis (OR = 12.024, 95%CI: 1.724-83.872, P = 0.012).

CONCLUSION

The prevalence of cognitive frailty in older persons with type 2 diabetes mellitus was higher. It was closely related to age, hypomnesia, depression, diabetic retinopathy and history of diabetic ketoacidosis. Early detection of the risk and effective intervention can reduce the incidence of adverse events and improve the quality of life of patients.

Cognitive impairment and self-reported health outcomes among older adults: Longitudinal evidence from Australia

BACKGROUND

Australia's population is ageing, with forecasts indicating that individuals aged 65 years and over will account for >20 % of the total population by 2066. Ageing is strongly linked with a significant decrease in cognitive capabilities. This study aimed to explore the association between cognitive impairment and four types of health outcomes among older Australians.

METHODS

Data used for this study was collected from the Household, Income and Labour Dynamics in Australia (HILDA) Survey. The final analysis consisted of 11,146 person-year observations from 7035 unique individuals from Wave 2012 and Wave 2016, respectively. A longitudinal random-effects generalised least squares, and ordered logistic regression were used to analyse the association between cognitive impairment and health outcomes.

RESULTS

The study results suggest that cognitive impairment was negatively associated with general health, mental health, self-assessed health and health satisfaction. Older Australians with cognitive impairment scored lower on general health (β = -2.82, SE = 0.56), mental health (β = -2.93, SE = 0.53), self-assessed health (β = - 0.75, SE = 0.10), and health satisfaction (β = -0.19, SE = 0.09) compared to the counterparts without cognitive impairment. The heterogeneous results also showed cognitive impairment was associated with poor health outcomes across age groups.

CONCLUSION

This study found evidence that cognitive impairment is associated with poor health outcomes. To enhance the physical and mental health and well-being of older adults, the community, government and non-government organizations, and other stakeholders should prioritize routine healthcare prevention, targeted interventions, and treatment practices, particularly for individuals with or at risk of cognitive impairment.

Metacognition facilitates theory of mind through optimal weighting of trait inferences

The ability to represent and infer accurately others' mental states, known as Theory of Mind (ToM), has been theorised to be associated with metacognitive ability. Here, we considered the role of metacognition in mental state inference through the lens of a recent theoretical approach to explaining ToM, the 'Mind-space' framework. The Mind-space framework posits that trait inference, representation of the qualities of the mind giving rise to the mental state, is important in forming accurate mental state inferences. We tested a potential role for metacognition in facilitating optimal weighting of trait inferences, as well as several theoretical predictions regarding factors associated with the accuracy of trait inference and confidence in those trait inferences. Participants completed a judgement-of-confidence task in the trait inference domain alongside the Interview Task, a recently-developed task for assessing the accuracy of trait and mental state inferences. A simple relationship in which increased metacognitive sensitivity is associated with increased accuracy of mental states inferences was not found. However, when predicting trial-level performance, confidence in trait inference was shown to modulate the effect of trait inference accuracy on mental state inference accuracy. This effect was greater in magnitude with lower metacognitive sensitivity, i.e., when confidence is more likely to be misplaced. Furthermore, participants' trait inference ability was associated with the accuracy of their understanding of the average mind. In addition, the accuracy of specific trait inferences was predicted by the participant's similarity to the target, but this similarity benefit was reduced in participants whose self-perception was inaccurate. Reported confidence in a given trait inference was also predicted by participant-target similarity, such that participants showed greater overconfidence in judgements made about similar targets. This overconfidence effect was larger when self-perception was more erroneous. Results support several theoretical claims made by the Mind-space theory, and further elucidate the processes underlying accurate mental state inference.

Neural correlates of lexical, sublexical and motor processes in word handwriting

Writing recruits a vast neural network underpinning both linguistic and motor processes. Previous studies have tried to identify which brain areas underpin both the linguistic and motor aspects of writing. However, little is known about the neural substrate of the lexical and sublexical "routes" for spelling. In this fMRI study, participants (n = 25) copied or saw/read symbols or words. Words varied in lexical frequency and phonology-to-orthography (P-O) consistency. Anterior parts of the inferior frontal gyrus were selectively recruited when copying P-O inconsistent words, while the right Heschl's gyrus was recruited only when copying consistent words. Non-specific motor and linguistic areas were also identified. Our results contribute to our knowledge of the neural substrate of the lexical and sublexical spelling routes and suggest that different brain areas might be involved in the lexical processing of input (reading) and output (writing) orthography.

Gaps in dementia knowledge: a nationwide study of public awareness and misconceptions in Bulgaria

BACKGROUND

Dementia is a global health concern which can be mitigated by primary prevention and improved literacy. Effective educational initiatives are informed by studies of dementia knowledge. However, most of these studies are conducted in high-income countries, leaving the Balkan region underrepresented. This study aimed to conduct the first investigation of dementia knowledge among the Bulgarian population, exploring recognition of symptoms, general dementia knowledge, and risk factors awareness.

METHODS

Using an online survey we assessed the following components of knowledge: (i) recognition of dementia symptoms from a vignette; (ii) dementia literacy measured with the Dementia Knowledge Assessment Scale (DKAS); and (iii) knowledge about dementia risk factors. Demographic characteristics, previous experience with dementia, and patterns of informing about dementia were also considered in the study.

RESULTS

One thousand, eight hundred and ninety-six adults (mean age = 44.99; 51.79% female) completed the survey. Half of the respondents correctly recognised dementia symptoms from a vignette. The average DKAS score was 9.51. Dementia knowledge was linked to education, marital status, employment, ethnicity, experience with dementia, and informational sources. 56.7% of the respondents thought dementia was a normal part of ageing and 74.8% did not know a healthy lifestyle reduces the risk of dementia. The average number of identified risk factors was eight (out of 17), with many mistakenly citing dental fillings, laziness, and witchcraft as contributors to dementia.

CONCLUSIONS

The Bulgarian society has a poor understanding of dementia, highlighting the need for improved awareness and education. Policy-makers should prioritise dementia as a social issue and take coordinated actions to educate society and eradicate harmful misconceptions.

Different cortex activation between young and middle-aged people during different type problem-solving: An EEG&fNIRS study

Problem-solving strategies vary depending on the type of problem and aging. This study investigated the hemodynamic response measured by the changes in the oxyhemoglobin concentration (HbO), alpha frequency power, and their interrelation during problem-solving in healthy young and middle-aged individuals, employing combined electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS) recordings. The study included 39 young and 30 middle-aged subjects. The brain activation that occurred while answering different questions was recorded using combined EEG and fNIRS. During the EEG & fNIRS recording, four questions (arithmetic, general knowledge, insight, and basic operation) were used for problem-solving. Alpha power (8-13 Hz) and HbO changes were analyzed. The behavioral results indicated significant differences between age groups in various question types. While the middle-aged group performed better on the general knowledge questions, the older group performed better on the insight and four-process questions. The fNIRS results reveal significant differences in brain activation during problem-solving tasks, particularly in regions like DLPFC/TA, STG, pSSC/Wernicke, and STG/angular gyrus Wernicke's area. The young group with the highest HbO was recorded during arithmetic questions, general knowledge questions, and basic operation questions. In contrast, there was no significant highest HbO during insight questions. Similar findings were observed in the middle-aged group, with the highest HbO recorded during general knowledge questions. However, there was no significant HbO in other channels during the solving of other question types in this group. The alpha power varied across different electrodes for various question types in both young and middle-aged groups. The highest alpha frequency band power for different electrodes was recorded while solving general knowledge questions in the young group and insight questions in the middle-aged group. Finally, the EEG and fNIRS correlation results showed positive correlations between HbO and alpha frequency band power in specific brain regions while solving general knowledge questions, particularly in the middle-aged group. The study reveals age-related differences in behavioral performance, brain activation patterns, and neural correlates during various cognitive tasks, showcasing distinct strengths between middle-aged and young individuals in specific question types.

Regression-based thresholds to detect clinical changes in verbal fluency after STN-DBS in Parkinson's disease

INTRODUCTION

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) improves motor functions in patients with Parkinson's disease (PD) but may cause a decline in specific cognitive domains including executive processes and language. The aim of this study was to derive standardized regression-based (SRB) reliable change indices (RCIs) in an Italian cohort of Parkinson's patients undergoing STN-DBS to detect clinically meaningful variations in verbal fluency (VF) one year after surgery define.

METHODS

Before (T0) and 12 months after (T1) surgery, 36 PD patients who underwent bilateral STN-DBS were evaluated with the Alternate Verbal Fluency Battery (AVFB), including phonemic (PVF), semantic (SVF) and alternate VF tests (AVF) and a composite shifting index (CSI). At T0, motor status was assessed using the Unified Parkinson's Disease Rating Scale-III (UPDRS-III) and L-dopa equivalent daily dose was recorded.

RESULTS

Group-level declines were limited to PVF and SVF scores. Applications of these RCIs revealed idiosyncratic patterns of longitudinal trends that differed from those at the group level. Indeed, when looking at individual performances, no clustered pattern of decline or improvement could be visibly detected. The UPDRS-III predicted T1 AVF and CSI scores.

CONCLUSION

Our study provides Italian practitioners and researchers with SRB-RCIs to detect meaningful differences in the VF performance of PD patients undergoing STN-DBS one year after surgery. Variables associated with postoperative cognitive changes can be used in future studies to develop multivariable predictive models to support clinical decision making and patient counselling.

Hemispheric co-lateralization of language and spatial attention reduces performance in dual-task

Hemispheric specialization of different functions is proposed to confer evolutionary benefits, yet the behavioral impacts of lateralization and its cognitive and neural mechanisms remain unclear. This study investigated the effect of lateralization pattern between language and spatial attention on dual-task performance and its association with callosal connectivity. Functional lateralization was assessed using fMRI verbal fluency and landmark tasks, and interhemispheric connections were evaluated through diffusion-weighted imaging. The typical lateralization pattern enhanced overall performance and reduced interference in dual-task compared to the co-lateralized pattern (both functions lateralized to one hemisphere). However, no differences were observed between the mirrored pattern (right language dominance and left attention dominance) and the co-lateralized pattern. While callosal connectivity did not significantly differ among groups, a negative correlation was observed between the lateralization degree and callosal connectivity. Our findings partially support the functional crowding hypothesis and offer insights into neurocognitive mechanisms underlying functional reorganization after brain lesions.

Interpersonal synchronization: An overlooked factor in development, social cognition, and psychopathology

Intact social functioning relies on a combination of explicit and implicit behavioral, attentional, and interpersonal processes referred to as "social cognition". Characterizing these interpersonal processes forms a critical underpinning to understanding and treating psychopathology, particularly in disorders where deficits in social functioning do not emerge as a secondary symptom but rather as an essential feature of the disorder. Two of such disorders are autism spectrum disorders (ASD) and schizophrenia spectrum disorders (SZ). However, despite the substantial overlap in the features of social dysfunction between ASD and SZ, including social cognitive deficits in theory of mind, perspective-taking, and empathy, there is a limited understanding of the mechanisms underlying those shared deficits, and how to treat them. We suggest that disruptions of interpersonal functioning emerge over the course of development, and that interpersonal synchronization, a phenomenon in which behavioral and physiological cues align between interacting partners, forms a critical component of social cognition that underlies the disruption in social functioning in ASD and SZ. We present a conceptual review of typical and atypical development of social processes and highlight the role of interpersonal synchronization across the course of development. Then, we review the existing evidence suggesting impairments in both the intentional and spontaneous synchronization of interpersonal processes in ASD and SZ, as well as studies suggesting that interpersonal synchronization and clinical symptoms may be improved through body-oriented interventions within these disorders. Finally, we suggest potential mechanisms that may underpin typical and atypical development of interpersonal synchronization.

Validity of the Chinese version of the weekly calendar planning activity (WCPA) on assessing executive function in adults with stroke

The weekly calendar planning activity (WCPA) is a performance-based assessment of executive function (EF) via a cognitively-based instrumental activity of daily life (C-IADL). This study aimed to examine the validity of the Chinese version of the WCPA in adults with stroke and to explore the characteristics of cognitive strategy use among the population. Fifty-eight hospitalized patients with stroke aged 26-82 years and 53 controls completed the WCPA, two neuropsychological tests and instrumental activity of daily life (IADL) scale. Participants with stroke were subdivided into a stroke cognitive impaired group (Stroke-CI) and a general stroke group (Stroke-NCI) based on the Montreal Cognitive Assessment. Results showed that the WCPA was able to discriminate between Stroke-CI with controls and the Stroke-NCI group with controls. We found significant limitations in stroke patients' ability to use strategies. Concurrent and ecological validities were demonstrated through correlations between the neuropsychological test scores, IADL and the WCPA performance. This study provides initial evidence for the validity of the Chinese version of the WCPA-10 for adults with stroke and suggests the need to use performance-based tests even in patients with normal cognitive screening test results. The WCPA could provide useful information for strategy-based interventions for adults with stroke.

Early detection of Alzheimer's disease using the MEMORIES mnemonic

The rising incidence and death rates linked to Alzheimer's disease (AD) highlight an urgent issue. Genetic screening is celebrated as a significant advancement for its early detection capabilities, pinpointing those at risk before the emergence of symptoms. Yet, the limited availability of these technologies highlights a critical gap in widespread application. This review pivots to the potential of presymptomatic clinical assessments as a readily available, economical, and simple strategy for early detection. Traditionally, AD diagnosis relies on the late-stage identification of cognitive deterioration, functional impairments, and neuropsychiatric symptoms, coinciding with advanced brain degeneration. Conversely, emerging research identifies early indicators preceding significant degeneration, manifesting years before clinical symptoms. We introduce a mnemonic, MEMORIES, to categorize these prodromal: Metabolism changes, Eye/visual impairments, March (refer to gait disturbances), Olfactory dysfunction, Rhythm (blood pressure and heart rate), Insensitivity of the tongue, Ears (hearing loss), and Stool alterations. Recognizing these prodromal through clinical examinations provides a valuable strategy for initiating preventative actions against brain degeneration. This approach advocates for broadening the screening lens beyond genetic screening to encompass clinical evaluations, enhancing early detection and intervention opportunities for AD.

Epilepsy management in primary healthcare: Knowledge, attitudes, and practices among health professionals in Palestine

BACKGROUND

Primary healthcare practitioners play a key role in the comprehensive care of epilepsy. People with epilepsy require suitable guidance for self-management to enhance their health and well-being. The aim was to evaluate knowledge, attitudes, and practices about epilepsy management among the primary healthcare professionals.

METHODS

Cross-sectional quantitative research was employed. Healthcare professionals working in primary healthcare clinics completed an online, self-administered questionnaire between April and June 2024.

RESULTS

Three hundred valid questionnaires were analyzed. Healthcare professionals demonstrated moderate knowledge, favorable attitudes, and proactive practices in epilepsy management. Pearson's correlation revealed a significant negative relationship between practices and knowledge (r = -0.170, p < 0.01) and a positive association with attitudes (r = 0.279, p < 0.01). Multivariate analysis showed that knowledge were negatively correlated with gender and specialty but positively with educational degree (OR = 0.640, 95 % CI: 1.260-0.020, p = 0.043; OR = 1.970, 95 % CI: 2.841-0.099, p < 0.001). Attitudes were positively associated with age (OR = 2.552, 95 % CI: 0.974-4.130, p = 0.002) and years of experience (OR = 2.387, 95 % CI: 0.546-4.227, p = 0.011).

CONCLUSIONS

Findings indicate gaps in epilepsy knowledge, attitudes, and practices. The study underscores the need for comprehensive training initiatives in Palestine to enhance epilepsy management in primary healthcare settings.

Assessing cognitive impairment in HIV-infected: a comparative study of international HIV Dementia Scale, HIV Dementia Scale Italian version and Montreal cognitive assessment in clinical practice

The combination of antiretroviral therapy (cART) and preventive measures has significantly enhanced the management of Human Immunodeficiency Virus (HIV) infection. However, HIV-associated neurocognitive disorders (HAND) remain a challenge. This study aims to compare cognitive impairment (CI) assessments in people living with HIV/AIDS (PLWHA) using the International HIV Dementia Scale (IHDS), HIV Dementia Scale-Italian Version (HDS-IT) and MoCA (Montreal Cognitive Assessment), while also identifying significant associations. The cross-sectional study encompassed 294 outpatient PLWHA (median age: 57) on cART. Participants underwent cognitive, functional, and depression assessments, laboratory testing and CNS Penetration-Effectiveness (CPE) index assessment. IHDS, HDS-IT and MoCA identified CI in different proportions of PLWHA. Factors such as age, education level, infection duration, and substance use were associated with CI. The IHDS score (OR 0.79) and Level CD4 + T-lymphocytes nadir (OR 0.99) demonstrated independent and negative associations with the CPE-index. IHDS and MoCA tests appear to be useful for detecting CI in outpatient settings, enabling healthcare providers to conduct initial evaluations of PLWHA. IHDS assessment may be used for detecting CI related to high CPE regimens, while the MoCA provides a comprehensive assessment, also in domains not studied by IHDS. However, further research is needed to confirm these findings and refine their clinical applicability.

A potential role for the middle temporal gyrus in mediating pain rumination in patients with chronic pain

Perception of pain offset is essential to free one from any aftereffects of nociception. Because patients with chronic pain show impaired temporal contrast of pain, we tested whether they show slower perception of pain offset after the end of a nociceptive stimulus compared with pain-free subjects. We sought for cerebral correlates for offset and aftereffects of pain using functional magnetic resonance imaging (fMRI). In 19 patients with chronic pain and 15 pain-free subjects, we gave 10 blocks of pain stimuli by a Peltier-type thermal stimulator on the left volar forearm and recorded pain intensity continuously by a visual analogue scale (VAS), while performing whole-brain fMRI. We measured latency to reach "no pain" after stimulus offset (VAS End Latency). We analyzed fMRI signal changes during cessation of pain and made a between-group comparison. Individual parameters were sought for correlations with the rumination score from the Pain Catastrophizing Scale. Patients showed a longer VAS End Latency, and a larger after-pain activity in the left middle temporal gyrus, the right parietal lobule and, after small-volume correction, the right dorsolateral prefrontal cortex than pain-free subjects. Both VAS End Latency and after-pain activity were positively correlated with the rumination score. Psychophysiological interaction analysis revealed that higher rumination scores were associated with weaker coupling between the middle temporal and prefrontal cortices in patients and pain-free subjects with positive rumination scores. We suggest a possible role for the middle temporal gyrus in mediating pain aftereffects and rumination, and its modulation by the prefrontal-temporal network.