Executive function and the frontal lobes: a meta-analytic review

The subcortical role in executive functions: Neural mechanisms of executive inhibition in the flanker task

While executive functions (EFs) have traditionally been linked to the cerebral cortex, our understanding of EFs has evolved with increasing evidence pointing to the involvement of cortico-subcortical networks. Despite the importance of investigating EFs within this broader context, the functional contributions of subcortical regions to these processes remain largely unexplored. This study addresses this gap by specifically examining the involvement of subcortical regions in executive inhibition, as measured by the classic Eriksen flanker task. In this study, we used a stereoscope to differentiate between subcortical (monocular) and cortical (mostly binocular) visual pathways in EF processes. Our findings indicate that monocular visual pathways play a crucial role in representing executive conflict, which necessitates cortical involvement. The persistence of a monoptic advantage in conflict representation highlights the substantial contribution of subcortical regions to these executive processes. This exploration of subcortical involvement in executive inhibition provides valuable insights into the intricate relationships between cortical and subcortical regions in EFs.

Psychosocial and executive functioning late effects in pediatric brain tumor survivors after proton radiation

PURPOSE

Pediatric brain tumor survivors can experience detrimental effects from radiation treatment. This cross-sectional, large cohort study examined late psychosocial and executive functioning effects in pediatric patients treated ≥ 3 years after proton radiation therapy (PRT).

METHODS

Parents of 101 pediatric brain tumor survivors completed the Behavior Assessment System for Children and the Behavior Rating Inventory of Executive Function. Standard scores were compared to published normative means, rates of impairment (T-score > 65) were calculated, and demographic and clinical characteristics were examined.

RESULTS

Mean age at PRT was 8.12 years and mean interval from PRT to assessment was 6.05 years. Half were female (49.5%), 45.5% received craniospinal irradiation (CSI), and 58.4% were diagnosed with infratentorial tumors. All mean T-scores were within normal range. Mean T-scores were significantly elevated compared to the norm on the withdrawal, initiate, working memory, and plan/organize scales. Rates of impairment were notably high in working memory (24.8%), initiate (20.4%), withdrawal (18.1%), and plan/organize (17.0%). Greater withdrawal was significantly associated with CSI and also with chemotherapy and diagnosis of hearing loss. Mean T-scores were significantly lower than the norm on the hyperactivity, aggression, conduct problems, and inhibition scales. No significant problems were identified with social skills or depression. Interval since treatment was not correlated with any scale.

CONCLUSION

Although psychosocial and executive functioning was within the normal range, on average, social withdrawal and metacognitive executive functioning (working memory, initiating, planning/organizing) were areas of concern. Targeted yearly screening and proactive executive skill and social interventions are needed for this population.

tDCS-enhanced cognitive training improves attention and alters connectivity in control and somatomotor networks: A triple blind study

BACKGROUND

Executive dysfunction such as inattention or forgetfulness can lead to disruptions in a person's daily functioning and quality of life.

OBJECTIVE/HYPOTHESIS

This triple-blinded randomized clinical trial assessed the efficacy of bifrontal (over the forehead) transcranial direct current stimulation (tDCS) concurrent with cognitive training to improve cognitive performance in a healthy sample.

METHODS

Fifty-eight participants were randomly assigned to one of three stimulation conditions (2 mA left anode-right cathode, 2 mA right anode-left cathode, or sham), which was administered with cognitive training tasks 3x/week over 12 weeks with assessments at baseline, midpoint (6 weeks), and post-training (12 weeks). We assessed cognitive performance, functional connectivity, and the influence of individual differences in training advancement.

RESULTS

Forty participants completed training. We found that at midpoint and post, all groups improved significantly on overall cognitive performance. The left anode group's attention & vigilance score improved significantly at post, but the other two groups did not. Greater attention training advancement predicted attention improvement by post, most notably in the left anode group. Finally, within-network connectivity decreased in the control network and increased in the somatomotor network across all groups.

CONCLUSIONS

These results suggest that, given cognitive training, the left anode montage is more effective at improving attention than the right anode montage and sham. Future research may focus on the application of the left anode montage during cognitive training to assess its effectiveness in improving cognition in neuropsychiatric disorders.

Cardiac vagal activity changes moderated the association of cognitive and cerebral hemodynamic variations in the prefrontal cortex

Phasic cardiac vagal activity (CVA), reflecting ongoing, moment-to-moment psychophysiological adaptations to environmental changes, can serve as a predictor of individual difference in executive function, particularly executive performance. However, the relationship between phasic CVA and executive function demands requires further validation because of previous inconsistent findings. Moreover, it remains unclear what types of phasic changes of CVA may be adaptive in response to heightened executive demands. This study used the standard N-back task to induce different levels of working memory (WM) load and combined functional Near-Infrared Spectroscopy (fNIRS) with a multipurpose polygraph to investigate the variations of CVA and its interactions with cognitive and prefrontal responses as executive demands increased in fifty-two healthy young subjects. Our results showed phasic decreases in CVA as WM load increased (t (51) = -3.758, p < 0.001, Cohen's d = 0.526). Furthermore, phasic changes of CVA elicited by increased executive demands moderated the association of cognitive and cerebral hemodynamic variations in the prefrontal cortex (B = 0.038, SE = 0.014, p < 0.05). Specifically, as executive demands increased, individuals with larger phasic CVA withdrawal showed a positive relationship between cognitive and hemodynamic variations in the prefrontal cortex (β = 0.281, p = 0.031). No such significant relationship was observed in individuals with smaller phasic CVA withdrawal. The current findings demonstrate a decrease in CVA with increasing executive demands and provide empirical support for the notion that a larger phasic CVA withdrawal can be considered adaptive in situations requiring high executive function demands.

Impacts of conservative treatment on the clinical manifestations of obstructive sleep apnea-systematic review and meta-analysis

INTRODUCTION

Obstructive sleep apnea (OSA) is a chronic disease with a high populational prevalence that is characterized as airway closure during sleep. Treatment is multidisciplinary and varies according to each case. Continuous positive airway pressure (CPAP), oral appliances, and surgery are the primary therapeutic options. Non-invasive conservative treatments such as sleep hygiene, positional therapy, physical exercises, and weight loss aim to reduce the worsening of the disease while being complementary to the invasive primary treatment.

OBJECTIVE

To analyze the impact of non-invasive conservative therapies on the clinical manifestations of OSA syndrome (OSA), compared with other interventions.

METHOD

This was a systematic review with meta-analysis. The searches were performed without filters for the time period, type of publication, or language. Randomized clinical trials on subjects over 18 years of age diagnosed with untreated OSA were included. Responses to non-invasive conservative treatment were compared with responses to the primary intervention. Primary outcomes were assessed using the Epworth Sleepiness Scale and/or Functional Outcomes of Sleep Questionnaire (FOSQ).

RESULTS

A total of eight studies were included in the review. The heterogeneity of the effect was estimated at 89.77%. Six studies compared conservative treatment with CPAP, one with oral appliances, and one with oropharyngeal exercises. Using the Epworth Sleepiness Scale measurements, the standardized difference in the estimated means, based on the random-effects model, was 0.457 (95% CI (1.082 to 0.169)) and the mean result did not differ significantly from zero (z = 1.43; p = 0.153). The conservative therapies assessed in this study improved the subjective quality of sleep, although the post-treatment ESE scores did not show significant results. The reduction in AHI and better outcomes in the evaluated domains, as well as in cognition and mood, were superior in the groups that received CPAP and IOD.

CONCLUSION

The most commonly used treatments of choice for OSA are invasive, including the use of CPAP, oral appliances, and surgeries, being the most utilized options. This study demonstrated that non-invasive conservative treatments, such as sleep hygiene, yield results as effective as invasive treatments. Further studies are needed to confirm this result and to predict whether invasive treatment can be used as the primary treatment or only as a supplement.

Exploring the relationship between manual dexterity and cognition in people with multiple sclerosis: 9-hole peg and multiple cognitive functions

AIM AND RATIONALE

Problems with manual dexterity and cognition impact the everyday performance of people with multiple sclerosis (PwMS). Accumulated findings point to the relationship between deficits in manual dexterity and auditory domains of cognition with a lack of evidence on visuospatial and verbal aspects of cognitive functioning. Therefore, this study explores the relationship between manual dexterity and cognition in a cohort of PwMS.

METHOD

This cross-sectional study collected data from 63 PwMS aged 22 to 55 through a convenient sampling method. Participants were diagnosed with relapsing-remitting multiple sclerosis (RRMS). Cognition was measured using a multi-domain computerized cognitive testing, NeuroTrax, and manual dexterity was measured using a 9-hole peg assessment. Spearman correlation was used to identify the correlation among cognition subtests as well as with manual dexterity. Linear regression analysis was also conducted to identify whether manual dexterity predicts cognitive functioning.

RESULTS

A significant negative correlation was found between 9-hole peg scores and global cognitive scores (GCS), r = -0.34, p = 006. The manual dexterity scores were also shown to predict GCS, R2= 0.165, p = 0.001.

CONCLUSION

Manual dexterity was found to not only predict cognitive dysfunction but was also associated with multiple cognitive domains. Understanding the relationship between manual dexterity and cognition and the inferred progression of deficits can assist clinicians to provide interventions at earlier stages of disease progression to potentially increase daily functioning and quality of life (QoL).

Association of screen-based sedentary behavior with executive function in school-aged children: A functional near-infrared spectroscopy study

Screen-based sedentary behavior (SSB) is a significant risk factor for the health of school-aged children, and guidelines recommend limiting SSB to 2 hr per day. This study aimed to examine association and potential mechanisms between SSB and executive function (EF) by comparing Stroop performance and frontal hemodynamic responses between children with and without excessive SSB. A total of 70 children aged 10 to 15 years were recruited and divided into two groups: excessive screen time (≥2 hr/day; n = 35; ES group) and normal screen time (<2 hr/day; n = 35; NS group). The Chinese version of the Adolescent Sedentary Activities Questionnaire was used to assess SSB, whereas EF was evaluated using the Stroop task. The frontal hemodynamic responses during the Stroop task were measured using functional near-infrared spectroscopy. The results indicated that the ES group had lower accuracy, longer reaction times, and greater activation in the bilateral dorsolateral prefrontal cortex (DLPFC) and left pre-supplementary motor area (Pre-SMA) compared with the NS group. Furthermore, significant correlations were observed between Stroop performance and cortical activation in the left DLPFC and Pre-SMA. These findings demonstrate that excessive SSB is associated with poor EF, which may be explained by a decrease in neural efficiency of the left DLPFC and Pre-SMA.

Errorful learning improves recognition memory for new vocabulary for people living with memory and dysexecutive impairment following brain injury

A widely accepted view is that errorless learning is essential for supporting new learning in people with anterograde amnesia, but findings are mixed for those with a broader range of memory impairments. People at a chronic stage of recovery from brain injury (BI) with impaired memory and executive function (N = 26) were compared with adults in a comparison group without any known risks to brain function (N = 25). Learning techniques were compared using a "Generate-and-correct" and "Read-only" condition when learning novel word pairs. At test, both groups scored above chance and showed benefits of Generate-and-correct (errorful learning). Poor learners in the BI group were classified from "flat" learning slopes extracted from an independent word-pair learning task. Critically, poor learners showed no benefit, but also no decrement to learning, using the Generate-and-correct method. No group was harmed by errorful learning; all, except the poorest learners, benefitted from errorful learning. This study indicates, that in some rehabilitation settings, encouraging clients to guess the meaning of unfamiliar material (e.g., from cards, magazines, newspapers) and then correct their errors, could have benefits for recognition memory. Determining when and how errorful learning benefits learning is a key aim for future research.

Exploring behavioural and cognitive dysexecutive syndrome in patients with focal prefrontal cortex damage

This study's objectives were to characterize the frequency and profile of behavioral and cognitive dysexecutive syndromes in patients with focal prefrontal cortex damage and how these syndromes overlap. We also examined the contribution of the prefrontal brain regions to these syndromes. Therefore, thirty patients with prefrontal cortex damage and thirty control subjects were compared on their performances using the GREFEX battery assessing the dysexecutive syndromes. The results showed that combined behavioral and cognitive dysexecutive syndrome was observed in 53.33%, while pure cognitive dysexecutive syndrome was observed in 20% and behavioral in 26.67%. Also, almost all behavioral and cognitive dysexecutive disorders discriminated frontal patients from controls. Moreover, correlations and regression analyses between task scores in both domains of dysexecutive syndromes showed that the spectrum of behavioral disorders was differentially associated with cognitive impairment of initiation, inhibition, generation, deduction, coordination, flexibility and the planning process. Furthermore, the patterns of cognitive and behavioral dysexecutive syndrome were both predictors of impairment in daily living activities and loss of autonomy. Finally, frontal regions contributing to different dysexecutive syndromes assessed by MRI voxel lesion symptom analysis indicate several overlapping regions centered on the ventromedial and dorsomedial prefrontal cortex for both domains of dysexecutive syndrome. This study concludes that damage to the frontal structures may lead to a diverse set of changes in both cognitive and behavioral domains which both contribute to loss of autonomy. The association of the ventromedial and dorsomedial prefrontal regions to both domains of dysexecutive syndrome suggests a higher integrative role of these regions in processing cognition and behavior.

Advanced Cognitive Patterns in Multiple System Atrophy Compared to Parkinson's Disease: An Individual Diffusion Tensor Imaging Study

RATIONALE AND OBJECTIVES

Although both Multiple system atrophy (MSA) and Parkinson's disease (PD) belong to alpha-synucleinopathy, they have divergent clinical courses and prognoses. The degeneration of white matter has a considerable impact on cognitive performance, yet it is uncertain how PD and MSA affect its functioning in a similar or different manner.

METHODS

In this study, a total of 116 individuals (37 PD with mild cognitive impairment (PD-MCI), 37 MSA (parkinsonian variant) with mild cognitive impairment (MSA-MCI), and 42 healthy controls) underwent diffusion tensor imaging (DTI) and cognitive assessment. Utilizing probabilistic fiber tracking, association fibers, projection fibers, and thalamic fibers were reconstructed. Subsequently, regression, support vector machine, and SHAP (Shapley Addictive exPlanations) analyzes were conducted to evaluate the association between microstructural diffusion metrics and multiple cognitive domains, thus determining the white matter predictors of MCI.

RESULTS

MSA-MCI patients exhibited distinct white matter impairment extending to the middle cerebellar peduncle, corticospinal tract, and cingulum bundle. Furthermore, the fractional anisotropy (FA) and mean diffusivity (MD)values of the right anterior thalamic radiation were significantly associated with global efficiency (FA: B = 0.69, P < 0.001, VIF = 1.31; MD: B = -0.53, P = 0.02, VIF = 2.50). The diffusion metrics of white matter between PD-MCI and MSA-MCI proved to be an effective predictor of the MCI, with an accuracy of 0.73 (P < 0.01), and the most predictive factor being the MD of the anterior thalamic radiation.

CONCLUSIONS

Our results demonstrated that MSA-MCI had a more noticeable deterioration in white matter, which potentially linked to various cognitive domain connections. Diffusion MRI could be a useful tool in comprehending the neurological basis of cognitive impairment in Parkinsonian disorders.

Shared and Distinct Neurobiological Bases of Bipolar Disorder and Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: A Comparative Meta-Analysis of Structural Abnormalities

OBJECTIVE

Pediatric bipolar disorder (PBD) and attention-deficit/hyperactivity disorder (ADHD) frequently co-occur and share dysfunctions in affective and cognitive domains. As the neural substrates underlying their overlapping and dissociable symptomatology have not been well delineated, a meta-analysis of whole-brain voxel-based morphometry studies in PBD and ADHD was conducted.

METHOD

A systematic literature search was performed in PubMed, Web of Science, and Embase. The seed-based d mapping toolbox was used to identify altered clusters of PBD or ADHD and obtain their conjunctive and comparative abnormalities. Suprathreshold patterns were subjected to large-scale network analysis to identify affected brain networks.

RESULTS

The search revealed 10 PBD studies (268 patients) and 32 ADHD studies (1,333 patients). Decreased gray matter volumes in the right insula and anterior cingulate cortex relative to typically developing individuals were conjunctive in PBD and ADHD. Reduced volumes in the right inferior frontal gyrus, left orbitofrontal cortex, and hippocampus were more substantial in PBD, while decreased volumes in the left precentral gyrus, left inferior frontal gyrus, and right superior frontal gyrus were more pronounced in ADHD. Neurodevelopmental effects modulated patterns of the left hippocampus in PBD and those of the left inferior frontal gyrus in ADHD.

CONCLUSION

These findings suggest that PBD and ADHD are characterized by both common and distinct patterns of gray matter volume alterations. Their overlapping abnormalities may represent a transdiagnostic problem of attention and emotion regulation shared by PBD and ADHD, whereas the disorder-differentiating substrates may contribute to the relative differences in cognitive and affective features that define the 2 disorders.

PLAIN LANGUAGE SUMMARY

Pediatric bipolar disorder (BD) and attention-deficit/hyperactivity disorder (ADHD) frequently co-occur, with overlapping changes in emotional and cognitive functioning. This meta-analysis summarizes findings from 10 articles on BD and 32 articles on ADHD to identify similarities and differences in brain structure between youth with BD and youth with ADHD. The authors found that both disorders share decreased gray matter volumes in the right insula and anterior cingulate cortex, which play important roles in emotion processing and attention, respectively. Youth with BD had decreased gray matter volume in the right inferior frontal gyrus, left orbitofrontal gyrus, and left hippocampus, while youth with ADHD had decreased volumes in the left precentral gyrus, left inferior frontal gyrus, and right superior frontal gyrus.

STUDY PREREGISTRATION INFORMATION

Structural Brain Abnormalities of Attention-Deficit/Hyperactivity Disorder and Bipolar Disorder in Children/Adolescents: An Overlapping Meta-analysis; https://osf.io; trg4m.

An embarrassment of richnesses: the PFC isn't the content NCC

Recent years have seen the rise of several theories saying that the prefrontal cortex (PFC) is a neural correlate of visual consciousness (NCC). Especially popular here are theories saying that the PFC is the 'content NCC' for vision, i.e. it contains those brain areas that are not only necessary for consciousness, but also determine 'what' it is that we visually experience (e.g. whether we experience green or red). This article points out how this "upper-deck" form of PFC theory is at odds with the character of visual experience: on the one hand, visual consciousness appears to contain copious amounts of content, with many properties (such as object, shape, or color) being simultaneously represented in many parts of the visual field. On the other hand, the functions that the PFC carries out (e.g. attention and working memory) are each dedicated to processing only a relatively small subset of available visual stimuli. In short, the PFC probably does not produce enough or the right kind of visual representations for it to supply all of the content found in visual experience, in which case the idea that the PFC is the content NCC for vision is probably false. This article also discusses data thought to undercut the idea that visual experience is informationally rich (inattentional blindness, etc.), along with theories of vision according to which "ensemble statistics" are used to represent features in the periphery of the visual field. I'll argue that these lines of evidence fail to close the apparently vast gap between the amount of visual content represented in the visual experience and the amount represented in the PFC.

Trait Impulsivity as a Feature of Parkinson's Disease Treatment and Progression

Heightened trait impulsivity in both subclinical and pathological senses is becoming increasingly recognised in Parkinson's disease (PD). Impulsive behaviours and impulse control disorders (ICDs) are a consequence of perturbation to the rewards pathway leading individuals to conduct activities in a repetitive, excessive, and maladaptive fashion. Commonly linked to PD, heightened trait impulsivity has been found to primarily manifest in the forms of hypersexuality, pathological gambling, compulsive shopping, and binge eating, all of which may significantly impact social and financial standing. Subsequent burden to quality of life for both individuals with PD and caregivers are common. Although risk factors and indicators for ICDs in PD are currently lacking, it is recognised that the condition is often precipitated by dopamine replacement therapies, primarily dopamine agonist administration. While this nonmotor symptom is being increasingly diagnosed in PD populations, it remains relatively elusive in comparison to its motor counterparts. Through discussion of impulsivity characteristics, neuroanatomy, and neurochemistry, in addition to reviewing existing research on the potential contributing factors to impulsivity in PD, this review highlights impulsivity as a significant and detrimental PD symptom. Thus, emphasising the imperative need to establish efficacious diagnostic tools and treatments.

Motoric Cognitive Risk Syndrome as a Predictor of Adverse Health Outcomes: A Systematic Review and Meta-Analysis

INTRODUCTION

Motoric cognitive risk syndrome (MCR) is a newly proposed pre-dementia syndrome characterized by subjective cognitive complaints (SCCs) and slow gait (SG). Increasing evidence links MCR to several adverse health outcomes, but the specific relationship between MCR and the risk of frailty, Alzheimer's disease (AD), and vascular dementia (VaD) remains unclear. Additionally, literature lacks analysis of MCR's components and associated health outcomes, complicating risk identification. This systematic review and meta-analysis aimed to provide a comprehensive overview of MCR's predictive value for adverse health outcomes.

METHODS

Relevant cross-sectional, cohort, and longitudinal studies examining the association between MCR and adverse health outcomes were extracted from ten electronic databases. The Newcastle-Ottawa Scale (NOS) and modified NOS were used to assess the risk of bias in studies included in the analysis. Relative ratios (RRs) and 95% confidence intervals (CIs) were pooled for outcomes associated with MCR.

RESULTS

Twenty-eight longitudinal or cohort studies and four cross-sectional studies with 1,224,569 participants were included in the final analysis. The risk of bias in all included studies was rated as low or moderate. Pooled analysis of RR indicated that MCR had a greater probability of increased the risk of dementia (adjusted RR = 2.02; 95% CI = 1.94-2.11), cognitive impairment (adjusted RR = 1.72; 95% CI = 1.49-1.99), falls (adjusted RR = 1.32; 95% CI = 1.17-1.50), mortality (adjusted RR = 1.66; 95% CI = 1.32-2.10), and hospitalization (adjusted RR = 1.46; 95% CI = 1.16-1.84); MCR had more prominent predictive efficacy for AD (adjusted RR = 2.23; 95% CI = 1.81-2.76) compared to VaD (adjusted RR = 3.78; 95% CI = 0.49-28.95), while excluding analyses from the study that utilized the timed-up-and-go test and one-leg-standing to evaluate gait speed. One study examined the association between MCR and disability (hazard ratios [HR] = 1.69; 95% CI = 1.08-2.02) and frailty (OR = 5.53; 95% CI = 1.46-20.89). SG was a stronger predictor of the risk for dementia and falls than SCC (adjusted RR = 1.22; 95% CI = 1.11-1.34 vs. adjusted RR = 1.19; 95% CI = 1.03-1.38).

CONCLUSION

MCR increases the risk of developing any discussed adverse health outcomes, and the predictive value for AD is superior to VaD. Additionally, SG is a stronger predictor of dementia and falls than SCC. Therefore, MCR should be routinely assessed among adults to prevent poor prognosis and provide evidence to support future targeted interventions.

Long-term cognitive and neurovascular changes after carotid endarterectomy

BACKGROUND

Carotid endarterectomy (CEA) has been associated with both cognitive decline and improvement, but the underlying neurovascular mechanisms are unclear. The aim of this study was to investigate the relationship between neurovascular indices and cognitive changes after CEA.

METHODS

We studied 55 patients with severe (≥70%) symptomatic or asymptomatic carotid stenosis before and six months after CEA. A wide array of neuropsychological tests was arranged in eight cognitive domains and cognitive functions specific to hemisphere ipsilateral to operation. Differences in cognitive performance between patients and 38 matching healthy controls were studied with linear mixed models. Neurovascular functioning and microembolic signals were assessed with transcranial Doppler ultrasound of the middle cerebral artery. Associations between neurovascular indices and cognitive change were assessed with linear regression analyses.

RESULTS

On group level, the CEA patients improved more than controls in working memory, whereas no cognitive deterioration was detected. Also on individual level, improvement was most frequently observed in working memory. Worse preoperative cerebrovascular reactivity was related with improvement in cognitive functions of the ipsilateral hemisphere. Low preoperative pulsatility index was associated with improvement in executive functioning and ipsilateral cognitive functions. Poorer preoperative blood flow velocity associated with improvement in complex attention. Microembolic signals were rare.

CONCLUSION

The present findings suggest that CEA may have beneficial long-term effects on cognition. These effects may specifically involve patients with impaired preoperative circulatory adaptive mechanisms.

Childhood trauma moderates schizotypy-related brain morphology: analyses of 1182 healthy individuals from the ENIGMA schizotypy working group

BACKGROUND

Schizotypy represents an index of psychosis-proneness in the general population, often associated with childhood trauma exposure. Both schizotypy and childhood trauma are linked to structural brain alterations, and it is possible that trauma exposure moderates the extent of brain morphological differences associated with schizotypy.

METHODS

We addressed this question using data from a total of 1182 healthy adults (age range: 18-65 years old, 647 females/535 males), pooled from nine sites worldwide, contributing to the Enhancing NeuroImaging Genetics through Meta-Analysis (ENIGMA) Schizotypy working group. All participants completed both the Schizotypal Personality Questionnaire Brief version (SPQ-B), and the Childhood Trauma Questionnaire (CTQ), and underwent a 3D T1-weighted brain MRI scan from which regional indices of subcortical gray matter volume and cortical thickness were determined.

RESULTS

A series of multiple linear regressions revealed that differences in cortical thickness in four regions-of-interest were significantly associated with interactions between schizotypy and trauma; subsequent moderation analyses indicated that increasing levels of schizotypy were associated with thicker left caudal anterior cingulate gyrus, right middle temporal gyrus and insula, and thinner left caudal middle frontal gyrus, in people exposed to higher (but not low or average) levels of childhood trauma. This was found in the context of morphological changes directly associated with increasing levels of schizotypy or increasing levels of childhood trauma exposure.

CONCLUSIONS

These results suggest that alterations in brain regions critical for higher cognitive and integrative processes that are associated with schizotypy may be enhanced in individuals exposed to high levels of trauma.

Excessive daytime sleepiness in young and middle-aged Chinese adults with obstructive sleep apnea: implications for cognitive dysfunction

OBJECTIVE

The objective of this study was to investigate the effects of excessive daytime sleepiness (EDS) on cognitive function among Chinese young and middle-aged Chinese patients with obstructive sleep apnea (OSA).

METHODS

Chinese adults struggling from moderate to severe OSA with apnea-hypopnea index (AHI) ≥ 15 events per hour and adults with primary snoring and mild OSA (AHI < 15 events per hour) were included in the study. The Epworth Sleepiness Scale measured hypersomnia, and cognitive function was assessed using the Mini-mental State Examination (MMSE) and Montreal Cognitive Assessment (MOCA).

RESULTS

In comparison to the primary snoring and mild OSA group (n=635), the moderate to severe OSA group (n=1423) tended to be older men with higher scores on the Epworth Sleepiness Scale (ESS), as well as higher levels of oxygen desaturation (ODI) and a higher body mass index (BMI). Patients with moderate to severe OSA had fewer years of education, lower minimum arterial oxygen saturation (min-SaO2), and more severe sleep disturbances, such as decreased slow wave sleep (SWS) and rapid eye movement (REM) and increased non-REM stages (N1 and N2). Comorbid conditions such as hypertension and diabetes mellitus were more common in these patients (P < 0.01 and P < 0.05, accordingly). Only the delayed recall scores were statistically lower in the moderate to severe OSA group than the primary snoring and mild OSA group (P < 0.05). The main factor associated with delayed recall was the ESS score rather than age or years of education among moderate-severe OSA patients ≤ 40 years of age (P < 0.05). After controlling for potential confounding factors such as age, gender, BMI, education, hypertension, diabetes, sleep stages (SWS and REM), minimum arterial oxygen saturation (min-SaO2), oxygen ODI, and AHI, there was a negative correlation between the Epworth Sleepiness Scale (ESS) score and the delayed recall scores.

CONCLUSION

Patients with moderate to severe OSA had cognitive dysfunction, particularly impairment of delayed recall. Excessive daytime sleepiness (EDS) was significantly associated with cognitive dysfunction in young and middle-aged patients with OSA.

SARS-CoV-2's brain impact: revealing cortical and cerebellar differences via cluster analysis in COVID-19 recovered patients

BACKGROUND

COVID-19 is a disease known for its neurological involvement. SARS-CoV-2 infection triggers neuroinflammation, which could significantly contribute to the development of long-term neurological symptoms and structural alterations in the gray matter. However, the existence of a consistent pattern of cerebral atrophy remains uncertain.

OBJECTIVE

Our study aimed to identify patterns of brain involvement in recovered COVID-19 patients and explore potential relationships with clinical variables during hospitalization.

METHODOLOGY

In this study, we included 39 recovered patients and 39 controls from a pre-pandemic database to ensure their non-exposure to the virus. We obtained clinical data of the patients during hospitalization, and 3 months later; in addition we obtained T1-weighted magnetic resonance images and performed standard screening cognitive tests.

RESULTS

We identified two groups of recovered patients based on a cluster analysis of the significant cortical thickness differences between patients and controls. Group 1 displayed significant cortical thickness differences in specific cerebral regions, while Group 2 exhibited significant differences in the cerebellum, though neither group showed cognitive deterioration at the group level. Notably, Group 1 showed a tendency of higher D-dimer values during hospitalization compared to Group 2, prior to p-value correction.

CONCLUSION

This data-driven division into two groups based on the brain structural differences, and the possible link to D-dimer values may provide insights into the underlying mechanisms of SARS-COV-2 neurological disruption and its impact on the brain during and after recovery from the disease.

High peak drinking levels mediate the relation between impulsive personality and injury risk in emerging adults

BACKGROUND

Alcohol-induced injury is one of the leading causes of preventable morbidity and mortality. We investigated the relationship between impulsive personality and physical injury (e.g. falls, sports), and whether peak drinking quantity specifically, and/or risky behaviour more generally, mediates the relationship between impulsivity and injury in undergraduates.

METHOD

We used data from the winter 2021 UniVenture survey with 1316 first- and second-year undergraduate students aged 18-25 years (79.5% female) from five Canadian Universities. Students completed an online survey regarding their demographics, personality, alcohol use, risky behaviours, and injury experiences. Impulsivity was measured with the substance use risk profile scale, past 30-day peak alcohol use with the quantity-frequency-peak Alcohol Use Index, general risky behaviour with the risky behaviour questionnaire, and past 6-month injury experience with the World Health Organization's (2017) injury measurement questionnaire.

RESULTS

Of 1316 total participants, 12.9% (n = 170) reported having sustained a physical injury in the past 6 months. Mean impulsivity, peak drinking quantity, and risky behaviour scores were significantly higher among those who reported vs. did not report injury. Impulsivity and peak drinking quantity, but not general risky behaviour, predicted injury in a multi-level generalized mixed model. Mediation analyses supported impulsivity as both a direct predictor of physical injury and an indirect predictor through increased peak drinking (both p < .05), but not through general risky behaviour.

CONCLUSION

Results imply emerging adults with impulsive tendencies should be identified for selective injury prevention programs and suggest targeting their heavy drinking to decrease their risk for physical injury.

Examining the effects of exercise with different cognitive loads on executive function: A systematic review

Executive functions (EFs) play a pivotal role in daily functioning, academic and vocational achievement, well-being, and the regulation of cognitive processes that impact the quality of life. Physical exercise has been shown to have positive effects on EFs. However, there remains some controversy regarding whether exercise with greater cognitive loads may be more effective for improving EFs. Through this systematic review, we aimed to synthesize available cross-sectional and longitudinal intervention studies concerning the effects of exercise with varying cognitive loads on EFs. The literature search was conducted across three electronic databases, retrieving cross-sectional and longitudinal intervention (randomized controlled trials) studies, using a standardized EF measurement from inception until June 2023. Our search yielded a total of 1570 potentially relevant articles, of which 53 were considered for full-text reading, and 28 were included in the review after full-text reading. The present study utilized Gentile's (2000) taxonomy classification to determine the cognitive load levels in exercises. Overall, findings from the 28 included studies suggested that exercise training interventions are a promising way to promote overall EF. Noteworthy, there is preliminary empirical evidence to suggest that exercises with higher cognitive loads resulted in greater benefits for EF than those with lower cognitive loads.

Different neurocognitive controls modulate obstacle avoidance through pregnancy

Understanding why falls during pregnancy occur at over 25% rate over gestation has clinical impacts on the health of pregnant individuals. Attention, proprioception, and perception of the environment are required to prevent trips and falls. This research aimed to understand how the changes to these neurocognitive processes control obstacle avoidance through gestation. Seventeen pregnant participants were tested five times in 6-week intervals. Participants walked an obstacle course (OC), and we analyzed the crossings over obstacles that were set to 10% of participants' body height. Participants also performed an attentional network test (ANT: performance of specific components of attention), an obstacle perception task (OP: ability to visually define an obstacle and translate that to a body posture), and a joint position sense task (JPS: ability to recognize and recreate a joint position from somatosensation). In the OC task, average leading and trailing foot crossing heights significantly reduced by 13% and 23% respectively, with no change in variation, between weeks 13 and 31 of pregnancy, indicating an increased risk of obstacle contact during this time. The variability in minimum leading foot distances from the obstacle was correlated with all three neurocognition tasks (ANT, OP, and JPS). Increased fall rates in the second and third trimesters of pregnancy may be driven by changes in attention, with additional contributions of joint position sense and environmental perception at various stages of gestation. The results imply that a holistic examination on an individual basis may be required to determine individual trip risk and appropriate safety modifications.

Nightmare experiences and perceived ethnic discrimination amongst female university students in the United Arab Emirates: a cross-sectional study

Perceived ethnic discrimination is known to be associated with anxiety and depression, and in turn, anxiety and depression are known to be associated with nightmare frequency and distress. This elicits a question: is perceived ethnic discrimination associated with nightmare frequency and distress? In this study, 179 female university students from the United Arab Emirates were assessed to answer that question. Results showed that while anxiety and depression were related to nightmare experiences, perceived ethnic discrimination was a stronger predictor of nightmare experiences. We posit two explanations for this finding: one based on psychoanalytical insights, and the other based on the Disposition-Stress model with neurobiological correlates. No significant differences were found across ethnicity when it comes to nightmare experiences or perceived ethnic discrimination. This is an encouraging sign of optimal societal integration in the United Arab Emirates.

Baseline Frontoparietal Gray Matter Volume Predicts Executive Function Performance in Aging and Mild Cognitive Impairment at 24-Month Follow-Up

Background

Executive dysfunction in mild cognitive impairment (MCI) has been associated with gray matter atrophy. Prior studies have yielded limited insight into associations between gray matter volume and executive function in early and late amnestic MCI (aMCI).

Objective

To examine the relative importance of predictors of executive function at 24 months and relationships between baseline regional gray matter volume and executive function performance at 24-month follow-up in non-demented older adults.

Methods

147 participants from the Alzheimer's Disease Neuroimaging Initiative (mean age = 70.6 years) completed brain magnetic resonance imaging and neuropsychological testing and were classified as cognitively normal (n = 49), early aMCI (n = 60), or late aMCI (n = 38). Analyses explored the importance of demographic, APOEɛ4, biomarker (p-tau/Aβ42, t-tau/Aβ42), and gray matter regions-of-interest (ROI) variables to 24-month executive function, whether ROIs predicted executive function, and whether relationships varied by baseline diagnostic status.

Results

Across all participants, baseline anterior cingulate cortex and superior parietal lobule volumes were the strongest predictors of 24-month executive function performance. In early aMCI, anterior cingulate cortex volume was the strongest predictor and demonstrated a significant interaction such that lower volume related to worse 24-month executive function in early aMCI. Educational attainment and inferior frontal gyrus volume were the strongest predictors of 24-month executive function performance for cognitively normal and late aMCI groups, respectively.

Conclusions

Baseline frontoparietal gray matter regions were significant predictors of executive function performance in the context of aMCI and may identify those at risk of Alzheimer's disease. Anterior cingulate cortex volume may predict executive function performance in early aMCI.

Assessment of cognitive function and sleep-wake rhythms in community-dwelling older adults

Disruption of the circadian rhythm and sleep-wake cycles is a consequence of aging and is associated with the cognitive decline and many neurodegenerative conditions. We investigated the bedtime, wake-up time, sleep timing (midpoint between bedtime and wake-up time), and sleep timing standard deviation (SD) using the actigraphy among 80 consecutive volunteers aged ≥ 60 years. Global cognitive function and executive function of detailed cognitive domains were evaluated using the mini-mental state examination (MMSE) and Wisconsin card sorting test (WCST) and subjective daytime sleepiness was assessed using the Epworth Sleepiness Scale (ESS). The category achievement (CA), total errors (TE), perseverative errors of Nelson (PEN), non-perseverative errors (NPE), and difficulties in maintaining set (DMS) on the WCST were significantly correlated with sleep timing SD (CA: r = - 0.276, p = 0.013, TE: r = 0.311, p = 0.005, PEN: r = 0.241, p = 0.032, NPE: r = 0.250, p = 0.025, DMS: r = 0.235, p = 0.036), but not with the MMSE score. Multiple regression analyses with the stepwise forward selection method including age, ESS score, bedtime, sleep timing, and sleep timing SD, revealed that the ESS score, and sleep timing SD were significant factors related to CA on the WCST (ESS score: β = - 0.322, p = 0.004; sleep timing SD: β = - 0.250, p = 0.022). Assessment of sleep-wake rhythms, daytime sleepiness, and cognitive function using the MMSE and WCST is valuable for the prediction of cognitive decline in the geriatric population.

Cerebral perfusion differences are linked to executive function performance in very preterm-born children and adolescents

Children and adolescents born very preterm are at risk of cognitive impairment, particularly affecting executive functions. To date, the neural correlates of these cognitive differences are not yet fully understood, although converging evidence points to a pattern of structural and functional brain alterations, including reduced brain volumes, altered connectivity, and altered brain activation patterns. In very preterm neonates, alterations in brain perfusion have also been reported, but the extent to which these perfusion alterations persist into later childhood is not yet known. This study evaluated global and regional brain perfusion, measured with arterial spin labelling (ASL) MRI, in 26 very preterm children and adolescents and 34 term-born peers. Perfusion was compared between groups and relative to executive function (EF) scores, derived from an extensive EF battery assessing working memory, cognitive flexibility, and planning. Very preterm children and adolescents showed regions of altered perfusion, some of which were also related to EF scores. Most of these regions were located in the right hemisphere and included regions like the thalamus and hippocampus, which are known to play a role in executive functioning and can be affected by prematurity. In addition, perfusion decreased with age during adolescence and showed a significant interaction between birth status and sex, such that very preterm girls showed lower perfusion than term-born girls, but this trend was not seen in boys. Taken together, our results indicate a regionally altered perfusion in very preterm children and adolescents, with age and sex related changes during adolescence.

Relationship between cognitive function and brain activation in major depressive disorder patients with and without insomnia: A functional near-infrared spectroscopy (fNIRS) study

BACKGROUND

Patients with major depressive disorder (MDD) frequently present with sleep disturbances and cognitive impairment. The purpose of this study was to investigate whether cognitive impairment is more severe in MDD patients with insomnia, and the underlying neural mechanisms.

METHODS

A total of 41 MDD patients with insomnia and 43 MDD patients without insomnia were recruited. We used functional near-infrared spectroscopy (fNIRS) to assess changes in oxyhemoglobin (Oxy-Hb) concentrations in the brain of patients while performing a verbal fluency task (VFT). Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI), cognitive function by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and severity of depression by the Hamilton Depression Scale (HAMD).

RESULTS

Compared to MDD patients without insomnia, those with insomnia had lower scores on the RBANS total and immediate memory, visuospatial/constructional, and delayed memory subscales, as well as lower oxy-Hb concentrations in the bilateral dorsolateral prefrontal cortex (DLPFC) and bilateral medial prefrontal cortex (mPFC).Further correlation analysis showed that there was a significant correlation between the RBANS total score in all brain regions except left mPFC in MDD patients with insomnia(all p < 0.05). Further multiple linear regression showed that Oxy-Hb concentrations of left DLPFC were independently associated with RBANS total score.

CONCLUSION

Our study suggests that MDD patients with insomnia have more cognitive impairment, which is associated with impaired frontal brain activity. Our findings may provide new insights to understand the underlying neural mechanisms of both disorders MDD patients and provide potential clinical value for developing treatment strategies for insomnia in MDD patients.

Psychometric properties of the Behavior Rating Inventory of Executive Function, second edition (BRIEF2) self-report form in Iranian adolescents

BACKGROUND

This study investigated the psychometric properties of a Persian translation of the Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2) Self-Report form.

METHOD

Participants were 589 typically developing adolescents (336 girls and 253 boys), ages 11-18 years old (M = 15.16; SD = 2.04), in Iran. They completed the Persian version of the BRIEF2 Self-Report form and Teenage Executive Functioning Inventory (TEXI). The Persian translated BRIEF2 psychometric properties were examined via internal consistency, test-retest reliability, convergent validity via associations with TEXI scores, and internal structure using structural equation modeling (SEM) to evaluate fit of the three-factor structure from the original English version BRIEF2.

RESULTS

Findings indicated the Persian version of BRIEF2 Self-Report form yielded scores with robust reliability, with internal consistency ranging from .87 to .93 and test-retest correlations ranging from .89 to .96, and adequate convergent validity, with correlations with the TEXI ranging from .48 to .79. SEM revealed that a three-factor solution was the best fitting model for the seven subscales of the Persian BRIEF2.

CONCLUSION

These findings support the clinical use of the Persian BRIEF2 in Iranian adolescents, including the interpretation of the BRIEF2 three-factor structure, as well as the multidimensional nature of executive functions.

The Effects of Digital Addiction on Brain Function and Structure of Children and Adolescents: A Scoping Review

The escalating prevalence of studies investigating digital addiction (DA) and its detrimental impact on the human brain's structure and functionality has been noticeable in recent years. Yet, an overwhelming majority of these reviews have been predominantly geared towards samples comprising college students or adults and have only inspected a single variant of DA, such as internet gaming disorder, internet addiction disorder, problematic smartphone use, tablet overuse, and so forth. Reviews focusing on young children and adolescents (ages 0-18), or those which amalgamate various types of DA, are decidedly scarce. Given this context, summarizing the effects of DA on brain structure and functionality during the vital developmental stage (0-18 years) is of immense significance. A scoping review, complying with the PRISMA extension for such reviews, was conducted to amalgamate findings from 28 studies spanning a decade (2013-2023) and to examine the influence of assorted forms of DA on the brains of children and adolescents (0-18 years). The synthesized evidence indicated two primary results: (1) DA exerts harmful effects on the structure and functionality of the brains of children and adolescents, and (2) the prefrontal lobe is the region most consistently reported as impacted across all research. Furthermore, this review discerned a notable void of studies investigating the neural indices of digital addiction, along with a shortage of studies focusing on young children (0-6 years old) and longitudinal evidence. This research could provide the necessary theoretical basis for the thwarting and intervention of digital addiction, a measure indispensable for ensuring healthy brain development in children and adolescents.

Intelligence-Dependent Differential Effects of Media Exposure on Executive Function Changes in Children: A Population-Based Cohort Study With a Longitudinal Design

BACKGROUND

Excessive media use is known to be associated with executive dysfunction in children, but it's unclear whether this exposure can lead to long-term changes of executive function. This study aimed to investigate the association between media exposure and longitudinal changes in executive function within a population-based study, while considering the potential influence of intelligence.

METHODS

This study used data from 1,209 participants in the Panel Korea Study for Children. The children's media exposure was measured at ages 7 and 8, and executive function was evaluated annually from ages 7 to 10 using the Executive Function Difficulty Screening Questionnaire. Participants were grouped by media exposure level (low, medium, or high), and longitudinal changes in executive function were analyzed using linear mixed effects models. Subgroup analysis was conducted to investigate how executive function changes varied based on intelligence within each media exposure group.

RESULTS

Children with high media exposure (n = 97) had severer executive function difficulties than those with low (n = 141) or medium (n = 971) exposure in all waves. The high exposure group demonstrated persistent higher executive function difficulties up to age 10 after controlling for child gender, intelligence, parental education level and maternal depression. Children with intelligence quotient (IQ) ≤ 100 in the medium to high media exposure group had significantly more severe executive function difficulties than those with IQ > 100.

CONCLUSION

This study provided evidence of a longitudinal negative association between media exposure and executive function. The findings suggest that excessive media exposure may lead to long-term changes in executive function in children and highlight the importance of implementing targeted interventions and educational strategies to mitigate the potential negative effects of excessive media use, particularly for children with lower cognitive abilities.

Effect of temperature reduction of the prefrontal area on accuracy of visual sustained attention

Objectives. Detection of sensitive signs in many work environments with automated systems (aviation industry, flight safety tower, maritime industry, monitoring in the military industry, etc.) is essential and requires constant visual attention. Therefore, the aim of this study was to investigate the effect of forehead cooling on the accuracy of stable visual attention. Methods. This interventional study was performed on 34 male students. The sampling method was a randomized block design. Subjects were assessed by demographic questionnaire, Snellen chart, Spielberger state-trait anxiety inventory (STAI) and physiological and cognitive measurements. Results. Prefrontal cortex (PFC) cooling caused significant changes in sublingual temperature during four measurements in the intervention group. There were no significant changes in heart rate, diastolic blood pressure and saturation of peripheral oxygen (%SpO2) between the two groups. The critical flicker frequency (CFF) as an indicator of cognitive fatigue showed that cognitive improvement after PFC cooling occurred following a reduction in cognitive fatigue. Conclusions. Considering the importance of choosing non-invasive methods to improve the operator's cognitive skills while performing cognitive tasks in the field of neuroergonomics, it can be concluded that PFC cooling is an effective and safe way to improve some cognitive skills such as visual attention.

Cognitive Deficits in Executive and Language Functions Predict Postoperative Delirium

OBJECTIVES

Postoperative delirium (POD) remains the most common complication in older adults, with cognitive impairment being the main risk factor. Patients with mild cognitive impairment, in particular, have much to lose from delirium; despite this, their cognitive impairment might be clinically overlooked. Understanding which cognitive domains are particularly predictive in this regard may improve the sensitivity of preoperative testing and allow for a more targeted application of resource-intensive measures to prevent delirium in the perioperative period. The authors conducted this study with the aim of identifying the most indicative cognitive domains.

DESIGN

A secondary analysis of a randomized controlled trial.

SETTING

At a single center, the University Medical Centre Hamburg in Hamburg, Germany.

PARTICIPANTS

Patients ≥60 years without major neurocognitive disorders (dementia, Mini-Mental State Examination score ≤23) scheduled for cardiovascular surgery.

MEASUREMENTS AND MAIN RESULTS

Preoperative neuropsychologic testing and delirium screening were performed twice daily until postoperative day 5. A multiple logistic regression model was applied to determine the predictive ability of test performances for the development of delirium.

RESULTS

A total of 541 patients were included in the analysis; the delirium rate was 15.6%. After controlling for confounders, only low performance within the Trail Making Test B/A (odds ratio [OR] = 1.32; 95% CI: 1.05-1.66) and letter fluency (OR = 0.66; 95% CI: 0.45-0.96) predicted a particularly high risk for delirium development. The discriminative ability of the final multiple logistic regression model to predict POD had an area under the curve of 0.786.

CONCLUSIONS

Impairment in the cognitive domains of executive function and language skills associated with memory, inhibition, and access speed seem to be particularly associated with the development of delirium after surgery in adults ≥65 years of age without apparent preoperative neurocognitive impairment.

Executive function elevated by long term high-intensity physical activity and the regulation role of beta-band activity in human frontal region

The importance of physical activity (PA) to people's health has become a consensus around the world, and regular long-term PA has been accepted as an alternative preventive measure for many chronic medical conditions. Although the daily PA have several benefits for the public, the systematic research on its effect in human physiology, cognition and cerebral nerve level is not fully studied. Hence, in this study, we aim to investigate this question in several specific aspects: basal heart rate, executive function, and neural oscillatory activity in the brain. A total of 146 subjects participated in this study and they were divided into two groups. One group (SG) is the long-term training (more than 8 years) subjects in soccer (n = 31), and the other group (CG) is a normal control group (n = 115). The heart rate was monitored with a portable equipment. Besides, 24 subjects (14 in SG and 10 in CG) participated the Go/No-Go task and EEG recording before and after exercise fatigue task. In the physiology level, we found that in the non-training time, the heart rate in CG group is significantly higher than that of the SG group (P < 0.001). In the cognition level, we found that the SG group has a faster reaction time that that of CG group (P < 0.01), while for the accuracy, two groups did show significant difference. In the neural level in the brain, we found a significant abnormal increased beta-band (around 25 Hz) activity in CG group after the exercise fatigue task immediately. Long-term high-intensity physical activity reduces basal heart rate, improves executive function, and improve the central tolerance of the body under the stimulation of fatigue and stress. These benefits of long-term activity could be used as a manual to guide people's healthy life.

Inhibitory Control in Young Healthy Adults - a tDCS Study

Inhibitory control plays a role in the behavior selection and detection of conflicts. Defects in inhibitory control are an integral part of many neuropsychiatric disorders and the possibilities of influencing it are the subject of active study. Studies have shown and confirmed the activation of the dorsolateral prefrontal cortex (DLPFC) during the Stroop task and other tests involving response inhibition. Non-invasive brain stimulation is an emerging and actively developing group of methods used in cognitive research. In the present study, we used non-invasive, painless, and delicate transcranial direct stimulation (tDCS) for the study of inhibitory control, and to explore the effect of impulsivity on response inhibition ability in young healthy participants. We conducted a cross-over study with cross-hemispheric application of 2 mA tDCS with electrodes placed on the right - cathode, and left - anode - DLPFC. Participants performed a classic Stroop test before and after stimulation. Impulsivity was measured via the personal impulsiveness questionnaire. There was no significant difference in interference score alteration between active and sham stimulations, anodal and sham tDCS both induced slight improvement in Stroop test results. Individual impulsivity in healthy participants showed no influence on their results. Our study adds to the picture and helps to deepen knowledge about the impact of different stimulation parameters on cognitive functions.

Neuroimaging in Adolescents: Post-Traumatic Stress Disorder and Risk for Substance Use Disorders

Trauma in childhood and adolescence has long-term negative consequences in brain development and behavior and increases the risk for psychiatric disorders. Among them, post-traumatic stress disorder (PTSD) during adolescence illustrates the connection between trauma and substance misuse, as adolescents may utilize substances to cope with PTSD. Drug misuse may in turn lead to neuroadaptations in learning processes that facilitate the consolidation of traumatic memories that perpetuate PTSD. This reflects, apart from common genetic and epigenetic modifications, overlapping neurocircuitry engagement triggered by stress and drug misuse that includes structural and functional changes in limbic brain regions and the salience, default-mode, and frontoparietal networks. Effective strategies to prevent PTSD are needed to limit the negative consequences associated with the later development of a substance use disorder (SUD). In this review, we will examine the link between PTSD and SUDs, along with the resulting effects on memory, focusing on the connection between the development of an SUD in individuals who struggled with PTSD in adolescence. Neuroimaging has emerged as a powerful tool to provide insight into the brain mechanisms underlying the connection of PTSD in adolescence and the development of SUDs.

Magnetoencephalography reveals impaired sensory gating and change detection in older adults in the somatosensory system

Brain electrophysiological responses can provide information about age-related decline in sensory-cognitive functions with high temporal accuracy. Studies have revealed impairments in early sensory gating and pre-attentive change detection mechanisms in older adults, but no magnetoencephalographic (MEG) studies have been undertaken into both non-attentive and attentive somatosensory functions and their relationship to ageing. Magnetoencephalography was utilized to record cortical somatosensory brain responses in young (20-28 yrs), middle-aged (46-56 yrs), and older adults (64-78 yrs) under active and passive somatosensory oddball conditions. A repeated standard stimulus was occasionally replaced by a deviant stimulus (p = .1), which was an electrical pulse on a different finger. We examined the amplitudes of M50 and M100 responses reflecting sensory gating, and later components reflecting change detection and attention shifting (M190 and M250 for the passive condition, and M200 and M350 for the active condition, respectively). Spatiotemporal cluster-based permutation tests revealed that older adults had significantly larger M100 component amplitudes than young adults for task-irrelevant stimuli in both passive and active condition. Older adults also showed a reduced M250 component and an altered M350 in response to deviant stimuli. The responses of middle-aged adults did not differ from those of younger adults, but this study should be repeated with a larger sample size. By demonstrating changes in both somatosensory gating and attentional shifting mechanisms, our findings extend previous research on the effects of ageing on pre-attentive and attentive brain functions.

Predicting executive functioning from brain networks: modality specificity and age effects

Healthy aging is associated with structural and functional network changes in the brain, which have been linked to deterioration in executive functioning (EF), while their neural implementation at the individual level remains unclear. As the biomarker potential of individual resting-state functional connectivity (RSFC) patterns has been questioned, we investigated to what degree individual EF abilities can be predicted from the gray-matter volume (GMV), regional homogeneity, fractional amplitude of low-frequency fluctuations (fALFF), and RSFC within EF-related, perceptuo-motor, and whole-brain networks in young and old adults. We examined whether the differences in out-of-sample prediction accuracy were modality-specific and depended on age or task-demand levels. Both uni- and multivariate analysis frameworks revealed overall low prediction accuracies and moderate-to-weak brain-behavior associations (R2 < 0.07, r < 0.28), further challenging the idea of finding meaningful markers for individual EF performance with the metrics used. Regional GMV, well linked to overall atrophy, carried the strongest information about individual EF differences in older adults, whereas fALFF, measuring functional variability, did so for younger adults. Our study calls for future research analyzing more global properties of the brain, different task-states and applying adaptive behavioral testing to result in sensitive predictors for young and older adults, respectively.

Cognitive impairment in Chinese adult patients with type III spinal muscular atrophy without disease-modifying treatment

Objective

Spinal muscular atrophy (SMA) is a neurodegenerative disorder characterized by the degeneration of motor neurons in the spinal cord. It remains uncertain whether the cognitive performance of adult patients with SMA is impaired. The objective of this study was to assess the cognitive profile of adult Chinese patients with SMA and the association between clinical features and cognitive ability, particularly executive function.

Methods

This cross-sectional study included 22 untreated adult patients with type III SMA and 20 healthy subjects. The following variables were assessed: general intelligence, memory, attention, language, executive function, depression, anxiety, and other demographic and clinical parameters. In addition, physical function was evaluated using the Hammersmith Functional Motor Scale Expanded (HFMSE), the Revised Upper Limb Module (RULM), and the 6-Minute Walk Test (6MWT).

Results

SMA patients had lower scores than healthy subjects in the Verbal Fluency Test, Stroop effect, Total Errors, Perseverative Responses, Perseverative Errors, and Non-perseverative Errors in the Wisconsin Card Sorting Test, showing impaired abilities of SMA patients in executive function. In the Attention Network Test (ANT), the results indicated that the SMA patients also had selective deficits in their executive control networks. Ambulant patients had better executive function test performance than non-ambulant ones. Compromised executive abilities in patients with SMA were correlated with a younger age at onset, poorer motor function, and higher levels of anxiety and depression.

Conclusion

Our study presented the distribution of cognitive impairment in a Chinese cohort with SMA. Patients with type III SMA showed selective deficits in executive function, which may be associated with disease severity, physical impairment, depression and anxiety. Future cognitive studies, accounting for motor and emotional impairment, are needed to evaluate if executive impairment is driven by specific brain changes or by those confounding factors.

Clarifying the link between psychopathologies and heart rate variability, and the sex differences: Can neuropsychological features serve as mediators?

BACKGROUND

Patients with common mental disorders (depression, anxiety, and somatic symptoms) often exhibit lower heart rate variability (HRV) than healthy individuals. Under the hypothesis that disorder status affects cognitive function, we examined whether neuropsychological features can be mediators between psychopathologies and HRV and possible sex differences.

METHODS

We recruited 359 individuals (aged 42.47 ± 12.23) with and without common mental disorders. Questionnaires were used to measure their psychopathologies. Eight tests from the Cambridge Neuropsychological Test Automated Battery were selected to measure neuropsychological functions. Resting-state HRV measurements were obtained for 5 min. The associations among these constructs were analyzed using multiple linear regression analysis and structural equation modelling.

RESULTS

Among women, Reaction Time (RTI, a task of psychomotor speed) indicator mediated the relationship between depression and low-frequency power (LF); Emotion Recognition Task (ERT, a task of emotional regulation) indicator mediated the relationship between health anxiety and high-frequency power (HF). Among men, Intra-Extra Dimensional Set Shift (IED, a task of shifting) indicator mediated the relationship between depression and LF; Match to Sample Visual Search (MTS, a task of selective attention) indicator mediated the relationship between health cognition and HF. The depression-RTI-LF pathway in women tended to lower HRV; whereas health anxiety-ERT-HF in women, depression-IED-LF and health cognition-MTS-HF in men tended to increase HRV.

LIMITATIONS

Possible medication effects; not directly measuring brain activity; only gathering resting-state HRV.

CONCLUSION

Our findings support the notion that neuropsychological features mediate the relationship between psychopathologies and HRV, and that sex differences exist.

The moderating role of depressive symptoms in the association between heart rate variability and cognitive performance in cardiac patients

INTRODUCTION

Coronary heart disease (CHD) is strongly associated with cognitive impairment, which is a core feature of depression, highly prevalent in patients with CHD. Interestingly, patients with CHD and individuals with depression display reduced heart rate variability (HRV), which proxies a complex network integrating autonomic and attentional systems. This study investigated the moderating role of depressive symptoms in the relation between reduced HRV and cognitive performance in patients with CHD.

METHOD

The sample included 274 patients with CHD (mean [standard deviation] age = 62 [9.5] years; 13 % women) admitted to cardiac rehabilitation units. Visual attention and task switching were assessed through the Trail Making Test (TMT). Depressive symptoms were assessed with the Beck Depression Inventory-II (BDI-II). Resting electrocardiographic recordings were collected to compute HRV indices.

RESULTS

Patients with more severe depressive symptoms displayed an inverse association between HRV and cognitive performance (TMT-A: b = -0.08, p = .022; TMTB: b = -0.07, p = .042), whereas patients with milder depressive symptoms showed no significant association (TMT-A: b = -0.00, p = .90; TMTB: b = -0.02, p = .44).

CONCLUSIONS

Depressive symptoms may strengthen the relation between reduced HRV and poorer cognitive performance in cardiac patients. The presence of depressive symptoms may signal the dysfunction of a network subserving autonomic and cognitive function.

Associations Between Cognitive Function and ACL Injury-Related Biomechanics: A Systematic Review

CONTEXT

Does lower baseline cognitive function predispose athletes to ACL injury risk, especially when performing unplanned or dual-task movements?

OBJECTIVE

To evaluate the association between cognitive function and biomechanics related to ACL injuries during cognitively challenging sports movements.

DATA SOURCES

PubMed (MEDLINE), Web of Science, Scopus, and SciELO databases were searched; additional hand searching was also conducted.

STUDY SELECTION

The following inclusion criteria had to be met: participants completed (1) a neurocognitive test, (2) a cognitively challenging sport-related task involving lower limbs, and (3) a biomechanical analysis. The following criteria determined exclusion from the review: studies involving participants with (1) recent or current musculoskeletal injuries; (2) recent or current concussion; (3) ACL surgical reconstruction, reviews of the literature, commentary or opinion articles, and case studies.

STUDY DESIGN

Systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) statement and registered at the International Prospective Register of Systematic Reviews (PROSPERO).

LEVEL OF EVIDENCE

Level 3.

DATA EXTRACTION

Two of authors independently extracted data and assessed the methodological quality of the articles with the Downs and Black and ROBINS-I checklists, to assess methodological quality and risk of bias, respectively.

RESULTS

Six studies with different methodologies and confounding factors were included in this review. Of these 6 studies, 3 were ranked as high-quality, 3 demonstrated a low risk of bias, 2 a moderate risk, and 1 a severe risk. Five studies found a cognitive-motor relationship, with worse cognitive performance associated with increased injury risk, with 1 study reporting the opposite directionality for 1 variable. One study did not identify any interaction between cognitive function and biomechanical outcomes.

CONCLUSION

Worse cognitive performance is associated with an increased injury risk profile during cognitively challenging movements.

The effect of working memory load on inattentional deafness during aeronautical decision-making

Operating an aircraft requires pilots to handle a significant amount of multi-modal information, which creates a high working memory load. Detecting auditory alarms in this high-load scenario is crucial for aviation safety. According to cognitive control load theory, an increase in working memory load may enhance distractor interference, resulting in improved detection sensitivity for task-irrelevant stimuli. Therefore, understanding the effect of working memory load on auditory alarm detection is of particular interest in aviation safety research. The studies were designed to investigate the effect of storage load and executive function load of working memory on auditory alarm detection during aeronautical decision-making through three experiments. In Experiment 1 and 2, participants performed an aeronautical decision-making task while also detecting an auditory alarm during the retention interval of a working memory task (visual-spatial, visual-verbal and auditory-verbal). In Experiment 3, participants were required to detect an auditory alarm while performing the 2-back and 3-back aeronautical decision-making tasks. Experiment 1 found that the auditory alarm sensitivity was higher in conditions of low visual-spatial working memory storage load compare to high load conditions. Experiment 2 found that a high storage load of visual-verbal working memory reduced auditory alarm sensitivity but auditory-verbal working memory load did not. Experiment 3 found that, unlike storage load, auditory alarm sensitivity was stronger under high executive function load relative to low executive function load. These findings show that working memory storage load and executive function load have different effects on auditory alarm sensitivity. The relationship between executive function and auditory alarm sensitivity supports cognitive control load theory, while the impact of the storage function on auditory alarm sensitivity does not adhere to this theory.

The executive functions among patients with an initial Glasgow coma scale score of 15

Executive functions (EF) were the critical neuropsychological functions linked to long-term adaptation. Given the heterogeneous prognosis trajectories of mild traumatic brain jury (mTBI), the mildest TBI may not always be benign in the chronic stage. The present study explored the long-term EF in patients with chronic complicated mTBI and a Glasgow Coma Scale (GCS) score of 15. Fifty patients with complicated mTBI and GCS scores of 15 and 35 control participants were recruited in this study. Medical records were retrospectively analyzed, and neuropsychological assessments and subjective measures examined the neuropsychological functions. Compared with healthy controls, complicated mTBI patients with a GCS score of 15 performed significantly worse on most EF assessments, including longer reaction time (RT) and poor cognitive flexibility and abstract reasoning performances. Patients also reported more EF problems and lower quality of life (QoL) than healthy controls. Females and those with subdural hematoma (SDH) had significantly longer reaction times (RT) on executive attention tests. This study found that complicated mTBI with a GCS score of 15 had incomplete recovery of EF, even in the chronic stage. We suggest that early neuropsychological assessment and rehabilitation should be arranged for such patients.

Association of loneliness and grey matter volume in the dorsolateral prefrontal cortex: the mediating role of interpersonal self-support traits

As a social and public health concern, loneliness is associated with an abundance of negative life outcomes such as depressive symptomatology, mortality, and sleep disturbance. Nevertheless, the neural basis underlying loneliness remains elusive; in addition, previous neuroimaging studies about loneliness mainly focused on the elderly and were limited by small sample sizes. Here, utilizing the voxel-based morphometry (VBM) approach via structural magnetic resonance imaging, we investigated the association between brain GMV and loneliness in 462 young adults (67.7% females, age = 18.59 ± 1.14 years). Results from whole-brain VBM analyses revealed that individuals with higher loneliness tended to have greater GMV in the right dorsolateral prefrontal cortex (DLPFC), which was thought to be associated with emotional regulation deficits and executive dysfunction. Importantly, the GMV-based predictive models (a machine-learning method) demonstrated that the correlation between loneliness and GMV in the DLPFC was robust. Further, interpersonal self-support traits (ISS), a Chinese indigenous personality construct and pivotal personality factor for resisting negative life outcomes, mediated the relationship between the GMV in the right DLPFC and loneliness. Taken together, the present study reveals that the GMV in right DLPFC acts as an underlying neurostructural correlate of loneliness in the healthy brain, and further provides a brain-personality-symptom pathway for protection against loneliness in which GMV of DLPFC affects loneliness through ISS traits. Future intervention procedures aiming to decrease loneliness and enhance mental health levels among young adults should be developed through improving interpersonal relationships such as social skills training.

Serum glial fibrillary acidic protein and neurofilament light chain in treatment-naïve patients with unipolar depression

BACKGROUND

Unipolar depression has been associated with increased levels of glial dysfunction and neurodegeneration biomarkers, such as Glial Fibrillary Acidic Protein (GFAP) and Neurofilament light chain (NfL). However, previous studies were conducted on patients taking psychotropic medication and did not monitor longitudinal associations between disease status and GFAP/NfL.

METHODS

Treatment-naïve patients with unipolar depression (n = 110) and healthy controls (n = 33) were included. GFAP/NfL serum levels were analyzed by Single Molecule Array at baseline and 3-month follow-up. The primary endpoint was GFAP/NfL levels in patients with depression compared with healthy controls. The secondary endpoint was the associations between GFAP/NfL with depression severity and cognitive function.

RESULTS

The patients' mean HAM-D17 score was 18.9 (SD 3.9) at baseline and improved by 7.9 (SD 6.8) points during follow-up. GFAP/NfL was quantified in all individuals. At baseline, the adjusted GFAP levels were -16.8 % (95 % CI: -28.8 to -1.9, p = 0.03) lower among patients with depression compared to healthy controls, while NfL levels were comparable between the groups (p = 0.57). In patients with depression, mean NfL levels increased from baseline to follow-up (0.68 pg/ml, p = 0.03), while GFAP levels were unchanged (p = 0.24). We did not find consistent associations between NfL/GFAP with depression scores or cognitive function.

CONCLUSION

This largest study of serum NfL/GFAP levels in patients with depression did not support previous findings of elevated GFAP/NfL in patients with depression or positive associations with depression severity. Although limited by a small control group, our study may support the presence of glial dysfunction but not damage to neurons in depression.

Personalized clinical managements through exploring circulating neural cells and electroencephalography

BACKGROUND

Since an initial diagnosis of Alzheimer disease (AD) in 1907, early detection, was unavailable through 116 years. Up-regulation of V-Ets erythroblastosis virus E26 oncogene homolog 2 (Ets2) is capable to enhance neuronal susceptibility and degeneration. Protein expression (PE) of Ets2 has functional impact on AD and Down's syndrome, with diverse intensity. PE of Ets2 has an influential pathogenic impact on AD. Clinical aspects of neurological disorders directly interact with psychological maladies. However, deterioration requires an early management including programmed based protection.

AIM

To include cell biology in neuro-genetics; personalized, prognostics, predictive, preventive, predisposing (5xP) platform, accompanied by stratifying brain channels behavior pre- and post-intervention by light music in the AD-patients.

METHODS

Include exploration of PE assay and electroencephalography of brain channels. The processes are applied according to: (1) Triangle style, by application of cellular network; and (2) PE assay of Ets2 in the peripheral blood of the patients with AD, by Manual single cell based analysis, and Flow-cytometry. (1) Applying the Genetic counselling and pedigree analysis; (2) considering the psychological status of the referral cases; (3) considering the macro-and/or micro-environmental factors; (4) performing the required Genetics' analysis; and (5) applying the required complementary test(s).

RESULTS

PE of Ets2 has pathogenic role in AD. PE unmasked the nature of heterogeneity/diversity/course of evolution by exploring Ets2, D1853N polymorphism in Ataxia Telangiectasia mutated gene (ATM), vascular endothelial growth factor (VEGF), epidermal growth factor (EGF) and course of evolution at the single cell level of the brain. Ets2 revealed different cellular behavior in the blood and suggested the strategy as 'Gene Product-Based Therapy' and the personalized managements for the patients. PE reflected weak expression of ATM, mosaic pattern of Ets2; remarkable expression of VEGF and EGF by highlighting an early detective platform, considering circulating neural cells (CNCs) and the required molecular investigation, for the target individual(s) predisposed to AD or other neural disease including brain neoplasia. Brain channels-cooperation with diverse/interactive-ratios lead to strategic balancing for improving the life-quality in AD.

CONCLUSION

We highlighted application of the single CNCs and correlated Ratio based between Brain channels by providing the 5xP personalized clinical management model for an early detection and therapy of the patients with AD and their targeted/predisposed relatives. Novel-evolutionary/hypothetic/heterogenic-results in brain-channels offer personalizd/constructive markers with unlimited cooperation in health and disease.

Clinical Neuropsychology of Bilingual Mexican American Adults: Effect of Language Proficiency and Dominance

OBJECTIVE

To assess the association between language proficiency and absolute dominance on language versus visual-perceptual formatted and executive versus delayed memory neuropsychological measures in bilingual adults.

METHODS

Data from 55 bilingual, conversationally fluent, neurologically intact, Mexican American, consecutive, adults tested in separate sessions in Spanish and English in a counterbalanced order were analyzed. Age, years of education, self-reported language proficiency, Woodcock-Muñoz Language Survey-Revised (WMLS-R) picture vocabulary measures of language proficiency, and dominance (absolute Spanish-English WMLS-R difference scores) were correlated with 11 measures from La Batería Neuropsicólogica en Español and its original English language tests.

RESULTS

Self-reported and WMLS-R measures of language proficiency were significantly correlated in each language. Absolute language dominance was not significantly associated with any Spanish or English neuropsychological raw score. The WMLS-R language proficiency, but not age or years of education, was significantly correlated with language-formatted neuropsychological measures of California Verbal Learning Test delayed free recall number of words (both languages), letter fluency (both languages), delayed story memory (in English), and Stroop interference (Spanish). Linear regression models using age, years of education, and WMLS-R picture vocabulary scores as predictors were significant for all these measures excepting the last. The WMLS-R language proficiency was not significantly associated with raw scores on any visual-perceptual formatted measure.

CONCLUSIONS

Monolingual neuropsychological test norms for language-formatted tests likely overestimate bilingual Mexican Americans' performance.

Comment on Muth et al. Assessing Critical Flicker Fusion Frequency: Which Confounders? A Narrative Review. Medicina 2023, 59, 800

We first want to thank the authors of the excellent review for their contributions to summarizing the confounders associated with critical flicker fusion frequency (CFFF) [...].

Runners with better cardiorespiratory fitness had higher prefrontal cortex activity during both single and exercise-executive function dual tasks: an fNIRS study

Objective: This study investigated the relationship between executive function and prefrontal cortex oxygenation during exercise in young adults with different Cardiorespiratory fitness (CRF) levels. Methods: A total of 28 amateur runners (n = 14) and sedentary college students (n = 14) were recruited. The maximum oxygen uptake estimated for the sub-maximal intensity run (4.97 miles/h) was used to indicate the different CRF levels. After 1 week, participants must complete the Stroop and 2-Back tasks in silence while performing moderate-intensity exercise. Using 19-channel functional near-infrared spectroscopic (fNIRS) to examine changes in prefrontal cortex oxyhemoglobin. Results: There was no significant difference in the correctness of the Stroop and 2-Back tasks between the two groups during exercise, but the amateur runner group showed an acceleration in reaction time. fNIRS results showed that during the exercise 2-Back task, the left dorsolateral prefrontal cortex oxyhemoglobin was higher in the amateur runner group than in the sedentary group. Conclusion: Executive function during exercise was similarly improved in participants with better fitness, suggesting that CRF provides an excellent metabolic reserve and directed allocation for cognitive tasks during exercise.

Faster Walking Speeds Require Greater Activity from the Primary Motor Cortex in Older Adults Compared to Younger Adults

Gait speed declines with age and slower walking speeds are associated with poor health outcomes. Understanding why we do not walk faster as we age, despite being able to, has implications for rehabilitation. Changes in regional oxygenated haemoglobin (HbO2) across the frontal lobe were monitored using functional near infrared spectroscopy in 17 young and 18 older adults while they walked on a treadmill for 5 min, alternating between 30 s of walking at a preferred and fast (120% preferred) speed. Gait was quantified using a triaxial accelerometer (lower back). Differences between task (preferred/fast) and group (young/old) and associations between regional HbO2 and gait were evaluated. Paired tests indicated increased HbO2 in the supplementary motor area (right) and primary motor cortex (left and right) in older adults when walking fast (p < 0.006). HbO2 did not significantly change in the young when walking fast, despite both groups modulating gait. When evaluating the effect of age (linear mixed effects model), greater increases in HbO2 were observed for older adults when walking fast (prefrontal cortex, premotor cortex, supplementary motor area and primary motor cortex) compared to young adults. In older adults, increased step length and reduced step length variability were associated with larger increases in HbO2 across multiple regions when walking fast. Walking fast required increased activation of motor regions in older adults, which may serve as a therapeutic target for rehabilitation. Widespread increases in HbO2 across the frontal cortex highlight that walking fast represents a resource-intensive task as we age.

Exergames improves cognitive functions in adolescents with depression: study protocol of a prospective, assessor-blind, randomized controlled trial

BACKGROUND

Depression is a condition that imposes a significant disease burden, with cognitive impairment being one of its costly symptoms. While cognitive rehabilitation is crucial, it is also challenging. Although some studies have investigated the impact of exergames on cognitive function improvement, these have primarily focused on the elderly population, with limited attention given to individuals with depression. Consequently, this study aims to investigate the effects of exergames on cognitive functions in adolescents with depression and compare the effectiveness of exergames with traditional exercise.

METHOD

The present investigation is a single-center randomized controlled trial that employs the ANOVA method to calculate the sample size using G*Power software, assuming a 25% dropout rate. The study enrolls fifty-four eligible patients with depression who are randomly allocated to one of three treatment groups: the exergames group, which receives standard treatment and exergames intervention; the exercise group, which receives standard treatment and traditional exercise intervention; and the control group, which receives standard treatment exclusively. The study provides a comprehensive regimen of 22 supervised exercise and exergame sessions over an 8-week period, with a frequency of twice per week for the initial two weeks and three times per week for the subsequent six weeks. The researchers gather cognitive, mood, and sleep metrics at the onset of the first week, as well as at the conclusion of the fourth and eighth weeks. The researchers employ a wearable device to track participants' heart rate during each intervention session and evaluate the Borg Rating of Perceived Exertion scale at the conclusion of each session.

DISCUSSION

The findings from this study make several contributions to the current literature. First, this study comprehensively reports the efficacy of an exergames intervention for multidimensional symptoms in adolescents with depression. Second, this study also compares the efficacy of exergames with that of traditional exercise. These findings provide a theoretical basis for the use of exergames as an adjunctive intervention for depression and lay the groundwork for future research.

TRIAL REGISTRATION

This trial is registered with the Chinese Clinical Trials Registry (Registration number: ChiCTR2100052709; Registration Status: Prospective registration;) 3/11/2021, URL:    http://www.chictr.org.cn/edit.aspx?pid=135663&htm=4 .