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Brain Sciences
Volume 15
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Brain Sci., Volume 15, Issue 5 (May 2025) – 103 articles

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28 pages, 516 KiB  
Perspective
Cognitive Behavioural Therapy (CBT) for Managing Tinnitus, Hyperacusis, and Misophonia: The 2025 Tonndorf Lecture
by Hashir Aazh
Brain Sci. 2025, 15(5), 526; https://doi.org/10.3390/brainsci15050526 - 19 May 2025
Abstract
Cognitive behavioural therapy (CBT) is an evidence-based intervention for managing distress associated with tinnitus, hyperacusis, and misophonia. This paper summarises key points from the 2025 Tonndorf Lecture presented at the third World Tinnitus Congress and the 14th International Tinnitus Seminar in Poland. The [...] Read more.
Cognitive behavioural therapy (CBT) is an evidence-based intervention for managing distress associated with tinnitus, hyperacusis, and misophonia. This paper summarises key points from the 2025 Tonndorf Lecture presented at the third World Tinnitus Congress and the 14th International Tinnitus Seminar in Poland. The lecture addressed (1) the theoretical foundations of CBT for these conditions, (2) clinical evidence on CBT delivered by psychologists, audiologists, and digital self-help, and (3) the proportion of patients who may benefit from CBT. Research demonstrates that CBT can effectively reduce distress related to tinnitus, hyperacusis, and misophonia. Both psychologist- and audiologist-delivered CBT approaches have demonstrated significant improvements in reducing the impact of tinnitus, hyperacusis, and misophonia on patients’ quality of life, while guided internet-based CBT also demonstrates positive outcomes. Unguided internet-based CBT is also effective, though it faces challenges such as higher dropout rates. Despite these promising results, not all patients experience the same level of benefit. Some continue to experience distress even after completing CBT, highlighting the need for alternative or complementary interventions and ongoing support. This paper estimates that approximately 1 in 52 individuals with tinnitus require CBT, indicating that while tinnitus is relatively common, the need for intensive therapy is comparatively small. To enhance treatment outcomes, future research should compare the effectiveness of psychologist- and audiologist-delivered CBT, explore hybrid models that combine face-to-face and digital interventions, and address challenges with internet-based CBT, particularly for hyperacusis and misophonia. Furthermore, incorporating neuroimaging and physiological measures in future randomised controlled trials could provide objective insights into the neural mechanisms underlying symptom improvement, ultimately helping to refine CBT interventions. Identifying characteristics of non-responders to CBT may also guide the development of more tailored therapeutic approaches. Full article
(This article belongs to the Section Behavioral Neuroscience)
24 pages, 436 KiB  
Systematic Review
Physical, Cognitive, Social, and Functional Health Correlates of Major Depressive Disorder Subtypes: A Systematic Review
by Jen E. McKeough, Christopher F. Sharpley, Kirstan A. Vessey, Vicki Bitsika, Rebecca J. Williams, G. Lorenzo Odierna and Ian D. Evans
Brain Sci. 2025, 15(5), 525; https://doi.org/10.3390/brainsci15050525 - 19 May 2025
Abstract
Background/Objectives: Major Depressive Disorder (MDD) is a neuropsychiatric disorder affecting nearly 200 million people worldwide. While it has broad health effects, relatively little is known about how these vary across MDD ‘subtypes’, which reflect distinct symptom profiles. This systematic review examined the methods [...] Read more.
Background/Objectives: Major Depressive Disorder (MDD) is a neuropsychiatric disorder affecting nearly 200 million people worldwide. While it has broad health effects, relatively little is known about how these vary across MDD ‘subtypes’, which reflect distinct symptom profiles. This systematic review examined the methods used to define several MDD subtypes and their associations with physical, cognitive, social, and functional health outcomes. Methods: A systematic search of PubMed was conducted in accordance with PRISMA 2020 guidelines to identify peer-reviewed studies published in English between 2014 and 2025. The final search was conducted on 21 January 2025. Studies were included if they examined adults with MDD subtypes and reported health-related outcomes. Risk of bias was assessed using the Newcastle–Ottawa Scale. A narrative synthesis was conducted due to heterogeneity in the subtype definitions and outcome measures. Results: Sixteen studies were included. Atypical and melancholic depression were most consistently associated with metabolic dysfunction, higher BMI, and a greater waist circumference. Melancholic depression was frequently associated with cognitive deficits, though results varied. Cognitive impairments were also observed in DSM-defined atypical depression, particularly in attention, vigilance, and social cognition. Anxious and melancholic depression may be associated with more severe social and functional impairment compared to other subtypes. However, the findings were limited by inconsistent definitions and outcome measures. Conclusions: Some subtypes, particularly atypical, melancholic, and anxious depression, are differentially associated with specific patterns of impairment, though inconsistencies limit firm conclusions. Registration: This review was retrospectively registered with the Open Science Framework (OSF): No specific funding was received. Full article
(This article belongs to the Section Cognitive, Social and Affective Neuroscience)
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24 pages, 641 KiB  
Article
Partner-Inflicted Brain Injury: Intentional, Concurrent, and Repeated Traumatic and Hypoxic Neurologic Insults
by Julianna M. Nemeth, Clarice Decker, Rachel Ramirez, Luke Montgomery, Alice Hinton, Sharefa Duhaney, Raya Smith, Allison Glasser, Abigail (Abby) Bowman, Emily Kulow and Amy Wermert
Brain Sci. 2025, 15(5), 524; https://doi.org/10.3390/brainsci15050524 - 19 May 2025
Abstract
(1) Background: Traumatic brain injury (TBI) is caused from rapid head acceleration/deceleration, focal blows, blasts, penetrating forces, and/or shearing forces, whereas hypoxic–anoxic injury (HAI) is caused through oxygen deprivation events, including strangulation. Most service-seeking domestic violence (DV) survivors have prior mechanistic exposures that [...] Read more.
(1) Background: Traumatic brain injury (TBI) is caused from rapid head acceleration/deceleration, focal blows, blasts, penetrating forces, and/or shearing forces, whereas hypoxic–anoxic injury (HAI) is caused through oxygen deprivation events, including strangulation. Most service-seeking domestic violence (DV) survivors have prior mechanistic exposures that can lead to both injuries. At the time of our study, some evidence existed about the exposure to both injuries over the course of a survivor’s lifetime from abuse sources, yet little was known about their co-occurrence to the same survivor within the same episode of physical intimate partner violence (IPV). To better understand the lived experience of service-seeking DV survivors and the context in which partner-inflicted brain injury (PIBI) is sustained, we sought to understand intentional brain injury (BI) exposures that may need to be addressed and accommodated in services. Our aims were to 1. characterize the lifetime co-occurrence of strangulation and intentional head trauma exposures from all abuse sources to the same survivor and within select physical episodes of IPV and 2. establish the lifetime prevalence of PIBI. (2) Methods: Survivors seeking DV services in the state of Ohio in the United States of America (U.S.) completed interview-administered surveys in 2019 (n = 47). Community-based participatory action approaches guided all aspects of the study development, implementation, and interpretation. (3) Results: The sample was primarily women. Over 40% reported having Medicaid, the government-provided health insurance for the poor. Half had less than a postsecondary education. Over 80% of participants presented to DV services with both intentional head trauma and strangulation exposures across their lifetime from intimate partners and other abuse sources (i.e., child abuse, family violence, peer violence, sexual assault, etc.), though not always experienced at the same time. Nearly 50% reported an experience of concurrent head trauma and strangulation in either the first or last physical IPV episode. Following a partner’s attack, just over 60% reported ever having blacked out or lost consciousness—44% experienced a loss of consciousness (LOC) more than once—indicating a conservative estimate of a probable brain injury by an intimate partner. Over 80% of service-seeking DV survivors reported either a LOC or two or more alterations in consciousness (AICs) following an IPV attack and were classified as ever having a partner-inflicted brain injury. (4) Conclusions: Most service-seeking IPV survivors experience repetitive and concurrent exposures to abusive strangulation and head trauma through the life course and by intimate partners within the same violent event resulting in brain injury. We propose the use of the term partner-inflicted brain injury (PIBI) to describe the physiological disruption of normal brain functions caused by intentional, often concurrent and repeated, traumatic and hypoxic neurologic insults by an intimate partner within the context of ongoing psychological trauma, coercive control, and often past abuse exposures that could also result in chronic brain injury. We discuss CARE (Connect, Acknowledge, Respond, Evaluate), a brain-injury-aware enhancement to service delivery. CARE improved trauma-informed practices at organizations serving DV survivors because staff felt knowledgeable to address and accommodate brain injuries. Survivor behavior was then interpreted by staff as a “can’t” not a “won’t”, and social and functional supports were offered. Full article
(This article belongs to the Special Issue Shedding Light on the Hidden Epidemic of Violence and Brain Injury)
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36 pages, 3285 KiB  
Review
A Unified Framework for Alzheimer’s Disease Knowledge Graphs: Architectures, Principles, and Clinical Translation
by Jovana Dobreva, Monika Simjanoska Misheva, Kostadin Mishev, Dimitar Trajanov and Igor Mishkovski
Brain Sci. 2025, 15(5), 523; https://doi.org/10.3390/brainsci15050523 - 19 May 2025
Abstract
This review paper synthesizes the application of knowledge graphs (KGs) in Alzheimer’s disease (AD) research, based on two basic questions, as follows: what types of input data are available to construct these knowledge graphs, and what purpose the knowledge graph is intended to [...] Read more.
This review paper synthesizes the application of knowledge graphs (KGs) in Alzheimer’s disease (AD) research, based on two basic questions, as follows: what types of input data are available to construct these knowledge graphs, and what purpose the knowledge graph is intended to fulfill. We synthesize results from existing works to illustrate how diverse knowledge graph structures behave in different data availability settings with distinct application targets in AD research. By comparative analysis, we define the best methodology practices by data type (literature, structured databases, neuroimaging, and clinical records) and application of interest (drug repurposing, disease classification, mechanism discovery, and clinical decision support). From this analysis, we recommend AD-KG 2.0, which is a new framework that coalesces best practices into a unifying architecture with well-defined decision pathways for implementation. Our key contributions are as follows: (1) a dynamic adaptation mechanism that adapts methodological elements automatically according to both data availability and application objectives, (2) a specialized semantic alignment layer that harmonizes terminologies across biological scales, and (3) a multi-constraint optimization approach for knowledge graph building. The framework accommodates a variety of applications, including drug repurposing, patient stratification for precision medicine, disease progression modeling, and clinical decision support. Our system, with a decision tree structured and pipeline layered architecture, offers research precise directions on how to use knowledge graphs in AD research by aligning methodological choice decisions with respective data availability and application goals. We provide precise component designs and adaptation processes that deliver optimal performance across varying research and clinical settings. We conclude by addressing implementation challenges and future directions for translating knowledge graph technologies from research tool to clinical use, with a specific focus on interpretability, workflow integration, and regulatory matters. Full article
(This article belongs to the Section Neurodegenerative Diseases)
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16 pages, 1674 KiB  
Article
Validation of a New Stress Induction Protocol Using Speech Improvisation (IMPRO)
by Marina Saskovets, Mykhailo Lohachov and Zilu Liang
Brain Sci. 2025, 15(5), 522; https://doi.org/10.3390/brainsci15050522 - 19 May 2025
Abstract
Background: Acute stress induction is essential in psychology research for understanding physiological and psychological responses. In this study, ‘acute stress’ refers to a short-term, immediate stress response—distinct from chronic, long-term stress exposure. Traditional methods, such as the Trier Social Stress Test (TSST), have [...] Read more.
Background: Acute stress induction is essential in psychology research for understanding physiological and psychological responses. In this study, ‘acute stress’ refers to a short-term, immediate stress response—distinct from chronic, long-term stress exposure. Traditional methods, such as the Trier Social Stress Test (TSST), have ecological validity and resource-efficiency limitations. This study introduces the Interactive Multitask Performance Response Observation (IMPRO) protocol, a novel stress-induction method utilizing speech improvisation in a dynamic and unpredictable social setting. Methods: Thirty-five healthy adults (aged 18–38 years; 19 males, 16 females) participated in the study. The IMPRO protocol consisted of three speech improvisation tasks with increasing cognitive and social stressors. Salivary cortisol was used as a biochemical marker of acute stress, while electrodermal activity (EDA) provided real-time autonomic arousal measurements. Stress responses were assessed using paired t-tests for cortisol levels and repeated-measures ANOVA for EDA variations across experimental stages. Results: Salivary cortisol levels significantly increased from baseline (M = 2.68 nM, SD = 0.99) to post-task (M = 3.54 nM, SD = 1.25, p = 0.001, Cohen’s d = 0.59), confirming hypothalamic–pituitary–adrenal (HPA) axis activation. EDA showed a significant rise during the anticipation phase (p < 0.001), peaking at the final task and decreasing during recovery (η2 = 0.643). Conclusions: The IMPRO protocol effectively induces acute stress responses, providing a scalable, ecologically valid alternative to traditional stress paradigms. Its low-cost, adaptable design makes it ideal for research in psychology, neuroscience, and behavioral sciences. Future studies should explore its application in clinical populations and group settings. Full article
(This article belongs to the Topic The Relationship Between Bodily, Autonomic, and Communicative Behaviors and the Experiential and Cognitive Aspects of Emotion)
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12 pages, 5510 KiB  
Article
Image Fusion of High-Resolution DynaCT and T2-Weighted MRI for Image-Guided Programming of dDBS
by Fadil Al-Jaberi, Matthias Moeskes, Martin Skalej, Melanie Fachet and Christoph Hoeschen
Brain Sci. 2025, 15(5), 521; https://doi.org/10.3390/brainsci15050521 - 19 May 2025
Abstract
Objectives: This study aimed to develop a semi-automated registration method for aligning preoperative non-contrast T2-weighted MRI with postoperative high-resolution cone-beam CT (DynaCT) in patients undergoing directional deep brain stimulation (dDBS) surgery targeting the subthalamic nucleus (STN). The aim was to facilitate image-guided programming [...] Read more.
Objectives: This study aimed to develop a semi-automated registration method for aligning preoperative non-contrast T2-weighted MRI with postoperative high-resolution cone-beam CT (DynaCT) in patients undergoing directional deep brain stimulation (dDBS) surgery targeting the subthalamic nucleus (STN). The aim was to facilitate image-guided programming of DBS devices and postoperative verification of the alignment of segmented contacts. Materials and Methods: A dataset of ten patients undergoing bilateral dDBS implantation was retrospectively collected, including DynaCT (acquired postoperatively) and non-contrast T2-weighted MRI (obtained preoperatively). A semi-automated registration method was used, employing manual initialization due to dissimilar anatomical information between DynaCT and T2-weighted MRI. Image visualization, initial alignment using a centered transformation initializer, and single-resolution image registration involving the Simple Insight Toolkit (SimpleITK) library were performed. Manual landmark-based alignment based on anatomical landmarks and evaluation metrics such as Target Registration Error (TRE) assessed alignment accuracy. Results: The registration method successfully aligned all images. Quantitative evaluation revealed an average of the mean TRE of 1.48 mm across all subjects, indicating satisfactory alignment quality. Multiplanar reformations (MPRs) based on electrode-oriented normal vectors visualized segmented contacts for accurate electrode placement. Conclusions: The developed method demonstrated successful registration between preoperative non-contrast T2-weighted MRI and postoperative DynaCT, despite dissimilar anatomical information. This approach facilitates accurate alignment crucial for DBS programming and postoperative verification, potentially reducing the programming time of the DBS. The study underscores the importance of image quality, manual initialization and semi-automated registration methods for successful multimodal image registration in dDBS procedures targeting the STN. Full article
(This article belongs to the Section Sensory and Motor Neuroscience)
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22 pages, 3487 KiB  
Article
Voice-Evoked Color Prediction Using Deep Neural Networks in Sound–Color Synesthesia
by Raminta Bartulienė, Aušra Saudargienė, Karolina Reinytė, Gustavas Davidavičius, Rūta Davidavičienė, Šarūnas Ašmantas, Gailius Raškinis and Saulius Šatkauskas
Brain Sci. 2025, 15(5), 520; https://doi.org/10.3390/brainsci15050520 - 19 May 2025
Abstract
Background/Objectives: Synesthesia is an unusual neurological condition when stimulation of one sensory modality automatically triggers an additional sensory sensation in an additional unstimulated modality. In this study, we investigated a case of sound–color synesthesia in a female with impaired vision. After confirming a [...] Read more.
Background/Objectives: Synesthesia is an unusual neurological condition when stimulation of one sensory modality automatically triggers an additional sensory sensation in an additional unstimulated modality. In this study, we investigated a case of sound–color synesthesia in a female with impaired vision. After confirming a positive case of synesthesia, we aimed to determine the sound features that played a key role in the subject’s sound perception and color development. Methods: We applied deep neural networks and a benchmark of binary logistic regression to classify blue and pink synesthetically voice-evoked color classes using 136 voice features extracted from eight study participants’ voice recordings. Results: The minimum Redundancy Maximum Relevance algorithm was applied to select the 20 most relevant voice features. The recognition accuracy of 0.81 was already achieved using five features, and the best results were obtained utilizing the seventeen most informative features. The deep neural network classified previously unseen voice recordings with 0.84 accuracy, 0.81 specificity, 0.86 sensitivity, and 0.85 and 0.81 F1-scores for blue and pink classes, respectively. The machine learning algorithms revealed that voice parameters, such as Mel-frequency cepstral coefficients, Chroma vectors, and sound energy, play the most significant role. Conclusions: Our results suggest that a person’s voice’s pitch, tone, and energy affect different color perceptions. Full article
(This article belongs to the Special Issue Perceptual Learning and Cortical Plasticity)
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34 pages, 1771 KiB  
Systematic Review
Neurophysiological Approaches to Lie Detection: A Systematic Review
by Bewar Neamat Taha, Muhammet Baykara and Talha Burak Alakuş
Brain Sci. 2025, 15(5), 519; https://doi.org/10.3390/brainsci15050519 - 18 May 2025
Abstract
Background and Objectives: Lie detection is crucial in domains such as security, law enforcement, and clinical assessments. Traditional methods suffer from reliability issues and susceptibility to countermeasures. In recent years, electroencephalography (EEG) and particularly the Event-Related Potential (ERP) P300 component have gained prominence [...] Read more.
Background and Objectives: Lie detection is crucial in domains such as security, law enforcement, and clinical assessments. Traditional methods suffer from reliability issues and susceptibility to countermeasures. In recent years, electroencephalography (EEG) and particularly the Event-Related Potential (ERP) P300 component have gained prominence for identifying concealed information. This systematic review aims to evaluate recent studies (2017–2024) on EEG-based lie detection using ERP P300 responses, especially in relation to recognized and unrecognized face stimuli. The goal is to summarize commonly used EEG signal processing techniques, feature extraction methods, and classification algorithms, identifying those that yield the highest accuracy in lie detection tasks. Methods: This review followed PRISMA guidelines for systematic reviews. A comprehensive literature search was conducted using IEEE Xplore, Web of Science, Scopus, and Google Scholar, restricted to English-language articles from 2017 to 2024. Studies were included if they focused on EEG-based lie detection, utilized experimental protocols like Concealed Information Test (CIT), Guilty Knowledge Test (GKT), or Deceit Identification Test (DIT), and evaluated classification accuracy using ERP P300 components. Results: CIT with ERP P300 was the most frequently employed protocol. The most used preprocessing method was Bandpass Filtering (BPF), and the Discrete Wavelet Transform (DWT) emerged as the preferred feature extraction technique due to its suitability for non-stationary EEG signals. Among classification algorithms, Support Vector Machine (SVM), Linear Discriminant Analysis (LDA), and Convolutional Neural Networks (CNN) were frequently utilized. These findings demonstrate the effectiveness of hybrid and deep learning-based models in enhancing classification performance. Conclusions: EEG-based lie detection, particularly using the ERP P300 response to face recognition tasks, shows promising accuracy and robustness compared to traditional polygraph methods. Combining advanced signal processing methods with machine learning and deep learning classifiers significantly improves performance. This review identifies the most effective methodologies and suggests that future research should focus on real-time applications, cross-individual generalization, and reducing system complexity to facilitate broader adoption. Full article
(This article belongs to the Section Neurotechnology and Neuroimaging)
16 pages, 479 KiB  
Review
Anti-NMDA Receptor Encephalitis: A Narrative Review
by Vlad Pădureanu, Dalia Dop, Rodica Pădureanu, Denisa Floriana Vasilica Pîrșcoveanu, Gabriela Olaru, Ioana Streata and Ana Maria Bugă
Brain Sci. 2025, 15(5), 518; https://doi.org/10.3390/brainsci15050518 - 18 May 2025
Abstract
Antibodies against the NR1 or NR2 subunits of the NMDA receptor are linked to anti-N-methyl-D-aspartate (NMDA) receptor encephalitis, a type of encephalitis that mainly affects women. Clinicians who treat patients of all ages should be aware of this type of encephalitis since it [...] Read more.
Antibodies against the NR1 or NR2 subunits of the NMDA receptor are linked to anti-N-methyl-D-aspartate (NMDA) receptor encephalitis, a type of encephalitis that mainly affects women. Clinicians who treat patients of all ages should be aware of this type of encephalitis since it may be a treatable differential for symptoms and indicators observed in neurology and psychiatric clinics. Auditory and visual hallucinations, delusions, altered behavior (often accompanied by agitation), reduced consciousness, motor disruption (from dyskinesia to catatonia), seizures, and autonomic dysfunction are typical clinical characteristics. In recent years, the incidence of autoimmune encephalitis diagnoses has markedly risen among adults, children, and adolescents. This fact is unequivocally connected to the dynamic evolution of novel diagnostic techniques and the advancement of medical knowledge. A specific variant of this illness is anti-NMDA receptor encephalitis. Psychiatrists frequently serve as the initial specialists to treat patients with this diagnosis, owing to the manifestation of psychiatric symptoms associated with the condition. The differential diagnosis is quite challenging and predominantly relies on the patient’s history and the manifestation of characteristic clinical signs. Given its high prevalence, anti-NMDA receptor encephalitis should be included in the differential diagnosis in routine psychiatric treatment. We provide an overview of the research on the condition, covering its prognosis, management, epidemiology, differential diagnosis, and clinical presentation. Full article
(This article belongs to the Special Issue Novel Insights into Neuroinflammation and Brain Disease)
16 pages, 4737 KiB  
Article
Co-Community Network Analysis Reveals Alterations in Brain Networks in Alzheimer’s Disease
by Xiaodong Wang, Zhaokai Zhang, Lingli Deng and Jiyang Dong
Brain Sci. 2025, 15(5), 517; https://doi.org/10.3390/brainsci15050517 - 18 May 2025
Abstract
Background: Alzheimer’s disease (AD) is a common neurodegenerative disease. Functional magnetic resonance imaging (fMRI) can be used to measure the temporal correlation of blood-oxygen-level-dependent (BOLD) signals in the brain to assess the brain’s intrinsic connectivity and capture dynamic changes in the brain. [...] Read more.
Background: Alzheimer’s disease (AD) is a common neurodegenerative disease. Functional magnetic resonance imaging (fMRI) can be used to measure the temporal correlation of blood-oxygen-level-dependent (BOLD) signals in the brain to assess the brain’s intrinsic connectivity and capture dynamic changes in the brain. In this study, our research goal is to investigate how the brain network structure, as measured by resting-state fMRI, differs across distinct physiological states. Method: With the research goal of addressing the limitations of BOLD signal-based brain networks constructed using Pearson correlation coefficients, individual brain networks and community detection are used to study the brain networks based on co-community probability matrices (CCPMs). We used CCPMs and enrichment analysis to compare differences in brain network topological characteristics among three typical brain states. Result: The experimental results indicate that AD patients with increasing disease severity levels will experience the isolation of brain networks and alterations in the topological characteristics of brain networks, such as the Somatomotor Network (SMN), dorsal attention network (DAN), and Default Mode Network (DMN). Conclusion: This work suggests that using different data-driven methods based on CCPMs to study alterations in the topological characteristics of brain networks would provide better information complementarity, which can provide a novel analytical perspective for AD progression and a new direction for the extraction of neuro-biomarkers in the early diagnosis of AD. Full article
(This article belongs to the Special Issue Understanding the Functioning of Brain Networks in Health and Disease)
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24 pages, 1188 KiB  
Article
Impathy and Emotion Recognition: How Attachment Shapes Self- and Other-Focused Emotion Processing
by Dirk W. Eilert, Karin de Punder, Jeff Maerz, Johanna Dose, Manuela Gander, Philipp Mensah, Stefanie Neubrand, Josef Hinterhölzl and Anna Buchheim
Brain Sci. 2025, 15(5), 516; https://doi.org/10.3390/brainsci15050516 - 18 May 2025
Abstract
Background/Objectives: Early attachment experiences and psychopathology both shape individuals’ emotion processing. However, the specific influence of adult attachment representations on self- (intrapersonal) and other-focused (interpersonal) emotion processing remains unclear, particularly in the context of personality disorders. This study examined how attachment representations (organized [...] Read more.
Background/Objectives: Early attachment experiences and psychopathology both shape individuals’ emotion processing. However, the specific influence of adult attachment representations on self- (intrapersonal) and other-focused (interpersonal) emotion processing remains unclear, particularly in the context of personality disorders. This study examined how attachment representations (organized vs. unresolved) modulate intrapersonal emotion perception (“impathy”) and interpersonal emotion recognition while accounting for personality pathology. Methods: Thirty-three adults (twenty-four patients with a personality disorder and nine healthy controls) were assessed for attachment representation using the Adult Attachment Projective Picture System (AAP). Emotion processing was measured via the Impathy Inventory and a facial emotion recognition task (READ-64). Group differences (organized vs. unresolved attachment; patients vs. controls) and correlations with the severity of unresolved attachment status were analyzed. Results: Patients with organized attachment representations did not differ from healthy controls in emotion recognition but showed significantly reduced impathy (M difference = −21.72, SE = 6.20, p = 0.002, 95% CI [−34.42, −9.01], d = −1.57). In contrast, patients with unresolved attachment exhibited impairments in both intrapersonal (M difference = −32.99, SE = 6.20, p < 0.001, 95% CI [−45.69, −20.29], d = −2.39) and interpersonal (M difference = −12.37, SE = 4.36, p = 0.008, 95% CI [−21.28, −3.46], d = −1.23) emotion processing compared to healthy controls. Furthermore, the severity of unresolved attachment status correlated with greater impairment in recognizing anger (r = −0.74, p = 0.004). Conclusions: An organized attachment representation may act as a protective factor, preserving interpersonal emotion recognition even in the presence of psychopathology. Conversely, an unresolved attachment constitutes an additional risk factor that exacerbates emotion processing impairments in the context of personality pathology. Attachment representation thus emerges as an active modulator of core emotion processes, with important implications for theory and targeted interventions in personality disorders. Full article
(This article belongs to the Section Cognitive, Social and Affective Neuroscience)
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20 pages, 1350 KiB  
Review
Autobiographical Memory: A Scoping Meta-Review of Neuroimaging Data Enlightens the Inconsistencies Between Theory and Experimentation
by Edoardo Donarelli, Cristina Civilotti, Giulia Di Fini, Gabriella Gandino and Alessia Celeghin
Brain Sci. 2025, 15(5), 515; https://doi.org/10.3390/brainsci15050515 - 18 May 2025
Abstract
Background/Objectives: Autobiographical memory (AM) is typically viewed in terms of comprising episodic (EAM) and semantic (SAM) components. Despite the emergence of numerous meta-analyses, the literature on these constructs remains fragmented. We aimed to summarize neural activations and to discuss the relations between constructs [...] Read more.
Background/Objectives: Autobiographical memory (AM) is typically viewed in terms of comprising episodic (EAM) and semantic (SAM) components. Despite the emergence of numerous meta-analyses, the literature on these constructs remains fragmented. We aimed to summarize neural activations and to discuss the relations between constructs based on theory and experimentation, while evaluating the consistency between literature sources and discussing the critical issues and challenges of current research. Methods: We conducted a scoping meta-review on AM, EAM, and SAM based on meta-analytic studies in five scientific databases (PubMed, Web of Science, Scopus, PsychInfo, and PsychArticles). No temporal or language limits were applied. Results: We included twelve meta-analyses on AM, EAM and SAM in healthy populations. The meta-analyses of AM and EAM actually investigated the same construct, leading to misinterpretation. The two available meta-analyses on SAM used two different operationalizations of the construct. Neural data about EAM were analyzed via mean rank classification, finding the most relevant areas in the posterior cingulate cortex, hippocampus, precuneus, temporo-parietal junction, angular gyrus, and medial prefrontal cortex. SAM was linked to the posterior and anterior cingulate cortexes, middle and inferior frontal gyri, thalamus, middle and superior temporal gyri, inferior frontal and fusiform gyri, and parahippocampal cortex. Conclusions: Variability in reported activation patterns persists, reflecting differences in methodology and assumptions. We propose the homogenization the notations of EAM and AM based on experimental practice. In this notation, AM does not have a separate experimental task nor activation pattern and may not indicate a separate construct but an array of its components. Full article
(This article belongs to the Section Neurotechnology and Neuroimaging)
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14 pages, 604 KiB  
Article
A Randomized Controlled Trial Comparing Subcutaneous Preservation of Bone Flaps with Cryogenic Preservation of Bone Flaps for Cranioplasty in Cases of Traumatic Brain Injury
by Rachith Sridhar, Anil Kumar, Harendra Kumar, Abdul Vakil Khan, Abdul Hakeem, Deepak Kumar, Anurag Kumar and Majid Anwer
Brain Sci. 2025, 15(5), 514; https://doi.org/10.3390/brainsci15050514 - 17 May 2025
Viewed by 141
Abstract
Background and objectives: Decompressive craniectomy (DC) is a surgical procedure, useful for relieving the intracranial pressure following trauma. Following reduction in cerebral oedema, the bone is placed back to cover the defect. During the interim period, the bone flap may be preserved using [...] Read more.
Background and objectives: Decompressive craniectomy (DC) is a surgical procedure, useful for relieving the intracranial pressure following trauma. Following reduction in cerebral oedema, the bone is placed back to cover the defect. During the interim period, the bone flap may be preserved using cryopreservation or in subcutaneous tissue. This leads to a need to determine the benefits and risks involved in preservation of bone flap in a subcutaneous pocket or conventional freezer following decompressive craniectomy in traumatic brain injury. Materials and methods: An open randomized controlled trial was conducted at a level one trauma centre from July 2023 to December 2024. Simple randomization was performed in order to allocate patients into the subcutaneous preservation group and the cryogenic preservation group. Patients underwent cranioplasty after 3 months and were followed up post-operatively for complications and Glasgow Outcome Scale assessment. Results: The study initially recruited a total of 158 patients, out of which 104 patients remained eligible for the final analysis. The patients with cryopreserved flaps were found to have a higher rate of surgical site infection (31.3%) as compared to those with subcutaneously preserved flaps (5.6%), with the differences being statistically significant (p < 0.001). Among the 87 patients who had a poorer Glasgow Outcome Scale (GOS) score before the intervention, 55 (63.2%) patients had at least some improvement in GOS over a period of one month. Conclusion: The use of subcutaneous preservation of bone is more beneficial in resource-limited settings as compared to conventional freezer storage. Full article
(This article belongs to the Special Issue New Advances in Surgical Treatment of Brain Injury)
14 pages, 1322 KiB  
Article
Examination of Psychotropic Medication Use Following Outpatient Behavioral Assessment and Treatment
by Maria G. Valdovinos, Melissa Trites and Janelle Ausenhus
Brain Sci. 2025, 15(5), 513; https://doi.org/10.3390/brainsci15050513 - 17 May 2025
Viewed by 114
Abstract
Background/Objectives: Psychotropic medications are often prescribed to treat challenging behavior in children with neurodevelopmental disorders. This study examined patterns of psychotropic medication use following outpatient behavioral assessment and treatment in children ages 2–16 years. Methods: Medication use at the time of behavioral assessments, [...] Read more.
Background/Objectives: Psychotropic medications are often prescribed to treat challenging behavior in children with neurodevelopmental disorders. This study examined patterns of psychotropic medication use following outpatient behavioral assessment and treatment in children ages 2–16 years. Methods: Medication use at the time of behavioral assessments, six months after the assessment, and a later follow-up time point (mean 25 months following the six-month time point, range 1 month to 41 months) were evaluated via a chart review. Alterations in psychotropic medication use were grouped into eight categories according to the type of medication change experienced. Care providers also completed a social validity survey rating their satisfaction with the assessment and interventions developed for their child. Results: This retrospective study revealed that children in this sample were more likely to experience starting a new medication and increases in the dose of psychotropic medication as time passed. Children were also less likely to remain on the same regimen of psychotropic medication as when they were first seen in the clinic. Additionally, although caregivers generally rated their experiences and outcomes with the behavioral clinic as favorable, additions and increases to psychotropic medication regimens still occurred. Conclusions: These findings are consistent with other reports of continued and increased prescribing of psychotropic medication across time in children with neurodevelopmental disorders, however, the results must be interpreted with caution given the small sample sizewhich limits generalizability of these findings. Additionally, the lack of follow-up with the patients in this sample made it difficult to correlate changes in challenging behavior with psychotropic medication prescribing. Full article
(This article belongs to the Special Issue Advances in Psychopharmacology in Neurodevelopmental Disorders (NDDs))
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17 pages, 855 KiB  
Article
The Influence of Transcranial Alternating Current Stimulation on the Excitability of the Unstimulated Contralateral Primary Motor Cortex
by Erik W. Wilkins, Richard J. Young, Ryder Davidson, Reese Krider, George Alhwayek, Jonathan A. Park, Armaan C. Parikh, Zachary A. Riley and Brach Poston
Brain Sci. 2025, 15(5), 512; https://doi.org/10.3390/brainsci15050512 - 17 May 2025
Viewed by 170
Abstract
Objectives: Transcranial alternating current stimulation (tACS) can enhance primary motor cortex (M1) excitability and improve motor skill when delivered unilaterally to the dominant hemisphere. However, the impact of tACS on contralateral M1 excitability both during and after application has not been studied. The [...] Read more.
Objectives: Transcranial alternating current stimulation (tACS) can enhance primary motor cortex (M1) excitability and improve motor skill when delivered unilaterally to the dominant hemisphere. However, the impact of tACS on contralateral M1 excitability both during and after application has not been studied. The purpose of this study was to examine the effects of tACS delivered to the dominant left M1 on the excitability of the unstimulated contralateral non-dominant right M1. Methods: This study implemented a double-blind, randomized, SHAM-controlled, within-subjects, crossover experimental design. Eighteen young adults completed a tACS condition and a SHAM condition on two different days in counterbalanced order with a week washout period between days. Transcranial magnetic stimulation (TMS) was utilized to assess excitability of the contralateral right M1 while tACS was delivered to the left M1. TMS was administered in five test blocks (termed Pre, D5, D10, D15, and Post) relative to a 20 min application of tACS (70 Hz, 1 mA current strength). The Pre and Post TMS test blocks were conducted before and immediately after tACS was applied to the left M1, whereas the TMS test blocks performed during tACS were completed at time points starting at the 5, 10, and 15 min marks of the 20 min stimulation period. The primary dependent variable was the 1 mV motor evoked potential (MEP) amplitude. MEP data were analyzed with a 2 condition (tACS, SHAM) × 5 test (Pre, D5, D10, D15, Post) within-subjects ANOVA. Results: The main effect for condition (p = 0.704) and condition × test interaction (p = 0.349) were both non-statistically significant. There was a significant main effect for test (p = 0.003); however, post hoc analysis indicated that none of the pairwise comparisons were statistically significant. Conclusions: Overall, the findings indicate that tACS applied to the left M1 does not significantly modulate contralateral right M1 excitability during or immediately after stimulation, at least when utilizing the present tACS parameters. Full article
(This article belongs to the Special Issue New Insights into Movement Generation: Sensorimotor Processes)
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10 pages, 269 KiB  
Article
Interrater Reliability of the Occupational Therapy Anticipatory Awareness Test: A Performance-Based Cognitive Assessment
by Danielle Mahoney, Stephanie Alvarado and Rochelle Mendonca
Brain Sci. 2025, 15(5), 511; https://doi.org/10.3390/brainsci15050511 - 16 May 2025
Viewed by 57
Abstract
Background: Functional cognitive impairments caused by acquired brain injury (ABI) negatively impact an individual’s daily functioning. Impaired self-awareness can pose obstacles to task execution and participation. Traditional assessment methods for self-awareness lack a functional approach, highlighting the need for performance-based assessments such as [...] Read more.
Background: Functional cognitive impairments caused by acquired brain injury (ABI) negatively impact an individual’s daily functioning. Impaired self-awareness can pose obstacles to task execution and participation. Traditional assessment methods for self-awareness lack a functional approach, highlighting the need for performance-based assessments such as the Occupational Therapy Anticipatory Awareness Test (OTAAT). The purpose of this study was to establish the interrater reliability of the OTAAT in adults with ABI. Methods: This was a two-phase study. Phase One involved the recruitment of three participants with ABI, who then underwent OTAAT administration within a setting of their choosing. OTAAT performances were recorded. In Phase Two, ten occupational therapists assessed the Phase One participants’ performances using the OTAAT. Phase Two’s raters’ outcomes were obtained by research personnel. These data were then collected and analyzed by research staff to measure interrater reliability using the Intraclass Correlation Coefficient (ICC) via IBM Statistical Package for the Social Sciences (SPSS) software. A two-way random effect, absolute agreement, multiple-rater/measurement ICC was adopted for this study. Results: Data analysis demonstrated strong interrater reliability for the OTAAT, demonstrating its consistency to measure self-awareness in individuals with ABI across different raters. Specifically, the ICC values indicated strong agreement among raters in their assessment of participants’ self-awareness performance using the OTAAT. Conclusion: The OTAAT has strong interrater reliability and holds promise as a valuable addition to neurorehabilitation practice. This study demonstrates the reliability of the OTAAT as a tool for assessing self-awareness in the ABI population. Full article
(This article belongs to the Special Issue The Impact of Stroke on Functional Cognition and Rehabilitation Approaches)
12 pages, 319 KiB  
Article
Superficial Neuromodulation in Dysautonomia in Women with Post-COVID-19 Condition: A Pilot Study
by Alberto Melián-Ortíz, Eduardo Zurdo-Sayalero, Sara Perpiñá-Martínez, Antonio Delgado-Lacosta, Carmen Jiménez-Antona, Josué Fernández-Carnero and Sofía Laguarta-Val
Brain Sci. 2025, 15(5), 510; https://doi.org/10.3390/brainsci15050510 - 16 May 2025
Viewed by 45
Abstract
Post-COVID-19 condition involves persistent symptoms after acute infection, often linked to dysautonomia, which affects heart rate variability, pain perception, fatigue, and sleep. Superficial neuromodulation has been proposed as a treatment. Objective: To assess the effects of superficial neuromodulation on symptoms, sleep quality, and [...] Read more.
Post-COVID-19 condition involves persistent symptoms after acute infection, often linked to dysautonomia, which affects heart rate variability, pain perception, fatigue, and sleep. Superficial neuromodulation has been proposed as a treatment. Objective: To assess the effects of superficial neuromodulation on symptoms, sleep quality, and autonomic function in post-COVID-19 condition patients. Methods: A pilot study was conducted based on a triple-blind randomized controlled trial methodology involving 16 female participants. The experimental group received neuromodulation, while the control group used a placebo device. The intervention spanned 15 sessions over two months. Primary outcomes included heart rate variability, pain threshold, cortisol levels, fatigue, sleep quality, and quality of life, analyzed using repeated-measures ANOVA. Results: Both groups improved over time. Heart rate variability (SDNN) increased in the experimental group (30.42 to 39.11 ms) but decreased in controls (31.88 to 28.73 ms) (p < 0.05). Pain threshold at C5–C6 improved in the experimental group (2.1 to 3.5 kg/cm2) but remained stable in controls (p = 0.032). Fatigue decreased significantly in both groups (p = 0.002). Sleep quality improved, with Pittsburgh Sleep Quality Index scores decreasing similarly in both groups. Cortisol levels increased, with a non-significant trend favoring controls. Conclusions: While improvements were seen, both groups benefited, suggesting a possible placebo effect. Superficial neuromodulation appears safe, but further studies with larger samples are needed to confirm efficacy. Full article
(This article belongs to the Special Issue Neuromodulation for Pain Management: Evidence of Safety and Efficacy)
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25 pages, 5709 KiB  
Article
EEG-Based Seizure Detection Using Dual-Branch CNN-ViT Network Integrating Phase and Power Spectrograms
by Zhuohan Wang, Yaoqi Hu, Qingyue Xin, Guanghao Jin, Yazhou Zhao, Weidong Zhou and Guoyang Liu
Brain Sci. 2025, 15(5), 509; https://doi.org/10.3390/brainsci15050509 - 16 May 2025
Viewed by 70
Abstract
Background/Objectives: Epilepsy is a common neurological disorder with pathological mechanisms closely associated with the spatiotemporal dynamic characteristics of electroencephalogram (EEG) signals. Although significant progress has been made in epileptic seizure detection methods using time–frequency analysis, current research still faces challenges in terms of [...] Read more.
Background/Objectives: Epilepsy is a common neurological disorder with pathological mechanisms closely associated with the spatiotemporal dynamic characteristics of electroencephalogram (EEG) signals. Although significant progress has been made in epileptic seizure detection methods using time–frequency analysis, current research still faces challenges in terms of an insufficient utilization of phase information. Methods: In this study, we propose an effective epileptic seizure detection framework based on continuous wavelet transform (CWT) and a hybrid network consisting of convolutional neural network (CNN) and vision transformer (ViT). First, the raw EEG signals are processed by the CWT. Then, the phase spectrogram and power spectrogram of the EEG are generated, and they are sent into the designed CNN and ViT branches of the network to extract more discriminative EEG features. Finally, the features output from the two branches are fused and fed into the classification network to obtain the detection results. Results: Experimental results on the CHB-MIT public dataset and our SH-SDU clinical dataset show that the proposed framework achieves sensitivities of 98.09% and 89.02%, specificities of 98.21% and 95.46%, and average accuracies of 98.45% and 94.66%, respectively. Furthermore, we compared the spectral characteristics of CWT with other time–frequency transforms within the hybrid architecture, demonstrating the advantages of the CWT-based CNN-ViT architecture. Conclusions: These results highlight the outstanding epileptic seizure detection performance of the proposed framework and its significant clinical feasibility. Full article
(This article belongs to the Section Computational Neuroscience and Neuroinformatics)
16 pages, 588 KiB  
Study Protocol
The Effects of Endoscopic Third Ventriculostomy Versus Ventriculoperitoneal Shunt on Neuropsychological and Motor Performance in Patients with Idiopathic Normal Pressure Hydrocephalus—ENVENTOR-iNPH: Study Protocol
by Gianluca Scalia, Nicola Alberio, Pietro Trombatore, Mariangela Panebianco, Grazia Razza, Gianluca Galvano, Giovanni Federico Nicoletti and Francesca Graziano
Brain Sci. 2025, 15(5), 508; https://doi.org/10.3390/brainsci15050508 - 16 May 2025
Viewed by 30
Abstract
Background: Idiopathic normal pressure hydrocephalus (iNPH) is a progressive neurological disorder characterized by cognitive decline, gait disturbances, and urinary incontinence. Surgical interventions such as ventriculoperitoneal shunt (VPS) and endoscopic third ventriculostomy (ETV) are the primary treatment options. While VPS is the standard of [...] Read more.
Background: Idiopathic normal pressure hydrocephalus (iNPH) is a progressive neurological disorder characterized by cognitive decline, gait disturbances, and urinary incontinence. Surgical interventions such as ventriculoperitoneal shunt (VPS) and endoscopic third ventriculostomy (ETV) are the primary treatment options. While VPS is the standard of care, ETV offers a minimally invasive alternative with potentially fewer complications. However, comparative evidence regarding their impact on cognitive, motor, and structural outcomes remains limited. This study, titled ENVENTOR-iNPH (endoscopic ventriculostomy versus shunt on neuropsychological and motor performance in patients with iNPH), aims to address this gap through a rigorously designed comparative protocol. Methods: This protocol is designed as a multicenter, randomized, controlled trial (ENVENTOR-iNPH) to compare the effects of ETV and VPS in patients diagnosed with iNPH. The study will enroll 100 patients aged 60 years or older, randomly assigned to undergo ETV (n = 50) or VPS (n = 50). Preoperative and postoperative evaluations will include comprehensive cognitive and motor assessments, standardized quality-of-life instruments, and advanced neuroimaging techniques such as MRI with flowmetry and diffusion tensor imaging (DTI). Functional outcomes will also be evaluated using navigated transcranial magnetic stimulation (nTMS) and wearable motion analysis systems. The objective of this study is to compare the efficacy and safety of ETV versus VPS in restoring cognitive and motor performance in patients with iNPH. Results: Primary outcomes include cognitive and motor function improvements. Secondary endpoints are surgical complications, hospital stay duration, and changes in quality of life. Neuroimaging will assess changes in white matter integrity and cerebrospinal fluid dynamics, while nTMS will provide insights into neuroplasticity and motor pathway recovery. ETV is hypothesized to demonstrate clinical outcomes comparable or superior to VPS, particularly in terms of complication reduction and hospital recovery metrics. Conclusions: The ENVENTOR-iNPH protocol establishes the framework for a comprehensive, multicenter study comparing ETV and VPS in iNPH patients. The findings from this initial study will inform the design of larger-scale multicenter trials, guide clinical decision making, and potentially position ETV as a preferred treatment option for eligible patients. Full article
(This article belongs to the Special Issue Editorial Board Collection Series: Insight into Neurosurgery)
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52 pages, 1790 KiB  
Review
Emotion, Motivation, Reasoning, and How Their Brain Systems Are Related
by Edmund T. Rolls
Brain Sci. 2025, 15(5), 507; https://doi.org/10.3390/brainsci15050507 - 16 May 2025
Viewed by 167
Abstract
A unified theory of emotion and motivation is updated in which motivational states are states in which instrumental goal-directed actions are performed to obtain anticipated rewards or avoid punishers, and emotional states are states that are elicited when the (conditioned or unconditioned) instrumental [...] Read more.
A unified theory of emotion and motivation is updated in which motivational states are states in which instrumental goal-directed actions are performed to obtain anticipated rewards or avoid punishers, and emotional states are states that are elicited when the (conditioned or unconditioned) instrumental reward or punisher is or is not received. This advances our understanding of emotion and motivation, for the same set of genes and associated brain systems can define the primary or unlearned rewards and punishers such as a sweet taste or pain, and the brain systems that learn to expect rewards or punishers and that therefore produce motivational and emotional states. It is argued that instrumental actions under the control of the goal are important for emotion, because they require an intervening emotional state in which an action is learned or performed to obtain the goal, that is, the reward, or to avoid the punisher. The primate including human orbitofrontal cortex computes the reward value, and the anterior cingulate cortex is involved in learning the action to obtain the goal. In contrast, when the instrumental response is overlearned and becomes a habit with stimulus–response associations, emotional states may be less involved. In another route to output, the human orbitofrontal cortex has effective connectivity to the inferior frontal gyrus regions involved in language and provides a route for declarative reports about subjective emotional states to be produced. Reasoning brain systems provide alternative strategies to obtain rewards or avoid punishers and can provide different goals for action compared to emotional systems. Full article
(This article belongs to the Special Issue Defining Emotion: A Collection of Current Models)
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23 pages, 663 KiB  
Systematic Review
The Use of Griffiths III in the Appraisal of the Developmental Profile in Autism: A Systematic Search and Review
by Flavia Lecciso, Chiara Martis and Annalisa Levante
Brain Sci. 2025, 15(5), 506; https://doi.org/10.3390/brainsci15050506 - 15 May 2025
Viewed by 203
Abstract
Background: Griffiths III is a child-friendly and play-oriented direct gold-standard measure of a 0–6-year-old child’s developmental profile. It is a measure that helps practitioners in detecting the weaknesses in children who have an increased likelihood or a diagnosis of neurodevelopmental disorders, e.g., autism. [...] Read more.
Background: Griffiths III is a child-friendly and play-oriented direct gold-standard measure of a 0–6-year-old child’s developmental profile. It is a measure that helps practitioners in detecting the weaknesses in children who have an increased likelihood or a diagnosis of neurodevelopmental disorders, e.g., autism. Objectives: Following the PICO protocol, two research questions addressed the current systematic search and review (Prospero registration: CRD42024554286): What is(are) the main developmental domain(s) evaluated by Griffiths III impaired in autism? (RQ1); Using Griffiths III, what is(are) the main developmental domain(s) improved after an autism-specific early intervention? (RQ2). Methods: Six studies have been reviewed: three case–control studies, a case report study, and two studies examining the effectiveness of early autism-specific interventions. According to the study design, the methodological quality was evaluated using three standardised protocols: STROBE; JBI; CEC. Results: The results highlighted that the Language and Communication and Personal–Social–Emotional domains are the most impaired in autistic children and in those with an increased likelihood (RQ1). The results outlined that early target intervention enhanced the same domains (RQ2). Conclusions: In conclusion, the findings highlight the importance of screening not only for autism traits but also for impairments in language, communication, and socio-emotional skills. The future direction of the results is discussed. Full article
(This article belongs to the Section Developmental Neuroscience)
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31 pages, 1010 KiB  
Review
Cognitive Factors in Process Model Comprehension—A Systematic Literature Review
by Maximilian Möller, Michael Winter and Manfred Reichert
Brain Sci. 2025, 15(5), 505; https://doi.org/10.3390/brainsci15050505 - 15 May 2025
Viewed by 199
Abstract
Process models constitute essential tools in business process management and software engineering for representing and managing real-world business processes. Hence, the proper comprehension of these models is crucial for enabling an effective and efficient communication among stakeholders. While several studies have examined factors [...] Read more.
Process models constitute essential tools in business process management and software engineering for representing and managing real-world business processes. Hence, the proper comprehension of these models is crucial for enabling an effective and efficient communication among stakeholders. While several studies have examined factors affecting process model comprehension, such as the used modeling notation or process complexity, there is a lack of in-depth research on the cognitive processes important to comprehend process models deeper. This systematic literature review explores the cognitive mechanisms underlying process model comprehension by integrating insights from relevant disciplines such as cognitive neuroscience and psychology. Key areas of cognition include perception, attention, memory, language, problem solving, emotion, and metacognition. This review was conducted following the well-established Kitchenham methodology and included an extensive search in the following digital libraries: Web of Science, IEEE Xplore, ScienceDirect, ACM Digital Library, PubMed, and SpringerLink. By analyzing 47 studies, this literature review identifies gaps in current research, emphasizing the need for further investigation into these cognitive processes to improve model comprehensibility. Full article
(This article belongs to the Section Neuropsychology)
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17 pages, 923 KiB  
Article
Defective Awareness of Person-Recognition Disorders Through Face, Voice and Name in Right and Left Variants of Semantic Dementia: A Pilot Study
by Simona Luzzi, Oscar Prata and Guido Gainotti
Brain Sci. 2025, 15(5), 504; https://doi.org/10.3390/brainsci15050504 - 15 May 2025
Viewed by 198
Abstract
Background/Objectives: The aim of this investigation consisted of evaluating if the prevalence of anosognosia in right-brain-damaged patients is greater for tasks in which the right hemisphere plays a dominant role and if this prevalence is at least in part due to automatic [...] Read more.
Background/Objectives: The aim of this investigation consisted of evaluating if the prevalence of anosognosia in right-brain-damaged patients is greater for tasks in which the right hemisphere plays a dominant role and if this prevalence is at least in part due to automatic processing mechanisms typical of this hemisphere. Methods: We assessed defective awareness of person-recognition disorders in 14 patients with the right variant (rv-SD) and 15 with the left variant (lv-SD) of Semantic Dementia. A battery exploring person-recognition disorders through familiarity judgement of faces, voices and names was applied. In patients with pathological performance in one of these modalities, anosognosia was assessed comparing the patients’ subjective judgment to the objective result of their performance (objective evaluation) and to the subjective judgment given by an informed caregiver (external comparison). Results: In the comparison between subjective awareness and objective scores in the various person-recognition modalities, only anosognosia for face recognition disorders was significantly more frequent of in patients with rv-SD. When compared to their caregivers, subjects with rv-SD were significantly less aware than caregivers of their difficulties only on face recognition. On the contrary, patients with a lv-SD showed a greater (non-significant) trend to be unaware of their name recognition deficit. Conclusions: These data show that the prevalence of anosognosia in right-brain-damaged patients is greater for face recognition in which the right hemisphere plays a dominant role and that this prevalence is at least in part due to automatic processing mechanisms (evocation of familiarity feelings) typical of this hemisphere. Full article
(This article belongs to the Special Issue Anosognosia and the Determinants of Self-Awareness)
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17 pages, 575 KiB  
Article
The Mediating Role of Social Camouflaging on the Relationship Between Autistic Traits and Orthorexic Symptoms
by Barbara Carpita, Benedetta Nardi, Cristiana Pronestì, Gianluca Cerofolini, Matilde Filidei, Chiara Bonelli, Gabriele Massimetti, Ivan Mirko Cremone, Stefano Pini and Liliana Dell’Osso
Brain Sci. 2025, 15(5), 503; https://doi.org/10.3390/brainsci15050503 - 14 May 2025
Viewed by 174
Abstract
Background/Objectives: Recent lifestyle and dietary changes, driven by health awareness and ecological concerns, have led to the rise in numerous type of diets, which can promote well-being but may also contribute to Orthorexia Nervosa (ON), which have been suggested to be linked [...] Read more.
Background/Objectives: Recent lifestyle and dietary changes, driven by health awareness and ecological concerns, have led to the rise in numerous type of diets, which can promote well-being but may also contribute to Orthorexia Nervosa (ON), which have been suggested to be linked to autism spectrum disorder. This study aimed to explore the relationship between autistic traits, social camouflaging, and orthorexic tendencies in female university students, focusing on how these factors intersect with specific dietary habits. Methods: 554 female students were recruited via an online survey and assessed with the Adult Autism Subthreshold (AdAS) Spectrum, the Camouflaging Autistic Traits Questionnaire (CAT-Q), and the ORTO-R. Participants were categorized into four groups based on AdAS Spectrum and CAT-Q quartiles. Results: Vegans and vegetarians exhibited higher orthorexic tendencies and specific autistic traits. High scorers on the AdAS Spectrum and CAT-Q also showed higher ORTO-R scores, with both AdAS Spectrum and CAT-Q total scores, as well as certain domains, serving as significant positive predictors of higher ORTO-R scores. Notably, the AdAS Spectrum total score had a significant direct and indirect effect (through the CAT-Q) on the ORTO-R total score. Conclusions: The study found significant associations between autistic traits, social camouflaging behaviors, and orthorexic tendencies in female university students. These findings suggest that the strict dietary behaviors and rigid thinking characteristic of orthorexia may be influenced by underlying autistic features, highlighting the need for further research into the intersection of autism and eating disorders. Full article
(This article belongs to the Special Issue Advanced Clinical Diagnosis, Evaluation, and Treatment of Psychosis)
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17 pages, 488 KiB  
Systematic Review
Dysautonomia in Alzheimer’s Disease: A Systematic Review
by Marianna Papadopoulou, Maria-Ioanna Stefanou, Eleni Bakola, Christos Moschovos, Athanasia Athanasaki, Evdoxia Tsigkaropoulou, Ioannis Michopoulos, George P. Paraskevas, Rossetos Gournellis and Georgios Tsivgoulis
Brain Sci. 2025, 15(5), 502; https://doi.org/10.3390/brainsci15050502 - 14 May 2025
Viewed by 169
Abstract
Background: Alzheimer’s disease (AD) is the most common cause of dementia. In addition to cognitive decline, non-cognitive symptoms, including dysautonomia, have been reported, although these symptoms are rarely acknowledged by patients. Dysautonomia in AD is thought to arise from either cholinergic deficits [...] Read more.
Background: Alzheimer’s disease (AD) is the most common cause of dementia. In addition to cognitive decline, non-cognitive symptoms, including dysautonomia, have been reported, although these symptoms are rarely acknowledged by patients. Dysautonomia in AD is thought to arise from either cholinergic deficits or hypothalamic involvement. A wide range of tests has been used to investigate the role of the autonomic nervous system; however, the results have been inconsistent. Aim: To systematically review all published research investigating autonomic nervous system (ANS) involvement in patients with AD. A comprehensive literature search was conducted in December 2024 across the following databases: PubMed, Cochrane Library, ScienceDirect, and Scopus. Results: A total of 1422 records were identified, of which 30 studies fulfilled the inclusion criteria and were included in the review. Several autonomic tests were employed, with Heart Rate Variability (HRV) being the most frequently used. Other tests included assessments of orthostatic hypotension (OH), postprandial hypotension (PPH), sympathetic skin response (SSR), the tilt test, 123I-MIBG cardiac scintigraphy, norepinephrine (NE) measurements in serum and cerebrospinal fluid, and baroreflex sensitivity. In most studies, AD patients were compared to either healthy controls or patients with other types of dementia. Discussion: The primary finding of this review is that, although patients with AD rarely report dysautonomic symptoms, they frequently exhibit abnormal results on various autonomic tests. In some cases, these findings were sufficient to differentiate AD patients from healthy controls as well as from patients with Diffuse Lewy Body disease (DLB). The inconsistency in reporting symptoms, along with the variability in test results, suggests that autonomic dysfunction in AD may be under-recognized and warrants further investigation. Conclusions: The heterogeneity of the included studies limits the generalizability of the results. However, given the potential impact of dysautonomia on both quality of life and mortality, it is recommended that AD patients be systematically assessed for autonomic dysfunction. Even in the absence of overt symptoms, appropriate treatment should be considered where indicated to mitigate potential risks. Full article
(This article belongs to the Special Issue Aging-Related Changes in Memory and Cognition)
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16 pages, 3978 KiB  
Systematic Review
Impact of Flipped Classroom Instruction on Brain-Mediated Motor Skill Performance in University Students: A Systematic Review and Meta-Analysis
by Kerui Liu, Zikang Hao, Jiping Chen, Qingxu Wu, Wei Jin, Yang Pan and Xianliang Zhang
Brain Sci. 2025, 15(5), 501; https://doi.org/10.3390/brainsci15050501 - 14 May 2025
Viewed by 198
Abstract
Objective: This systematic review and meta-analysis evaluates how the flipped classroom model—considered as a neurocognitive training environment—affects cognitive–motor integration and brain-mediated motor skill performance in university students, providing scientific evidence for optimizing higher-education physical education pedagogy (a course related to physical literacy and [...] Read more.
Objective: This systematic review and meta-analysis evaluates how the flipped classroom model—considered as a neurocognitive training environment—affects cognitive–motor integration and brain-mediated motor skill performance in university students, providing scientific evidence for optimizing higher-education physical education pedagogy (a course related to physical literacy and the cultivation of physical and mental health, rather than a training program for professional physical education teachers). Methods: In order to compare the effects of flipped classroom and traditional teaching on the motor skill performance of university students, this study conducted a systematic review and meta-analysis according to PRISMA rules, whereby studies were screened according to specific inclusion criteria and data were extracted, assessed for quality, and then meta-analyzed to assess the effectiveness of the flipped classroom model in improving motor skill performance. Results: A total of 12 original randomized controlled trials (RCTs) were included in the study. The meta-analysis results indicated that the flipped classroom model significantly outperformed traditional teaching methods in improving university students’ motor skill scores (standardized mean difference (SMD) = 1.22, 95% CI = 0.64–1.79, p < 0.0001). Subgroup analysis showed significant effects in both general major students and sports science major students, with no significant difference between studies conducted in China and those conducted in non-China regions. Conclusions: The flipped classroom model demonstrates significant advantages over traditional PE teaching methods in improving motor skill performance. It enhances students’ skill acquisition and classroom engagement, showing promising potential for future implementation in university PE programs. Further research should explore the model’s applicability across different sports and student populations, as well as its long-term impact on skill retention and postgraduation sports participation. Full article
(This article belongs to the Special Issue Advances in the Relationship Among Brain, Physical Function, and Exercise Performance)
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65 pages, 3445 KiB  
Review
Exploring Virtual Reality-Based Reminiscence Therapy on Cognitive and Emotional Well-Being in People with Cognitive Impairments: A Scoping Review
by Susanna Pardini, Riccardo Calcagno, Anna Genovese, Elio Salvadori and Oscar Mayora Ibarra
Brain Sci. 2025, 15(5), 500; https://doi.org/10.3390/brainsci15050500 - 13 May 2025
Viewed by 310
Abstract
Background/Objectives: Virtual reality (VR) is increasingly being explored as a non-pharmacological therapy to enhance the well-being of people with cognitive impairment (PwCI). Studies suggest that VR-based interventions improve mood, reduce apathy, and enhance emotional engagement, making VR a valuable tool for cognitive and [...] Read more.
Background/Objectives: Virtual reality (VR) is increasingly being explored as a non-pharmacological therapy to enhance the well-being of people with cognitive impairment (PwCI). Studies suggest that VR-based interventions improve mood, reduce apathy, and enhance emotional engagement, making VR a valuable tool for cognitive and emotional support. This scoping review synthesizes evidence on VR-based reminiscence therapy (VRRT) for PwCI. It aims to map existing knowledge, highlight implementation challenges, and offer practical, technical design, and evidence-informed recommendations for clinical integration—building on prior reviews that have touched on these aspects, but placing a stronger and more structured emphasis on real-world applicability and translational insights. This review draws extensively on qualitative findings across the included studies to better capture contextual factors, user experiences, facilitator roles, and barriers to usability. Moreover, unlike previous research, we included only studies involving individuals—either directly or via proxies—with an age-related cognitive impairment, formally diagnosed by a qualified authority. Methods: A systematic search based on the PRISMA-ScR guideline identified 310 studies, of which 11 met the inclusion criteria. These studies assessed the effectiveness and feasibility of immersive VRRT. Research methodologies included longitudinal (n = 2), cross-sectional (n = 2), mixed-methods (n = 4), and randomized controlled trials (n = 3)—with most studies focusing on feasibility—with a cumulative sample size of approximately 287 participants. The quality of the included studies was generally moderate; common limitations included small sample sizes, short intervention periods, and limited control conditions. Results: The findings highlight VRRT’s potential to enhance engagement, emotional well-being, and cognitive function. However, usability challenges and technical limitations persist. While VR offers promising benefits, further research is needed to refine interventions, address personalization barriers, and assess long-term effects. Conclusions: This review underscores the importance of integrating VRRT into care programs and improving accessibility. Future research should enhance methodological rigor to ensure reliable outcomes and maximize VR’s impact on PwCI well-being. The scoping review protocol is registered a priori with the Center for Open Science (OSF) (registration type: OSF Preregistration, data registered: 15 November 2024, associated project: osf.io/r7jha, identifier: DOI 10.17605/OSF.IO/R7JHA). Full article
(This article belongs to the Section Neurodegenerative Diseases)
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19 pages, 667 KiB  
Review
Is There a Link Between Type 2 Diabetes Mellitus and Negative Symptoms in Schizophrenia? A Scoping Review
by István Bitter, Pál Czobor and László Tombor
Brain Sci. 2025, 15(5), 499; https://doi.org/10.3390/brainsci15050499 - 13 May 2025
Viewed by 205
Abstract
Background/Objectives: Type 2 diabetes mellitus (T2DM) and impaired glucose metabolism are more prevalent among patients with schizophrenia than in the general population. The incidence of T2DM is associated with lifestyle factors that are often influenced by the negative symptoms of schizophrenia; comorbid T2DM [...] Read more.
Background/Objectives: Type 2 diabetes mellitus (T2DM) and impaired glucose metabolism are more prevalent among patients with schizophrenia than in the general population. The incidence of T2DM is associated with lifestyle factors that are often influenced by the negative symptoms of schizophrenia; comorbid T2DM may contribute to the reduced life expectancy observed in patients with schizophrenia. The existing literature reveals a scarcity of data regarding the potential causal relationship between T2DM and negative symptoms. Methods: A scoping review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria, utilizing the PubMed database to identify clinical studies investigating the association between T2DM and the negative (but not cognitive) symptom domain of schizophrenia. Subsequently, the reference lists of these identified publications were searched. Results: Seventeen publications were included. There is evidence supporting the association between impaired glucose tolerance and increased negative symptoms in patients with first-episode psychosis, and several studies indicate that poorer glucose metabolic status correlates with more severe negative symptoms. Patients with T2DM and chronic schizophrenia, however, had milder negative symptom scores compared to those without diabetes, although this association was less pronounced than in early disease stages. Conclusions: There is insufficient confirmatory evidence regarding the potential causality of T2DM on the negative symptoms of schizophrenia. Further, preferably prospective studies are needed to explore the complex and potentially causal relationship between T2DM and negative symptoms of schizophrenia. If T2DM were found to have a causal relationship with negative symptoms or to exacerbate pre-existing symptoms, it could lead to significant changes in therapeutic approaches for schizophrenia. Full article
(This article belongs to the Special Issue Exploring Negative Symptoms of Schizophrenia: Where Do We Stand?)
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5 pages, 173 KiB  
Editorial
Amyotrophic Lateral Sclerosis: Recent Considerations for Diagnosis, Pathogenesis and Therapy
by Andrew Eisen
Brain Sci. 2025, 15(5), 498; https://doi.org/10.3390/brainsci15050498 - 13 May 2025
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Abstract
Amyotrophic lateral sclerosis (ALS/MND) is considered a uniquely human complex neurodegenerative disorder, presenting with a variety of clinical phenotypes, which include frontotemporal dementia [...] Full article
(This article belongs to the Special Issue Amyotrophic Lateral Sclerosis: Recent Considerations for Diagnosis, Pathogenesis and Therapy)
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Article
Cognitive Control After ACL Reconstruction: A Cross-Sectional Study on Impaired Proactive Inhibition Compared to Healthy Controls
by Jesús Jiménez-Martínez, Alejandro Gutiérrez-Capote, Iker Madinabeitia, David Cárdenas and Francisco Alarcón
Brain Sci. 2025, 15(5), 497; https://doi.org/10.3390/brainsci15050497 - 12 May 2025
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Abstract
Background/Objectives: Anterior cruciate ligament (ACL) injury is common in interaction sports and has severe physical and psychological consequences. Recent research suggests that neurocognitive factors, such as proactive inhibitory control, may influence injury risk. The present work compares the proactive inhibitory performance ability [...] Read more.
Background/Objectives: Anterior cruciate ligament (ACL) injury is common in interaction sports and has severe physical and psychological consequences. Recent research suggests that neurocognitive factors, such as proactive inhibitory control, may influence injury risk. The present work compares the proactive inhibitory performance ability of athletes with no ACL injury and ACL-rehabilitated athletes (ACLR). Methods: This study involved 60 athletes from interaction sports (30 with no history of ACL injury and 30 ACL rehabilitated athletes). During the experimental session, participants performed an executive go–no-go task to assess proactive inhibitory control. Results: The ACLR group exhibited higher adjusted-precision response times (p = 0.011), higher inhibitory failures response times (p < 0.001), poorer accuracy (p = 0.003), and higher commission error rate (p = 0.026) than the group of athletes with no history of ACL injury. Conclusions: Athletes rehabilitated from an ACL injury show inferior performance in proactive inhibitory control, evidenced by lower accuracy and higher reaction times than athletes without a history of injury. Consequently, physiotherapists and exercise professionals should consider cognition during ACL injury rehabilitation and physical retraining before returning to sporting activity. Full article
(This article belongs to the Special Issue Mind in Motion: Exploring Neuropsychophysiological Aspects of Sports Performance, Health and Physical Activity)
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