Brain Sciences

Background/Objectives: This systematic review summarizes the evidence regarding potential mechanisms underlying the relationship between spiritual practices and cognitive health in adults. The review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Methods: An extensive search of six electronic databases (i.e., PubMed, PsycINFO, Embase, Sociological Abstracts, ATLA, CINAHL) was conducted using keywords related to spiritual practices, religious activities, and cognitive health from 1 January 2000 to December 2025. The quality of the included studies was assessed using the Mixed Methods Appraisal tool aligned with the study design. Results: A total of 34 studies were selected for final inclusion in this review, and a narrative synthesis is provided. The studies were conducted throughout the world, with most studies conducted in North America and Asia. Short- and medium-term effects of spiritual practices on cognitive health were identified across heterogeneous practices ranging from meditation, tai chi and yoga to general spiritual and religious activities. Across the strongest evidence, 73% of the randomized control trials examined reported better cognitive health among the more spiritually active; neurobiological factors of decreased inflammation and improved immune response helped to explain these effects. A total of 5 studies examined mediators, while 29 studies contained only secondary outcomes for determining potential mechanisms. Informed by findings across psychosocial, behavioral, and neurobiological pathways, a conceptual model was created and needs testing. Conclusions: Possible mechanisms for spiritual effects on cognition may be through mental health and neurobiological factors, although more rigorous and long-term studies are needed.

Background/Objectives: Acquired brain injuries (ABIs), such as stroke, are a major cause of disability globally and frequently affect functional cognition. Functional cognition is the ability to use cognitive processes including memory, attention, and executive functioning to perform daily tasks. When these processes are disrupted, it affects the individual in their participation, independence, and quality of life; it also places a significant burden on family members who often become primary caregivers. The aim of this review is to summarize evidence-based strategies to enhance functional cognition following strokes in an attempt to decrease the caregiver burden and improve both patients and their caregivers’ quality of life. Methods: This review summarizes and interprets findings using an annotated bibliography review and systematic search strategy to gather the most effective and relevant evidence-based interventions for those with ABIs and strokes experiencing memory, attention, and executive dysfunction. Studies outlining adaptive and compensatory interventions were included. Results: Evidence suggests compensatory strategies including environmental and external memory aids, structured routine, technological interventions, metacognitive strategies, as well as attention processing, strategy, and visual imagery training. These tactics demonstrate improvement in functional cognition domains of memory, (particularly prospective memory, i.e., remembering to perform future tasks), attention, and executive functioning after stroke and other ABIs. Conclusions: Effective intervention strategies can help individuals’ post-stroke become more independent in their participation and activities of daily living, leading to decreased caregiver burden and improvements in functional independence and quality of life in both patients and their caregivers. It is suggested that caregivers use these evidence-based approaches in their residential environments.

Background: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that causes severe motor, respiratory and communication impairment and imposes a high psychosocial burden on patients and families. Recent evidence shows that integrated neuropalliative care—early collaboration between neurology and palliative services with community support—improves quality of life and reduces avoidable hospitalisations. Yet there are few descriptions of how such integration is operationalised. Objective: This study examines a Community-Integrated Neuropalliative Pathway (CINP) implemented in the province of Modena (Emilia-Romagna, Italy), analysing how neurology, palliative care and emergency services collaborate to provide continuous, person-centred care for people with ALS. Methods: A single, holistic case study was conducted following Yin’s analytical approach. Data sources included ten semi-structured interviews with neurologists, palliative physicians, nurses, home-care professionals and emergency clinicians; ethnographic observations in the ALS outpatient clinic; relevant organisational documents (the regional Clinical Pathway on ALS); and aggregated quantitative data from the palliative care registry (January 2023–December 2024). Thematic analysis with investigator triangulation was used to explore care integration, advance care planning and emergency coordination. Quantitative data were summarised descriptively. Results: Three interrelated themes were identified: (1) Progressive and flexible integration between neurology and palliative care. Neurologists remained longitudinal reference points while palliative teams were activated in response to evolving needs and became more relevant with the progression of the disease. Regular multidisciplinary meetings and shared discharge planning facilitated coordination. (2) The shared culture of advance care planning. Professionals framed advance care planning (ACP) as a relational, iterative process anchored in therapeutic relationships. Shared care plans, once completed, triggered an electronic Emergency Warning (“warning 118”) procedure that notified the emergency service of patient preferences. (3) The integration of palliative and emergency services. The warning system enabled emergency clinicians to respect care plans and avoid aggressive interventions during crises. Quantitative data on 47 ALS patients followed by territorial palliative services showed that 16 had an active Emergency Warning flag; among these, most died at home or in a hospice rather than in hospital. Conclusions: The Modena CINP exemplifies how a public health system can operationalise early neuropalliative integration and connect hospital, community and emergency services. The qualitative findings illustrate the cultural and organisational shifts required for continuous care, while the quantitative data show that the system is correctly used and that patients with the Emergency Warning activation died mostly at home or in a hospice. Lessons from this analytical case study can inform the development of similar pathways in other regions, although further research is needed to assess outcomes in larger populations and such models need to be adapted to local contexts.