NeuroSci

Rosemary (Salvia rosmarinus) has been linked to improvements in psychological wellbeing through cholinergic mechanisms. However, this study investigated whether individual differences in eye blink rate (EBR) and blink variability (EBV), which are proxies of dopaminergic activity and attentional control, influence the cognitive and mood-enhancing properties of a rosemary-containing drink. Forty-eight healthy adults completed a three-stimulus odd-ball cognitive task under rosemary or control conditions, while vertical electrooculograms were recorded. Event-related brain potentials (ERPs) were also measured using the P3a component at the Cz scalp electrode as an additional index of dopaminergic activity. Subjective mood and arousal (alert, contented, calm) were collected pre- and post-task using Bond–Lader visual analogue scales. Reaction times during the task were modelled with ex-Gaussian parameters (μ, σ, τ). Rosemary ingestion led to increased alertness and contentedness following the task. Cognitive effects were moderated by blink metrics, with significant interactions between rosemary and blink metrics for mean reaction time μ and response variability σ. Rosemary also increased P3a amplitudes, indicative of dopaminergic contribution. The effects of rosemary on cognition and mood were moderated by individual blink profiles, indicating that baseline neurocognitive state plays a role. Although cholinergic accounts are well established, this study highlights the use of proxies of dopamine to investigate broader neurotransmitter involvement in rosemary’s enhancing properties. Full article

Background: Patients with primary central nervous system (CNS) tumors often experience fatigue and sleep disturbances, significantly impacting their quality of life. Exercise has been shown to improve these symptoms in various cancer populations. The aim of this study is to evaluate the effects of different types of exercise on fatigue and sleep in less-investigated CNS tumor patients. Methods: A literature search was conducted in PubMed, Scopus, Cochrane Library, and CINAHL. Eligible randomized and non-randomized studies evaluating exercise interventions in patients diagnosed with primary brain tumors were systematically reviewed, primarily using a narrative synthesis approach. Cancer-related fatigue and sleep-related outcomes were extracted as variables of interest. Where possible [≥2 Randomized Control Trials (RCTs) available for glioma patients], meta-analyses were conducted to assess the overall effects of physical therapy on the above-mentioned outcomes. Results: A total of 15 relevant intervention studies were identified, either RCTs or other types of studies, such as prospective feasibility cohort studies and case studies. A total of 448 participants were enrolled, with the majority diagnosed with glioma. There were single reports on pituitary adenoma after surgery and meningioma patients. In glioma patients, the overall effect of various modality exercise interventions on fatigue was non-significant, reflecting the heterogeneous characteristics of studies with diverse outcomes. However, meta-analysis focusing on combined exercise interventions (aerobic and resistance training) showed a positive effect on reducing fatigue in these patients [Standardized Mean Difference (SMD) = 0.866, p = 0.03]. Fatigue in glioma patients may also improve through yoga and Pilates. Aerobic but not strength exercise seems to improve sleep in glioma patients (SMD = 1.14, p = 0.02). Sleep quality may also improve through yoga and combined exercise. Conclusions: Certain types of exercise appear to effectively reduce fatigue and improve sleep in patients with CNS tumors. Future, well–controlled, multi-arm, larger-scale studies are necessary to resolve discrepancies, as well as to explore long-term outcomes and define factors influencing individualized exercise responses. Full article

Alzheimer’s disease (AD) remains an unmet medical challenge, as there are no effective therapies that alter the disease’s progression. While approaches have targeted molecules like acetylcholine (ACh) and glutamate, these strategies have provided only limited benefits and do not address the complex molecular mechanisms underlying AD development. This review suggests that β-alanine (3-aminopropanoic acid) is an underexplored neurotransmitter that could serve as a potential AD drug target. Existing evidence indicates that β-alanine modulates GABAergic and glutamatergic neurotransmission, thereby affecting neuronal hyperexcitability. Additionally, studies suggest that β-alanine has antioxidant effects, reducing oxidative stress caused by reactive oxygen species (ROS). We propose that β-alanine might bind to Aβ/tau proteins, possibly targeting the six-amino acid sequences EVHHQK/DDKKAK, which are involved in protein aggregation. β-Alanine may also influence the release of pro-inflammatory cytokines from microglia, potentially reducing neuroinflammation. We also hypothesize that β-alanine may help regulate metal dyshomeostasis, which leads to ROS production. Taurine, structurally like β-alanine, appears to influence comparable mechanisms. Although structural similarity doesn’t ensure therapeutic effectiveness, this evidence supports considering β-alanine as a treatment for AD. Furthermore, β-alanine and its analogues face challenges, including crossing the blood–brain barrier (BBB) and optimizing structure–activity relationships (SAR). This review includes articles through September 2025, sourced from four databases. Full article

Hand representation maps of the primate primary motor (M1) and somatosensory (SI) cortices exhibit plasticity, with their spatial extent modifiable through training. While activation and map enlargement during tapping tasks are well documented, the directionality of information flow between these regions remains unclear. We applied Information Imbalance Gain Causality (IIG) to examine the propagation and temporal dynamic of BOLD activity among Area 4 (precentral gyrus), Area 3a (fundus of the central sulcus), and SI areas (postcentral gyrus). Data were collected from both hemispheres of nine participants performing alternating right–left hand finger tapping inside a 1.5T fMRI scan. The results revealed strong information flow from both the precentral and postcentral gyri toward the sulcus during tapping task, with weaker bidirectional exchange between the gyri. When not engaged in tapping, both gyri communicated with each other and the sulcus. During active tapping, flow bypassed the sulcus, favoring a more direct postcentral to precentral way. Overtime, postcentral to sulcus influence strengthened during non task periods, but diminished during tapping. These findings suggest that M1, Area 3a, and SI areas form a dynamic network that supports rapid learning processing, where Area 3a of the sulcus may contribute to maintaining representational plasticity during complex tapping tasks. Full article

Objectives: This pilot study examined telerehabilitation, which has emerged as a crucial modality in light of recent global challenges such as the COVID-19 pandemic. We examined the effectiveness of a mobile health telerehabilitation intervention developed for older adults with frailty. Methods: Six participants received a telerehabilitation intervention (Rehab Studio) that included exercise training videos. The participants were aged ≥65 years, had no history of dementia or psychiatric disorders, and had mild-to-moderate care needs. For 1 month, the participants received 1 h live online rehabilitation sessions with real-time communication with rehabilitation specialists (physical therapists and occupational therapists: PTs/OTs). The quality of life (QoL) (EuroQol 5 dimensions 5-level [EQ-5D-5L] questionnaire) and self-rated health scores were recorded before and after the intervention, and the data were analyzed using paired t-tests to determine whether the service was effective. Results: Significant differences were found in the total EQ-5D-5L and self-rated health scores (p < 0.05). The mean EQ-5D-5L score increased from 0.63 ± 0.13 before the intervention to 0.77 ± 0.14 after the intervention (p = 0.010), while the mean self-rated health score increased from 66.0 ± 18.0 to 83.3 ± 10.3, respectively (p = 0.019). Conclusions: This study revealed that the mobile health telerehabilitation intervention is safe and can improve QoL for older adults with frailty. However, the effectiveness of the intervention needs to be further investigated in patients with poor performance in daily living activities. Telerehabilitation could help to reduce the burden of nursing care in aging societies with declining birthrates. However, given the extremely small sample size (N = 6), these p-values should be interpreted with considerable caution. Statistical significance in such a small sample does not provide strong evidence for population-level effects, and our findings should be regarded as hypothesis-generating rather than confirmatory. Full article

Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment disorder, with a lifetime prevalence estimated at approximately 10%. This narrative review explores the historical evolution, current management strategies, and emerging trends in CTS diagnosis and treatment. Early recognition of CTS led to the development of conservative interventions, including splinting, corticosteroid injections, and physical therapy, aimed at alleviating median nerve compression and associated symptoms. The advent of open carpal tunnel release established surgery as the definitive treatment for moderate-to-severe CTS, with subsequent refinements—such as mini-open and endoscopic techniques—focused on minimizing tissue trauma and expediting recovery. Comparative studies demonstrate similar long-term efficacy between surgical modalities, though endoscopic approaches often provide faster short-term recovery. Advances in diagnostic imaging, including high-resolution ultrasound, have improved early detection and dynamic assessment of median nerve compression. Emerging therapies, such as regenerative biologics, neuromobilization, and minimally invasive surgical innovations, offer promising adjuncts to current care. Despite substantial progress, further research is needed to clarify optimal patient selection, refine minimally invasive techniques, and explore regenerative interventions. This review underscores the importance of individualized, evidence-based, and patient-centered approaches to CTS management, integrating both established and emerging strategies to optimize functional outcomes and quality of life. Full article

Background: Currently, there is a considerable number of studies addressing vagus nerve stimulation (VNS) for the treatment of different stroke-related outcomes. We aimed to promote a broad view of the outcomes studied and what are the opportune outcomes to be studied involving this therapeutic strategy for the treatment of post-stroke complications. Methods: This is a scoping review that followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Two investigators conducted independent searches on PubMed/MEDLINE, Scopus, and Embase till July 2025. Randomized clinical trials and preclinical studies using invasive or non-invasive vagus nerve stimulation conducted with a population diagnosed with stroke were included. Results: Forty-one experimental studies and sixteen clinical trials were included. The outcomes found were neuroprotection; motor, functional, and cognitive rehabilitation; dysphagia; comparison of different stimulation intensities; safety, efficacy, and feasibility of the non-invasive approach; comparison between transcutaneous auricular vagus nerve stimulation (taVNS) and transcutaneous cervical vagus nerve stimulation (tcVNS); and comparison between two models of ischemia (permanent and transient). Preclinical studies mostly investigated molecular elements involved in neuroprotection, neuroinflammation, and cellular apoptosis, while clinical studies evaluating the effectiveness of this technique used for rehabilitation and its comparison or combination with other techniques remain scarce. Conclusions: Most studies investigating the effects of VNS on different post-stroke outcomes are experimental studies. Clinical studies are still scarce and with limited analysis of outcomes. Full article

Neonatal seizures are common complications in neonatal intensive care units. They have been noticed to be more common in preterm infants, but they can also affect term infants. Levetiracetam is a broad-spectrum antiepileptic drug that has been studied to manage seizures, yet limited data are available on its use in neonatal seizures. Objectives: Study the effect of levetiracetam on neonatal seizures in terms of maintaining seizure freedom after the initiation of levetiracetam and investigating its safety profile in the neonate population. Method: Retrospective cohort study comparing two groups of patients identified through accessing their medical profiles after searching the following keywords: phenobarbital, levetiracetam, and neonatal seizures amongst all NICU admissions in King Abdulaziz Medical City, Ministry of National Guard Health Affairs, from the period between December 2016 and January 2020. Forty-eight patients were included based on the inclusion/exclusion criteria. The selected sample was further subclassified into 28 neonates who received phenobarbital and 20 who received levetiracetam. Results: Seizure control was significantly observed in neonates with onset <24 h and those born at <37 weeks GA. In the first arm, 22 out of 28 neonates achieved seizure freedom while using phenobarbital; in the second arm, 11 out of 20 neonates achieved seizure control on levetiracetam after failing with phenobarbital. While seizure control was better achieved by phenobarbital, it was found that almost 57% of the first arm developed side effects on phenobarbital; however, only 10% of the neonates on levetiracetam developed side effects. While PB remains effective for acute suppression, LEV demonstrated a superior safety profile with no serious adverse events and a high rate of successful seizure management as an add-on therapy (83% control in combined cohorts). Conclusions: The study concluded that using levetiracetam could result in improved outcomes. LEV is a safe and effective alternative or adjunct to PB. Its use may mitigate the neurotoxic risks associated with GABAergic drugs, though continuous EEG monitoring is essential to ensure electrical seizure cessation and avoid electroclinical dissociation. The number of patients who received levetiracetam initially is not considered a representative sample to reach a conclusion on the use of levetiracetam as an effective monotherapy. Full article

Neurodegenerative diseases such as Alzheimer’s, Parkinson’s, amyotrophic lateral sclerosis, and Huntington’s disease represent a major challenge in neuroscience due to their complex, multifactorial nature and the absence of curative treatments. These disorders share common molecular mechanisms, including oxidative stress, mitochondrial dysfunction, proteostasis collapse, calcium dyshomeostasis, chronic neuroinflammation, and the prion-like propagation of misfolded proteins. Together, these processes trigger a cascade of cellular damage that culminates in synaptic dysfunction and programmed neuronal death. This review integrates current evidence on the sequential stages of neurodegeneration, emphasizing the convergence of oxidative, inflammatory, and proteotoxic pathways that drive neuronal vulnerability. Moreover, it explores emerging therapeutic strategies aimed at restoring cellular homeostasis, such as Nrf2 activation, modulation of the unfolded protein response (UPR), enhancement of autophagy, immunotherapy against pathological proteins, and gene therapy approaches. The dynamic interplay among mitochondria, endoplasmic reticulum, and glial cells is highlighted as a central element in disease progression. Understanding these interconnected mechanisms provides a foundation for developing multi-targeted interventions capable of halting or delaying neuronal loss and improving clinical outcomes in neurodegenerative disorders. This work provides an integrative and introductory overview of the convergent mechanisms underlying neurodegeneration rather than an exhaustive mechanistic analysis. Full article

REM sleep behavioral disorder (RBD) is of increasing interest in Parkinson’s disease (PD). Previous studies exploring the association between REM sleep without atonia (RWA) and clinical PD features or other objective sleep metrics are scarce and have used PSG findings. A mobile electroencephalography (EEG)/electrooculography (EOG) recording system with two channels can objectively measure sleep parameters, including RWA, during natural sleep at home. We investigated whether RWA measured on a portable recording device at home could be associated with clinical PD features or other sleep metrics using baseline data from the ZEAL study. Differences between patients with and without RWA was analyzed using ANCOVA test. REM sleep length was significantly longer in patients with RWA than in those without RWA. A multivariate comparison using ANCOVA showed a significant difference in log-transformed REM sleep duration of patients with RWA after adjustment for potential confounders (adjusted mean difference of 1.203; 95% confidence interval 0.468 to 1.937; p = 0.003). The strength of this study was that it evaluated the association between RWA during natural sleep at home and clinical variables as well as other sleep metrics. The major result was that patients with and without RWA did not differ in their clinical variables, and there was no relation between RWA and objective sleep metrics other than REM sleep. The duration of REM sleep may be associated with RWA during natural sleep at home. Full article

In non-vasculitic immune-mediated neuropathies, imaging studies demonstrate an enlargement not only of clinically involved but also of clinically intact nerves. The present study aimed to present a pattern of nerve swelling and its relation to nerve function. In a group of patients with dysimmune motor and sensorimotor mononeuropathies, nerve cross-sectional areas (CSAs) were measured using ultrasonography (US) and compound muscle action potential (CMAP) amplitudes using electrodiagnostic (EDx) studies. Nerve CSAs were compared in (1) clinically involved, (2) swollen and clinically uninvolved, and (3) non-swollen (clinically uninvolved) nerves. Patients’ non-swollen nerves were also compared to those of controls. In swollen nerves, the correlation between nerve CSA and CMAP amplitude was calculated. Twenty-two patients (12 men) and 50 controls (28 men) were included in the study. Clinically involved nerves were thicker than swollen segments of clinically intact nerves (p < 0.001). The patients’ non-swollen (clinically uninvolved) nerves were thicker than the controls’. In swollen nerves, CSA was strongly negatively correlated with CMAP amplitude (r = −0.54, p < 0.001). In patients with immune-mediated mononeuropathies, nerve swelling correlates with clinical and EDx findings. Patients’ clinically uninvolved nerves were also swollen, but to a lesser degree. Full article

Religious experiences represent a universal and timeless phenomenon that has accompanied humanity since its origins. In recent decades, neuroscience has explored the relationship between temporal lobe epilepsy (TLE) and hyperreligiosity phenomena, describing sudden convictions, states of ecstasy, and spiritual conversions associated with epileptic seizures. This article offers a narrative review of the literature on the relationship between epilepsy and religion, including its clinical manifestations (ictal, postictal, and interictal) and the main neurobiological models proposed to explain it, such as the limbic marker hypothesis and theory of mind (ToM). The possible role of the uncinate fasciculus as an integrative pathway between temporal and limbic regions is also explored, based on recent neuroimaging studies. Finally, we present an illustrative clinical case of a patient with meningioma and TLE associated with episodes of intense religious conviction, in whom a structural alteration of the right uncinate fasciculus was observed. This case reinforces the relevance of considering both neuronal networks and white matter tracts in the study of religious experiences, while underscoring the need for broader and more systematic studies to confirm these findings. Full article

The experience of childhood maltreatment (CM) increases the risk for depressive disorders by two-and-a-half times across the lifespan. Although stress system and immunological models offer some explanation of this vulnerability, further investigation is required to understand the underlying neurophysiological mechanisms and identify potential biomarkers for diagnosis and treatment. Resting-state electroencephalography (EEG) offers a low-cost, non-invasive, and accessible methodology for that purpose. This narrative review synthesizes resting-state EEG findings that are common to CM and depression as a primer for further research and the future formulation of a model that may link these two in a causal manner. Although evidence supports atypical beta and theta band power, frontal alpha asymmetry and altered default mode network functional connectivity as possible indicators of the CM-EEG association, there is a paucity of EEG-based CM research available to complement the extensive depression-focused literature. Large-sample, prospective EEG studies of CM that consider confounding factors and assess the neurophysiological impact of CM independent of psychopathologies are required. Full article

Mild cognitive impairment (MCI) is a nosological entity that requires special attention from a therapeutic perspective, because annual conversion rates to dementia of 5–15% in these cases are considered typical. This narrative review aimed to identify available data supporting the efficacy and tolerability of various pharmacological therapeutic interventions by searching PubMed/MEDLINE, the Cochrane Database of Systematic Reviews, and the Web of Science (WoS) Core Collection for primary and secondary reports published over the last 25 years on the pharmacological treatment of MCI. The retrieved interventions were distributed in five large categories: (1) conventional cognitive enhancers; (2) disease-modifying therapeutic interventions; (3) strategies mitigating vascular risk and management of concomitant medications; (4) adjuvant and nootropic formulations; (5) case management of non-cognitive symptoms in MCI. The most broadly applicable pharmacological strategies in MCI include systematic deprescribing and optimisation of concomitant therapies, reducing anticholinergic and sedative load, avoiding iatrogenic hypoglycaemia and excessive blood pressure lowering, and careful, individualised treatment of vascular risk factors. Based on the randomised controlled trials, meta-analyses, and contemporary guidelines, a pragmatic pharmacological approach to MCI is suggested. Further trials with better design are urgently needed to document the efficacy and safety of pharmacological interventions in patients diagnosed with MCI. Full article

Objectives: The aim of this study was to investigate the effectiveness of Cryoflow cooling on forearm skin temperature and nerve conduction velocity (NCV) in normal subjects. Methods: Thirty male volunteers participated in this study, with a mean age of 20.8 ± 0.74 years. A Cryoflow hose with a nozzle was positioned approximately 10 cm from the forearm and scanned the anterior surface of the non-dominant forearm for 10 min, with temperatures adjusted to −10 °C. Participants’ average skin temperature was measured by using an infrared camera. Motor and sensory NCV for both the median and ulnar nerves were measured from both forearms. The dominant side served as a control side. The level of significance was set at p value ≤ 0.05. Results: Following treatment, the experimental group experienced a reduction in average skin temperature, dropping from 32.94 ± 1.11 °C to 16.92 ± 1.68 °C, while the control group showed no significant change. Both the median and ulnar nerves exhibited significant decreases in motor NCV (−10.37 m/s and −8.79 m/s, respectively), alongside slight increases in distal motor latency. Sensory NCV of the median and ulnar nerves decreased significantly (−5.20 m/s and −8.40 m/s, respectively), accompanied by increased onset latency. No significant changes were found in the control group. Conclusions: Cryoflow air-based cryotherapy to the forearm causes a substantial reduction in local skin temperature and significant slowing of peripheral nerve conduction. Both motor and sensory fibers of the median and ulnar nerves exhibited decreased conduction velocities and increased latencies following cooling. Full article

Background: Innovative treatments for lung cancer patients have significantly improved their lives. Therefore, patients who develop brain metastases are more likely to require management of quality of life (QoL) by reducing pathological decline in brain function. New therapeutic strategies have allowed us to manage brain metastases, thanks to the ability to cross the blood–brain barrier. Moreover, new molecules have been designed as adjuvants to standard treatments for the management of cancer patients with brain metastases. Methods: We implemented a descriptive, observational, retrospective study. Therefore, we consecutively collected the data of eighty-six (N  =  86) patients admitted to our department (April 2020–April 2025) diagnosed with brain involvement in a thoracic neoplasm and treated with silibinin, in association with standard treatment. The main endpoint of our analysis is to define the safety profile of silibinin and to evaluate its eventual benefits in terms of QoL. Results: Silibinin was well tolerated (only one mild adverse event was reported); furthermore, patients taking silibinin had a good quality of life that was maintained over a long period of time, and in some cases, an improvement in neurological symptoms and overall patient well-being was also documented. Conclusions: Our study is the first collection of a large number of lung cancer patients with brain metastasis taking silibinin, which is very well tolerated and allows patients to maintain a good QoL. Full article

Background/aim: Vitamin D (VitD) has been implicated in neuroprotection, yet its role in Parkinson’s disease (PD) remains unclear. This systematic review and meta-analysis aimed to evaluate the association between VitD status, supplementation, and vitamin D receptor (VDR) gene polymorphisms with PD risk and outcomes. Methodology: Following PRISMA guidelines, we searched PubMed, Scopus, and Google Scholar through August 2025 for observational studies, clinical trials, and genetic association studies. Primary outcomes included serum VitD levels in PD versus healthy controls (HCs), prevalence of VitD insufficiency/deficiency, and effects of VitD supplementation on motor symptoms. Secondary outcomes assessed associations between VDR polymorphisms and PD susceptibility. Data were synthesized using random- and fixed-effects models, with heterogeneity and publication bias evaluated. PROSPERO (CRD420251133875). Results: Sixty-three studies (n ≈ 10,700 participants) met inclusion criteria. PD patients exhibited significantly lower VitD levels (SMD = −0.46; 95% CI: −0.51 to −0.41) and higher odds of insufficiency (OR = 1.52) and deficiency (OR = 2.20) compared to HC. Cohort data suggested sufficient VitD may reduce PD risk (HR = 0.83). Supplementation yielded modest, non-significant improvements in motor outcomes. Among 20 genetic studies, FokI (rs2228570) was most consistently associated with PD, while other VDR SNPs showed variable or null associations. Conclusions: VitD deficiency is common in PD and may influence disease risk and motor function. Current evidence indicates limited benefit of supplementation for motor outcomes, and genetic associations remain inconsistent. Full article

Background: Cardiovascular diseases (CVD) affect the heart and blood vessels. Cardiorenal syndrome (CRS) highlights the interaction between the heart and kidneys, worsening the clinical course. Assessing renal function is essential for risk stratification and guiding therapeutic decisions. Furthermore, cognitive and psychological aspects are often impaired in these patients. Aim: To compare clinical, cognitive, emotional, and quality of life parameters between patients with CRS and those with heart failure (HF) alone, and to assess the agreement between estimated glomerular filtration rate equations (Cockcroft–Gault and CKD-EPI). Methods: This observational study was conducted at the Cardiology Unit of the IRCCS Centro Neurolesi Bonino Pulejo “Piemonte” Hospital (Messina, Italy) between June 2024 and March 2025. Thirty participants aged 45–85 years were enrolled: 15 with type 1 cardiorenal syndrome (CRS group) and 15 with heart failure without cardiorenal syndrome (HF group). All participants had a confirmed diagnosis and provided informed consent. Clinical evaluation and standardized tests (MoCA, BDI-II, BAI, and SF-12v2) were administered. Statistical analyses were performed using t-tests, chi-square tests, and Bland–Altman analysis, with significance set at p < 0.05. Results: The two groups were comparable in body mass index and left ventricular ejection fraction. CRS patients had significantly higher serum creatinine and lower GFR with both equations. The two GFR equations were strongly correlated (r = 0.94; p < 0.0001). Bland–Altman analysis showed a mean difference of 5.80 mL/min (95% limits of agreement: –12.4 to +24.0 mL/min), indicating wide individual variability. No significant differences were found in cognitive performance or quality of life. However, CRS patients exhibited significantly higher depressive symptoms (BDI-II mean 11.33 ± 8.19 vs. 5.40 ± 6.68; p = 0.0384) and a trend toward higher anxiety (BAI mean 8.13 ± 4.73 vs. 4.67 ± 5.79; p = 0.0834). Conclusions: A multidisciplinary approach, including psychological support, is necessary for patients with CRS. Full article

This study evaluated participation outcomes one year after aneurysmal subarachnoid hemorrhage (aSAH) compared with matched healthy controls and identified factors associated with participation within the patient group. Forty aSAH survivors and seventy-five controls were assessed 12–14 months post-ictus. Participation was measured with the Utrecht Scale for Evaluation of Rehabilitation–Participation (USER-P), psychological distress with the Hospital Anxiety and Depression Scale (HADS), coping with the Brief COPE, and cognition with the Montreal Cognitive Assessment (MoCA). Compared with controls, patients reported greater participation restrictions (82 vs. 100, p < 0.001), lower frequency (35 vs. 51, p < 0.001), and reduced satisfaction (65 vs. 75, p < 0.001). Anxiety, depression, and avoidant coping independently predicted restrictions (adjusted R² = 0.48), while satisfaction was predicted by employment, fewer depressive symptoms, and less avoidant coping (adjusted R² = 0.52). Lower MoCA scores predicted reduced participation frequency (p = 0.032), and patients with cognitive impairment showed significantly greater restrictions and lower satisfaction. One year after aSAH, survivors experience substantial participation limitations associated with psychological distress, maladaptive coping, and cognitive deficits. These results underscore the importance of cognitive and psychological rehabilitation to enhance long-term participation and social reintegration after aSAH. Full article