Search Results (941)

Background/Objectives: Post-traumatic epileptogenesis is a frequent and clinically relevant consequence of traumatic brain injury (TBI), often contributing to worsened neurological and functional outcomes. In patients experiencing early post-injury seizures, rehabilitative strategies that support recovery while considering increased epileptogenic risk are needed. This case study explores the potential benefits of combining neurofeedback (NFB) with motor therapy on cognitive and motor recovery. Methods: A patient hospitalized for severe TBI who experienced an acute symptomatic seizure in the early post-injury phase underwent baseline quantitative EEG (qEEG), neuromotor, functional, and neuropsychological assessments. The patient then completed a three-week rehabilitation program (five days/week) including 30 sensorimotor rhythm (SMR) NFB sessions (35 min each) combined with daily one-hour motor therapy. qEEG and clinical assessments were repeated post-intervention and at 6-month follow-up. Results: Post-intervention qEEG showed significant reductions in Delta and Theta power, reflecting decreased cortical slowing and enhanced neural activation. Relative power analysis indicated reduced Theta activity and Alpha normalization, suggesting improved cortical stability. Increases were observed in Beta and High-beta activity, alongside significant reductions in the Theta/Beta ratio, consistent with improved attentional regulation. Neuropsychological outcomes revealed reliable improvements in global cognition, memory, and visuospatial abilities, mostly maintained or enhanced at follow-up. Depressive and anxiety symptoms decreased markedly. Motor and functional assessments demonstrated meaningful improvements in motor performance, coordination, and functional independence. Conclusions: Findings suggest that integrating NFB with motor therapy may support recovery processes and be associated with sustained neuroplastic changes in the early post-injury phase after TBI, a condition associated with elevated risk for post-traumatic epilepsy. Full article

Background: Studies on the association between cognitive dysfunction and criminality have shown that individuals in prison, particularly repeat offenders and those convicted of violent crimes, tend to exhibit difficulties in cognitive, social, and emotional functioning. The objective of this study was to evaluate and characterize cognitive and executive functioning of incarcerated individuals, while also seeking to understand the impact of incarceration on executive functions. Methods: The sample consisted of 30 participants at various stages of their sentences. Neuropsychological assessments were conducted using cognitive screening tests and tests directed to assess executive functions and decision making. Results: Neurocognitive performance was within normative ranges. Selective associations between sentence duration and specific executive functions were observed, suggesting a relationship with criminal severity indicators. Decision-making also appeared impaired, as no evidence of learning was found and deck selection focused on more disadvantageous decks. Conclusions: These findings a relationship between indicators of criminal severity and specific aspects of executive functioning and decision making, rather than a generalized cognitive impairment. However, these conclusions require further research under this topic in larger and more diverse samples. Full article

Acquired brain injury (ABI) often results in cognitive and motor impairments that can compromise driving ability, an essential aspect of independence and social participation. This study utilized a custom-designed driving simulator to compare driving performance between individuals with ABI and controls, and to examine the relationship between cognitive performance and driving behavior within the control group. All participants completed a series of standardized driving simulation tasks of varying complexity. The control group also completed a neuropsychological battery that assessed attention, processing speed, executive function, and visuospatial abilities. Simulator data were analyzed using generalized linear mixed models to evaluate group differences and, for the control group, cognitive predictors of performance. Results showed that individuals with ABI performed comparably to controls in basic operational tasks but demonstrated reduced performance in cognitively demanding scenarios requiring sustained attention, visuospatial monitoring, and adaptive control, such as rural driving, vehicle following, and parking. In the control group, strong associations were found between simulator outcomes and measures of attention, processing speed, and spatial orientation. The findings support the use of simulator-based assessment as an objective tool sensitive to post-injury impairments and highlight its links to cognitive domains relevant to driving. Full article

Background/Objectives: Mild cognitive impairment (MCI) affects multiple functional and cognitive domains, rendering it challenging to diagnose. Brief mental status exams are insensitive while detailed neuropsychological testing is time-consuming and presents accessibility issues. By contrast, the Oculo-Cognitive Addition Test (OCAT) is a rapid, objective tool that measures oculometric features during mental addition tasks under one minute. This study aims to develop artificial intelligence (AI)-derived predictive models using OCAT eye movement and time-based features for the early detection of those at risk for MCI, requiring more thorough assessment. Methods: The OCAT with integrated eye tracking was completed by 250 patients at the Mayo Clinic Arizona Department of Neurology. Raw gaze data analysis yielded time-related and eye movement features. Random Forest and univariate decision trees were the feature selection methods used to identify predictors of Dementia Rating Scale (DRS) outcomes. Logistic regression (LR) and K-nearest neighbors (KNN) supervised models were trained to classify PMCI using three feature sets: time-only, eye-only, and combined. Results: LR models achieved the highest performance using the combined time and eye movement features, with an accuracy of 0.97, recall of 0.91, and an AUPRC of 0.95. The eye-only and time-only LR models also performed well (accuracy = 0.93), though with slightly lower F1-scores (0.87 and 0.86, respectively). Overall, models leveraging both time and eye movement features consistently outperformed those using individual feature sets. Conclusions: Machine learning models trained on OCAT-derived features can reliably predict DRS outcomes (PASS/FAIL), offering a promising approach for early MCI identification. With further refinement, OCAT has the potential to serve as a practical and scalable cognitive screening tool, suitable for use in clinics, at the bedside, or in remote and resource-limited settings. Full article

Alzheimer’s disease (AD) is a progressive neurodegenerative disorder characterized by cognitive and motor decline. Early detection remains challenging, as traditional neuroimaging and neuropsychological assessments often fail to capture subtle, preclinical changes. Recent advances in digital health and artificial intelligence (AI) offer new opportunities to identify non-invasive biomarkers of cognitive impairment. In this study, we propose an AI-driven framework for early AD based on handwriting motion data captured using a sensor-integrated Smart Pen. The system employs an inertial measurement unit (MPU-9250) to record fine-grained kinematic and dynamic signals during handwriting and drawing tasks. Multiple machine learning (ML) algorithms—Logistic Regression, Support Vector Machine (SVM), Random Forest (RF), and k-Nearest Neighbors (kNN)—and deep learning (DL) architectures, including one-dimensional Convolutional Neural Networks (1D-CNN), Long Short-Term Memory (LSTM), and a hybrid CNN-BiLSTM network, were systematically evaluated. To address data scarcity, we implemented a Sim-to-Real Domain Adaptation strategy, augmenting the training set with physics-based synthetic samples. Results show that classical ML models achieved moderate diagnostic performance (AUC: 0.62–0.76), while the proposed hybrid DL model demonstrated superior predictive capability (accuracy: 0.91, AUC: 0.96). These findings underscore the potential of motion-based digital biomarkers for the automated, non-invasive detection of AD. The proposed framework represents a cost-effective and clinically scalable informatics solution for digital cognitive assessment. Full article

Background: Research to identify changes in driving behavior that occur with the onset of Pre-MCI and MCI is an emerging area with many gaps still to be addressed. These gaps include limited use of objective, continuous measurement of driver behavior in real-life traffic conditions and comprehensive, biomarker-validated, cognitive evaluation based upon both testing and clinical ratings. Using these strategies, the questions addressed in this exploratory study are whether or not differences in driving behavior are indicative of Pre-MCI/MCI and which behaviors are most predictive of Pre-MCI/MCI. Methods: As part of a naturalistic longitudinal study, older drivers with a Montreal Cognitive Assessment score ≥ 19 had telematic sensors installed in their vehicles and underwent comprehensive cognitive assessment quarterly for three years. Thirty-six participants were classified as Unimpaired (n = 23) or Pre-MCI/MCI (n = 10/3) based upon a neuropsychological battery and diagnostic algorithm. A penalized generalized linear mixed-effects model (GLMM) with a logistic link and LASSO regularization was used to model Pre-MCI/MCI group membership vs. unimpaired as a function of ten trip-level telematic features (trip distance, hard acceleration, hard braking, hard turns, speed average, maximum speed, RPM average, fuel level, throttle average, and throttle variability) at the end of their first 12 months in the study. Results: Higher RPM, shorter average trips, and greater throttle variability predicted higher odds of Pre-MCI/MCI, while more frequent hard braking, hard turns, higher mean speed, and lower average throttle (steadier pedal control) predicted lower odds of Pre-MCI/MCI. Conclusions: The model clearly distinguished unimpaired older drivers from those with MCI or Pre-MCI, suggesting that distinct patterns of driver behavior may be related to levels of cognitive function. Full article

Background/Objectives: Mild Cognitive Impairment (MCI) represents a critical transition stage between normal aging and dementia, with executive dysfunction playing a key prognostic role. Traditional neuropsychological tests show limited ecological validity and may fail to detect early executive deficits. Virtual Reality (VR) offers an innovative alternative by reproducing everyday situations in realistic environments. This study investigated whether the Picture Interpretation Test 360° (PIT 360°), a VR-based assessment, can (1) discriminate between MCI patients and healthy controls (HCs); (2) identify executive dysfunction within the MCI group; and (3) correlate with standard neuropsychological measures. Methods: One hundred and one participants aged ≥65 years (53 MCI, 48 HCs) underwent a comprehensive neuropsychological assessment and PIT 360° evaluation. The PIT 360° requires interpreting a complex scene in a 360-degree virtual environment. Hierarchical linear regression, Receiver operating characteristic (ROC) curve analysis, and binary logistic regression were performed to examine group differences and diagnostic accuracy. MCI patients were stratified based on their performance on the Modified Five Point Test to identify visuospatial dysexecutive deficits. Results: MCI patients showed significantly longer PIT 360° completion times than HCs (92.6 vs. 65.3 s, p = 0.006), independent of age. MCI patients with visuospatial dysexecutive deficits exhibited the most severe deficits (median = 105 s, p = 0.017 vs. HCs). ROC analysis revealed adequate discriminative ability (AUC = 0.64, 95% CI [0.53, 0.75]) with a preliminary, sample-derived cut-off at ≥22 s, yielding high sensitivity (86.5%) but low specificity (42.6%). This threshold requires validation in independent samples. PIT 360° completion time correlated significantly with visuospatial executive functions, visual memory, and verbal fluency. Conclusions: The PIT 360° effectively screens for visuospatial executive dysfunction in MCI with high sensitivity, making it suitable for ruling out clinically significant impairment. Its ecological validity, brief administration, and correlations with traditional measures support integration into routine clinical practice for early detection and rehabilitation planning. Full article

Stroke often results in lasting cognitive impairments that severely reduce independence and quality of life. Traditional neuropsychological assessments rely on mean scores that provide an average estimate of overall cognitive function but neglect the fluctuations in performance. The variability in performance can be captured as inconsistency, i.e., fluctuations across multiple trials within a single task or as dispersion, i.e., fluctuations across multiple tasks. While inconsistency has been extensively studied, the impact of post-stroke cognitive impairment on cognitive dispersion is unknown. In this study, ninety-five stroke survivors (41 cognitively impaired and 54 cognitively normal) completed a neuropsychological battery that captured performance across five cognitive domains: executive function, attention, memory, language, and processing speed. We compared the stroke groups on across- and within-domain cognitive dispersion. Cognitively impaired stroke individuals showed elevated dispersion within executive function compared to cognitively normal individuals. The two groups did not differ on any other within-domain or across-domain cognitive dispersion. Post-stroke cognitive impairment increased variability within executive functioning. Incorporating cognitive dispersion into routine post-stroke assessment can advance clinical practice by identifying subtle cognitive instability, anticipate supportive needs, and tailor rehabilitation plans for improving stroke care. Full article

Background/Objectives: Heart failure with reduced ejection fraction (HFrEF) is associated with significant neuropsychological burden, including cognitive impairment and mood disturbances. While sacubitril/valsartan has demonstrated cardiovascular benefits, its effects on cognitive and emotional functioning remain underexplored, particularly in Middle Eastern populations. We aimed to evaluate the impact of sacubitril/valsartan on intellectual capacity, cognitive function and mood in patients with HFrEF using an idiographic study design. Methods: This study was conducted in adult patients with HFrEF selected to take sacubitril/valsartan to improve their clinical status. Participants were assessed at baseline and 3 months after treatment initiation using Al Khoudh Cognitive Test, PHQ-9 and Raven’s Progressive Colored Matrices. Results: Following three months of treatment, participants showed a statistically significant improvement in left ventricular ejection fraction (LVEF) (p = 0.043), depression severity (p = 0.025) and a non-significant trend toward improvement in abstract reasoning scores (p = 0.051). On the other hand, participants did not demonstrate significant improvements in the cognitive subdomains assessed by the Al Khoudh Test. Among these subdomains, the largest improvement was observed with verbal fluency (p = 0.057). Improvements in LVEF were not significantly associated with the changes in mood (p = 0.93), cognitive function (p = 0.34) or verbal fluency (p = 0.46). Conclusions: This study provides preliminary, hypothesis-generating evidence of potential short-term improvement in mood and reasoning scores in HFrEF patients treated with sacubitril/valsartan. Notably, these changes were not attributed to the observed improvements in cardiac function. These findings underscore the need for further investigation into the neurocognitive benefits of sacubitril/valsartan in larger and more diverse populations. Full article

Background/Objective: Neuroimmune and metabolic dysregulation have been increasingly implicated in the cognitive heterogeneity of autism spectrum disorder (ASD). However, it remains unclear whether anti-inflammatory diets engage distinct biological and cognitive pathways in autistic and neurotypical children. This study examined whether a 12-week anti-inflammatory dietary protocol produces group-specific neuroimmune–metabolic signatures and cognitive responses in autistic children, neurotypical children receiving the same diet, and untreated neurotypical controls. Methods: Twenty-two children (11 with ASD, six a on neurotypical diet [NT-diet], and five neurotypical controls [NT-control]) completed pre–post assessments of plasma IFN-γ, CXCL1, RANTES (CCL5), trimethylamine-N-oxide (TMAO), and an extensive ENI-2/WISC-IV neuropsychological battery. Linear mixed-effects models were used to test the Time × Group effects on biomarkers and cognitive domains, adjusting for age, sex, and baseline TMAO. Bayesian estimation quantified individual changes (posterior means, 95% credible intervals, and posterior probabilities). Immune–cognitive coupling was explored using Δ–Δ correlation matrices, network metrics (node strength, degree centrality), exploratory mediation models, and responder (≥0.5 SD domain improvement) versus non-responder analyses. Results: In ASD, the diet induced robust reductions in IFN-γ, RANTES, CXCL1, and TMAO, with decisive Bayesian evidence for IFN-γ and RANTES suppression (posterior P(δ < 0) > 0.99). These shifts were selectively associated with gains in verbal learning, semantic fluency, verbal reasoning, attention, and visuoconstructive abilities, whereas working memory and executive flexibility changes were heterogeneous, revealing executive vulnerability in individuals with smaller TMAO reductions. NT-diet children showed modest but consistent improvements in visuospatial processing, attention, and processing speed, with minimal biomarker changes; NT controls remained biologically and cognitively stable. Network analyses in ASD revealed a dense chemokine-anchored architecture with CXCL1 and RANTES as central hubs linking biomarker reductions to improvements in fluency, memory, attention, and executive flexibility. ΔTMAO predicted changes in executive flexibility only in ASD (explaining >50% of the variance), functioning as a metabolic node of executive susceptibility. Responders displayed larger coordinated decreases in all biomarkers and broader cognitive gains compared to non-responders. Conclusions: A structured anti-inflammatory diet elicits an ASD-specific, coordinated neuroimmune–metabolic response in which suppression of CXCL1 and RANTES and modulation of TMAO are tightly coupled with selective improvements in verbal, attentional, and executive domains. Neurotypical children exhibit modest metabolism-linked cognitive benefits and minimal immune modulation. These findings support a precision-nutrition framework in ASD, emphasizing baseline immunometabolic profiling and network-level biomarkers (CXCL1, RANTES, TMAO) to stratify responders and design combinatorial interventions targeting neuroimmune–metabolic pathways. Full article

Background/Objectives: Prolonged fasting—defined as voluntary abstinence from caloric intake for periods exceeding 24 h—is increasingly recognized not only as a metabolic intervention but also as a psycho-behavioral modulator. According to the 2024 international consensus, intermittent fasting encompasses diverse temporal patterns including time-restricted feeding, alternate-day fasting, and periodic fasting of multi-day duration. While metabolic benefits are well documented, the psychoneurobiological and psychiatric consequences remain incompletely characterized. This review critically appraises current evidence on the psychological and psychiatric effects of prolonged and intermittent fasting, including both secular and religious practices. Methods: A narrative synthesis was conducted on clinical trials, observational studies, and translational research published between January 2010 and June 2025 in PubMed, Scopus, and PsycINFO. Search terms included combinations of “prolonged fasting,” “intermittent fasting,” “psychological,” “psychiatric,” “religious fasting,” “Ramadan,” and “Orthodox Church.” Eligible studies required explicit evaluation of mood, cognition, stress physiology, or psychiatric symptoms. Data were analyzed qualitatively, with particular attention to study quality, fasting regimen characteristics, and participant vulnerability. This is a non-registered narrative synthesis drawing on clinical trials, observational studies, and preclinical evidence published between January 2010 and June 2025. Results: Eighty-seven studies met inclusion criteria (39 human; 48 preclinical). In metabolically healthy adults, short-term time-restricted eating and supervised prolonged fasting were associated with modest reductions in depressive symptoms and perceived stress, with small improvements in executive functioning—typically observed in small samples and with limited follow-up. Religious fasting during Ramadan and the Orthodox Christian fasting periods demonstrated similar neuropsychological effects, including greater perceived spiritual meaning and affective modulation, though cultural context played a moderating role. Potential adverse mental-health impacts included mood destabilization, anxiety exacerbation, and rare psychotic or manic decompensations in vulnerable individuals. Randomized trials reported few adverse events and no signal for severe psychiatric harm, whereas observational studies more often noted symptom exacerbations in at-risk groups. Patients with eating disorder phenotypes exhibited increased cognitive preoccupation with food and a heightened risk of behavioral relapse. Methodological heterogeneity across studies—including variation in fasting protocols, psychological assessments, and follow-up duration—limited cross-study comparability. Conclusions: Evidence indicates a bidirectional relationship wherein fasting may foster psychological resilience in select populations while posing significant psychiatric risks in others. Inclusion of religious fasting traditions enriches understanding of culturally mediated outcomes. To enhance rigor and safety, future studies should incorporate clinician-rated outcomes (e.g., HDRS-17, CGI-S/CGI-I), standardized adverse-event tracking using validated psychiatric terminology, and prospective safety monitoring protocols, with ≥6–12-month follow-up. Full article

Background/Objectives: Primary progressive aphasia (PPA) is characterised by progressive decline in language and communication. However, existing diagnostic frameworks and assessment tools are largely based on Indo-European languages, which limits their applicability to Chinese bilingual speakers whose linguistic profiles differ markedly in tonal phonology, logographic writing, and bilingual organisation. This review aimed to (a) describe how PPA presents in Chinese bilingual speakers, (b) evaluate how well current speech–language and neuropsychological assessments capture these impairments, and (c) identify linguistically and culturally informed strategies to improve clinical practice. Methods: A systematic review was conducted in accordance with the PRISMA-ScR guidelines. Four databases (PubMed, Scopus, Web of Science, PsycINFO) were searched, complemented by backward and forward citation chaining. Eight empirical studies met the inclusion criteria. Data were extracted on participant characteristics, PPA variant, language background, speech–language and writing profiles, and assessment tools used. Thematic analysis was applied to address the research questions. Results: Across variants, Chinese bilingual speakers demonstrated universal PPA features expressed through language-specific pathways. Mandarin speakers exhibited tone-segment integration errors, tonal substitution, and disruptions in logographic writing. Lexical-semantic degradation reflected homophony and compounding characteristics. Bilingual individuals showed parallel or asymmetric decline influenced by dominance and usage. Standard English-based naming, repetition, and writing assessments did not reliably capture tone accuracy, radical-level writing errors, or bilingual patterns. Sociocultural factors, including stigma, delayed help-seeking, and family-centred care expectations, further shaped diagnostic pathways. Conclusions: Chinese PPA cannot be meaningfully assessed using tools designed for Indo-European languages. Findings highlight the need for tone-sensitive repetition tasks, logographic writing assessments, bilingual diagnostic protocols, and culturally responsive communication-partner support. This review provides a comprehensive synthesis to date on Chinese bilingual PPA and establishes a foundation for linguistically inclusive diagnostic and clinical models. Full article

Smartphones have become the “backbone” of the connected society, reshaping social interactions in a period of adolescence marked by a neuropsychology vulnerability that is sensitive to intensive technological mediation. This study analyzes the relationship between problematic mobile phone use and the social and assertiveness skills of adolescents. Through a cross-sectional design, the answers of 1864 adolescents aged between 11 and 21 years old from education centers located in Cordoba (Spain) were analyzed, through a questionnaire that collected sociodemographic variables, the MPPUSA scale, to measure the inadequate use of mobile phones, and the ADCA-1 to assess social skills and assertiveness. The results revealed inadequate levels of mobile phone use and low levels of social skills, with nomophobia and negative consequences emerging as the dimensions most related to these outcomes. A decision tree analysis identified negative consequences as the variable with the strongest association with the level of social development. The findings point to a concerning situation in which not only the usage time but also quality of use are associated with the psychosocial development of this population group. Therefore, preventive and educational interventions addressing digital literacy, management of emotions, and the promotion of face-to-face social skills are necessary. Full article

Background and Objectives: Fibrosing interstitial lung diseases (ILDs) may predispose to neurocognitive impairment through chronic hypoxemia and systemic inflammation, yet data integrating pulmonary physiology, disease severity, and cognition are limited. We aimed to compare global cognitive performance between adults with fibrosing ILD and contemporaneous non-ILD clinic comparators, explore differences across ILD subtypes, and identify physiologic and clinical predictors of low MMSE scores. Materials and Methods: In this single-center cross-sectional study, 45 adults with fibrosing ILD and 32 non-ILD participants from university-affiliated pulmonology clinics completed the Mini-Mental State Examination (MMSE) and standardized lung function testing (including diffusing capacity, DLCO%). Comorbidity (Charlson index), inflammatory markers (C-reactive protein), and GAP (Gender–Age–Physiology) severity were recorded. Associations with MMSE and MMSE < 24 were examined using correlations and multivariable logistic regression. Results: Mean MMSE was lower in ILD than in non-ILD participants (23.9 ± 3.6 vs. 26.8 ± 2.8; p < 0.001), and MMSE < 24 occurred in 33.3% versus 12.5%, respectively. Within ILD, the usual interstitial pneumonia (UIP) pattern showed the lowest MMSE scores. DLCO% and total lung capacity correlated positively with MMSE (r = 0.44 and r = 0.34, respectively). In multivariable models, ILD diagnosis remained associated with MMSE < 24 (odds ratio [OR] 2.72, 95% CI 1.14–6.48), and each 10-percentage-point decrement in DLCO% increased the odds of MMSE < 24 (OR 1.42, 95% CI 1.11–1.92). GAP ≥ 4 was also associated with impaired cognition (OR 2.91, 95% CI 1.13–7.57). Conclusions: Fibrosing ILD, particularly with reduced diffusing capacity and higher GAP stage, is associated with lower MMSE scores and a higher frequency of values below a conventional impairment threshold. Prospective studies incorporating comprehensive neuropsychological testing are needed to determine whether and how neurocognitive assessment should be integrated into routine ILD care. Full article

Entrepreneurship is increasingly important for economic and societal innovation, yet the individual characteristics that encourage entrepreneurial entry remain insufficiently understood. This study examined whether character strengths, attention deficit hyperactivity disorder (ADHD), and highly sensitive person (HSP) traits influence entrepreneurial entry. Two independent web-based surveys were conducted, with ADHD assessed using a psychological scale in Study 1 and self-reported medical diagnosis in Study 2. The Character Strengths Test24 showed a revised factor structure, and an extracted factor (Drive) positively influenced entrepreneurial entry in both samples. ADHD (Hyperactivity/Impulsivity) consistently facilitated entrepreneurial entry, while HSP (Ease of Excitation) inhibited it. The robust positive contribution of ADHD traits across both symptomatic and clinically diagnosed individuals suggests that entrepreneurial potential is not limited by clinical labels and may also be found among individuals who are often marginalized, misunderstood, or discouraged in traditional career pathways. These findings highlight the importance of educational and support systems that not only develop character strengths linked to entrepreneurial drive but also recognize, accommodate, and strategically leverage diverse neuropsychological traits. Empowering individuals with varied cognitive profiles may expand pathways to innovation and contribute to a more inclusive entrepreneurial ecosystem. Full article