Search Results (1,740)

Background and Objectives: To evaluate the impact of Holmium Laser Enucleation of the Prostate (HoLEP) versus Transurethral Resection of the Prostate (TURP) on cognitive function and psychological well-being three months post-surgery. Materials and Methods: This prospective observational cohort study involved 150 patients undergoing surgical treatment for BPH; 132 patients (66 HoLEP, 66 TURP) completed baseline and 3-month follow-up evaluations. The Montreal Cognitive Assessment (MoCA) served as the primary measure of cognitive function, while the Mini-Mental State Examination (MMSE) functioned as a secondary measure. The Beck Anxiety Inventory and Beck Depression Inventory were utilized to assess individuals’ mental states. We employed repeated-measures General Linear Models, adjusted for age and educational attainment, to examine temporal variations. Results: Baseline demographic, clinical, cognitive, and psychological characteristics were comparable among the groups. The modified analysis revealed no significant interaction between time and surgical procedure for MoCA (p = 0.405), indicating that both groups exhibited comparable cognitive trajectories. No significant differences were seen between the groups in the adjusted MoCA scores (p = 0.162). A minor, statistically insignificant temporal effect was observed (p = 0.058; partial η² = 0.028). Educational attainment independently forecasted cognitive performance (p = 0.024). The MMSE demonstrated a slight temporal effect (p = 0.015) with no interaction of approaches. Anxiety and depressive symptoms persisted uniformly and comparably among the groups. Conclusions: Three months post-surgery, neither HoLEP nor TURP was associated with a notable deterioration in cognitive performance. The surgical modality did not independently influence cognitive trajectory after adjusting for demographic variables. Contemporary endoscopic BPH surgery appears to be neurocognitively safe during the medium-term postoperative period. Full article

Background/Objectives: The evaluation of cognition is central to many neurological conditions, including traumatic brain injury, Alzheimer’s disease, Lewy body disease, frontotemporal degeneration, and vascular disorders. In clinical practice, particularly in aging populations, cognitive complaints often arise in the context of mixed neurological processes, requiring careful integration of cognitive and non-cognitive findings. Despite this, there remains limited clarity regarding the respective roles of neurologists and clinical neuropsychologists and the distinction between cognitive and neuropsychological assessments, terms that are often used interchangeably despite important differences in methodology and scope. This lack of a shared framework has practical consequences. Cognitive test results, when interpreted in isolation for diagnosis, may be misconstrued as comprehensive measures of brain function, particularly when non-cognitive neurological features such as motor, cerebellar, or vestibular abnormalities should have been considered (but were not). Methods: In this narrative review, we synthesize clinical guidelines, consensus statements, regulatory sources, and representative empirical literature to articulate a competence-based framework in which cognitive assessment is a medically integrated process incorporating history, functional evaluation, neurological examination, and the targeted use of standardized neuropsychological instruments. Results: Neurologists are trained to establish medical diagnoses and integrate cognitive findings into the context of neurological disease, while neuropsychologists contribute detailed psychometric characterization, culturally and demographically informed interpretation, cognitive phenotyping, functional characterization, and validity assessment in complex clinical and medicolegal contexts. Although neuropsychologists are qualified to diagnose neurocognitive disorders using standardized diagnostic criteria, attribution to specific neurological etiologies requires a comprehensive medical evaluation that extends beyond cognitive testing alone. Conclusions: We outline a tiered approach to evaluation that aligns assessment methods with clinical questions and supports accurate diagnosis, interdisciplinary collaboration, and patient-centered care. Full article

HIV-associated neurocognitive disorders (HAND) arise from HIV infection of the central nervous system, resulting in chronic neuroinflammation and progressive neuronal damage that impair cognitive, motor, and behavioral functions. Clinically, HAND encompasses a spectrum of neurological impairments ranging from asymptomatic neurocognitive impairment to severe HIV-associated dementia. Despite the widespread use of combination antiretroviral therapy (cART) and significant improvements in the life expectancy of people living with HIV, HAND remains prevalent and continues to pose a major clinical challenge. One of the primary limitations of cART is the limited penetration of many antiretroviral drugs across the blood–brain barrier (BBB), thereby allowing the persistence of viral reservoirs within the CNS and contributing to sustained neuroinflammation and neuronal damage. To address these challenges, novel nanotherapeutic strategies have been developed to enhance the delivery of antiretroviral agents to the brain. These approaches include targeted delivery systems and the co-delivery of therapeutics across the BBB through mechanisms such as receptor-mediated transcytosis and other transport pathways. In this review, we discuss the pathophysiological challenges associated with HAND and recent advances in nanotherapeutic approaches designed to improve treatment efficacy. We also discuss the current state of the art in vitro and in vivo models used to test the efficacy of these advanced therapeutics. Finally, we outline the remaining challenges and future prospects for the development of nanotherapeutics to improve the treatment of HAND. Full article

Circadian desynchronization is increasingly linked to metabolic, immune, neurocognitive, and oncological disease, but integrated clinical phenotyping across endocrine, microbiome, metabolic, and neuroimaging domains remains limited. We conducted a prospective, single-centre, observational study in 179 symptomatic patients referred for chronic multisystem features consistent with circadian dysregulation and 107 practically healthy controls. Circadian melatonin status was assessed using fractionated 24 h urinary 6-sulfatoxymelatonin (aMT6s) and standardized dim-light plasma sampling at daytime (14:00–16:00) and nocturnal (02:00–04:00) windows. Microbiome composition was assessed by 16S rRNA sequencing, urolithin A by targeted metabolomics, and putative glymphatic/perivascular clearance by MRI-derived DTI-ALPS index, perivascular space scoring, and white-matter-hyperintensity (WMH) volumetry. Patients showed markedly reduced nocturnal melatonin output and loss of day–night contrast (night aMT6s 10.2 vs. 40.6 ng/mL; urinary aMT6s day/night ratio 0.81 vs. 0.14; plasma nocturnal melatonin 12.7 vs. 54.4 pg/mL; all p < 0.0001), accompanied by altered cortisol day–night patterning. Patients also showed reduced microbiome diversity, depletion of Gordonibacter and Ellagibacter, lower plasma urolithin A, higher WMH volume and perivascular space scores, and a lower DTI-ALPS index. Age distributions broadly overlapped in the individual-level dataset, and key biomarkers were not significantly correlated with chronological age within the patient cohort; however, this finding is interpreted as an exploratory absence of detectable age gradient within the symptomatic cohort, not as proof of biological age-independence. Overall, the data support a coherent cross-sectional association among blunted nocturnal melatonin rhythmicity, dysbiosis/urolithin depletion, and MRI markers compatible with impaired perivascular clearance. The MGM axis framework should be regarded as hypothesis-generating; causal direction, melatonin receptor involvement, and AQP4-related mechanisms require longitudinal and mechanistic validation. Full article

Creativity relies on dynamic processing within the semantic network system; however, how this system varies under different cognitive strategies remains unclear. Grounded in the Associative Theory of Creativity, this study applied four cognitive strategies (application, analogy, abstraction, and combination) as distinct input constraints to the cognitive system. We tracked the N400 component using event-related potentials (ERPs), which capture brain activity time-locked to specific cognitive events. Specifically, the N400 serves as a reliable neural marker reflecting semantic mismatch and the integration of new information. Repeated-measures analysis of covariance (RM-ANCOVA) revealed that the abstraction strategy yielded the highest level of creativity, while the application strategy yielded the lowest. Neural data indicated that attenuated N400 amplitudes under the application strategy reflected minimal prediction errors within familiar conceptual spaces, whereas pronounced N400 amplitudes under abstraction and combination strategies represent substantial cognitive effort associated with feature extraction and concept integration. Subsequent linear mixed-effects model (LMM) analysis revealed that the N400 component exerted a significant negative moderating effect on individual creativity under the analogy strategy, establishing a boundary condition for transforming semantic updating into final creative output. By exploring associative processes through micro-neural mechanisms, this research provides practical insights for optimizing creative task design and evaluation structures. Full article

Background/Objectives: Sleep problems, cognitive deficits, and mood disorders are prevalent in justice-involved populations, especially among individuals with a history of traumatic brain injury (TBI), though the association between these variables remains understudied. This retrospective study examined the relationship between subjective sleepiness and mood state on neuropsychological functioning in a forensic population with self-reported TBI. Methods: Data were obtained from 419 inmates and probationers with a self-reported history of TBI using the Ohio State University Traumatic Brain Injury Identification Method and Automated Neuropsychological Assessment Metrics (ANAM). Multiple linear regression models examined associations between cognitive performance across domains (i.e., reaction time, learning, attention, processing speed, working memory, delayed memory, and inhibition) and subjective sleepiness and mood states (i.e., depression, anxiety, fatigue, restlessness, anger, happiness, and vigor) measured by self-report scales embedded in the ANAM. Results: Negative mood state was most associated with impaired performance on tests of learning, delayed memory, spatial working memory, and reaction time, as well as global neurocognitive test performance. Subjective sleepiness was predictive of poorer performance on reaction time tasks, while positive mood states were related to better performance on the same task. Regression models were statistically significant (p < 0.05), with subjective sleepiness and mood accounting for approximately 1–5% of the variance in cognitive performance. Conclusions: Subjective sleepiness and mood symptoms are significantly related to cognitive performance among justice-involved individuals with self-reported TBI. While these factors can contribute to the need for rehabilitation, they may also reduce the likelihood of successful engagement. Importantly, both sleepiness and mood are modifiable treatment targets, and adapting interventions to accommodate cognitive inefficiencies can improve engagement and overall treatment benefit. Full article

Human performance in critical environments is frequently degraded by mistimed communication delivered during periods of visual–cognitive saturation. In such settings, failures arise not only from individual limitations but also from poor coordination between operators under rapidly changing workload conditions. We present a dual-loop neuro-adaptive simulation framework based on real-time spectral–topographic EEG representations, in which multichannel cortical activity is transformed into dynamic spatial maps and decoded to regulate both operator assistance and team communication. The system integrates 14-channel wireless EEG (Emotiv EPOC X, 256 Hz), gaze tracking, telemetry, and communication events through an LSL-based multimodal synchronization pipeline. A hybrid CNN–LSTM model processes sequences of spectral-topographic EEG maps to classify three operationally actionable neurocognitive states—Channelized Attention, Diverted Attention, and Surprise/Startle—while also estimating a continuous Cognitive Load Index (CLI). These representation-derived features are then used by a multi-agent proximal policy optimization (MAPPO) controller to generate two coordinated outputs: (i) adaptive haptic guidance for the pilot, designed to reduce reliance on overloaded visual and auditory channels, and (ii) a traffic-light communication gate for the telemetry engineer, regulating whether radio intervention should proceed, be delayed, or be withheld. In a high-fidelity dual-station simulation with 25 pilot–engineer pairs, the proposed framework was associated with a reduction of more than 30% in communication breakdown errors relative to open-loop telemetry, with the strongest effects observed during peak-load windows, while preserving realistic task progression. It also improved pilot reaction time to time-critical warnings and reduced engineer decision load under the tested conditions. These findings support the use of spectral-topographic EEG representations as a practical basis for combining multimodal neurophysiological sensing, spatiotemporal pattern decoding, and adaptive coordination in high-pressure human–machine teams. At the same time, the study should be interpreted as evidence of controlled feasibility in a simulated setting rather than as definitive proof of field-level generalization. We further discuss deployment constraints and propose privacy-by-design safeguards to ensure that neurocognitive signals are used exclusively for operational adaptation rather than employability assessment or performance scoring. Full article

Human endogenous retroviruses (HERVs) are potential driving forces of the pathophysiology of Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), linking post-infectious immune dysfunction to chronic inflammation and immune and neurocognitive dysfunction that are hallmark features of ME/CFS. Accumulating evidence from related autoimmune diseases and cancers has shown that reactivated HERVs can contribute to disease pathogenesis by amplifying immune activation through viral protein-mediated innate sensing, long terminal repeat (LTR)-driven transcription, and disrupting epigenetic silencing. HERV signatures are therefore promising biomarkers for diagnosis, patient stratification for drug-repurposing trials, and therapy monitoring. Accumulating evidence suggests a possible correlation between HERV expression and ME/CFS symptom severity, alterations in immune phenotypes, function and inflammatory gene networks. Importantly, locus-specific HERV profiling is a promising approach for distinguishing ME/CFS from overlapping or co-morbid conditions and healthy controls. Furthermore, HERV-targeted antibodies, immune modulators, epigenetic and antiviral interventions offer promise as concomitant therapeutic strategies for ME/CFS. Additional research incorporating viromics and other-omics validation, functional assays, and HERV-stratified clinical trials is now needed to realise this potential and to transform ME/CFS from a symptom-based syndrome into a mechanism-driven, treatable condition. Full article

Background/Objectives: Post-COVID-19 condition involves heterogeneous, multisystem symptoms with uncertain recovery. We characterized symptom trajectories from hospitalization to approximately 4 weeks and to 6–8 months and compared the 6–8-month symptom burden with season-matched controls, accounting for serology-identified, previously unrecognized infections. Methods: An individually pair-matched case–control study of adults with RT-PCR–confirmed SARS-CoV-2 and population controls from the Bialystok PLUS cohort, matched on age, sex and a two-month visit window, was performed. All participants underwent anti-nucleocapsid serology. Hospitalized cases were reassessed at approximately 4 weeks and 6–8 months. Cross-sectional outcomes used non-parametric tests and multivariable regression; longitudinal change used paired tests and generalized estimating equations. Results: We included 402 adults (201 post-COVID-19; 201 controls). In hospitalized cases, respiratory symptoms declined rapidly by approximately 4 weeks and remained low at 6–8 months; smell/taste recovered more slowly; fatigue improved modestly; anxiety changed minimally. At 6–8 months, total symptom counts were higher in post-COVID-19 than in controls (median 4 vs. 2), with serology-positive controls intermediate (median 3). Excess burden was concentrated in non-respiratory domains (fatigue, neurocognitive, cardiovascular, and dermatologic), whereas respiratory differences were not significant. In the multivariable model, female sex remained an independent predictor of higher multisystem burden, whereas age, body mass index, hospitalization, and acute biomarker severity were not associated. Conclusions: Six to eight months after symptomatic COVID-19, multisystem symptom burden remains substantial relative to season-matched controls, despite substantial resolution of respiratory complaints. Serology-based identification of previously unrecognized infections indicates an intermediate burden and can guide targeted follow-up. Full article

A growing body of empirical study recognises a tendency for users to form (para)social bonds with Large Language Models, even when users know explicitly that these systems lack interiority or personhood. This contribution argues that such attachments arise from evolved human capacities to attribute being, moral status and, in some ways, ‘soul’ to nonhuman others—and that this capacity now operates without the belief-systems that have historically mediated it. When users encounter helpful, patient, emotionally available behaviour in conversational agents, they project the interior states that would produce those behaviours in themselves: authentic interiority and phenomenal consciousness. Humans have been making such assessments throughout our cultural history, developing ontologies and theologies for managing our relations with nonhuman, mythic and spiritual others. By contrast, modernity has disenchanted its landscapes, dismantling these cultural models even as the ‘ensouling architecture’ of our social and semiotic cognition remained unchanged. Contemporary users thus encounter machine others through the same neurocognitive lens as their ancestors did with spirits and animals on enchanted, animate landscapes, but without the mediation of culture, norm and taboos which place a premium on appropriate conduct, reciprocity and moderation. The resulting condition—a ‘Turing Animism’—leads users to ‘feel soul’ where there is only simulacrum. Full article

Background: Posttraumatic stress disorder (PTSD) in ages 3–18 is associated with disturbances in attention, working memory, processing speed, and executive control, as well as persistent difficulties in affect regulation. These neuropsychological vulnerabilities might interfere with learning, peer relationships, and the consolidation of age-appropriate developmental skills. Methods: We conducted a narrative review informed by a structured literature search in PubMed, Scopus, PsycINFO, Embase, EBSCOhost, Web of Science, and Google Scholar. English-language publications from 1990 to 2025 were considered if they examined (1) neuropsychological outcomes of trauma exposure or PTSD in youth and/or (2) interventions with potential to modify neurocognitive or affective functioning, including trauma-focused cognitive behavioral therapy (TF-CBT), mindfulness-based interventions, cognitive rehabilitation strategies, and biofeedback/neurofeedback. Results: Across study designs, trauma exposure and PTSD in youth are consistently linked to impairments in attentional control and executive functioning, with downstream effects on everyday memory and academic performance. Neurobiological studies commonly implicate altered reactivity within amygdala-centered threat circuits and reduced top-down modulation by prefrontal networks, although findings vary with trauma type, developmental stage, and comorbidity. TF-CBT remains the best-supported intervention for pediatric PTSD symptoms; however, neurocognitive outcomes are measured less frequently. Mindfulness-based programs show promise for strengthening attention and emotion regulation when carefully adapted for trauma-exposed youth. Neurofeedback and targeted cognitive rehabilitation represent emerging approaches with preliminary evidence, but the literature remains heterogeneous. Conclusions: An intervention strategy that combines symptom-focused trauma therapy with explicit targeting of executive control, memory processes, and affect regulation may represent a developmentally informed clinical framework for trauma-exposed youth. Future trials need to incorporate standardized neuropsychological endpoints and examine moderators that inform treatment matching. Full article

Intracranial mesenchymal tumors (IMTs) with FET::CREB fusion are rare mesenchymal neoplasms that rely on the confirmation of the molecular hallmark FET::CREB gene fusion for diagnosis. We report a case of a 53-year-old female presenting with neurocognitive decline and seizures. Neuroimaging demonstrated a heterogeneously enhancing solid-cystic lesion in the left frontal lobe. Gross total resection (GTR) of the tumor was achieved and the patient recovered to premorbid status. Definitive diagnosis was achieved via next-generation sequencing that identified an EWSR1 (exon 7)::CREM (exon 7) fusion transcript. A systematic literature review of 72 IMTs with FET::CREB-positive cases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Publications reporting confirmed FET::CREB fusion-positive IMTs, without restriction on year of publication, were included to analyze clinicopathological correlations and prognostic determinants. Mean age at diagnosis was 27.8 (±18.3). Patients who underwent GTR demonstrated a significantly lower rate of recurrence compared to those who underwent subtotal resection (STR) (p < 0.001), suggesting that extent of resection may be an important prognostic factor; however, causal inference is precluded by the observational nature of the data. Patients who received adjuvant therapy had a higher rate of recurrence (p = 0.043); however, this association is likely attributable to confounding by indication, as adjuvant treatment was predominantly administered to patients with subtotal resection or more aggressive disease. No causal inference regarding adjuvant therapy efficacy can be drawn from these data. Our study results corroborate that accurate diagnosis relies on molecular interrogation and the extent of resection appears to be an important prognostic factor for IMTs with FET::CREB fusion. Full article

The nonfluent/agrammatic variant of primary progressive aphasia (nfav-PPA) and primary progressive apraxia of speech (PPAOS) are neurodegenerative syndromes that raise diagnostic challenges related to several issues. First, there are two divergent conceptions, one stipulating that (i) nfav-APP and PPAOS are distinct entities, and the other (ii) that PPAOS has to be integrated into the nfav-APP spectrum. A second related issue concerns the consideration of phonological dimensions, lying at the language interface with speech, which could potentially help overcome the nfva-PPA/PPAOS controversy. Third, there is a lack of internationally validated clinical tests assessing apraxia of speech and syntactic abilities with sufficient specificity and sensitivity. This narrative review discusses these issues taking into account clinical, neurocognitive and neurobiological dimensions. It proposes a conceptual-integrative framework conciliating competing nfav-APP/PPAOS accounts while suggesting a graded continuum with subdivisions, related to neurodegenerative expansion throughout language/speech production systems, ranging from syntactic to phonological to phonetic-articulatory impairments. A second controversy in the field of PPA arises from divergent conceptions of semantic PPA (sv-PPA), defined by primary damage to verbal semantics, and of semantic dementia (SD) characterized by multimodal semantic impairments. The current consensus criteria of PPA have deconstructed the initial SD conception by absorbing it into sv-PPA, hence leaving mixed and some non-verbal semantic phenotypes nosologically orphaned. Again, the article proposes a conceptual and integrative model, built on findings from clinical research and cognitive neuroscience, suggesting a graded continuum with subdivisions spanning from verbal to different non-verbal semantic impairments including social-semantic/behavioral phenotypes. Full article

Education for Sustainable Development (ESD) increasingly relies on e-learning environments to deliver scalable, flexible, and accessible educational experiences. While existing research has extensively examined the role of digital technologies in facilitating sustainability-oriented learning, significantly less attention has been given to how learners themselves adapt to the structures and dynamics of these environments. This study adopts a theory-building approach, grounded in integrative conceptual synthesis, to develop a coherent explanatory framework that combines insights from cognitive load theory, self-regulated learning, neurocognitive adaptation, and systems theory. The paper proposes the Sustainable Learning Loop, a recursive mechanism describing how repeated interaction with e-learning systems leads to pattern recognition, expectation stabilization, reduced cognitive effort, decreased active engagement, and the emergence of stable behavioral learning patterns. In addition, a novel typology of Sustainable Learning Habituation (SLH) is developed, distinguishing between cognitive, engagement, behavioral, and sustainability habituation. The framework highlights a dual dynamic in digital learning environments. On the one hand, habituation enhances efficiency, usability, and scalability, supporting the broader goals of sustainable education. On the other hand, it introduces critical risks, including superficial sustainability learning, reduced critical thinking, platform dependency, and the emergence of an illusion of learning, where perceived competence exceeds actual understanding. The study contributes to the literature by reframing e-learning as a co-adaptive system that actively shapes cognitive and behavioral processes, rather than merely delivering content. From a practical perspective, the findings underscore the need to design digital learning environments that balance efficiency with reflexivity, ensuring that ESD remains transformative rather than procedural. The framework also offers actionable design implications, suggesting that e-learning environments for ESD should incorporate reflective prompts, task variability, learning analytics indicators, and metacognitive feedback mechanisms to prevent excessive routinization and support deeper sustainability-oriented engagement. Future research should focus on the empirical operationalization of SLH and the development of adaptive systems that support critical engagement and sustainable learning outcomes. Full article

Background/Objectives: Pediatric hematology and oncology patients are at increased risk for psychosocial and neurocognitive difficulties following treatment. Survivorship programs monitor late effects associated with disease and treatment history, with most programs focusing on screening and referring. Relatively less focus is placed on psychoeducation and intervention. The current paper describes the process of creating a novel psychology trainee-led consultation service embedded within a multidisciplinary survivorship clinic. Methods: A psychology intern collaborated with clinic staff and reviewed existing literature to inform the nature of the service. Patients seen in clinic met with the psychology intern for a 20-min visit focused on an area of concern identified during existing neuropsychology and/or social work assessment visits. Topics addressed included coping with stress, anxiety management, improving mood, sleep hygiene, parenting responses to common behavioral issues, and the acquisition of academic support. Pilot patient satisfaction data were collected via a questionnaire at the end of the visit, without any patient-identifiable factors attached to response data. Results: Most patients and families (90%) found the service helpful. Moreover, the majority of families (90%) found a 20-min service delivery to be adequate. The most common topic area addressed was anxiety management. Conclusions: Results demonstrate high patient satisfaction. Advantages of this service include rapid access to a no-fee support addressing common mental health and neurocognitive sequelae of childhood cancer and the expansion of psychology training opportunities. Future research should evaluate the service using validated outcome measures and examine its long-term effects. Full article