Brain and Behavior

Background The involvement of immune cells in the pathophysiology of intracerebral hemorrhage (ICH) is becoming increasingly recognized, yet their specific causal contributions remain uncertain. The objective of this research is to uncover the potential causal interactions between diverse immune cells and ICH using Mendelian randomization (MR) analysis. Methods Genetic variants associated with 731 immune cell traits were sourced from a comprehensive genome‐wide association study (GWAS) involving 3757 participants. Summary statistics data for ICH were acquired from FinnGen, comprising 4056 ICH cases and 371,717 controls. The principal analytical tool utilized in our study was the inverse‐variance weighted (IVW) method, incorporated as a key component of a two‐sample MR approach. To mitigate potential biases and verify the stability of the conclusions drawn from the primary analytical methods, a series of sensitivity analyses were performed. Results MR analysis elucidated 33 immune cell traits with causal associations, comprising B cells (eight traits), conventional dendritic cells (cDC, two traits), maturation stages of T cells (two traits), monocytes (two traits), myeloid cells (five traits), TBNK cells (six traits), and regulatory T cells (Treg, eight traits). DP (CD4+CD8+) %T cell (OR = 0.83, CI = 0.72–0.96, p = 0.013) exhibited the strongest protective effect. In contrast, transitional AC (OR = 1.09, CI = 1.02–1.16, p = 0.006) and IgD− CD27− %lymphocyte (OR = 1.08, CI = 1.00–1.17, p = 0.045) showed a higher tendency to increase the ICH risk. The sensitivity analyses validated the robustness and consistency of these results. Conclusion Our research provides robust evidence substantiating the causal relationship between specific immunophenotypes and ICH risk. The identification of these findings significantly enhances our understanding of the pathogenic mechanisms underlying ICH, particularly pertaining to the immune system. This breakthrough paves the way for innovative clinical and pharmaceutical research opportunities, potentially promoting the development of targeted therapies and enhanced strategies for managing and preventing ICH.

Purpose Genetic studies on the transgender and gender diverse (TGD) community have started to appear in the literature. However, there are limited studies on how genetic data will impact attitudes and perspectives toward TGD individuals. In this study, we investigated the impact of genetic alterations on physicians' attitudes toward TGD individuals and on physicians' decisions concerning gender confirmation surgery (GCS). In this context, we intended to highlight a number of strategies to reduce the inequalities that the TGD community is exposed to in accessing health‐care services. Method An online survey including the Turkish version of the Attitudes Toward Transgendered Individuals Scale (ATTIS) was completed by 224 physicians from relevant specialties. Scheffé and least significant difference (LSD) post hoc analysis methods were used to determine physicians' perspectives on whether genetic findings would cause TGD individuals to feel validated/invalidated. Multivariate multinomial logistic regression analysis was employed to assess their responses concerning the decision to perform GCS when genetic alterations had been identified. Results More than half of the physicians expressed the view that genetic analyses for TGD individuals would confer benefits (67.1%). Those who thought that the presence of gender–diversity‐related genetic alterations would have a “positive impact” on their GCS‐related decision to operate were found to have less positive attitudes toward TGD individuals (Bonferroni corrected p < 0.001). Multivariate multinomial logistic regression analysis revealed that age, presenting the odds ratio as the strongest factor, distinguished the “no impact” group from the reference “positive impact” group, particularly among those aged ≤ 35 years (3.299, 95% CI: 1.355–8.033; p = 0.009). Conclusion Although genetic analysis of TGD individuals is predicted to have a positive effect on physicians' attitudes toward them and on the GCS decision‐making process, it should be emphasized that the benefits for TGD individuals must outweigh the potential harm. The results showed that physicians need “early and continuing education” to develop a comprehensive perspective on gender identity. The most appropriate approach for genetic testing would be to include the TGD community in decision‐making processes and to develop guidelines for the interpretation of genetic data.

Background In recent years, cognitive impairment has emerged as a pivotal symptom in elderly patients with depression, exerting a substantial impact on the course and prognosis of diseases. Moreover, it persists even following remission from depression during the rehabilitation period. However, there remains an incomplete understanding of the relevant influencing factors for cognitive impairment in elderly depressed patients, which seriously impedes the development of risk prediction models and the subsequent research on precision intervention programs. Objective The purpose of this study is to examine the current state of negative influencing factors and assessment tools for cognitive impairment in patients with late‐life depression (LLD), thereby providing a theoretical framework for the construction of subsequent targeted intervention programs. Methods The search strategy employed in this study followed an evidence‐based approach, utilizing a systematic scoping review to thoroughly explore six English and four Chinese databases up until November 2023. Two researchers independently conducted article screening and employed thematic analysis to categorize the results into themes. Results Following two rounds of rigorous screening conducted by the evidence‐based research team, data were meticulously extracted and succinctly summarized from five distinct themes encompassing socio‐demographic, physiological, psychological, genetic, and other related factors. In addition, a comprehensive compilation of 19 diverse assessment tools was undertaken. Ultimately, a total of 22 articles met the eligibility criteria for inclusion in this study. These comprised five longitudinal studies, nine pathological controlled studies, five cross‐sectional studies, two cohort studies, and one randomized controlled study. Conclusion Cognitive dysfunction is an important symptom of LLD, which seriously affects the survival of patients. At present, the research on its influencing factors mainly includes socio‐demographic, physiological, psychological, genetic, and other related factors. There have been existing cognitive function assessment tools specifically for those 18‐ to 65‐year‐old patients of major depressive disorder, but there is still a lack of reliability and validity tests in LLD.

Purpose: Due to the highly individualized clinical manifestation of Parkinson's disease (PD), personalized patient care may require domain‐specific assessment of neurological disability. Evidence from magnetic resonance imaging (MRI) studies has proposed that heterogenous clinical manifestation corresponds to heterogeneous cortical disease burden, suggesting customized, high‐resolution assessment of cortical pathology as a candidate biomarker for domain‐specific assessment. Method: Herein, we investigate the potential of the recently proposed Mosaic Approach (MAP), a normative framework for quantifying individual cortical disease burden with respect to a population‐representative cohort, in predicting domain‐specific clinical progression. Using MRI and clinical data from 135 recently diagnosed PD patients from the Parkinson's Progression Markers Initiative, we first defined an extremity‐specific motor score. We then identified cortical regions corresponding to “extremity functions” and restricted MAP, respectively, and contrasted the explanatory power of the extremity‐specific MAP to unrestricted MAP. As control conditions, domain‐related but less specific general motor function and nondomain‐specific cognitive scores were considered. We also tested the predictive power of the restricted MAP in predicting disease progression over 1 and 3 years using support vector machines. The restricted, extremity‐specific MAP yielded higher explanatory power for extremity‐specific motor function at baseline as opposed to the unrestricted, whole‐brain MAP. On the contrary, for general motor function, the unrestricted, whole‐brain MAP yielded higher power. Finding: No associations were found for cognitive function. The extremity‐specific MAP predicted extremity‐specific motor progression over 1 and 3 years above chance level. The MAP framework allows for domain‐specific prediction of customized PD disease progression, which can inform machine learning, thereby contributing to personalized PD patient care.

Background Existing literature explores the relationship between voluntary work, loneliness, and social isolation, but there is a lack of research on how the onset and cessation of voluntary work relate to loneliness and social isolation among older adults. Many in this population may discontinue volunteering due to various life circumstances, making it important to investigate the longitudinal significance of these transitions. This study aims to assess whether engaging in volunteer work during retirement age is associated with changes in loneliness and social isolation. Methods Longitudinal data were obtained from Waves 5 (Year 2014) and 6 (Year 2017) of the German Ageing Survey, focusing on middle‐aged and older adults. The sample size (n = 6628) was limited to those aged 65 and above. Two groups were analyzed: the onset group, individuals who did not volunteer in 2014 but did by 2017 (188 individuals), and the cessation group, those who volunteered in 2014 but not by 2017 (307 individuals). Loneliness was assessed using the De Jong Gierveld tool, and perceived social isolation was measured using the Bude and Lantermann instrument. Asymmetric linear fixed effects (FE) regression analysis examined the associations. Results In an asymmetric FE regression analysis that adjusted for a multitude of time‐varying covariates, an association was shown between the onset of volunteer work and decreases in loneliness (β = −0.07; p = 0.04) in older adults. In contrast, there was no significant association between the onset of voluntary work and changes in perceived social isolation. Also, there was no significant association between the cessation of volunteer work and changes in perceived social isolation or loneliness. Conclusion Our findings suggest that older adults who choose to volunteer may experience a decrease in self‐reported loneliness. Further longitudinal studies are needed to confirm our present findings.

Background and Purpose The treatment effect of consciousness after brain injury is currently uncertain. Thus, this study aimed to retrieve the evidence from neurologists around the world on the management of consciousness disorders in patients with severe brain injury and evaluate and summarize the evidence, providing the guidance on the related management for clinicians. Methods Following the evidence summary report standard of Fudan University Center for Evidence‐Based Nursing, clinical guidelines, expert consensuses, systematic reviews, and evidence summaries were systematically retrieved from UpToDate; BMJ Best Practice; Guidelines International Network; the Cochrane Library; Embase; PubMed; Sinomed; Web of Science; CNKI; WanFang database; American Academy of Neurology (AAN); American Congress of Rehabilitation Medicine (ACRM); European Academy of Neurology; and National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). The publishing timeline for articles was limited from January 2017 to January 2024. Results Fourteen articles were finally identified. The 26 best pieces of evidence were recommended by inducting and integrating the evidence from these articles, covering the following seven aspects: consciousness assessment, multidisciplinary team, intervention in facilitating arousal, sensory stimulation programs, drug administration, rehabilitation program, and prevention of complications. Conclusion This study summarized the evidence of consciousness management in patients with brain injury, providing guidance for clinicians to develop and apply those interventions to improve the patient's clinical outcomes and quality of life. In addition, relevant factors such as the clinical environment and cooperation with the patient's family members should be evaluated and adjusted before applying such evidence. Future studies should focus on more targeted randomized clinical trials.

Background The occurrence and development of postoperative cognitive dysfunction (POCD) are closely linked to neuroinflammation. This bibliometric analysis aims to provide novel insights into the research trajectory, key research topics, and potential future development trends in the field of neuroinflammation‐induced POCD. Methods The Web of Science Core Collection (WoSCC) database was searched to identify publications from 2012 to 2023 on neuroinflammation‐induced POCD. Bibliometric analysis, involving both statistical and visual analyses, was conducted using CiteSpace, VOSviewer, and the R software. Results Research on neuroinflammation‐induced POCD has exhibited an increasing trend over the past 12 years. China had the highest number of publications, Nanjing Medical University had the most collaboration with other institutions, Zhiyi Zuo was the most published author, and the Journal of Neuroinflammation served as the primary publication in the field of neuroinflammation‐induced POCD. The most frequent keyword was POCD. Keyword clustering analysis indicated that the predominant cluster is dexmedetomidine. Burst detection revealed that postoperative delirium (POD), perioperative neurocognitive disorders (PND), apoptosis, and epigenetic modifications were the future research trends. Conclusions Our analysis identified the following key research areas associated with neuroinflammation‐induced POCD: anesthesia, surgery, dexmedetomidine, NLRP3 inflammasome, and mechanism of neuroinflammation‐induced POCD. The potential future research topics comprise POD, PND, apoptosis, and epigenetic modifications.

Introduction We aimed to explore the difference in choroidal vascular parameters using swept‐source optical coherence tomography (SS‐OCT) in patients with idiopathic intracranial hypertension (IIH) compared to controls. We also explored the ability of the choroidal parameters to reflect elevated intracranial pressure (ICP) in patients with IIH. Methods This observational study recruited patients diagnosed with IIH and healthy controls. A lumbar puncture was performed for ICP measurement. All the participants underwent OCT examinations. The choroid was automatically segmented and imaged by the OCT tool. The parafoveal choroidal vascular volume (CVV) and choroidal vascular index (CVI) were calculated in 3 mm annulus and 6 mm annulus. Results A total of 80 patients with IIH (34.67 ± 11.00 years; 37.50% males) and 92 controls (34.50 ± 12.08 years; 36.96% males) were included in the final analysis. Patients with IIH had higher BMI (< 0.001) and poor visual acuity (< 0.001) compared with controls. Patients with IIH demonstrated significantly lower parafovea CVI in both annuluses (p = 0.003 for 3 mm annulus, p = 0.001 for 6 mm annulus) compared to controls. Mean parafovea CVI in both annuluses was significantly correlated with ICP level (p = 0.014 for 3 mm annulus, p = 0.015 for 6 mm annulus). The combination of CVV and CVI in a 6 mm annulus demonstrated the highest diagnostic value with a mean AUC of 0.818. Conclusion CVI may serve as a potential marker for identifying IIH and reflecting ICP changes.

Background This systematic review and meta‐analysis evaluates peripheral and CNS BDNF levels in glioma patients. Methods Following PRISMA guidelines, we systematically searched databases for studies measuring BDNF in glioma patients and controls. After screening and data extraction, we conducted quality assessment, meta‐analysis, and meta‐regression. Results Eight studies were included. Meta‐analysis showed significantly reduced plasma BDNF levels in glioma patients versus controls (SMD: −1.0026; 95% CI: [−1.5284, −0.4769], p = 0.0002). High‐grade gliomas had lower plasma BDNF (p = 0.0288). Tissue BDNF levels were higher in glioma patients (SMD: 1.9513; 95% CI: [0.7365, 3.1661], p = 0.0016) and correlated with tumor grade (p = 0.0122). Plasma BDNF levels negatively correlated with patient age (p = 0.0244) and positively with female percentage (p = 0.0007). Conclusion BDNF is a promising biomarker in glioma, showing significant changes in plasma and tissue levels correlating with tumor grade, patient age, and gender.

Background In today's post‐truth times, where personal feelings and beliefs have become increasingly important, determining what is accurate knowledge has become an important skill. This is especially important during uncertainty crises (e.g., epidemics and pandemics) because alternative explanations other than scientific knowledge may be disseminated vigorously. Epistemic justification concerns how and in what way the truth of knowledge claims is justified and the criteria for knowledge to be true and/or a fact. Given this backdrop, the present study examined how individuals reacted to conspiracies in an uncertainty crisis (using the COVID‐19 pandemic as an example). Aim The mediating role of epistemic justification was investigated regarding its relationship between COVID‐19 conspiracy beliefs and COVID‐19 vaccine conspiracy beliefs. Methods A cross‐sectional study was conducted incorporating a multifactorial correlational design. Using convenience sampling, 690 participants (55.7% females, Mage = 32.24 years, SD = 9.75) from different regions of Türkiye completed an online survey via Google Forms. Results The results demonstrated a strong and statistically significant correlation between beliefs in COVID‐19 conspiracy theories and beliefs in COVID‐19 vaccination conspiracy theories. The mediating effects of justification by authority and personal justification were statistically significant between COVID‐19 conspiracy beliefs and COVID‐19 vaccine conspiracy theories. Conclusion Using the COVID‐19 pandemic as an example, the present results indicated the complex relationships between conspiracy beliefs and epistemic justification. The present results indicate the importance of authorities in taking early action to provide scientific evidence and information to the public to avoid individuals believing false information.

Introduction Stroke patients are at high risk of developing cerebral edema, which can have severe consequences. However, there are currently few effective tools for early identification or prediction of this risk. As machine learning (ML) is increasingly used in clinical practice, its effectiveness in predicting cerebral edema risk in stroke patients has been explored. Nonetheless, the lack of systematic evidence on its predictive value challenges the update of simple and user‐friendly risk assessment tools. Therefore, we conducted a systematic review to evaluate the predictive utility of ML for cerebral edema in stroke patients. Methods We searched PubMed, Embase, Web of Science, and the Cochrane Database up to February 21, 2024. The risk of bias in selected studies was assessed using a bias assessment tool for predictive models. Meta‐analysis synthesized results from validation sets. Results We included 22 studies with 25,096 stroke patients and 25 models, which were constructed using common and interpretable clinical features. In the validation cohort, the models achieved a concordance index (c‐index) of 0.840 (95% CI: 0.810–0.871) for predicting poststroke cerebral edema, with a sensitivity of 0.76 (95% CI: 0.72–0.79) and a specificity of 0.87 (95% CI: 0.83–0.90). Conclusion ML models are significant in predicting poststroke cerebral edema, providing clinicians with a powerful prognostic tool. However, radiomics‐based research was not included. We anticipate advancements in radiomics research to enhance the predictive power of ML for poststroke cerebral edema.

Purpose The prevalence of sedentary lifestyles (SL), which includes both high volumes of extended sitting behavior and a low volume of steps accumulated across the day, among older adults continues to rise contributing to increases in associated comorbidities and the loss of independence. The social, personal, and economic burdens are enormous. In recognition of the health implications of SL, current public health physical activity guidelines now emphasize the complimentary goals of sitting less by moving more. We recently completed a 6‐month weight loss (WL) study followed by 12 months of reduced contact to examine weight regain in older adults with obesity. One of the treatment conditions involved WL + a day‐long movement intervention that explicitly targeted reducing sitting time and increasing steps across the day (SitLess). Method The goal of the current study, using baseline fMRI and accelerometry data from 36 participants and advanced machine learning tools, was to determine if we could identify complex brain circuits underlying variability associated with changes in sitting time and daily steps during the 6‐month intensive phase among participants randomized to the WL + SitLess treatment condition. Models generated from these analyses produced accuracy in predicting pre–post change in both measures that exceeded 92%, suggesting a critical role for the identified brain subnetworks in explaining variability in these outcomes in response to the intervention. The identified networks comprised regions, predominantly in the default mode and sensorimotor networks, that have been extensively linked to self‐regulation and decision‐making. Finding These results provide insights into the theoretical basis of SL for older adults and in the design of future intervention research.

Background Different modes of motor acquisition, including motor execution (ME), motor imagery (MI), action observation (AO), and mirror visual feedback (MVF), are often used when learning new motor behavior and in clinical rehabilitation. Purpose The aim of this study was to investigate differences in brain activation during different motor acquisition modes among healthy young adults. Methods This cross‐sectional study recruited 29 healthy young adults. Participants performed a functional reaching and grasping task under ME, MI, AO, and MVF mode with their right arms at a frequency of 0.5 Hz for 1 min per task. Each task was performed three times in a random order. Brain activation in the supplementary motor area (SMA), premotor cortices (PMC), and primary motor cortices (M1) during tasks was measured using functional near‐infrared spectroscopy through 16 source‐detector channels. Results ME showed significant activation in bilateral PMC, M1, and right SMA, with higher activation in the contralateral M1. MI induced greater activity in the PMC and SMA, particularly in the ipsilateral regions. MVF resulted in significant activation in bilateral PMC, SMA, and M1. AO showed an increasing trend in brain activation, but no significant differences in any channels. Compared to AO, ME and MVF induced significantly greater brain activity in M1. Conclusion Activation levels under MI and MVF were comparable to that of ME. MI and MVF induced greater activity in the PMC and SMA, and MVF showed significant activity in all brain areas, especially in the bilateral M1. These findings support the application of different motor acquisition strategies according to individual needs. When ME cannot be executed, such as for individuals with hemiparesis or severe impairments of both upper extremities, MI and MVF may be applied, respectively, to drive neuroplastic changes.

Background Respirator failure (RF) is a severe malignant complication in both lateral medullary infarction (LMI) and medial medullary infarction (MMI) patients. However, the differences in clinical and radiological manifestations associated with RF between patients with LMI and MMI have not been fully elucidated. Methods A total of 435 consecutive patients with MI within 7 days of onset in our institute were retrospectively enrolled from January 2017 to January 2024. Lesions were categorized both rostral‐caudally and horizontally, and clinical characteristics were collected to evaluate the correlation between them and RF that occurred within 10 days of stroke onset. Results Among the 435 patients, 33 patients developed RF, with 19 exhibiting LMI and 12 exhibiting MMI. Multisegment involvement was more common among LMI patients experiencing RF compared to those without (52.6% vs. 23.9%, p = 0.012). However, this difference was not observed among MMI patients. Large (n = 12, 63.2%, p = 0.014) and typical (n = 6, 31.6%, p = 0.016) lesions were more common among LMI patients with RF. In MMI patients with RF, nine (75.0%) patients had long lesions extending from the ventral to the dorsal medulla, with six of these cases involving bilateral lesions, as V‐shape or heart‐shape on MRI. Univariate analysis of clinical symptoms revealed that bulbar symptoms, urinary retention, and pulmonary infection were significantly more common in both the LMI and MMI groups with RF. Conclusions Specific lesion patterns, such as large and typical infarctions in LMI patients or long lesions, particularly those with bilateral infarctions, as V‐shape or heart‐shape on MRI in MMI patients, appear to correlate with a higher incidence of RF, while clinical symptoms associated with RF are similar in LMI and MMI.

Purpose Essential tremor (ET) is a prevalent movement disorder, yet current therapeutic options remain limited. Emerging evidence implicates leucine‐rich repeat and immunoglobulin‐like domain‐containing protein (Lingo‐1) and neuroinflammation in the pathophysiology of ET. This study aimed to investigate whether agmatine, a biogenic amine neuromodulator attenuates tremors and modulates the expression of Lingo‐1 and proinflammatory markers in a rodent model of ET. Methods Tremor was induced in male Swiss Webster mice through intraperitoneal injections of harmaline (10 mg/kg) on Days 1, 3, and 5 of the study. During the same period, agmatine (40 mg/kg) was administered for 5 consecutive days. Behavioral assessments of tremor severity, gait, balance, muscular strength, locomotion, anxiety‐like behavior, and memory were conducted. Moreover, Lingo‐1 and interleukin (IL)‐6 gene expression was examined in the cerebellum using real‐time polymerase chain reaction (RT‐PCR). Findings Our findings demonstrated that agmatine administration significantly reduced tremors, ameliorated anxiety‐like behaviors, and attenuated harmaline‐induced locomotor deficits. At the molecular level, agmatine treatment significantly suppressed the overexpression of Lingo‐1 elicited by harmaline. Moreover, IL‐6 expression was attenuated to an extent comparable to control levels. Conclusions Collectively, this study provides the first evidence that agmatine dampens tremor severity, improves behavioral outcomes, and modulates key pathways implicated in ET pathogenesis in a rodent model. The ability of agmatine to normalize Lingo‐1 and IL‐6 expression suggests regulation of these pathways could underlie its neuroprotective action. These results suggest promise for agmatine as a prospective therapeutic agent in ET.

Background and Objectives Accumulation of metals quantified by quantitative susceptibility mapping (QSM) in deep gray matter (DGM) and their impact on cognition have not been studied in patients with liver cirrhosis. This study aims to use QSM to investigate the association between DGM susceptibility and cognition in cirrhotic patients. Methods Thirty cirrhotic patients and 30 age‐, gender‐, and education‐matched controls were imaged using a multiecho gradient‐echo sequence for QSM analysis in a 3T scanner. The susceptibility values were determined for the caudate nucleus (CN), putamen (PU), globus pallidus (GP), thalamus (TH), red nucleus (RN), substantia nigra (SN), and dentate nucleus (DN). All subjects underwent number connection test A (NCT‐A), digit substitution test (DST), and Montreal Cognitive Assessment (MoCA). Comparisons between the two groups and the correlation between the susceptibility values and neuropsychological scores were analyzed. Results The susceptibility values of bilateral CN, TH, and RN were significantly lower in cirrhotic patients. Cirrhotic patients exhibited significantly prolonged NCT‐A time and decreased DST and MoCA scores. The NCT‐A, DST, MoCA, and sub‐domain scores were correlated with susceptibility values of RN, DN, SN, and CN, respectively. The susceptibility value of the left RN was a predictor variable for the DST, MoCA, and visuospatial–executive scores; those of the right CN and left RN were predictor variables for the naming score, and that of the left SN was an independent predictor variable for the language score. Conclusions Altered susceptibility values of DGM measured by QSM are potential quantitative indicators of cognitive impairment in cirrhotic patients.

Introduction Multitasking during flights leads to a high mental workload, which is detrimental for maintaining task performance. Electroencephalography (EEG) power spectral analysis based on frequency‐band oscillations and microstate analysis based on global brain network activation can be used to evaluate mental workload. This study explored the effects of a high mental workload during simulated flight multitasking on EEG frequency‐band power and microstate parameters. Methods Thirty‐six participants performed multitasking with low and high mental workloads after 4 consecutive days of training. Two levels of mental workload were set by varying the number of subtasks. EEG signals were acquired during the task. Power spectral and microstate analyses were performed on the EEG. The indices of four frequency bands (delta, theta, alpha, and beta) and four microstate classes (A–D) were calculated, changes in the frequency‐band power and microstate parameters under different mental workloads were compared, and the relationships between the two types of EEG indices were analyzed. Results The theta‐, alpha‐, and beta‐band powers were higher under the high than under the low mental workload condition. Compared with the low mental workload condition, the high mental workload condition had a lower global explained variance and time parameters of microstate B but higher time parameters of microstate D. Less frequent transitions between microstates A and B and more frequent transitions between microstates C and D were observed during high mental workload conditions. The time parameters of microstate B were positively correlated with the delta‐, theta‐, and beta‐band powers, whereas the duration of microstate C was negatively correlated with the beta‐band power. Conclusion EEG frequency‐band power and microstate parameters can be used to detect a high mental workload. Power spectral analyses based on frequency‐band oscillations and microstate analyses based on global brain network activation were not completely isolated during multitasking.

Background Rhythmic median nerve stimulation (MNS) at 10 Hz has been shown to cause a substantial reduction in tic frequency in individuals with Tourette syndrome. The mechanism of action is currently unknown but is hypothesized to involve entrainment of oscillations within the sensorimotor cortex. Objective We used functional magnetic resonance spectroscopy (fMRS) to explore the dynamic effects of MNS on neurometabolite concentrations. Methods Here, we investigated the effects of rhythmic and arrhythmic 10 Hz MNS on glutamate (Glu) and GABA concentrations in the contralateral sensorimotor cortex in 15 healthy controls, using a blocked fMRS design. We used a Mescher–Garwood‐semi‐localized by adiabatic selective refocusing (MEGA‐sLASER) sequence at 7 T. Results Our results show no difference in the difference‐from‐baseline measures between the two stimulation conditions. Looking at the effect of MNS over both conditions there is a trend for an initial increase in Glu/tCr (total creatine) followed by a decrease over time, whereas GABA/tCr decreased during each stimulation block. Conclusions These results suggest that despite entrainment of oscillations during rhythmic MNS, there are no significant differences in the tonic neuromodulatory effects of rhythmic and arrhythmic stimulation. The reduction in Glu over the course of stimulation may reflect a decrease in the glutamatergic firing due to adaptation. This may make it less likely that an involuntary movement is generated during continuous stimulation.

Aims Atrial fibrillation (AF) accounts for about 20% of all ischemic strokes worldwide. It is known that AF impairs health‐related quality of life (HRQOL) in the general population, but data on HRQOL in stroke patients with newly diagnosed AF are sparse. Methods Post hoc analysis of the prospective, investigator‐initiated, multicenter MonDAFIS study (NCT02204267) to analyze whether AF‐related oral anticoagulation (OAC), and/or AF‐symptom severity are associated with HRQOL after ischemic stroke or transient ischemic attack (TIA). HRQOL was measured using the EQ‐5D‐3L‐questionnaire (including EQ‐index/EQ‐VAS) at baseline and after 12 months using multivariable linear mixed models. AF symptom severity was assessed using the European Heart Rhythm Association classification and symptom severity score (EHRA score) categorizing patients with no/mild/severe/disabling AF‐related symptoms. Results A first episode of AF was detected in 261/2927 (8.9%) patients within 12 months after the index stroke and 227/2920 (7.8%) patients had AF and were anticoagulated at 12 months. HRQOL (measured by EQ‐index, n = 2495 patients) was higher in AF patients on OAC compared to AF patients without OAC at 12 months after stroke (mean difference: MD: –16.8, 95% CI: 5.6 to 28.0), and similar in AF patients under OAC compared with patients without AF (MD: 2.0, 95% CI: –2.2 to 6.3). AF‐related symptoms were negatively associated with HRQOL (measured by EQ‐index) indicating that stroke patients with AF‐related symptoms had a lower HRQOL compared to asymptomatic AF patients (mild vs. asymptomatic: MD: –9.0, 95% CI: –17.7 to –0.3; severe/disabling vs. asymptomatic: MD: –19.1, 95% CI: –34.7 to –3.4). Discussion Stroke patients with newly diagnosed AF are at risk of lower quality of life at 12 months, depending on OAC status and AF symptom severity.

Objectives Limited research utilized a person‐centered approach in examining 21st‐century skills. This study used latent profile analysis to explore the relationships between resistance to change, cognitive flexibility, and 21st‐century skills, including creativity, cooperativity, critical thinking, communication, and problem‐solving. Materials and Methods A convenience sampling approach was used to recruit 502 individuals (342 females; meanage = 21.12 ± 2.34 years) via an online survey. Results The results showed that creativity, cooperativity, critical thinking, communication, problem‐solving, and resistance to change were determined as profile indicators. The cognitive flexibility of the subclasses was also predicted. Furthermore, the results revealed four distinct profiles: (i) average level across all skills (5.8%); (ii) low risk for most skills, moderate for cooperativity (18.1%); (iii) high risk for all skills (55.2%); and (iv) moderate risk for most skills, moderate for cooperativity (20.9%). Conclusions The study highlights the importance of cognitive flexibility in identifying risk profiles. Using mixture modeling provides a fresh perspective for researchers, potentially aiding in targeted interventions for at‐risk university students to enhance their 21st‐century skills.

Objective This study was conducted to determine the effect of fatalistic tendency on attitudes toward epilepsy patients. Methods The study was conducted between August 17 and October 1, 2022 in a family health center in Sakarya province in western Türkiye. The sample consisted of 479 adults. Data were collected in descriptive information forms, the fatalism tendency scale and the epilepsy attitude scale. The data were analyzed using SPSS 22.0, AMOS V 24.0, and G*Power 3.1 statistical package programs. Results Results showed that the model built according to the hypotheses was compatible, and the model fit indices χ²/Sd = 1.857, RMSEA = 0.04, CFI = 0.98, GFI = 0.99, AGFI = 0.97, and IFI = 0.98 were within the desired limits. Structural equation modeling to determine the effect of fatalistic tendency on attitudes toward epilepsy revealed that fatalistic tendency affected the attitudes toward epilepsy patients (β = 0.87, p < 0.05). Conclusion In our study, as the fatalistic tendency of individuals increased, their negative attitudes toward epilepsy patients increased. Longitudinal studies on attitudes toward epilepsy patients are recommended.

Introduction The neural substrates of reasoning, a cognitive ability we use constantly in daily life, are still unclear. Reasoning can be divided into two types according to how the inference process works and the certainty of the conclusions. In deductive reasoning, certain conclusions are drawn from premises by applying the rules of logic. On the other hand, in probabilistic reasoning, possible conclusions are drawn by interpreting the semantic content of arguments. Methods We examined event‐related oscillations associated with deductive and probabilistic reasoning. To better represent the natural use of reasoning, we adopted a design that required participants to choose what type of reasoning they would use. Twenty healthy participants judged the truth values of alternative conclusion propositions following two premises while the EEG was being recorded. We then analyzed event‐related delta and theta power and phase‐locking induced under two different conditions. Results We found that the reaction time was shorter and the accuracy rate was higher in deductive reasoning than in probabilistic reasoning. High delta and theta power in the temporoparietal, parietal, and occipital regions of the brain were observed in deductive reasoning. As for the probabilistic reasoning, prolonged delta response in the right hemisphere and high frontal theta phase‐locking were noted. Conclusion Our results suggest that the electrophysiological signatures of the two types of reasoning have distinct characteristics. There are significant differences in the delta and theta responses that are associated with deductive and probabilistic reasoning. Although our findings suggest that deductive and probabilistic reasoning have different neural substrates, consistent with most of the studies in the literature, there is not yet enough evidence to make a comprehensive claim on the subject. There is a need to diversify the growing literature on deductive and probabilistic reasoning with different methods and experimental paradigms.

Introduction Restless legs syndrome (RLS) is a frequently encountered neurological illness that has no effective treatment and imposes an enormous socioeconomic burden. Autophagy is essential for the maintenance of healthy cellular physiology, cell viability, and defense against pathogenic conditions. However, there is no study investigating the possible role of autophagy‐related proteins (ATGs) in RLS patients. Therefore, we aimed to investigate the expression and diagnostic potential of ATG3 and ATG5, as well as the relationships between these proteins and laboratory markers, depression, disease score, quality of life, and sleep in RLS patients. Methods A total of 49 patients with RLS and 26 healthy individuals were recruited for the current study. The severity of the disease was assessed using the international RLS rating scale. All participants were administered the Pittsburgh Sleep Quality Index, the Quality‐of‐Life Scale, and the Beck Depression Inventory. The enzyme‐linked immunosorbent assay was employed to quantify the expressions of ATG3 and ATG5. Results Serum ATG3 and ATG5 expressions were significantly upregulated in RLS patients compared to healthy controls (p = 0.005) and upregulated ATG3 and ATG5 expressions were relationship with the severity of the disease (p < 0.05). ATG3 was substantially correlated with the quality of sleep, whereas ATG5 was correlated with the quality of life and depression status (p < 0.05). The ROC curve analysis demonstrated that ATG3 expressions over 3146.5 ng/mL and ATG5 expressions over 4732.5 ng/mL may predict the presence of RLS (p < 0.01). Conclusion We report for the first time that autophagy may have a significant impact on the development of RLS.

Background Diabetic individuals are at an increased risk of mental illness and comorbidities. However, the precise association between depressive symptoms and comorbidity remains uncertain. Our study aimed to investigate this relationship among elderly Chinese diabetic patients. Methods Data from the China Health and Retirement Longitudinal Study (CHARLS) in 2020 were utilized for the cross‐sectional analysis. Depressive status was defined as the dependent variable, while the presence, number, and type of comorbidities served as independent variables. Logistic regression analyses were performed, adjusting for potential demographic factors, and health status and functioning factors. Results Our findings indicate that diabetic patients with complications are more likely to experience depression. With the exception for dyslipidemia (OR = 1.195, 95% CI: 0.969, 1.475), individuals with hypertension, heart disease, stroke, kidney disease, memory‐related disease, or arthritis/rheumatism were prone to develop depressive status in the fully adjusted model. After adjusting for covariates, diabetic patients with memory‐related diseases exhibited the most pronounced association with depressive symptoms (OR = 2.673, 95% CI: 1.882, 3.797). Furthermore, an increasing number of depression‐related comorbidities strengthened the association (p < 0.05). Sensitivity analysis revealed that there were no significant differences stratified by gender or marital status (p < 0.05). Conclusions In the elderly diabetic population in China, the presence, number, and type of comorbidities were independently associated with depressive symptoms. Diabetic patients with memory‐related diseases displayed the highest likelihood of experiencing depressive status. These findings underscore the importance of implementing effective strategies for multimorbidity management in diabetic patients.

Objectives Studies have shown that people living with multiple sclerosis (PwMS) were substantially impacted by the COVID‐19 pandemic. However, no study has compared the overall health‐related quality of life impact of the COVID‐19 pandemic on PwMS and the general population. Differences would have implications for crises/pandemic management policies. This study aimed to compare the prevalence and health‐related quality of life impact of COVID‐19‐related adversity (such as deteriorations in mental or physical health) in PwMS and the general population. Methods Cross‐sectional data were obtained from the How Is Your Life Australian general population study (comprising subsamples with and without chronic disease) and the Australian MS Longitudinal Study from August to October 2020. Health‐related quality of life was measured using health state utilities (HSUs; represented on a 0 [death] to 1 [full health] scale) generated by the EQ‐5D‐5L‐Psychosocial. COVID‐19‐related adversity was measured via specialized survey items. Descriptive and multivariable regression analyses were conducted. Results A total of 1020 general population individuals and 1635 MS participants entered the study (mean age 52.4 and 58.4; female 52.4% and 80.2%, respectively). COVID‐19‐related adversity prevalence was higher among PwMS compared to the general population with and without chronic diseases (PR: 1.430 [CI: 1.153, 1.774] and PR: 1.90 [CI: 1.56, 2.32], respectively). However, the HSU impact of COVID‐19‐related adversity was not dependent on disease status (p > 0.20, test for interaction). Conclusion This study found that PwMS were more likely to experience COVID‐19‐related adversity compared to the general population, though the health‐related quality‐of‐life impact was similar. This demonstrates that PwMS require additional support during national and global crises.