Brain Connectivity

ABSTRACT INTRODUCTION: Microscopic fractional anisotropy ({micro}FA), an emerging diffusion MRI metric, may be more sensitive than conventional metrics to gray matter microstructural changes in neurodegeneration. This pilot study compared {micro}FA, mean diffusivity (MD), and volume between genetic frontotemporal dementia (FTD) variant carriers and non-carriers in the insula, frontal pole, and medial orbitofrontal cortex (mOFC). METHODS: Carriers and familial non-carriers of FTD variants in C9orf72, GRN, or MAPT were scanned between October 2024-December 2025. Non-parametric aligned rank transform ANCOVAs were computed to analyze between-group differences in {micro}FA, MD, and volume while controlling for age. RESULTS: Carriers (n=12) exhibited lower insula {micro}FA than non-carriers (n=8): F(1,19)=5.89, 95% CI [-10.7,-0.75], p=0.027, 2p=0.26. No group-differences were observed in other metrics, including MD and volume. DISCUSSION: Reduced {micro}FA in the insula, a region vulnerable to early atrophy in FTD, may be more sensitive to early microstructural changes in genetic FTD than traditional diffusivity measures.

IntroductionWhile global topological properties of brain networks reach relative maturity early in development, functional reconfigurations at the regional level continue throughout adolescence to support cognitive maturation. However, regional age and sex-specific developmental patterns of functional reconfiguration remain incompletely understood. MethodsWe analyzed resting-state fMRI data from 528 participants aged 5-21 years from the Human Connectome Project in Development. Three regional graph-theory metrics (betweenness centrality, hub score, and local efficiency) were computed for each individuals functional network. Cognition was measured using NIH toolbox. Parallel factor analysis was employed to decompose an individual x region x metric array into factors representing distinct developmental properties in the full sample and separately for males and females. Brain-cognition associations were examined in developmental subgroups (<13, 13-18, >18 years). ResultsThree factors emerged, characterizing visual, multimodal integration, and higher-order factors. Across development, metrics capturing network integration (betweenness centrality and hubness) showed general stability, while metrics capturing segregation (local efficiency) presented distinct peaks, particularly in the visual factor. Females showed earlier peaks and declines in higher-order factor, while males exhibited greater variability and protracted maturation in multimodal and higher-order factors. Brain-cognition associations were modest with early childhood and crystallized cognition composites showed small negative correlations with hub score in entire sample (r=-0.212) and local efficiency in males aged <13 years (r=-0.215). ConclusionFindings highlight nonlinear, sex-specific functional reconfiguration at region-level during childhood and adolescence, underscoring the importance of sex-stratified analyses in developmental and providing a crucial foundation for future investigations of developmental disorders.

Cognitive decline is a major non-motor feature of Parkinsons disease (PD), but reliable and accessible biomarkers remain limited. Resting-state electroencephalography (EEG) is a promising candidate because it is low-cost, portable, and well suited to repeated assessment. Recent work has increasingly focused on source-space functional connectivity (FC) for the prediction of cognition. However, the influence of source-modelling based on an individualized MRI-based head model relative to that based on standard template model is unknown. To compare these two source-space EEG FC methods, we analysed EEG data from the New Zealand Parkinsons Progression Programme, including 136 people with PD and 51 age-similar controls. Source reconstructed resting-state EEG was parcellated with the HCP-MMP1 atlas, and used to derive amplitude envelope correlation (AEC) and debiased weighted phase lag index (dwPLI) across six canonical frequency bands. The twenty-four FC modalities were evaluated using six machine-learning regression algorithms within a nested cross-validation framework. Theta-, alpha-, and beta-band FC showed the most consistent prediction of global cognition, with the strongest performance observed for theta- and alpha-band AEC and dwPLI features (maximum R{superscript 2} = 0.170, r = 0.439). Standard and individualized head models showed comparable predictive performance across nearly all modalities. Feature-importance patterns for Cole-Anticevic networks were also highly similar between the two head-model options. These findings show that source-space resting-state EEG FC can predict cognitive performance in PD. The comparability of the two head models suggests that the more user-friendly and less resource intense standard head model template is satisfactory. This supports feasible, scalable, and clinically accessible EEG-based biomarkers of cognition in PD.

BackgroundMultiple sclerosis (MS) is characterized by focal white matter (WM) lesions, but subtle damage also occurs in normal-appearing white matter (NAWM). We developed a method to generate quantitative T1 maps from MPRAGE (Magnetization Prepared Rapid Gradient Echo) images and evaluated its ability to detect NAWM abnormalities across different MS phenotypes. MethodsT1 maps were derived from MPRAGE using a theoretical signal model and compared with MP2RAGE (Magnetization Prepared 2 Rapid Gradient Echoes) T1 values in four healthy volunteers. The method was then applied to 87 MS patients, divided into clinically isolated syndrome (CIS), relapsing-remitting MS (RRMS), and primary progressive MS (PPMS), with age- and sex-matched healthy controls. T1 was measured in NAWM and lesions. Histogram analysis provided mean T1, full width at half maximum (FWHM), and skewness. ResultsIn healthy volunteers, T1 values matched MP2RAGE. In controls matched to the MS cohort, T1 increased with age (r = 0.35, p < 0.05). CIS patients showed no significant differences in any metric. RRMS and PPMS patients showed unchanged mean NAWM T1 but significantly different distributions, with higher FWHM (p<0.05) and skewness (p<0.001). An increase in T1 values was observed in MS lesions compared to NAWM in all groups. ConclusionThis study confirms the feasibility of deriving quantitative T1 maps from standard MPRAGE, offering reliable information to facilitate MS monitoring without additional acquisitions.

Two decades of research have provided evidence for gray matter volume (GMV) differences in developmental dyslexia (or reading disability, RD) in the left perisylvian cortex. However, there are concerns about result inconsistencies, likely attributable to small sample sizes, lenient statistical thresholds, and insufficient accounting for demographic variables and global GMV (Ramus et al., 2018). To address these concerns, we conducted a Discovery and Replication Study (N=262) using data from the Adolescent Brain Cognitive Development Study. We found GMV differences between the RD and Control Groups did not replicate across the Discovery and Replication Studies using voxel-based morphometry (VBM) in Statistical Parametric Mapping (SPM), and that a more conservative threshold yielded far fewer results. We then conducted Reproducibility Studies and first found that when using surface-based morphometry in FreeSurfer instead of VBM, the Discovery and the Replication Study results again failed to converge. Second, we combined all groups in a factorial VBM/SPM analysis and the interaction analysis provided quantitative confirmation for diverging between-group difference results across the two studies. Third, we tested for the role of covariates of no interest and found that when total GMV is not controlled for, this divergence dissipates and group differences in RD (main effect of Reading Ability) are amplified. In conclusion, replication of GMV differences in RD is low, even when using large, well-matched groups, and analyses approaches play a modulating role. As such, results from prior studies using lenient statistical thresholds and not accounting for total GMV should therefore be viewed with caution.

Understanding the pathogenesis of amyloid-{beta} pathology in Alzheimers Disease (AD) proves to be a challenge. In this work, we expand upon the application of network diffusion models (NDM) to study pathophysiological spread of amyloid-{beta} throughout white matter structural brain networks. We found that the NDM successfully recaptures subpopulation-level spatial patterns (Pearsons R=0.45-0.48, PFDR < 0.01) of amyloid-{beta} deposition in the Alzheimers Disease Neuroimaging Cohort at a regional level, but with drawbacks in mechanism interpretability. We then moved to an extended NDM framework (eNDM), including a protein synthesis term to better reflect the role of amyloid-{beta} metabolism, as well as including regional vulnerability using spatial transcriptomics from the Allen Human Brain Atlas to modulate the region-level rate parameters of the synthesis term. The novel gene eNDMs exhibited significant performance increases in Pearsons correlation (Steigers Z, PFDR < 0.10) over baseline NDM performance in mild cognitive impairment and AD groups using APOE, SORL1, and FGL2 for gene modulation. The results were robust and replicable when testing on an external cohort of the Alzheimers Disease Sequencing Project. The study thus demonstrates the importance of regional genetic vulnerability, in conjunction with network diffusion mechanisms, in improving the modelling and prediction of amyloid-{beta} pathophysiological spread.

Tourette syndrome (TS) is a neurodevelopmental disorder of childhood onset characterised by vocal and motor tics and is associated with cortical-striatal-thalamic-cortical circuit [CSTC] dysfunction. TS often follows a developmental time course in which tics become increasingly more controlled during adolescence. However, many individuals continue to have debilitating tics into adulthood. This indicates that there may be important differences between adults with TS for whom the clinical phenotype is more stable, and children and adolescents with the disorder who may be undergoing developmental neuroplastic changes linked to the reduction of their tics. Previous studies have used transcranial magnetic stimulation (TMS) to investigate changes in cortical motor excitability in individuals with TS, including measurement of resting motor threshold (RMT). However, the findings from these studies have been mixed, have varied between adult and child samples, and have often been based on small sample sizes. Here we report a multi-centre, mega-analytic, study in which RMT data collected from children and adults with TS at multiple research centres was pooled for analysis. Results confirmed that mean RMT was significantly increased in individuals with TS compared to neurotypical controls. However, this result can be explained by the more important findings that: (a) RMT for adults with TS did not differ from that of neurotypical adults; and (b) the rate that RMT decreases with age during childhood and adolescence is reduced in individuals with TS compared to controls. Thus, while neurotypical individuals reach an adult RMT level by ~12-13 years of age, individuals with TS are substantially delayed in doing so, and do not reach an adult RMT level until much later, at ~24 years of age. We conclude therefore that differences in measures of cortical excitability between children and adolescents with TS and chronologically age-matched neurotypical controls may likely reflect a developmental delay in the maturation of functional brain networks in individuals with TS, which may normalise with age.

PurposeTo examine speech iconicity for shape in aphasia, we compared iconicity ratings from people with aphasia to those from neurologically intact individuals and evaluated how iconicity relates to phonological and semantic processing profiles in aphasia. MethodEleven people with aphasia and 11 age- and gender-matched neurologically intact participants rated how rounded or pointed 50 auditory pseudowords sounded using a 5-point scale. Ratings from participants with aphasia were compared to predicted iconicity ratings derived from reference ratings from prior work and to ratings from neurologically intact participants. For each participant with aphasia, correlations between individual ratings and predicted ratings were related to measures of phonological and semantic processing. ResultsRatings from people with aphasia were significantly correlated with both the predicted ratings and the ratings from neurologically intact participants. The strength of the correlation between individual ratings and predicted ratings did not differ significantly between groups, although there was a trend toward weaker correlations in the aphasia group. There were indications that greater language impairment was associated with greater disruption of iconicity ratings; in particular, deficits in phonological segmentation and semantic processing were associated with reduced sensitivity to shape iconicity. ConclusionThese findings suggest that sensitivity to shape iconicity is preserved in individuals with aphasia to varying degrees. The specific nature of language impairment appears to play an important role in determining iconicity processing in aphasia.

Objective Astrocyte activation is increasingly recognized as an important component of multiple sclerosis (MS) pathology. Natalizumab (NTZ), a highly effective therapy for relapsing-remitting MS (RRMS), primarily blocks leukocyte trafficking into the central nervous system. However, its effects on astrocytic metabolism remain unclear. We investigated astrocyte-associated metabolic changes after NTZ treatment using quantitative 1-11C-acetate positron emission tomography (PET). Methods Seven patients with RRMS underwent quantitative 1-11C-acetate PET before and after NTZ treatment. PET-derived k2, an index of oxidative acetate metabolism, was analyzed voxel-wise and within GM and white-matter volumes of interest. Clinical status and brain magnetic resonance imaging (MRI) findings were assessed, and cognitive performance was evaluated using Rao's Brief Repeatable Battery of Neuropsychological Tests. Results After NTZ treatment, k2 decreased in all patients compared with pretreatment levels. Both gray and white matter showed significant reductions, and voxel-based analysis demonstrated widespread decreases across cortical and subcortical regions of the cerebrum and cerebellum, with no regions showing significant posttreatment increases. MRI showed no worsening; Expanded Disability Status Scale scores were stable or improved, and cognitive performance was generally stable, with improvements in selected subtests. Interpretation Quantitative 1-11C-acetate PET demonstrated a whole-brain reduction in astrocyte-associated metabolism after NTZ treatment in RRMS, most prominently in gray matter. NTZ may modulate astrocyte activity, in addition to its established effects on peripheral immune cell trafficking.

Prior studies in bilinguals have reported relationships between brain structure and the dimensions of (i) language proficiency or (ii) language balance (the discrepancy between a bilinguals two proficiencies), but rarely both, even though they are highly related. These studies were often conducted in late bilinguals and the analyses limited to regions of interest. Here, we tested for relationships between brain structure and these two dimensions in 46 early cultural Spanish-English bilinguals (mean age = 16.7 years) at the level of the whole brain for gray matter volume (GMV) and cortical thickness (CT). Results revealed a positive association between GMV and proficiency in the weaker language in the right angular gyrus (AG; BA 39) extending into the superior temporal gyrus (BA 22). More balanced bilingualism was also associated with more GMV in the AG (BA 39), in addition to less GMV in left postcentral gyrus (BA 1), right cerebellum lobule IX and right superior occipital gyrus (BA 18). However, these relationships between GMV and balance disappeared after controlling for language proficiency. No significant associations were observed for CT and these two dimensions of language. Our findings suggest that relationships between GMV and balance are driven by language proficiency, and that the relationship between GMV and language proficiency likely does not involve language-specific mechanisms, given the location of the association is in the right inferior parietal cortex. Together, this study separates the neuroanatomical bases of these two language dimensions and places them in brain regions outside those usually targeted in prior studies. HighlightsO_LINeuroanatomy was correlated with proficiencies in early Spanish-English bilinguals C_LIO_LIRight angular gyrus gray matter volume (GMV) was positively related to proficiency C_LIO_LIGMV was positively related to balance, but not after controlling for proficiency C_LIO_LIRelations with these language dimensions are located outside of language cortex C_LIO_LINo significant associations were observed for cortical thickness C_LI

Verbal fluency is a behavioral task that requires the generation of words from a semantic category (category fluency) or words beginning with a specific letter (letter fluency). Although word production engages a frontal-temporal-parietal network, no studies have tested how lesions to temporal and parietal lobe areas that represent semantic and phonological knowledge dampen neural responses in the left pars triangularis and the left pars opercularis, two adjacent regions in the left inferior frontal gyrus implicated in word search and retrieval. Here, 52 patients with temporal lobe lesions underwent clinical functional MRI while performing the category and letter fluency tasks. We investigated where lesion presence was inversely related to the magnitude of task-specific neural responses in pars triangularis and pars opercularis using a technique referred to as voxel-based lesion activity mapping (VLAM). We found that lesions to the left anterior superior temporal gyrus, left temporal pole, left hippocampus, left insula, and underlying inferior fronto-occipital fasciculus were associated with reduced neural responses in the left pars triangularis during the category fluency task. Lesion damage to the right hippocampus was associated with reduced neural responses in the left pars opercularis during category fluency. By contrast, lesions to the left posterior superior temporal gyrus, left supramarginal gyrus, left parietal operculum, and the inferior fronto-occipital fasciculus and left arcuate fasciculus were associated with reduced neural responses in the left pars triangularis and the left pars opercularis during the letter fluency task. These results suggest that anatomically dissociable brain networks interact with the left inferior frontal gyrus when different search strategies constrain the retrieval of word representations.

Importance: Leukodystrophies are a heterogeneous group of genetic disorders affecting the white matter of the brain, often presenting with overlapping clinical features but differing in neuroanatomical involvement. There is a critical need for quantitative tools to characterize disease burden and support diagnosis, severity stratification, and clinical trial readiness. Objective: To characterize shared and distinct neuroanatomical patterns across six genetically confirmed leukodystrophies using anatomical MRI-derived phenotypes benchmarked against brain growth charts, and to assess the utility of this methodological approach for identifying imaging biomarkers of disease severity. Design, Setting, and Participants: Cross-sectional neuroimaging study using retrospective clinical MRI data. Setting: Multicenter study incorporating data from the Global Leukodystrophy Initiative Clinical Trials Network (GLIA-CTN) and control data from the Childrens Hospital of Philadelphia. Participants: The study included 434 MRI scan sessions from 274 patients with genetically confirmed leukodystrophies (Pelizaeus-Merzbacher disease, Metachromatic leukodystrophy, Alexander disease, Aicardi-Goutieres syndrome, TUBB4A-related leukodystrophies, and POLR3-related leukodystrophy). Control MRI data (7628 scans from 7205 subjects) were drawn from the Scans with Limited Imaging Pathology cohort at the Children's Hospital of Philadelphia. Exposures: All MRI scans underwent automated segmentation using deep learning segmentation tools to derive global and regional brain volumes. Normative models of brain development ("brain growth charts") were generated for the control cohort using generalized additive models for location, scale, and shape. Centile scores were then calculated for leukodystrophy subjects to quantify deviations from typical development. Main Outcomes and Measures: Centile scores for global and regional brain volumes were compared across leukodystrophy subtypes to identify disease-specific neuroanatomical patterns and to evaluate their potential utility for severity stratification. Results: Distinct patterns of neuroanatomical deviation were observed across leukodystrophy subtypes. Certain leukodystrophies showed preferential involvement of specific cortical or subcortical regions, while others displayed more diffuse volume loss. Centile scores demonstrated potential for differentiating disease subtypes and stratifying individuals by severity. Preliminary longitudinal data suggest centile scores may also track progression over time. Conclusions and Relevance:This study demonstrates the feasibility and utility of MRI profiling of individuals with leukodystrophy using anatomical MRI-derived phenotypes benchmarked against brain growth charts. The approach enables data-driven, quantitative characterization of structural brain abnormalities, offering a scalable method for phenotyping, diagnosis, and future use in clinical trials.

BackgroundThe relevance of spontaneous activity has been unlocked thanks to recent large scale recordings that revealed, via Shared Variance Component Analysis (SVCA), the high-dimensional nature of the ongoing activity. A fundamental problem is how the dimension modifies when more neurons are included in the analysis. Contradictory results have been reported on this subject based on SVCA and Principal Component Analysis (PCA). New MethodWe investigate pro et contra of SVCA and PCA for the identification of reliable responses encoding underlying state variables. We focus on common features of the spectra of the reliable variances (RVs) and on their dimensionality. The analysis is demonstrated on previously published Ca2+ data from the visual and the dorsal cortex in head fixed mice during spontaneous behavior. ResultsRVs grow proportionally to the number N of neurons and show a power-law decay k- with the k-th SVC dimension over a range bounded by a maximal dimension kc, initially diverging as N 1/ and then saturating at sufficiently large N. The reliable dimensionality, estimated with different methodologies, also shows a clear saturation to an asymptotic value for large N. Furthermore, its value decreases when becomes larger, as demonstrated by employing experimental data as well as theoretical predictions. ConclusionWe have shown that SVCA is an extremely effective tool to extract reliable features from the neural signals, and that the exponent represents a biomarker able to reveal the level of correlation of the neurons as well as the dimensionality of the reliable space. HighlightsO_LIAdvantages and drawbacks of Shared Variance Component Analysis to extract reliable signals from neural data C_LIO_LIComparison of different methods to estimate reliable neural dimensionality associated to spontaneous activity C_LIO_LIAnalytical expressions of embedding dimensionality for power-law decaying reliable variances C_LIO_LIBounded growth of the dimensionality with the number of neurons C_LI

Reading is a critical skill in modern society. Most research on reading is conducted in school age children or young adults. However, acquired brain disorders often affect reading ability, and these disorders tend to occur in older adults. It is therefore critical to examine the normative distribution of reading behavior and the brain basis of reading in older adults. Here, we provide trial-wise single word and pseudoword oral reading and lexical decision data, as well as structural, functional, and diffusion-weighted MRI data from 116 neurotypical adults aged 22 to 84 years (mean = 59). Accuracy, response times, and errors are provided for corpora that are parametrically modulated in frequency, imageability, and regularity for real words and consistency of spelling-sound mapping for pseudowords. This dataset includes both minimally processed behavior (trial-wise data) and MRI data, and participant- and item-wise summary metrics and processed MRI data. These data serve both as a normative sample for reading behavior in older adults, but also as a valuable resource for identifying novel brain-behavioral relationships.

BackgroundThis study examines a competition-based model (C-model) designed to capture the temporal dynamics of successive brain microstates derived from electroencephalography (EEG) recordings during eyes-open conditions. The analyzed data were obtained from a public repository comprising microstate sequences from 60 sessions of a single subject [1]. When applied to microstate dynamics, the C-model posits a stochastic competition among neural circuits underlying the expression of individual microstates. MethodsThe model is formulated at a conceptual level (computational level in Marrs framework) and employs a geometric distribution to account for the long right tail of microstate duration distributions, interpreted as the probability of "failure" of the currently active microstate to persist. To account for the short-lived left tail, the model incorporates a transient increase in the stability of the currently active network, or equivalently, a temporary decrease in the activation probability of competing microstates (refractory period). ResultsThe model provides a good fit to the microstate duration distributions across all 60 sessions. One third of sessions showed microstate identity sequential dependency with respect to the previous microstates. DiscussionThese results suggest that the C-model captures key aspects of microstate temporal structure. Moreover, because microstate probabilities can be modulated by psychophysiological conditions--including the influence of previously active networks--the model may serve as a building block for more comprehensive neurobiological frameworks of neural and behavioral dynamics. In such frameworks, microstate sequences could emerge from structured competition and flow among neural networks supporting microstate expression.

Impaired reading, i.e., alexia, is common after left hemisphere stroke. The most common deficit in alexia is a difficulty reading aloud pronounceable novel words, also called pseudowords. While semantic and phonological processes both subserve reading real words, pseudoword reading deficits in alexia are typically ascribed to phonological deficits alone. Some theories, however, suggest that pseudoword reading relies in part on lexical-semantic knowledge, such that semantic deficits could also contribute to poor pseudoword reading in alexia. Leveraging a large sample of left-hemisphere stroke survivors, we examine the cognitive and neural substrates of pseudoword reading accuracy and two error types: lexicalization errors, where a pseudoword is incorrectly read as a real word, and nonword errors, where a pseudoword is read as an incorrect nonword. 76 left-hemisphere stroke survivors read 60 pseudowords aloud, and performed two pseudoword repetition tasks to assess phonological processing and two picture naming tasks to assess mappings between lexical semantics and phonology. Regression models assessed how pseudoword repetition and naming related to overall accuracy and rates of lexicalization and nonword errors in pseudoword reading. Voxel-based and connectome lesion-symptom mapping localized the neural territory responsible for these errors. Both pseudoword repetition and naming independently related to pseudoword reading accuracy. Pseudoword repetition but not naming deficits predicted higher rates of lexicalization errors, while naming but not pseudoword repetition deficits predicted higher rates of nonword errors. Greater nonword error rate also predicted smaller imageability effects in real word reading (t(71)=-3.2, p=0.002). Lexicalization errors were associated with lesions to and disconnections of the left putamen and basal ganglia. Nonword errors were associated with lesions to the superior and middle temporal gyri, as well as broad temporo-parietal disconnections, overlapping with previous lesion-mapping results implicating these regions in semantic contributions to word reading. These results suggest that lexicalization errors result from impaired planning and execution of novel motor plans, causing a reliance on the well-learned motor plans associated with lexical items. In contrast, greater rates of nonword errors, relative to lexicalization errors, occur when semantic contributions to reading are impaired. Overall, these findings demonstrate that semantic processes are involved in reading pseudowords, at least in stroke alexia. These findings support connectionist accounts of reading in which damage in the direct orthography to phonology route for reading leads to reliance on semantic representations, even for pseudowords, suggesting a reinterpretation of pseudoword reading as a pure measure of phonological reading deficits.

ImportanceIn multiple sclerosis (MS), high-efficacy disease-modifying therapies (HEDMTs) effectively control relapse-associated worsening (RAW), but progression independent of relapse activity (PIRA) remains inadequately addressed. As HEDMTs become the standard of care, developing new therapies that target this residual progression is a critical unmet need. ObjectiveThis study quantifies disability progression in MS patients treated with ocrelizumab to evaluate how confirmed EDSS disability progression (EDSS-CDP) would perform as an endpoint in future trials using HEDMT as comparators. DesignRetrospective longitudinal cohort study. SettingPooled dataset from four multicenter phase III and IV clinical trials. Participants1,859 people with (pw) relapsing MS (RMS), primary progressive MS (PPMS), and secondary progressive MS (SPMS) who were treated with ocrelizumab within the OPERA I/II, ORATORIO, and CONSONANCE trials. InterventionOcrelizumab. Main Outcomes and MeasuresWe developed a hierarchical Bayesian model to analyze longitudinal EDSS trajectories using two components: an offset effect, used to capture changes occurring rapidly after treatment onset, followed by a steady, long term linear progression over time. We used this model to simulate future clinical trial scenarios, assuming different drug effects on the offset and the long term linear progression. ResultsOur model accurately describes longitudinal EDSS changes and the risk of EDSS-CDP in ocrelizumab-treated subjects. Disability improvement (offset effect) was most prominent in pwRMS, while pwPPMS exhibited the highest long-term progression rates. Baseline T1 gadolinium-enhancing lesions were associated with a greater initial benefit. Simulations of typical phase III trials suggest that the hazard ratio on the EDSS-CDP endpoint is mostly influenced by the magnitude of the offset effect rather than the impact on long-term linear progression. Conclusions and RelevanceWe attribute the disability improvement observed shortly after treatment onset to resolving focal inflammation, and the long-term steady progression rate to disease mechanisms not fully addressed by ocrelizumab. Our simulation results show that within the current trial paradigm, which uses EDSS-CDP as a measure of disability progression, the ability of a treatment to induce an initial improvement is the primary determinant of success. These results emphasize the urgent need for both innovative clinical trial designs and more sensitive endpoints to adequately assess the next generation of MS therapies targeting gradual disability progression. Key PointsO_ST_ABSQuestionC_ST_ABSWill the standard multiple sclerosis disability progression endpoint, confirmed EDSS disability progression (EDSS-CDP), prove to be an accurate measure of the efficacy of new therapies addressing long-term progression when compared against high-efficacy treatments (HET)? FindingsIn this modeling study of 10-year ocrelizumab data, observed changes in EDSS were characterized by an early improvement followed by a linear long-term worsening. EDSS-CDP was shown to be highly sensitive to initial improvement. Since this phenomenon strongly influences the overall treatment effect, trials that use ocrelizumab, or similar HET as a comparator may fail to identify novel treatments designed to further slow long-term progression. MeaningCurrent trial designs may be inadequate for evaluating next-generation MS therapies, necessitating the development of better metrics to capture treatment effects on gradual progression.

BackgroundEmotional and cognitive difficulties often co-occur in neurodevelopmental conditions. While transdiagnostic, dimensional approaches offer a more precise framework for understanding mental health than diagnostic categories, their neural correlates in youth with learning difficulties remain poorly understood. This study investigates associations between transdiagnostic mental health dimensions and resting-state functional connectivity in struggling learners. MethodsCross-sectional behavioural data from the Centre for Attention, Learning and Memory (CALM) for struggling learners (N = 378) was used to replicate a hierarchical model of mental health from the Conners Parent Rating Short Form, the Revised Childrens Anxiety and Depression Scale and the Strengths and Difficulties Questionnaire. Functional connectomes were derived from resting-state fMRI data (N = 67), and partial least squares regression related mental health dimensions to connectivity within and between large-scale brain networks. ResultsThe replicated model comprised a general p-factor, two broad domains (internalising and externalising), and three specific dimensions (specific internalising, neurodevelopmental and social maladjustment). Symptom severity was associated with two connectivity patterns: greater default mode network coupling to frontoparietal and attention networks, and reduced connectivity between visual and somatomotor systems. These effects were strongest for the neurodevelopmental and social maladjustment dimensions, respectively. ConclusionsThese findings align with population-level evidence linking mental health dimensions to brain network organization, extending it to struggling learners and offering new insight into the neural basis of mental health vulnerability in neurodevelopmentally at-risk youth.

Background: Anomia is common in frontotemporal dementia (FTD), although its clinical prominence varies by subtype, with the most marked impairment typically observed in primary progressive aphasia (PPA). It remains unclear whether naming impairment reflects language-specific impairment or broader cognitive severity, and how it relates to other cognitive domains across FTD syndromes. Methods: Fifteen healthy controls and twenty-two individuals across the FTD spectrum, including variant-specified and unclassifiable (NOS) presentations, completed two confrontation naming tasks (Boston Naming Test and Multilingual Naming Test) and a global cognitive screening measure (Montreal Cognitive Assessment, MoCA). Patient participants additionally completed a standardized language battery (Western Aphasia Battery Revised) and a comprehensive neuropsychological assessment (Uniform Data Set). Naming performance was compared between groups and associations with language severity, global cognition, and domain-specific cognitive functions were examined using regression analyses. Results: Naming was impaired in patients relative to healthy controls but did not differ between patient groups. Naming was strongly associated with language severity, but not global cognition. A significant group-by-MoCA interaction indicated that MoCA was positively associated with naming only in the unclassifiable group. In addition, naming was associated with episodic memory across both verbal and non-verbal domains. Conclusions: Naming in FTD primarily reflects language severity rather than global cognitive impairment. A robust association between naming and episodic memory suggests potential contributions from semantic cognition, shared frontally mediated retrieval processes, or parallel cognitive decline. These findings support the use of naming as a marker of language dysfunction while highlighting its relevance to broader cognitive systems in FTD.

It has been proposed that bilinguals have better executive function (EF) arising from the constant selection of one language while inhibiting the other, and gray matter has been found to differ in bilinguals in regions linked to EF (frontal-parietal and subcortical structures). Attention Deficit Hyperactivity Disorder (ADHD) is associated with poorer EF and neuroanatomical differences underlying EF. Given the EF advantage in bilinguals, we investigated whether a bilingual experience affects EF performance and brain structure differentially in those with ADHD. Using the Adolescent Brain and Cognitive Development Study, we compared early Spanish-English bilinguals and English-speaking monolinguals with and without ADHD. ANOVAs for the Flanker, Working Memory, and Card Sort Tasks revealed no main effects of Language Experience (Bilingual versus Monolingual), a main effect of Diagnostic Group for Card Sort (ADHD worse than Controls), and no interaction effects on performance for any task. ANOVAs for gray matter volume (GMV) revealed a main effect of Language Experience in many regions, a main effect of Diagnostic Group in some regions, but no interactions. GMV in left thalamus was affected by both ADHD and bilingualism, but the effect of ADHD was not significantly diminished or enhanced by the dual-language experience. For cortical thickness, there was a main effect of Language Experience in several regions, no main effect of Diagnostic Group, and no interactions. Taken together, bilingualism has some impact on EF performance, a strong impact on neuroanatomy, but there was no disproportionate impact by bilingualism on the differences caused by ADHD for any measure. Research HighlightsExecutive function and brain structure differ in ADHD and in bilinguals, prompting the need to investigate interactive effects. Bilingualism did not disproportionately affect performance differences in ADHD for executive function, nor for gray matter volume or for cortical thickness differences in ADHD. Gray matter volume was less in ADHD than non-ADHD, as well as greater in bilinguals than monolinguals in the left thalamus, but without interaction effect. These independent effects indicate that the brain basis of ADHD is not impacted by a dual-language experience.