Brain and Behavior

AO_SCPLOWBSTRACTC_SCPLOWThe practice of combat sports increases the risk of suffering white matter injuries. That is why, it is required the early damage detection to determine to what extent the athlete may be active preserving their performance and health status. The integrity of the white matter can be quantitatively characterized in diffusion tensor images, using fractional anisotropy. This study aims at characterizing the fractional anisotropy of white matter injuries in combat athletes that are exposed to repetitive trauma and also, to detect changes in fractional anisotropy between cerebral hemispheres with and without lesions. It is proposed a global and structural analysis of the hemispheres, as well as the selection of ROI in the lesions. 14 athletes, from Boxing, Karate and Taekwondo sports, participated. The sample was divided into two groups of seven subjects each: Injured (23.428{+/-}4.157 years old) and Healthy (24.285{+/-}5.023 years old) paired by sport denomination. Diffusion tensor images were used to obtain FA values in the analysis of the hemispheres and lesions. Global and structural analysis of the hemispheres did not detect the presence of white matter lesions; however, the use of ROI selection permitted maximum approximation of the injuries location. It also improved the breakdown of FA values as it allows a local analysis of the lesion. As an additional result, there were found ROIs values, FAmed = 0.454{+/-}0.062, which exceed the average fractional anisotropy of the white matter. The cohesion of acute and chronic phase lesions were found in the same subject. The apparently contradictory results in FA values are related to the stage of the lesions.

BackgroundThe study aims were to correlate acute head injury cognitive changes with ASL-MRI reduced glymphatic clearance rate (GCRs) and determine GC improvement with recovery. Concussive-brain injury disrupts the blood brain barrier (BBB) and reduces cMTT (capillary mean transit time) and GCRs. Concussion is clinically diagnosed utilizing history and exam findings. ASL-MRI assesses brain perfusion ingress and outflow. Methods3D TGSE (turbo-gradient and spin echo) PASL (pulsed arterial spin labeling) 3T MRI with 7 long TIs (time to inversion) assessed the GCRs (slope of the linear decay of signal vs. time) of labeled protons 2800-4000 ms post-labeling in bifrontal, bitemporal, and biparietal regions within 7 days of mild acute traumatic brain injury and after clinically cleared to return to usual activities. The Sport Concussion Assessment Tool Version 5 (SKAT5) and Brief Oculomotor/Vestibular Assessment (administered by sports physicians) evaluated injured student athletes cognitive function prior to ASL MRIs. ResultsPilot study demonstrated significant GCRs improvement (95% [CI] -0.06 to -0.03 acute phase; to [CI] - recovery [CI] 0.0772 to -0.0497 ; P <0.001 in Frontal lobes; and Parietal lobes (95% [CI] -0.0584 to -0.0251 acute; [CI] -0.0727 to - 0.0392 recovery; P = 0.024) in 9 head injured athletes (8 female 1 male mean age 20). 6 age/activity matched normal controls (4 female 2 male mean age 22) were also compared. ConclusionAcute head trauma disrupts the BBB reducing GCR measured using this 3D ASL MRI technique. ASL MRI is a potential noninvasive biomarker of acute brain injury and subsequent recovery. Key MessageObjective measure of post mild TBI recovery has remained elusive as conventional anatomic imaging techniques and biomarkers are not sensitive. This pilot study demonstrates the potential of leveraging alterations in brain perfusion in the late phase capturing both delayed capillary perfusion and retained free fluid clearance from the brain, both the result of blood brain barrier leak from the acute trauma. Our noninvasive ASL MRI technique identified both anatomic site-specific delay in clearance acutely as well as restoration of normal flow post recovery. This time and cost-efficient noninvasive technique may, with additional validation, provide a needed objective measure for identifying physiologic changes post-acute injury and upon clinical recovery.

ObjectiveAlongside objective performance declines, self-reported cognitive symptoms after traumatic brain injury (TBI) abound. Mental fog is one symptom that has been underexplored. The current project investigated mental fog across two studies of individuals with mild traumatic brain injury and moderate-to-severe traumatic brain injury to close our knowledge gap about differences in severity. We then explored the cognitive and affective correlates of mental fog within these groups. MethodsUsing between-groups designs, the first study recruited individuals with acute mild TBI (n = 15) along with a healthy control group (n = 16). Simultaneously, a second study recruited persons with post-acute moderate-to-severe TBI, a stage when self-reports are most reliable (n = 15). Measures across the studies were harmonized and involved measuring mental fog (Mental Clutter Scale), objective cognition (Cogstate(R) and UFOV(R)), and depressive symptoms. In addition to descriptive group difference analyses, nonparametric correlations determined associations between mental fog, objective cognition, and depressive symptoms. ResultsResults revealed higher self-reported mental fog in acute mild TBI compared to healthy controls. And though exploratory, post-acute moderate-to-severe TBI also appears characterized by greater mental fog. Correlations showed that mental fog in mild TBI corresponded to greater depressive symptoms (r = .66) but was unrelated to objective cognition. By contrast, mental fog in moderate-to-severe TBI corresponded to poorer working memory (r = .68) and slowed processing speed (r = -.55) but was unrelated to depressive symptoms. ConclusionAs a common symptom in TBI, mental fog distinguishes individuals with acute mild TBI from uninjured peers. Mental fog also appears to reflect challenges in recovery, including depressive symptoms and objective cognitive problems. Screening for mental fog, in addition to other cognitive symptoms, might be worthwhile in these populations.

BackgroundMajor Depressive Disorder (MDD) has a heritable component, with estimates of heritability ranging from 30% to 40%. Depression is a significant comorbidity in people living with HIV (PLWHIV), increasing the risk of suicide-related behaviors. This study investigated the genetic risk loci associated with MDD among adults living with HIV in Uganda, where limited data exist on this relationship. MethodsThe case-control study analyzed 282 samples (139 MDD cases and 143 controls), assessed for MDD at baseline, six months, and one year using the Mini International Neuropsychiatric Interview. Blood samples were collected at these intervals, with DNA genotyping conducted in South Africa using the H3Africa array. Data were analyzed using PLINK2 and GEMMA for quality control and genome-wide association analysis respectively, followed by functional mapping with FUMA. ResultsWhile no significant single nucleotide polymorphisms (SNPs) were identified at the genome-wide threshold, six SNPs were found to be suggestively associated with MDD. These SNPs, which have been associated with other psychiatric conditions like Alzheimers, alcohol use disorder, and bipolar disorder and have not previously been linked to MDD. ConclusionThe study suggests the potential for novel MDD genetic risk loci discovery in PLWHIV and people of African ancestry, especially with larger sample sizes.

Depression is a major albeit neglected complication in patients with traumatic brain injury (TBI). Elucidating its neural correlates remains an important milestone with respect to understanding the disorder and helping with the rehabilitation process. Towards this direction, neuropsychological theories have proposed abnormal brain dynamics as the neural basis of depressive symptomatology. This observational study addressed the question of whether depression in TBI patients is related to abnormal brain dynamics using a sample of 81 TBI patients with depressive symptomatology. To explore brain dynamics we employed the Hidden Markov model that utilises resting-state fMRI data to identify the states that the brain visits sequentially during scanning. Spatial (highest activated regions) and temporal (occupancy, switching rate) characteristics of these states were used to analyse the networks involved and probe differences between depressed and non-depressed TBI patients. We found a significant positive association between depression score and the fractional occupancy and switching rate of two specific states that distinguished between depressed and non-depressed TBI patients. These states spanned default mode, subcortical and cerebellar regions while also forming a temporally coherent "metastate" that the depressed brain would recurrently visit. Depression in TBI patients is characterised by abnormal recruitment and repetitive sequencing between certain neural networks. These results point to the existence of a reinforced, self-referential circuitry that could provide the basis for targeted therapies during the recovery process.

BackgroundFetal Alcohol Spectrum Disorders (FASD) encompass a group of highly prevalent conditions resulting from prenatal alcohol exposure. Alcohol exposure during the third trimester of pregnancy overlapping with the brain growth spurt is detrimental to white matter growth and myelination, particularly in the corpus callosum, ultimately affecting tissue integrity in adolescence. Traditional neuroimaging techniques have been essential for assessing neurodevelopment in affected youth; however, these methods are limited in their capacity to track subtle microstructural alterations to white matter, thus restricting their effectiveness in monitoring therapeutic intervention. In this preliminary study we use a highly sensitive and clinically translatable Magnetic Resonance Elastography (MRE) protocol for assessing brain tissue microstructure through its mechanical properties following an exercise intervention in a rat model of FASD. MethodsRat pups were divided into two groups: alcohol-exposed (AE) pups which received alcohol in milk substitute (5.25 g/kg/day) via intragastric intubation on postnatal days (PD) four through nine during the rat brain growth spurt (Dobbing and Sands, 1979), or sham-intubated (SI) controls. In adolescence, on PD 30, half AE and SI rats were randomly assigned to either a modified home cage with free access to a running wheel or to a new home cage for 12 days (Gursky and Klintsova, 2017). Previous studies conducted in the lab have shown that 12 days of voluntary exercise intervention in adolescence immediately ameliorated callosal myelination in AE rats (Milbocker et al., 2022, 2023). MRE was used to measure longitudinal changes to mechanical properties of the whole brain and the corpus callosum at intervention termination and one-month post-intervention. Histological quantification of precursor and myelinating oligoglia in corpus callosum was performed one-month post-intervention. ResultsPrior to intervention, AE rats had lower forebrain stiffness in adolescence compared to SI controls (p = 0.02). Exercise intervention immediately mitigated this effect in AE rats, resulting in higher forebrain stiffness post-intervention in adolescence. Similarly, we discovered that forebrain damping ratio was lowest in AE rats in adolescence (p < 0.01), irrespective of intervention exposure. One-month post-intervention in adulthood, AE and SI rats exhibited comparable forebrain stiffness and damping ratio (p > 0.05). Taken together, these MRE data suggest that adolescent exercise intervention supports neurodevelopmental "catch-up" in AE rats. Analysis of the stiffness and damping ratio of the body of corpus callosum revealed that these measures increased with age. Finally, histological quantification of myelinating oligodendrocytes one-month post-intervention revealed a negative rebound effect of exercise cessation on the total estimate of these cells in the body of corpus callosum, irrespective of treatment group which was not convergent with noninvasive MRE measures. ConclusionsThis is the first application of MRE to measure changes in brain mechanical properties in a rodent model of FASD. MRE successfully captured alcohol-related changes to forebrain stiffness and damping ratio in adolescence. These preliminary findings expand upon results from previous studies which used traditional diffusion neuroimaging to identify structural changes to the adolescent brain in rodent models of FASD (Milbocker et al., 2022; Newville et al., 2017). Additionally, in vivo MRE identified an exercise-related alteration to forebrain stiffness that occurred in adolescence, immediately post-intervention.

PurposeDepressive symptoms are a common and debilitating experience among people with breast cancer (BC), often impacting quality of life and recovery. However, the neural mechanisms underlying these symptoms are unclear. This systematic review synthesised resting-state functional magnetic resonance imaging (rsfMRI) literature in BC populations to identify functional connectivity (FC) correlates of depressive symptoms. MethodsA systematic search of EMBASE, PsycINFO, Medline, and CINAHL identified 27 eligible studies (15 cross-sectional, 12 longitudinal) examining the relationship between depressive symptoms and functional connectivity using rsfMRI in BC participants. Data were extracted on study design, participant characteristics, depressive symptoms, imaging acquisition, FC outcomes, and reported associations. Study quality was assessed using the Newcastle-Ottawa Scale. Findings were synthesised qualitatively. ResultsAcross cross-sectional studies, BC participants showed elevated depressive symptoms and widespread FC alterations, predominantly patterns of dysconnectivity, compared to healthy controls. However, most studies did not find significant associations between depressive symptoms and FC. Longitudinal studies revealed dynamic trajectories in depressive symptoms and FC patterns with cancer treatment or training intervention. ConclusionWhile depressive symptoms are frequently reported by BC participants, the underlying neural mechanisms remain unclear, possibly due to methodological and participant heterogeneity across studies. Implications for cancer survivorsFindings highlight the importance of timely and ongoing monitoring of depressive symptoms across the cancer care continuum. Future research should conduct more sensitive assessments of depressive symptomatology (e.g., ecological momentary assessment), adopt standardised rsfMRI protocols, and apply integrative network analysis. These future studies will inform rsfMRI metrics to be used as biomarkers to guide treatment at the individual cancer patient level.

BackgroundEvidence from animal and human studies suggests glutamatergic dysfunction in posttraumatic stress disorder (PTSD). The purpose of this study was to investigate glutamate abnormalities in the dorsolateral prefrontal cortex (DLFPC) of individuals with PTSD using 7T MRS, which has better spectral resolution and signal-to- noise ratio than lower field strengths, thus allowing for better spectral quality and higher sensitivity. We hypothesized that individuals with PTSD would have lower glutamate levels compared to trauma-exposed individuals without PTSD and individuals without trauma exposure. Additionally, we explored potential alterations in other neurometabolites and the relationship between glutamate and psychiatric symptoms. MethodsIndividuals with PTSD (n=27), trauma-exposed individuals without PTSD (n=27), and individuals without trauma exposure (n=26) underwent 7T MRS to measure glutamate and other neurometabolites in the left DLPFC. The severities of PTSD, depression, anxiety, and dissociation symptoms were assessed. ResultsWe found that glutamate was lower in the PTSD and trauma-exposed groups compared to the group without trauma exposure. Furthermore, N-acetylaspartate (NAA) was lower and lactate was higher in the PTSD group compared to the group without trauma exposure. Glutamate was negatively correlated with depression symptom severity in the PTSD group. Glutamate was not correlated with PTSD symptom severity. ConclusionIn this first 7T MRS study of PTSD, we observed altered concentrations of glutamate, NAA, and lactate. Our findings provide evidence for multiple possible pathological processes in individuals with PTSD. High-field MRS offers insight into the neurometabolic alterations associated with PTSD and is a powerful tool to probe trauma- and stress-related neurotransmission and metabolism in vivo.

Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy. Due to the drastic increase in survivor rate over the last 50 years, long lasting treatment effect on moods and neurocognitive function has become a present issue. Most studies of late effects of treatment of ALL survivors investigate patients in their adolescents. This pilot study aims to identify measurements for evaluating late effect of childhood ALL survivors regarding neurocognitive and mood problems in adulthood. ALL survivors who received neurotoxic treatment with high-dose methotrexate and cranial radiotherapy (Chemo+CRT) (n=10) and ALL survivors only treated with high-dose methotrexate (Chemo) (n=10), plus age and sex match controls (n=20) where recruited to the study. The study protocol involved questionnaires, neurocognitive tests and optical brain imaging with functional near infrared spectroscopy (fNIRS) over the frontal and parietal cortex. The fNIRS results indicate a reduced involvement of the parietal cortex during conflict processing for the ALL survivors compared to controls. The study protocol shows promising results for identifying subgroups that suffers from neurocognitive and mood problems and we aim to expand upon it in a larger study. As our results indicate increased challenges among female ALL survivors, especially pathological fatigue, anxiety, and information processing, it is important to explore in future investigations the interplay between the risk of hormonal interaction with chemotherapy during development and occupational and social pressure during adulthood.

The increasing number of reports of mild to severe psychological, behavioral, and cognitive sequelae in COVID-19 survivors motivates a need for a thorough assessment of the neurological effects of the disease. In this regard, we have conducted a neuroimaging study to understand the neurotropic behavior of the coronavirus. We hypothesize that the COVID recovered subjects have developed alterations in the brain which can be measured through susceptibility differences in various regions of brain when compared to healthy controls (HCs). Hence we performed our investigations on susceptibility weighted imaging (SWI) volumes. Fatigue, being of the most common symptoms of Long COVID has also been studied in this work. SWI volumes of 46 COVID and 30 HCs were included in this study. The COVID patients were imaged within six months of their recovery. We performed unpaired two-sample t-test over the pre-processed SWI volumes of both the groups and multiple linear regression was performed to observe group differences and correlation of fatigue with SWI values. The group analysis showed that COVID recovered subjects had significantly higher susceptibility imaging values in regions of the frontal lobe and the brain stem. The clusters obtained in the frontal lobe primarily show differences in the white matter regions. The COVID group also demonstrated significantly higher fatigue levels than the HC group. The regression analysis on the COVID group yielded clusters in anterior cingulate gyrus and midbrain which exhibited negative correlations with fatigue scores. This study suggests an association of Long COVID with prolonged effects on the brain and also indicates the viability of SWI modality for analysis of post-COVID symptoms. HighlightsO_LISusceptibility weighted imaging is used for neuroimaging study of Long COVID. C_LIO_LIA group-level study is performed to analyze the effects of COVID on the brain. C_LIO_LICOVID survivors showed susceptibility differences in the frontal lobe and brainstem. C_LIO_LIAnalyzed the relationship between MRI data of COVID survivors and fatigue scores. C_LI

ContextA previous study demonstrated a long-term functional improvement of spatial neglect after methylphenidate combined with prismatic adaptation in a group of patients suffering from left spatial neglect after a right stroke (RITAPRISM study). Objectivewe hypothesized that the functional improvement after MP combined with PA depends on striatal integrity in responders patients. MethodsWe conducted an MRI study in "MP+PA" program to identify lesional pattern in responders and non-responders patients in the RITAPRISM cohort. Using anatomical segmentation on morphological MRI, we compared lesional pattern in the striatum between responders and non-responders patients. ResultsThe beneficial effect of MP+PA co-administration should require striatal integrity in neglect patients. More specifically, our results suggest that the short-term effect is mediated by the ventral striatum whereas the long-term effect is mediated by the posterior putamen. ConclusionBenefical effet of MP+PA could rely on reinforcement processes at early stage of the MP+PA program and visuospatial substrates at long-term.

PurposeAssisted suicide (AS) is a socio-political and healthcare challenge. In Germany, AS is legal, with further regulation pending. Previous German legislation drafts proposed involving psychosocial professionals like psycho-oncologists. These are experienced in supporting seriously ill patients and end-of-life decisions. However, there is a lack of studies on their role in AS. This study aimed to explore psycho-oncologists current and future roles, tasks and needs regarding AS requests. MethodsWe conducted a cross-sectional, qualitative interview study with psycho-oncologists in Germany. Inclusion criteria were current clinical activity as a psycho-oncologist and having talked to at least one patient about AS. Invitations to participate were distributed via email and social media using the study teams network. Interested participants responded voluntarily (convenience sample). Data were analyzed using Practical Thematic Analysis. ResultsTwelve interviews were conducted (average length of 42 minutes). Participating psycho-oncologists (58% female, 50% up to 40 years, 100% psychology- or psychiatry-related professional background) primarily saw themselves as open-minded conversation partners, both currently and in the future. Opinions differed whether psycho-oncologists should assess capacity for free decision-making. The vast majority rejected participation in realizing AS. They opposed psycho-oncologists having to fulfill mandatory tasks in the context of AS. Key needs for engaging in AS-related work included clinical practice guidelines, legal clarity, and specific training opportunities. ConclusionThis study provides initial insights into (potential) roles, tasks, and needs of psycho-oncologists in AS requests. It can serve as a basis for follow-up studies. Suitable structures and training opportunities should be developed.

BackgroundAlterations in speech have long been identified as indicators of various neurologic conditions including traumatic brain injury (TBI), neurodegenerative diseases, and stroke. TBIs that can be assessed using the Glasgow Coma Scale often result in speech symptoms such as dysarthria and occasionally neurogenic stuttering. The manifestation of symptoms including the specific changes in speech occurring in mild TBIs (or concussions) may differ from more severe head injuries. This work aims to compare speech fluency in sport-related concussion to baseline performance as well as non-athlete controls. MethodsA total of 230 Division I student athletes participated in pre-season speech testing. Of these, 12 students (18-22 years) who sustained a concussion also participated in speech testing in the days following diagnosis of concussion. Samples of picture descriptions were independently coded by three trained raters as 17 error types within the three traditional categories of errors defined in fluency analysis (Stuttering-Like Disfluency, Articulation Error, Other Disfluency). ResultsWithin-subjects analysis comparing the difference in percent error scores at baseline and post-concussion revealed significant differences for interjections (t(11)=-2.678, p< .05). The Other Disfluency category was also significantly different (t(11)= -2.735, p< .05), with more errors occurring after a concussion. No change in the Stuttering-Like Disfluency (t(11)= -0.799, p>.05) or Articulation Error category (t(11)=-0.045, p>.05) was found. ConclusionsThese results demonstrate that speech changes occur following mild sports-related concussions. Specifically, the rate of interjections increased in a limited sample of college athletes who sustain a concussion. Changes in additional error types (fillers, pauses) were trending, but were not significant potentially due to the low sample size. Future studies should consider speech as a diagnostic tool for concussion.

IntroductionCognitive impairments of patients with a glioma are increasingly considered when making treatment decisions considering a personalized onco-functional balance. Predicting cognitive functioning before surgery can serve as a steppingstone for the clinical goal of predicting cognitive functioning after surgery. However, in a previous study, machine-learning models could not reliably predict cognitive functioning before surgery using a comprehensive set of clinical variables. The current study aims to improve predictions while making the uncertainty in individual predictions explicit. MethodPre-operative cognitive functioning was predicted for 340 patients with a glioma across eight cognitive tests. This was done using six multivariate Bayesian regression models following a machine-learning approach while using a comprehensive set of clinical variables. Four models included interactions with- or a multilevel structure over histopathological diagnosis. Point-wise predictions were compared using the coefficient of determination (R2) and the best-performing model was interpreted. ResultsBayesian models outperformed machine-learning models and benefitted from using shrinkage priors. The R2 ranged between 0.3% and 21.5% with a median across tests of 7.2%. Estimated errors of individual prediction were high. The best-performing model allowed parameters to differ across histopathological diagnoses while pulling them toward the population mean. ConclusionBayesian models can improve predictions while providing uncertainty estimates for individual predictions. Despite this, the uncertainty in predictions of pre-operative cognitive functioning using the included clinical variables remained high. Consequently, clinicians should not infer cognitive functioning from these variables. Different histopathological diagnoses are best treated as distinct yet related. HighlightsO_LIBayesian regression outperformed machine-learning models. C_LIO_LIPredictions were uncertain despite improvements. C_LIO_LIDifferent histopathological diagnoses are best treated as distinct yet related. C_LI Importance of the studyCognitive impairments of patients with a glioma are increasingly considered when making treatment decisions considering a personalized onco-functional balance. Predicting cognitive functioning before surgery serves as a steppingstone for the clinical goal of predicting cognitive functioning after surgery. The current study is important for two reasons. First, it demonstrates that Bayesian models can improve predictions of pre-operative cognitive functioning over popular machine-learning models. Second, it explicitly shows that individual predictions of pre-operative cognitive functioning based on a comprehensive set of readily available clinical variables included in the current study are uncertain. Consequently, clinicians should not infer cognitive functioning from these variables. Last, it shows that prediction models may benefit a multifaceted view of patients and from treating patients with different histopathological diagnoses as distinct yet related.

PurposeDepression is genetically influenced, but the mechanisms that underlie these influences are largely unknown. Recently, shared genetic influences were found between depression and both cognitive ability and educational attainment (EA). Although genetic influences are often thought to represent direct biological pathways, they can also reflect indirect pathways, including modifiable environmental mediations (gene-environment-trait correlations). Here, I tested whether the genetic correlation between cognitive ability and depressive symptoms partly reflects an environmental mediation involving socioeconomic status (SES). MethodsAs previously done to increase statistical power, and due to their high phenotypic and genetic correlation, EA was used as a proxy for cognitive ability. Summary statistics from a recent genome-wide association study of EA were used to calculate EA polygenic scores. Two independent samples were used: 522 non-Hispanic Caucasian university students from the Duke Neurogenetics Study (277 women, mean age 19.78{+/-}1.24 years) and 5,243 white British volunteers (2,669 women, mean age 62.30{+/-}7.41 years) from the UK biobank. ResultsMediation analyses in the two samples indicated that higher proxy-cognitive ability polygenic scores predicted higher SES, which in turn predicted lower depressive symptoms. ConclusionCurrent findings suggest that some of the genetic correlates of depressive symptoms depend on an environmental mediation and consequently that modifying the environment, specifically through social and economic policies, can affect the genetic influences on depression. Additionally, these results suggest that findings from genetic association studies of depression may be context-contingent and reflect social, cultural, and economic processes in the examined population.

BackgroundTraumatic encephalopathy syndrome (TES) is considered a long-term, neurodegenerative consequence of repetitive head injury (RHI). This cohort study aimed to characterise the episodic memory profiles (specifically, immediate and delayed memory) of individuals with RHI history through neuropsychological assessment. Hypotheses included participants demonstrating reduced episodic memory functioning, and greater reductions in functioning observed with greater years of RHI exposure. MethodsNeuropsychological assessment was conducted on 34 adults with [&ge;]10 years of RHI exposure as a cohort study. Main outcome measures were auditory memory indices (AMI), immediate memory indices (AII), and auditory delayed memory indices (ADI). Other potential predictors of outcome variables (in addition to years of exposure duration) were also measured and factored into analysis so that they could be controlled for. ResultsAMI [t (33) = -2.4, p = .020), AII (t = -2.7, p = .012), and ADI (t = -2.7, p = .44) were all significantly below normative levels. AMI [t (33) = 4.1, p <.001), AII (t = 4.3, p <.001), and ADI (t = 3.7, p <.001) were also significantly below participants measured premorbid functioning. None of the comorbidities that were considered as possible confounding variables predicted the relationship of any outcome variables. ConclusionsPrevious research (1) indicated that immediate episodic memory (i.e., encoding) impairments do not appear to be associated with RHI, and our study provides evidence to the contrary. However, further research is required on larger sample sizes to further understand the relationship between RHI and encoding deficits in this complex population. What is already known on this topic?Chronic Traumatic Encephalopathy (CTE) identified at autopsy, has been loosely associated with a history of repetitive head injury (RHI) sustained in life, yet factors that account for symptoms such as defined in life as Traumatic Encephalopathy Syndrome (TES) which can include abnormal cognitive function, behavioural dysregulation and mood disturbances in this patient cohort are yet to be comprehensively investigated. What this study adds?This research is beneficial to the scientific community mainly because it contributes to the pre-existing body of literature on the neuropsychological profile of RHI. Previous research (1) has indicated that immediate episodic memory (i.e., encoding) impairments do not appear to be associated with RHI, and our study provides evidence to the contrary. How might this study affect research, practice, or policy?This research represents progress towards further discerning a neuropsychological profile of TES, thereby potentially aiding a better clinical diagnostic presentation of the disease, which can build on potential earlier diagnosis, prevention strategies and treatment pathways.

Background and aimsIncreasing popularity of Internet has exposed our children pornography addiction. As in other types of addiction, it affects a brain region known as prefrontal cortex (PFC), which is important in executive functions and inhibitory control. However, this region was loosely defined, and there was no consensus for that definition. We aimed to use volumetric MRI in finding the defining region of PFC which would be suitable in distinguishing pornography addicted juveniles. MethodsWe enrolled 30 juveniles (12-16 y.o.) consisting of 15 pornography addiction and 15 non-addiction subjects. We proposed several models of PFC definition from mix-and-matched subregions, consisting of orbitofrontal (OFC), inferior frontal gyrus (IFG; pars orbitalis, opercularis, and triangularis), dorsolateral PFC (DLPFC), and anterior cingulate (ACC). Suitable PFC definition was defined as models which volume statistically different between both groups. Brain volumetric was measured using 3D-T1 3T MRI images and analyzed using FreeSurfer(R) for automatic cortical reconstruction and brain segmentation (recon-all command). ResultsWe found significant differences between groups in 6 models, which mainly included OFC, ACC, and DLPFC, with models devoid of DLPFC had lowest mean differences. ConclusionThe most suitable definition of PFC for pornography addiction study should consist of OFC, ACC, and especially DLPFC. Inferior frontal gyrus pars orbitalis was not necessary for this purpose, but may increase effect size if it is included.

BackgroundBrain tumors can present as focal neurologic deficits (reflecting the tumor location) or generalized symptoms due to increased intracranial pressure. Occasionally, brain tumors can be found incidentally in asymptomatic patients or in patients with unrelated symptoms who undergo brain imaging. The term incidentaloma is used to refer to these imaging abnormalities. ObjectiveThe object of this study was to examine the prevalence and correlates of asymptomatic glioma in a large epidemiological study of brain tumors. MethodsThe analysis was based on a large series of patients with glioma (N = 1989) enrolled in a multicenter clinic-based epidemiologic study between 2005 and 2017. Patients were considered asymptomatic from the tumor, and thus as having an incidentally detected glioma (IDG), if the tumor was diagnosed during workup of injury or unrelated medical condition. ResultsA total of 32 of 1989 (1.6%) patients were asymptomatic at diagnosis. The leading indication for brain imaging in IDG was non-workplace injuries followed by medical workup for unrelated conditions. IDG was more prevalent in patients younger than 50 years of age (2.6% vs 1.0%). IDG was also more common in patients with low grade gliomas (4.7% for WHO grade II and 1.5% for WHO grade III) vs glioblastomas (0.6% in WHO grade IV). ConclusionThe present data suggest that gliomas may be found incidentally, especially among low grade gliomas. Studies of IDG may be useful as a proxy for early detection of tumor as a means to improve patient survival.

AIMChildren born preterm (PT) experience perinatal white matter injury and later reading deficits at school age. We used two complementary neuroimaging modalities to determine if reading skills would be associated with contemporaneous white matter properties in school-aged PT children. METHODIn 8-year-old PT children (N=29), we measured diffusivity (fractional anisotropy, FA), from diffusion MRI, and myelin content (relaxation rate, R1) from quantitative relaxometry. We assessed reading (Grays Oral Reading Test, Fifth Edition) in each child. Whole-brain deterministic tractography coupled with automatic segmentation and quantification were applied to extract FA and R1 along four tracts and assess their statistical association with reading scores. RESULTSReading-FA correlations were not significant along the four analyzed tracts. Reading-R1 correlations were significantly positive in portions of the left superior longitudinal fasciculus, right uncinate fasciculus, and left inferior longitudinal fasciculus. FA positively correlated with R1 in limited areas of reading-R1 associations, but did not contribute to the variance in reading scores. INTERPRETATIONCombining complementary neuroimaging approaches identified relations between reading and white matter properties not found using a single MRI measure. Associations of reading skills and white matter properties may vary across white matter tracts and metrics in PT children. What this paper adds{blacksquare} Preterm childrens reading was associated with white matter myelin content. {blacksquare}Preterm childrens reading was not associated with white matter diffusivity.

IntroductionPost traumatic stress disorder (PTSD) is a psychiatric disorder that may develop after exposure to a traumatic event. Patients of traumatic spinal cord injuries are at risk of developing PTSD, and diagnosing this disorder and recognizing risk factors is important for effective treatment. ObjectiveTo determine the prevalence of PTSD in post-traumatic spinal cord injury patients and correlate the presence of PTSD to factors such as age, cause of injury, and level of injury. MethodsA descriptive cross sectional study was conducted at Paraplegic Center in Peshawar, Pakistan. The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) was used to assess the presence of post-traumatic stress disorder in patients at the Paraplegic Center. The study was carried out from 20 December 2014 to 20 February 2015 on a convenience sample of 51 patients. The criterion for inclusion in the study was to have a traumatic spinal cord injury, while the exclusion criterion was to have a spinal cord injury that was non-traumatic in nature. ResultsOut of 51 patients, 31% met the diagnostic criteria for PTSD. The age group of 15-24 years had a 27% prevalence of PTSD, while the age groups of 25-34 years and 35-44 years had a PTSD prevalence of 42% and 40% respectively. Patients who had fallen from a height had the highest prevalence of PTSD - 41%, as compared to patients who had other causes of traumatic spinal cord injury. Patients with a lumbar spinal lesion had a PTSD prevalence of 44%, whereas patients with a cervical and thoracic spinal lesion had a PTSD prevalence of 33% and 25% respectively. ConclusionThe study shows that the middle age groups had a higher prevalence of PTSD, and patients who had fallen from a height had the highest prevalence of PTSD. Lumbar spinal lesion patients had a higher prevalence of PTSD than patients who had spinal lesions at the cervical or thoracic level.