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.

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.

BackgroundCocaine Use Disorder (CUD) poses significant neurobiological and neuropsychiatric challenges, often resulting in severe cognitive and behavioral impairments. This study aims to explore the neural dynamics of CUD using a dynamic coactivation pattern (CAP) analysis approach to provide a deeper understanding of the transient neurobiological mechanisms of the disorder. MethodsResting-state functional MRI data (SUDMEX_CONN) from 56 CUD patients and 57 healthy controls (HC) were analyzed. CAP analysis was employed to capture transient brain states and their coactivation patterns. Temporal dynamic metrics such as Fraction of Time, Persistence (PST), and Counts were computed to assess differences between groups. Stationary functional connectivity (sFC) was also examined, and meta-analytic term mapping from the Neurosynth database was used to characterize functional associations. ResultsCAP analysis revealed six distinct coactivation patterns, with five showing high spatial similarity between CUD and HC groups. Notable differences were observed in State 6, which displayed inverse activation patterns between the groups. CUD individuals exhibited significantly reduced PST across all brain states and altered transition probabilities, particularly increased transitions from the default mode network (DMN) to the somatomotor network and decreased transitions from DMN to attentional/executive networks. Clinical correlations indicated that prolonged cocaine use was associated with altered PST in specific brain states. sFC analysis identified significant alterations in regions such as the right supramarginal gyrus, left superior frontal gyrus, right precentral gyrus, and right lingual gyrus, each linked to distinct cognitive and behavioral functions. ConclusionsThis study highlights the utility of CAP analysis in capturing the dynamic neural underpinnings of CUD. The findings provide insights into the neurobiological mechanisms of the disorder, suggesting potential biomarkers for CUD. These results have implications for developing an enhanced approach for substance use disorders, as well as improving our understanding and management of CUD.

The validation of objective neurophysiological monitoring of concussion from diagnosis to return to play has the potential to improve the clinical care of athletes. Extracted from event-related potentials (ERP), brain vital signs offer a non-invasive objective neurophysiological measure of three well established ERP responses that complement existing clinical assessments: 1) the N100 response related to auditory sensation; 2) the P300 response related to basic attention; and 3) the N400 response related to cognitive processing. The N400, in particular, has increasingly been demonstrated to be sensitive to head impact related cognitive impairment. Accordingly, brain vital sign measures were collected in n =165 rugby league players from two Australian professional National Rugby League clubs (NRL), with concussed players (n =26) being subsequently assessed over a total of five separate time points (Baseline, Day 2, Day 5, Day 10, and Day 42). This timeline aligned with acute (Day 2), NRL mandatory minimum return-to-play (RTP) guidelines (Day 10), and an extended post RTP period. Relative to baseline, the results revealed significant N400 cognitive processing latency delays at Day 2 post-concussion (p =0.002). The N400 latency delays persisted past day 5, significantly returning to baseline values at Day 10, consistent with the RTP mandatory minimum requirement. The findings indicated that neurophysiological recovery occurred in this cohort within an approximate 10-day time frame. Future studies monitoring brain vital sign changes across the trajectory of injury to recovery are needed in sports related concussion management.

Severe Acute Respiratory Syndrome Coronavirus 2 infection causes coronavirus disease 2019. COVID-19 was an unknown infection that reached pandemic proportions in 2020 and has shown to bring long-term negative consequences. Here, we used a case-control design to investigate the performance of relatively young people recovered from COVID 19 in objective neuropsychological tests. We found significant differences between groups for all measures of the ROCFT with a large difference in the copy, a moderate difference in immediate recall, and a large difference in delayed recall. No significant differences were found for the measures from all the other five neuropsychological tests used.About one quarter of COVID 19 patients were below the 10th percentile according to normative data.

Background and Objectives Transient ischemic attack (TIA) diagnosis is challenging because it relies mainly on clinical assessment and exclusion of common differential. Functional MRI (fMRI) may provide a diagnostic biomarker by detecting transient brain dysfunction not visible on conventional imaging. This pilot study aimed to characterize acute motor-task BOLD activation in patients with suspected DWI-negative TIA and compare functional patterns between confirmed TIA and alternative diagnoses. Secondary objectives were to assess longitudinal changes in activation and connectivity at 3 months. Methods In this prospective single-center study, adults presenting within 24 h of transient anterior-circulation neurological symptoms underwent conventional MRI and additional motor-task fMRI. Patients with acute DWI lesions were excluded. Final diagnosis was established after 3-month follow-up. Whole-brain analyses, individualized motor cortex region-of-interest (ROI) analyses, and generalized psychophysiological interaction (gPPI) connectivity analyses were performed during the acute phase and at 3 months. Results Eight patients were enrolled; six had complete longitudinal imaging data and were included in the final analyses. Final diagnoses were TIA (n=2), migraine aura (n=2), functional neurological disorder (n=1), and hypoglycemia (n=1). Whole-brain and ROI analyses showed reduced bilateral motor-related BOLD responses during the acute phase in both TIA patients and in the patient with hypoglycemia. In contrast, patients with migraine and functional neurological disorder exhibited less marked longitudinal changes. In TIA patients, motor cortex activation increased at 3 months, tending to normalize toward values observed in non-TIA participants. Connectivity analyses revealed heterogeneous patterns, but the 2 TIA patients demonstrated increased longitudinal connectivity between the motor cortex contralateral to symptoms and other sensorimotor regions, including supplementary motor, premotor, parietal, and postcentral cortices. Discussion These preliminary findings suggest that TIA may be associated with transient bilateral reductions in motor-network activity. Functional abnormalities appeared to improve over time, supporting the hypothesis of reversible network dysfunction. Although limited by the very small sample size, this study provides the first longitudinal assessment of emergency task-based fMRI in rigorously defined TIA and supports further investigation of acute functional MRI as a potential biomarker of transient cerebral dysfunction.

Past research has shown that the bilateral dorsolateral prefrontal cortices (dlPFC) are implicated in both emotional processing as well as cognitive processing,1,2,3 in addition to working memory4, 5. Exactly how these disparate processes interact with one another within the dlPFC is less understood. To explore this, researchers designed an experiment that looked at working memory performance during fMRI under both emotional and non-emotional task conditions. Participants were asked to complete three tasks (letters, neutral images, emotional images) of the Sternberg Sorting Task under one of two trial conditions (sort or maintain). Regions of interest consisted of the left and right dlPFC as defined by brain masks based on NeuroSynth6. Results showed a significant main effect of the sort condition on reaction speed for all three trial types, as well as a main effect of task type (letters) on accuracy. In addition, a significant interaction was found between trial type (sort) and task type (letters), but not for either of the picture tasks. These results reveal a discrepancy between BOLD signal and behavioral data, with no significant difference in BOLD activity during image trials being displayed, despite longer response times for every condition. While these results show that the dlPFC is clearly implicated in non-emotional cognitive processing, more research is needed to explain the lack of BOLD activation seen here for similar emotionally valanced tasks, possibly indicating involvement of other brain networks.

Transcranial magnetic stimulation (TMS) is widely used in both clinical and research settings to study and treat neurological and neuropsychiatric disorders, yet its underlying neural mechanisms remain unclear; particularly how stimulation influences both local and distant regional activity in relation to behavior. In this study, we combined single-pulse TMS with concurrent whole-head functional near-infrared spectroscopy (fNIRS) to examine hemodynamic and behavioral responses during a working memory task, with a focus on behavioral variability. Single TMS pulses were delivered to the left dorsolateral prefrontal cortex (DLPFC) while healthy participants rested; additionally, single pulses were delivered online to the left DLPFC while participants performed the working memory task. Across all participants, we observed a reliable load-dependent increase in hemodynamic activity associated with task. However, behavioral responses to TMS varied during the task. When participants were stratified into subgroups based on performance, a distinct topographic pattern emerged. During the task, TMS systematically modulated hemodynamic responses in regions including DLPFC, superior medial gyrus, precuneus, and parietal lobule, which are areas belonging to the default mode network. Moreover, the hemodynamic response during the single pulse alone sessions without any task was also found to be associated with the behavioral responses in a coherent pattern involving DLPFC, precuneus and parietal lobules. These findings suggest that variable behavioral outcomes during online TMS task are linked to distinct hemodynamic responses in a topographic pattern of local and distant regional areas.

ObjectivesThis study examined the impact of a single season of rugby union - and subsequent exposure to head acceleration events (HAEs) - on functional connectivity in adolescent males compared to non-collision sport athletes. MethodsResting-state functional MRI scans were acquired from 72 rugby players and 20 non-collision sport athletes. The rugby cohort were scanned longitudinally throughout the season. Voxel-wise maps of functional connectivity (FC) for 15 resting-state brain networks were generated for 178 datasets. Cross-sectional comparisons were performed between the rugby cohort at different stages of the season and the non-collision sport group. Longitudinal analyses were performed within the rugby cohort. An exposure analysis estimated HAE exposure based on the number of matches played. ResultsNo significant cross-sectional differences in FC were found between rugby and non-collision sport athletes or between rugby players with high versus low exposure to HAEs. Longitudinally, rugby players showed increased inter-network FC over the season, with strengthening of connectivity in the temporal, motor, secondary visual, and anterior intraparietal sulcus networks, and mid-season decreases in the cerebellar-visual network. No association was found between longitudinal FC changes and changes in self-reported symptoms. ConclusionsThese findings suggest that participation in a season of rugby is associated with neuroplastic changes. These changes may reflect compensatory adaptations to preserve neurological function during periods of HAE exposure. Alternatively, they may also represent developmental changes or responses to physical activity and/or motor learning. This highlights the complexity of interpreting changes in FC in adolescent athletes participating in collision sports and the need for further research.

Chemotherapy is a common treatment for women with ovarian cancer, and many women treated with chemotherapy experience cognitive dysfunction. However, few studies have investigated the mechanisms of chemotherapy-related cognitive impairment in women with ovarian cancer. The goal of this study was to assess the relationships among neurovascular coupling, iron levels and cognitive functions in women with ovarian cancer after first-line chemotherapy. Simultaneous fNIRS and EEG data were collected in women diagnosed with advanced stage ovarian cancer at baseline (N = 13) and after 3-9 rounds of chemotherapy (N = 8). The attentional network task (ANT) was administered for neurocognitive evaluation. Blood iron levels were measured using standard clinical assays. In parallel, similar concurrent fNIRS-EEG data were acquired in a group of 10 healthy participants in a test-retest design. Cognitive performance declined, as indicated by decreases in ANT sub scores after chemotherapy. Blood iron biomarkers indexing oxygen transport also declined and were related to decreases in the ANT sub scores. Both fNIRS and EEG data responses were shown to have excellent reliability in the healthy subjects, while cancer patients showed significant decreases in oxygenated hemoglobin response in fNIRS, despite no changes in EEG responses after chemotherapy. A significant dose relationship was also found in the changes of fNIRS responses. Our data indicate that chemotherapy produced cognitive deficits and decreases in the oxygenated hemoglobin response and that these may be related to reduced oxygen transport capacity. Results also suggest the utility of using fNIRS-EEG to monitor the progression of cognitive impairment and characterize those mechanisms.

Moyamoya is a rare chronic brain vascular disease with a set of potential life-threatening consequences due to a high probability of stroke occurrence. Patients suffering from this disease are often presented with diverse and severe sensory, motor and cognitive deficits, which often lead to general inability to work and, in the most severe cases, to complete loss of self-serving skills and gross disturbance of vital homeostatic functions. Here we present a case of a patient with moyamoya disease, who has been dynamically observed over more than 4 years after the first manifestation of her symptoms. We have been tracking the appearance of patients new symptoms and resolution of existing ones after neurosurgical treatment (revascularization surgery) with in-depth neurological examination, neuropsychological assessment and fMRI/DTI sessions. This study represents one of the first attempts to rigorously estimate the patterns of deficits at different levels, connecting neural circuits affected by the disease to behavior. Our findings lend further support to the idea that revascularization surgery can improve cognitive performance and highlights the importance of long-term follow-up in understanding the effects of surgery on brain function.

We investigated objective brain vital signs derived from event-related potentials (ERPs) for mixed martial arts (MMA) athletes and matched controls (N=24). Brain vital sign scans were acquired from 9 MMA athletes and 15 age- and sex-matched controls. Our analysis specifically compared differences in brain vital signs between MMA athletes and controls at baseline. We predicted that MMA athletes would show significant differences relative to controls due to their ongoing exposure to repetitive head impacts. Participants were scanned to extract three well-established ERPs: N100 for auditory sensation; P300 for basic attention; and N400 for cognitive processing. Scans were verified using automated reports, with N100, P300, and N400 amplitudes and latencies manually identified by a blinded reviewer. Groups were evaluated at the waveform level with a mass-univariate analysis using non-parametric resampling. Brain vital signs were compared across groups with a Kruskal-Wallis H-test for independent samples, with FDR correction for multiple comparisons. We identified significant differences between MMA athletes and controls. Specifically, there were significant N400 amplitude reductions, indicating that exposure to repetitive head impacts in MMA may be associated with changes in brain function.

PurposeCOVID-19, caused by the SARS-CoV-2 virus, has significantly altered modern society and lifestyles. We investigated its impact on brain glucose metabolism by meta-analyzing existing studies that utilized 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) scans of the brain. MethodsWe conducted a systematic search of MEDLINE and EMBASE databases from inception to August 2023 for English-language publications using the keywords "positron emission tomography," "single-photon emission computed tomography," and "COVID-19." We included original research articles that reported changes in brain glucose metabolism following COVID-19 infection. ALE values from these studies were aggregated and tested against a null hypothesis that anticipated a random distribution of ALE values, which proved to be significantly higher than chance. ResultsWe identified eight papers that met our inclusion criteria. Significant increases in brain glucose metabolism were noted in the left anterior cingulate gyrus, right thalamus, and brainstem. In children with COVID-19, decreased glucose metabolism was observed in the right and left cerebellum, left amygdala/hippocampus, left anterior cingulate gyrus, and right amygdala. In adults with COVID-19, decreased metabolism was seen in the right temporal lobe, brainstem (acute phase), left posterior cingulate gyrus, left precuneus, right cerebellum, right insula, right anterior cingulate gyrus, left occipital lobe, and left globus pallidus (chronic phase). ConclusionCOVID-19 impacts brain glucose metabolism, typically manifesting as areas of decreased metabolism in 18F-FDG PET scans, though increases are also observed. These changes in metabolism vary with the patients age and the time elapsed between the diagnosis of COVID-19 and the PET scan.

Background and ObjectivesGambling disorder is defined as persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress in DSM-5 diagnostic criteria. According to the DSM-5, the past-year prevalence rate of gambling disorder is about 0.2%-0.3% in the general population, and the lifetime prevalence is about 0.4%-1.0%. Japan currently has no casinos, but three integrated resorts (IRs), including casinos, are scheduled to open in the late 2020s. In abroad, there have been studies on the effect of casinos on the prevalence of gambling in a region, but similar empirical studies do not exist in Japan. There are a lot of surveys being conducted in many areas, but the different screening tests used make it difficult to compare the results. However, comparisons between screening tests are less common. The first objective of this study is to measure the prevalence of gambling disorder in areas where IRs are planned to open and control areas. The second objective is to identify relationships among screening tests and examine differences between measures by administering multiple screening tests for gambling disorder to the same subjects. Materials and methodsThis survey was a self-administered, online survey of 2000 people in Japan, ranging in age from 20 to 69 conducted in 2021. We administered 4 gambling disorder screening tests (SOGS, PGSI, LieBet Screen,DSM-5). Experience rates for each of 8 gambles were measured. Percentage above cut-off score (PAC) was calculated and compared by gender and region for 4 tests. ResultsAmong the eight gambling activities, the lottery had the largest experience rate at 58.5%, PACHINKO was second at 42.2%, and there were no major regional disparities. In each of the 4 screening tests, PAC was greater in males, and regional differences were found in SOGS and DSM-5. The distribution of PAC for different cut-off scores for each test is illustrated in a "dango chart" for comparison. DiscussionThis study indicates PACs for 4 gambling disorder screening tests in planned and non-IR areas, and this will be a baseline survey to measure the impact of opening an IR. Although our results will contain some biases likely due to methodological factors, by continuing to use the same measurement method, our research project will be able to reach its ultimate goal of observing changes in the applicable rate before and after the opening of the IR. In addition, this study administered several gambling disorder screening tests to the same subjects in the same region and illustrated them in a chart format named the dango chart. This visualized the changes in the applicable person rate when the cut-off scores of the screening tests were changed (within-test comparisons) and the differences in the distribution of the applicable person rate across tests (between-test comparisons). We think that the dango chart is a useful presentation method for comparing several different tests.

BackgroundCognitive deficits in bipolar affective disorder (BPAD), particularly during manic episodes, are well-documented. However, research on domain-specific memory impairments in bipolar mania is limited, especially in the Indian subcontinent. This study aimed to assess memory impairments in patients with bipolar mania using the Postgraduate Institute Memory (PGI-Memory) Scale and to highlight domain-specific deficits compared to healthy controls. MethodsThis cross-sectional study was conducted at Tertiary Care Centre in North India. Twenty patients diagnosed with bipolar mania and twenty age, sex and education-matched healthy controls between age 18 to 40 were recruited. Memory functions were assessed using the PGI-Memory scale, focusing on immediate, recent, remote, long-term memory, and associative memory. Mental control and working memory were also evaluated. ResultsBoth groups were matched in terms of age, sex, and education. the mean (sd) age for bipolar mania group was 27.2 (4.14) years. Patients with bipolar mania demonstrated significant deficits in various memory domains, including immediate, recent, remote, long-term, and associative memory, as well as in visual reproduction and recognition tasks. In contrast, their working memory performance was comparable to that of the control group. The largest deficits were observed in long-term memory (d =2.37) and visual reproduction (d=2.30). ConclusionsBipolar mania is associated with widespread memory impairments, particularly in long-term and associative memory, which may contribute to difficulties in emotional regulation and daily functioning. These findings emphasize the importance of considering memory impairments in the diagnosis and management of BPAD. Further studies are required to investigate the neurobiological foundations of these impairments and to develop specific interventions.

Consumption of alcohol is a practice world over that dates back to 10,000 Before Christ. Evaluation on the damages caused by the alcohol on the human organs such as the liver is paramount. There is no direct evaluation to liver parenchyma before admission rather blood samples are evaluated to show damage or no damage to the liver cells. The outcome of the blood samples denote the health status of the liver cells before admission. Alcohol biomarkers are usually elevated when there is damage to the liver parenchyma. This was a quantitative descriptive cross sectional study. Purpose sampling was used to select two Counties with the highest number of alcohol consumers. Simple Random sampling method was used to select participants for liver biomarkers. Participants were requested to consent for blood donation and confidentiality was maintained. Blood samples collected were separated for serum and cells using centrifuge within one hour after donation. The samples were transported for storage using cool boxes and temperature was maintained between -8 and +8 degrees during transportation. The blood samples were stored at -8 and +8 degrees in the deep freezer. Majority (97%) of the participants had alanine aminotransferase levels of 41 to 80 IU/L. Eighty eight percent of the participants had aspartate aminotransferase elevated to between 35 and 68 IU/L. Gamma Glutamyl aminotransferase was elevated in all of the participants while alanine phosphatase was elevated in 99% of the participants. Most participants had elevated liver biomarkers before admission to rehabilitation centre.

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

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.

Abstract Background The neuropsychiatric sequelae (cognitive deficits, anxiety and depression) post-COVID-19 exist as part of the spectrum of the multisystemic long COVID. People with these symptoms have been shown to have worse functional outcomes. Hence, this significantly impacts the economy, primarily due to productivity losses. Yet, the precise underlying pathogenesis remains unknown, as do any diagnostic or prognostic biomarkers. Aim This study aims to identify functionally impacted brain regions in those with post-COVID-19 neurological sequelae and to evaluate how alterations in brain function relate to acute serum inflammatory mediators and brain injury biomarkers. Methods The study will utilise data from the COVID-19 Clinical Neuroscience Study (CNS), a large UK multicentre study conducted during the pandemic. This sub-study will be a secondary analysis of the COVID-19 CNS, a prospective observational study that compared COVID-19-positive participants with negative controls. Participants had an MRI, blood tested for acute serum inflammatory mediators and brain injury biomarkers, and neuropsychiatric assessment (cognitron test, PHQ-9 and GAD-7) post-acutely and at follow-up. The DPABI (Data Processing & Analysis for Brain Imaging) toolbox will be used for pre-processing and analysis of the neuroimaging data (resting state functional MRI) to obtain regional homogeneity (ReHo). The association between ReHO and neuropsychiatric symptoms, acute inflammatory mediators and brain injury biomarkers will be explored. Regression models would be used to determine the risk and protective factors for developing these symptoms. Conclusion It is anticipated that the study will provide new insights into the functional basis of post-acute COVID-19 neuropsychiatric manifestations and identify new diagnostic biomarkers. Key words: Regional Homogeneity, COVID-19, functional MRI, neuropsychiatry, biomarkers

BackgroundAneurysmal Subarachnoid Haemorrhages (aSAH) are a severe condition often followed by vasospasm, causing several neurological and cognitive impairments in survivors. Nowadays there is still an open debate on actual impact of aSAH and vasospasm over cognitive abilities over time. This study aims at describing cognitive functioning focusing on the acute phases after bleeding and for 18 months, and to investigate the immediate and long-term effects of vasospasm. Methodsseventy adult patients have been prospectively recruited and were tested at different time points: within 48/72 hours from bleeding (T1); between 7 and 10 days after bleeding (T2); five long-term follow-ups from 1 (T3) to 18 months (T7). An extensive neuropsychological evaluation was administered, including memory, attentional and executive functions, language, praxis and level of daily functional independence. Half of the sample showed radiological vasospasm. Resultsresults show that at T1 all tests show high percentages of impairments (ranging from 38% to 100%), in particular for visual and verbal long-term memory, constructional praxis, abstract reasoning and functional independence. Many tasks gradually improve since T2, except for executive functions and visual memory which show a slower recovery. A severe diffuse impact of vasospasm emerges at T2 but, interestingly, a linear gradual recovery already since T3 emerges for almost all the investigated functions. At the last follow-ups several tests show no significant differences between patients with and without vasospasm. Conclusionsdespite a severe diffuse impact of bleeding and vasospasm in the acute stages, a low prevalence of cognitive and functional impairments at the chronic phase emerges. Our data may help to better understand the cognitive and autonomy trajectories of recover over time, a helpful element for clinicians to explain and reassure patients and relatives concerning real expectations of impairments and quality of life after the aSAH, and to tailor eventual rehabilitation programs.