NeuroImage: Reports

IntroductionFunctional magnetic resonance imaging (fMRI) is widely used to study neural processes of behavior, but evaluations of test-retest reliability (TRR) of task-related blood-oxygen-level-dependent (BOLD) responses are scarce for many cognitive tasks. Such information is particularly important for longitudinal and intervention research. The ability to learn associations between choices and outcomes across decision stages is crucial for daily behavior. We assessed the measurement reliability of behavioral performance and fMRI BOLD signals during value-based sequential decision making to evaluate the TRR of task-relevant regions for future research on non-invasive brain stimulations. MethodsTwenty healthy adults (22 to 40 years) completed two task-fMRI sessions that were at least 2 weeks apart. During scanning, participants performed two variants of a three-stage Markov decision task with conditions varied in temporal contingency (immediate vs. delayed) and magnitude of choice outcomes (high vs. low). Both sessions were conducted under sham tDCS via a focal 3 x 1 montage targeting left dorsolateral prefrontal cortex (DLPFC). The TRR was assessed using intraclass correlation coefficients (ICC) with a two-way mixed-effects consistency model for decision performance and task-related fMRI signals at voxel-wise level and summarized in key regions defined by the extended Human Connectome Project atlas (HCPex). ResultsDecision performance was lower with delayed than immediate outcomes (p < 0.001). Higher outcome magnitude improved performance (p < 0.001). Decision performance increased across learning bins (p < 0.001). The behavioral TRR was in the moderate to good level (ICC(3,1) = 0.742 for accuracy; ICC(3,1) = 0.801 for reaction time). At the whole-brain level, contrasting brain activities in delayed with immediate condition revealed suprathreshold cluster peaks in several frontal-parietal (e.g., bilateral orbitofrontal, bilateral dorsolateral prefrontal, and medial parietal cortices) and striatal regions (e.g., bilateral putamen). Voxel-wise ICCs revealed variable but partly good-to-excellent TRR across task-relevant regions, with stronger reliability in several striatal, orbitofrontal, and left dorsolateral prefrontal parcels, and more variable reliability across anterior cingulate and medial prefrontal parcels. ConclusionThese results from a 2-session tDCS sham-sham stimulation study establish the validity of using the three-stage Markov decision task in future studies about intervention effects on the frontal-parietal-striatal network.

Background: Post-stroke apathy (PSA) is a common, disabling syndrome with few evidence-based treatment options. We evaluated the safety, feasibility, acceptability, and evidence of effects of a three-day accelerated intermittent theta burst stimulation-repetitive transcranial magnetic stimulation (iTBS-rTMS) protocol targeting the left dorsomedial prefrontal cortex (dmPFC) in chronic stroke survivors with apathy. Methods: Stroke survivors with symptomatic apathy received open-label iTBS-rTMS at the left dmPFC (21,600 pulses across 36 sessions; 3 treatment days; 12 sessions/day within one week). Safety endpoints included adverse events, neuroradiological findings, and objective cognitive performance. Secondary outcomes included measures of apathy and other neuropsychiatric symptoms as well as psychosocial functioning, including quality of life and caregiver burden. Participants were followed up for one month. Results: Fourteen participants (mean age = 61.8 {+/-} 14.0 years; mean time since stroke = 55.6 {+/-} 31.6 months) completed the iTBS-rTMS treatment course. No serious adverse events occurred. Participants rated the treatment as highly acceptable, and cognitive performance was stable from pre- to post-rTMS with no treatment-related changes on structural MRI. Regarding apathy, participants had significant improvements with moderate to large effect sizes on the Lille Apathy Rating Scale (LARS), on both self (d = 0.78) and caregiver-rated versions (d = 1.28), p<0.05 pretreatment-to-one-month follow-up. In addition, secondary measures of psychosocial function also showed improvement with moderate to large effect sizes (Stroke Specific Quality of Life Scale: d = 0.62; Zarit Burden Interview: d = 0.72), and the Brief Inventory of Psychosocial Function: d = 0.89). Conclusions: In chronic stroke survivors with PSA, accelerated iTBS-rTMS targeting the left dmPFC appears to be safe, feasible, tolerable, and highly acceptable, with preliminary evidence suggesting a potential role in reducing apathy and secondarily promoting improvements in quality of life, caregiver burden, and broader psychosocial function.

Background: Understanding how transcranial direct current stimulation (tDCS) affects brain activity critically benefits from the use of functional magnetic resonance imaging (fMRI) to measure the related BOLD (blood-oxygenation-level-dependent) signal changes. However, the small magnetic fields induced by the stimulation currents can cause artifacts in the fMRI images that can compromise findings from concurrent tDCS-fMRI studies. Objective: To identify how the current-induced magnetic fields affect fMRI data and establish a quantitative framework for evaluating their impact on concurrent tDCS-fMRI measurements. Methods: Magnetic fields induced by currents inside the head and electrode cables were calculated for a standard motor cortex montage. Their effects on echo-planar images (EPI) were simulated based on a framework derived from MR physics first principles and validated using phantom experiments. The framework was applied to artificially induce artifacts related to the tDCS current flow in current-free fMRI time series from 5 participants. These were compared to active runs from the same participants where tDCS intensity was varied in a block design. Results: Currents in the electrode cables were the main contributors to the current flow-related artifacts in the EPI images, which occurred both locally by causing geometric distortions and remotely by affecting the dynamic update of the scanner demodulation frequency. The artificially induced fMRI activations corresponded well to those measured during real tDCS on the single-subject level for intensities of 2 mA and higher. Conclusion: The current-induced magnetic fields can cause intensity changes comparable to typical BOLD responses. Their impact on the statistical results depends on the chosen experimental design (electrode locations, cable paths, imaging parameters, fMRI paradigm). The simulation framework provides a principled approach to evaluate the impact of these artifacts during the design and data analyses of concurrent tDCS-fMRI studies.

Introduction Language functional MRI (fMRI) is a valuable tool for presurgical planning in epilepsy. Functional MRI can be challenging in children, and head motion can compromise its utility. The candidacy of patients with ADHD for fMRI is sometimes queried regarding concerns about possible head motion. In 2020, we implemented an fMRI task training program, via telehealth and/or mock MRI. We aimed to determine whether training increased language lateralisation success and/or reduced head motion in all patients, and in those with ADHD. We also aimed to determine whether patients with ADHD exhibited more head motion during fMRI than those without ADHD. Methods We retrospectively identified 223 epilepsy (85%) and other neurosurgery patients, (241 scans including repeats) with language fMRI at Royal Children's Hospital, Melbourne, Australia, 2016-2024. There were 24 individuals with ADHD listed in the Electronic Medical Record, five of whom had diagnoses of both ADHD and autism; and nine with autism. Language lateralisation success was determined by clinician description recorded as left/right/bilateral in the medical record. 99 patients were provided the training including fMRI task practise. Head motion was quantified by maximum Framewise Displacement (FDmax; mm). Results ADHD was associated with lower language lateralisation success. Training was associated with greater language lateralisation success, across all patients, and in those with ADHD. Regarding ADHD and head motion, outliers in FDmax were seen in 5 young patients with ADHD. Data were trimmed to allow separate investigation of FDmax for the sample with and without extremes of head motion. In untrimmed data, FDmax was significantly higher in patients with ADHD than in those without. In trimmed data, FDmax was on average lower in patients with ADHD than those without, however this was not statistically supported. Regarding training and head motion, across all patients, FDmax was significantly lower for scans with training than without. In patients with ADHD, FDmax was on average lower for scans with training, however training was not associated with FDmax. Conclusions Language fMRI training was associated with higher language lateralization success, particularly in patients with ADHD. Training was associated with reduced head motion across all patients. Although some young patients with ADHD had substantial head motion, most in our sample did not move more than those without ADHD. We conclude that the training program increases success of language fMRI, and that an ADHD diagnosis should not be a contraindication to language fMRI.

Background:Mild neurocognitive disorder (NCD) is a condition in which individuals experience mild cognitive decline but are independent in their activities of daily living. Due to the increasing number of people living with mild NCD and its negative impact on the quality of life, it poses a significant health burden worldwide. Thus, it warrants an urgent need for innovative approaches to address the lack of effective treatment options. Deep transcranial magnetic stimulation (dTMS), a non-invasive neuromodulation technique approved for the treatment of various neuropsychiatric disorders, could serve as a novel intervention for mild NCD. It can stimulate deeper and broader areas of the brain implicated in mild NCD, such as the prefrontal cortex, insula, and anterior cingulate cortex. Objectives:This study will examine the feasibility and tolerability of the Health Canada and Food and Drug Administration (FDA) approved dTMS coils (H1, H4 and H7 coils) in individuals with mild NCD. Secondarily, it will assess the impact of dTMS on cognition, mood, sleep, anxiety, brain activity (via electroencephalography), and blood biomarkers of neurodegeneration and inflammation. Methods: This open-label pilot study will recruit a total of N=30 participants between the ages of 60-90 with mild NCD. Participants will be assigned to one of the three dTMS coil conditions (H1, H4 & H7) and will complete a total of 20 dTMS sessions over 6 weeks. Data will be collected before, during, immediately after, and one-month following the intervention period. Discussion: This pilot study will generate necessary evidence regarding the feasibility and tolerability of dTMS in mild NCD. This will be used to determine whether a definitive trial is justified and inform the trial procedures. In the long term, dTMS may address a critical gap in therapeutic options for mild NCD. Clinical Trial registration:The protocol was registered on Clinicaltrials.gov (CT07038798) on June 2nd, 2025.

Background and Objectives In ADHD, a heterogeneous neurodevelopmental condition, behavioral and motor manifestations may reflect multiple inefficient or perturbed inhibitory systems. To evaluate Transcranial Magnetic Stimulation (TMS) evoked cortical silent period (CSP) duration, an indicator of GABA(B) receptor-mediated inhibition in motor cortex, as a potential biomarker of Attention-Deficit/Hyperactivity Disorder (ADHD) in children. Method We retrospectively analyzed TMS data, obtained using both round and figure-of-8 coils, from three cross-sectional studies conducted in 8- to 12-year-old children with ADHD (n=79; 10.7 +/- 1.5 years old) and age-and-sex-matched typically developing controls (n=96; 10.5 +/- 1.4 years old). Results Median CSP was 32% shorter in ADHD (p=0.02). Regression analysis demonstrated a relationship between shorter CSP and both lower active motor thresholds (p < 0.0001) and more severe hyperactivity symptom rating (p = 0.026). Test-retest CSP measures in 83 children showed moderate reliability (intraclass correlation 0.77 [ADHD], 0.75 [controls]). Conclusion TMS-evoked CSP may be a useful biomarker in future investigations of ADHD subtypes, domains of impaired function, or treatment outcomes.

BackgroundCognitive impairment poses a significant challenge to healthcare systems worldwide, impacting patient autonomy, social participation, and quality of life, while placing a considerable burden on caregivers. Non-pharmacological interventions, particularly cognitive training and non-invasive brain stimulation, have emerged as promising therapeutic strategies. ObjectiveThis study aims to quantify the synergistic effects of transcranial direct current stimulation (tDCS) with cognitive training on cognitive function across a spectrum of pathologies that induce cognitive impairment. MethodsWe conducted a systematic review and meta-analysis following PRISMA guidelines. We searched PubMed for randomized controlled trials that investigated the effect of combined tDCS and cognitive training compared with cognitive training alone. The analysis was based on the GRADE framework for systematic reviews and meta-analyses. ResultsAcross 27 studies including 1,012 participants, tDCS combined with cognitive training showed a small effect compared with cognitive training alone (SMD = 0.36, 95% CI: 0.15-0.56). The effect was found only immediately after the intervention and declined during follow-up. ConclusiontDCS combined with cognitive training may provide a small, short-term benefit for cognitive function, but high heterogeneity across studies and loss of effect at follow-up underscore the need for larger, better-standardized trials to clarify its clinical value. Highlights- Combined tDCS and cognitive training produce a small but statistically significant short-term improvement in global cognitive performance. - Effects attenuate over time, highlighting limited durability without sustained or maintenance interventions. - High methodological heterogeneity and very low certainty of evidence limit broad clinical generalization.

Apathy is characterized by reduced motivation for goal-directed behaviour and may emerge following brain injury. Currently, little is known about apathy in children and adolescents with neurodevelopmental disorders (NDDs) exposed to repetitive head impacts. This exploratory study investigated associations between apathy, repetitive head-banging behaviour, and substantia nigra neuromelanin-sensitive MRI (NM-MRI) signal in youth with NDDs. Forty-seven participants (14 typically developing; 33 ADHD/ASD) completed Behaviour Assessment System for Children (BASC-3) measures, from which apathy-related items were harmonized across developmental forms and subjected to principal component analysis. A one-component solution explained 47.3% of variance and was used to derive apathy scores. Although head-banging severity and NM-MRI signal were not independently associated with apathy, a significant interaction emerged, whereby greater head-banging severity strengthened the relationship between apathy and substantia nigra NM-MRI signal. These preliminary findings suggest repetitive self-injurious head impacts may influence dopaminergic systems linked to motivational dysfunction in youth with NDDs.

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.

BackgroundCognitive dysfunction is a prevalent and debilitating symptom of post-COVID-19 condition with limited evidence-based interventions. Here, we assessed the efficacy of cognitive training (CT) alone and combined with transcranial direct current stimulation (tDCS) for cognitive enhancement in post-COVID-19 patients. MethodsNeuromod-COV was a phase IIb, prospective, randomized, open-label, blinded-endpoint trial conducted at University Medicine Greifswald, Germany. The tDCS intervention was evaluated through a double-blind, sham-controlled design. Adults aged 18-60 with confirmed SARS-CoV-2 infection [&ge;] 6 weeks prior and post-infection cognitive complaints were eligible. Participants were randomly assigned (1:1:1) to CT with active tDCS (CT+AtDCS), CT with sham tDCS (CT+StDCS), or progressive muscle relaxation (PMR, non-cognitive control intervention) with sham tDCS. Intervention consisted of nine 20-minute sessions over three weeks of CT (letter updating task) or PMR with 2 mA tDCS (active/sham) applied over the left dorsolateral prefrontal cortex. The primary outcome was untrained working memory (WM; measured by N-back task accuracy) comparing CT with PMR at post-intervention. Secondary outcomes included trained and untrained WM, visuospatial memory, and self-report measures at post-intervention and 1-month follow-up comparing CT vs. PMR and CT+AtDCS vs. CT+StDCS. The trial was registered at ClinicalTrials.gov (NCT04944147). ResultsBetween October 1, 2021, and August 7, 2024, 60 participants were randomized (76.7% female) to CT+AtDCS (n = 20), CT+StDCS (n = 20), or PMR (n = 20). CT did not improve untrained WM at post-intervention compared with PMR (primary outcome: {beta} = 1.59, 95% CI - 1.30 to 4.48, p = 0.278; 1-back: {beta} = 2.52, 95% CI -1.27 to 6.31, p = 0.191; 2-back: {beta} = 0.66, 95% CI -3.12 to 4.44, p = 0.732). However, CT+AtDCS enhanced untrained WM at post-intervention and follow-up, and visuospatial memory at post-intervention compared with CT+StDCS (secondary outcomes). No intervention improved self-report outcomes. No serious adverse events occurred and incidence rate ratios were similar between groups. ConclusionCT alone did not improve untrained WM performance. However, CT with tDCS enhanced untrained WM and visuospatial memory, suggesting potential benefits of combined neuromodulation approaches for cognitive enhancement in post-COVID-19 patients.

IntroductionCoronary artery disease (CAD) increases the risk of cerebrovascular events, yet early brain injury in this population remains poorly characterized. White matter hyperintensities (WMHs), a biomarker of cerebrovascular lesions, are prevalent in CAD and are linked to risk of stroke. Beyond total burden, spatial distribution of WMHs carries pathological significance and is critical for understanding CAD-related injury. While clinical outcomes including coronary revascularization procedure and myocardial infarction influence CAD prognosis, their impact on WMH burden remains unclear. MethodsThis study investigated regional WMH burden in CAD and its relationship with clinical characteristics. 82 adults over 50 years participated, including 44 individuals with CAD and 38 controls. WMHs were segmented from fluid attenuated inversion recovery and T1-weighted MRI and categorized as total, periventricular, deep, and superficial regions. History of myocardial infarction and coronary revascularization (coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI)), was obtained from medical files. ResultsIndividuals with CAD exhibited higher total, periventricular, and deep WMH volumes than controls. Participants who underwent CABG had higher superficial WMH volumes than those with PCI, suggesting greater disease severity influences WMH burden. ConclusionCAD is characterized by a distinct pattern of cerebrovascular vulnerability, with revascularization procedures influencing WMH burden

PURPOSE: The UK7T travelling head dataset was used to characterise the reproducibility of 7T measurements of the susceptibility of the hippocampal subfields, focusing on the Cornu Ammonis (CA1, CA2 and CA3), dentate gyrus (DG), subiculum (SUB), tail of the hippocampus (TAIL) and entorhinal cortex (ERC). METHODS: Susceptibility maps were created from whole-brain 3D single-echo GRE data (TE=20 ms; 0.7 mm isotropic resolution) using Multi-Scale Dipole Inversion. Automatic Segmentation of Hippocampal Subfields (ASHS) was applied to high resolution T1- and T2-weighted images for segmentation. The mean magnetic susceptibility and volume of hippocampal subfields was evaluated in 50 data sets, comprising 5 repeat acquisitions on 10 healthy participants (age 32 + or -6 years; 3 female). RESULTS: Averaging over subjects, susceptibility values spanned an 18ppb range over the hippocampus (ranging from -13.3ppb in DG to 4.7ppb in ERC). Susceptibility values in the larger hippocampal subfields showed a consistent pattern of variation across subjects, being generally more positive in ERC and SUB than in CA1 and more positive in CA1 than in DG and TAIL. The standard deviation of subfield susceptibilities over subjects ranged from 8.2ppb in the TAIL to 1.7ppb in CA1, and the average standard deviation across repeated measurements, which ranges from 1.7 to 4 ppb, was less than half of the inter-participant standard deviation in all subfields. Susceptibility values in the smaller subfields (CA2 and CA3) were more variable, but ICC(2,k) values for all subfields were >0.82. CONCLUSION: The reported data characterises the variation and reproducibility of hippocampal subfield susceptibility measurements at 7T.

PurposePost-acute sequalae of SARS-CoV-2 (PASC) are associated with persistent neurological symptoms (neuroPASC). Perivascular spaces (PVS) in the brain may enlarge in the context of inflammation and vascular dysfunction, reflecting impaired glymphatic clearance, and have been linked to cognitive decline. SARS-CoV-2 may disrupt the blood-brain barrier and impair glymphatic function, contributing to PVS burden. This study used 7 Tesla MRI to segment and quantify PVS in neuroPASC participants and uninfected comparators and examined associations with cognitive performance. MethodsAdult participants (36 neuroPASC (44.3 {+/-} 12.7 years) and 33 comparators (38.4 {+/-} 13.0 years)) underwent a 7 Tesla MRI scan. White matter masks of the whole brain and four lobes were segmented, and semi-automated segmentation was used to quantify PVS count and volume. All participants completed cognitive testing including Trails A and B sequencing tasks; neuroPASC participants also self-reported brain fog, fatigue, anxiety, and depression. PVS count, PVS volume, and total white matter volume (WMV) between groups were compared and associations between PVS metrics and cognitive function were assessed controlling for age, sex, and intracranial volume and corrected for multiple comparisons. ResultsAmong neuroPASC participants, those reporting anxiety (p =0.009) and depression (p =0.01) had higher WMV than those without. Greater PVS burden was associated with worse cognitive performance in PASC, particularly processing speed (Trails A) and executive function (Trails B). Specifically, processing speed was negatively associated with whole-brain PVS count (p-FDR = 0.008, R2 = 0.27), frontal PVS count (p-FDR = 0.03, R2 = 0.25), and frontal PVS volume (p-FDR = 0.04, R2 = 0.23). Trails B was also negatively associated with whole-brain PVS count (p-FDR = 0.005, R2 = 0.26). In comparators, higher PVS burden (volume and count) across multiple lobes was associated with worse semantic fluency (Animal Naming). There were no other significant associations between PVS measures and neuropsychiatric tests among participants within any of the subgroups to report. ConclusionAlthough group-level differences in PVS were not observed, PVS burden was meaningfully negatively associated with cognitive performance in neuroPASC, with the strongest effects in frontal regions. These findings suggest that microvascular and glymphatic alterations may contribute to the characteristic processing speed and executive dysfunction seen in neuroPASC. Elevated WMV in those with anxiety and depression may reflect heightened inflammatory vulnerability. PVS may serve as a sensitive imaging marker of glymphatic dysfunction and neuroinflammation in neuroPASC, offering insight into the mechanisms underlying cognitive impairment and potential intervention targets.

BackgroundTheory of Mind (ToM) deficits are well-documented in right-hemisphere stroke but remain understudied in post-stroke aphasia. Prior work suggests that performance on tasks assessing ToM may be relatively preserved in aphasia and dissociable from language impairment, but these findings are based largely on small studies. This study examined performance on nonverbal false-belief tasks in post-stroke aphasia, its relationship with aphasia severity, and whether vascular brain health, operationalized using cerebral small vessel disease (CSVD) markers, contributed to variability in performance. MethodsForty-four individuals with aphasia completed two nonverbal belief-reasoning tasks assessing spontaneous perspective-taking and self-perspective inhibition. Task accuracy served as the primary outcome. Linear regression models examined associations between task performance, aphasia severity (Western Aphasia Battery-Revised Aphasia Quotient), and CSVD markers, including white matter hyperintensities, cerebral microbleeds, lacunes and enlarged perivascular spaces in the basal ganglia and centrum semiovale. ResultsPerformance was heterogeneous across tasks, with reduced performance observed in 23% of participants on the Reality-Unknown task and 36% on the Reality-Known task. Aphasia severity was not associated with task accuracy. Greater cerebral microbleed count was associated with lower accuracy on both tasks, while greater basal ganglia enlarged perivascular spaces burden showed a more selective association with lower performance. ConclusionsPerformance on nonverbal false-belief tasks in aphasia is variable and not explained by aphasia severity alone. These findings suggest that apparent ToM-related difficulties in aphasia may be shaped by broader vascular brain health, supporting a more multidimensional framework for interpreting social-cognitive task performance after stroke.

BackgroundDepression is a mood disorder frequently associated with episodic memory impairment. However, it remains unclear whether functional brain activity differs between depressed and non-depressed individuals during encoding or retrieval of autobiographical or non-autobiographical memories. Clarifying these differences is important for refining theoretical models of memory impairment in depression and, potentially, for developing targeted interventions. MethodsWe conducted three coordinate-based meta-analyses examining encoding and retrieval of autobiographical and non-autobiographical memory in control participants and individuals with current, remitted, or subthreshold depression, or those at risk for depression. Studies were identified via database searches and analysed using Seed-based d Mapping. ResultsWe included coordinates from 21 fMRI studies. During encoding, depression was associated with reduced activity in the thalamus, the caudate, the salience network, the frontoparietal executive control network, and motor-related areas (ten studies, N = 506). During non-autobiographical retrieval, depression was associated with higher activity in the right inferior frontal gyrus (six studies, N = 332). During autobiographical retrieval, depression was associated with reduced activity in the right insula and fusiform gyrus, alongside increased activity in the left anterior cingulate cortex and the left middle frontal gyrus (ten studies, N = 423). Between-study heterogeneity was low and no evidence for publication bias was found. DiscussionOur results indicate that depression may be associated with impaired salience integration during encoding and autobiographical retrieval. In contrast, during non-autobiographical retrieval, increased frontal activity suggests a more vigilant or self-monitoring retrieval mode. Functional brain activity changes in depression therefore appear stage- and content-specific.

Moderate-to-severe traumatic brain injury (msTBI) is recognized as a chronic and evolving neurological condition characterized by progressive structural brain changes and persistent cognitive impairment. While prior studies have demonstrated widespread atrophy following msTBI, less is known regarding the longitudinal trajectory of gray matter (GM) changes during recovery and post-rehabilitation. The current study used longitudinal voxel-based morphometry (VBM) to characterize GM volume changes over a period of 9 months, in individuals with msTBI relative to healthy controls (HC). Associations between regional GM volume and neuropsychological functioning were examined. Twenty-eight participants (14 msTBI, 14 HC) completed MRI and neuropsychological assessments across three timepoints spanning outpatient rehabilitation and follow-up. Longitudinal VBM analyses revealed significant group and time interactions within subcortical and limbic regions. Relative to HC, individuals with msTBI showed lower GM volume in these regions at baseline, with trajectories that converged toward HC values (right hippocampus) or increased relative to HC over the rehabilitation period (bilateral pulvinar), whereas the right amygdala and inferior cerebellar vermis remained persistently reduced. Significant longitudinal improvements in memory and psychomotor speed during the rehabilitation period were demonstrated in msTBI. Greater (preserved) GM volume within the right hippocampus, thalamus, and bilateral pulvinar was associated with better performance across measures of verbal memory, processing speed, executive functioning, and cognitive flexibility. These findings suggest that msTBI is associated with dynamic structural brain changes involving subcortical, limbic, and cerebellar networks, and that the rehabilitation period was accompanied by relative volumetric stabilization in these regions and by meaningful cognitive improvement.

Background: Amyloid-beta PET provides critical biomarker data for Alzheimer's disease diagnosis and anti-amyloid therapy evaluation, yet low spatial resolution and partial volume effects result in decreased interpretability, particularly in cases with low or borderline cortical amyloid burden. While quantitative metrics (SUVr, Centiloid) aid in interpretation of amyloid burden, disagreement between visual reads and quantitative burden does occur, further blurring the line between positive or negative scans. We evaluated whether a vendor-neutral MR-guided PET denoising and resolution enhancement method (MRG) that uses Bowsher regularization improves image interpretability and reader performance while preserving established quantitative biomarkers across multiple amyloid tracers, leading to increased concordance among visual reads and quantitative metrics. Methods: Standard (STN) and MRG PET images were compared for four tracers ([18F]AV-45 ([18F]florbetapir, FBP), [18F]florbetaben (FBB), [18F]flutemetamol (FMM), and [11C]Pittsburgh compound-B (PiB) collectively from 24 MRI and 33 PET scanners. Quantitative equivalence was assessed by comparing Standardized Uptake Value ratio (SUVr) and Centiloid scores. In three of the four tracers (FBP, FBB, FMM), visual-quantitative concordance (AUC) and reader performance were evaluated in a blinded multi-reader study by four highly experienced brain PET readers who assessed image quality, artifact severity, reader confidence, and binary amyloid positivity. Results: Across all tracers, MRG preserved quantitative SUVr and Centiloid metrics relative to STN (R2 >0.90 for all tracers) without introducing bias to the SUVr metric. Concordance between visual reads and quantitative burden measures significantly improved with MRG. In the multi-reader study, MRG resulted in significantly higher image quality, lower artifact burden, and greater reader confidence compared to STN (p < 0.0001). Reader accuracy increased from 0.89 to 0.94, and the false-negative rate decreased from 0.08 to 0.04. Crucially, improvements in reader confidence, accuracy, and the reduction in false negative reads were most pronounced in cases with low amyloid burden near the threshold of visual positivity. Conclusions: MRG denoising and resolution enhancement improved perceived image quality, reader confidence, and accuracy for amyloid PET while preserving standard quantitative behavior across tracers. By improving cortical definition in visually challenging low-burden cases without disrupting established SUVr/Centiloid behavior, MRG may reduce visual-quantitative discordance and support more confident amyloid PET interpretation near the threshold of positivity.

Obsessive-compulsive disorder (OCD) is characterized, in part, by repetitive, sequential behaviors, such as cleaning rituals, yet underlying neural circuitry related to abstract sequencing in OCD remains poorly understood. Prior work has implicated a set of cortical regions activated during abstract sequences, which are defined by rules rather than specific stimulus features (Desrochers et al., 2022). These regions include the rostrolateral prefrontal cortex (RLPFC) that is necessary for performance on abstract sequence tasks (Desrochers et al., 2015), as well as the anterior cingulate cortex/dorsolateral prefrontal cortex (ACC/DLPFC), supplementary motor area (SMA), middle temporal gyrus (MTG), and temporo-occipital junction (TOJ) that are differentially activated in OCD compared to healthy participants during abstract sequencing (Doyle et al., 2026). It remains unclear, however, whether these regions form a coordinated circuit, and how their interactions may differ in OCD. In the present study, we examined task based functional and effective connectivity among these regions using a previously published dataset. We tested hypotheses that connectivity within this circuit would be altered in OCD relative to healthy controls (HCs), and that prefrontal regions (ACC/DLPFC and RLPFC) would direct information to downstream regions (SMA, MTG, and TOJ) during a sequential task. We found that connectivity within this circuit differed significantly between groups. HCs exhibited less negative connectivity from the ACC/DLPFC to the TOJ and stronger positive coupling between the MTG and TOJ, as well as stronger coordination between the RLPFC and DLPFC, suggesting coordinated prefrontal control. In contrast, individuals with OCD showed increased connectivity between the RLPFC and MTG, indicating a more direct influence of RLPFC on posterior regions. Effective connectivity analyses further indicated that, across participants, the ACC/DLPFC and MTG function as central hubs of information flow, with task-related inputs entering the circuit via the TOJ, propagating through the MTG to the RLPFC, and subsequently modulating ACC/DLPFC and downstream regions. These findings suggest a shared underlying circuit architecture in OCD and healthy participants despite differences in functional coupling, particularly involving prefrontal cortical regions. Overall, differences arise at the level of functional coordination within a preserved circuit for abstract sequential processing in OCD, adding to current neurobiological models of OCD and suggesting a novel circuit that supports abstract sequencing.

BackgroundTheta-frequency transcranial alternating current stimulation (tACS) over prefrontal cortex has been proposed to modulate working memory (WM), yet behavioral effects are often inconsistent. One potential source of variability is the tACS phase during stimulus presentation. ObjectiveWe tested whether behavioral performance during WM depends on the phase of prefrontal theta-tACS. MethodsTwenty participants completed two sessions of prefrontal 4 Hz tACS in a within-subject design, receiving active and sham stimulation in separate sessions. Participants performed a visuospatial change detection task (CDT) and a verbal N-back task. Stimulation effects on overall accuracy and reaction time were analyzed. Subsequently, phase-specific analyses related stimulation phase at task-relevant stimulus presentation to behavioral performance using circular regression models. Preferred phases across participants were tested using Rayleigh tests. ResultsNo significant overall effects of active compared with sham tACS on accuracy or reaction time were observed in either task. However, phase-specific analyses revealed stronger phase-dependent modulation of reaction time during active tACS compared with sham. In the CDT, this effect was present across difficulty levels, whereas in the N-back task it was observed only in the 3-back condition. No reliable phase-dependent effects were observed for accuracy. Preferred phases varied across participants and did not cluster around a common phase. ConclusionsPrefrontal theta-tACS can modulate WM performance in a phase-dependent manner even in the absence of average behavioral effects. The observation of phase-dependent reaction-time modulation across visuospatial and verbal WM tasks suggests that stimulation phase may be a relevant source of variability across cognitive domains.

Much of a typical individuals mental life is characterized by spontaneous thoughts that occur independently of external stimuli. In prior studies, ongoing mental experiences and their neural correlates have been captured using thought probes presented at random intervals during functional Magnetic Resonance Imaging (fMRI). However, this approach results in temporally imprecise estimates of brain activity relative to the arising of mental experience. In this preregistered, proof-of-concept study, we aimed to improve temporal precision using a novel method termed real-time fMRI-triggered experience-sampling (rt-fMRI-ES). We analyzed blood-oxygenation-level-dependent signals in real time during a wakeful resting state (n=60) to trigger thought probes from spontaneous activations within two regions: the dorsal anterior insular cortex (daIC; a key region within salience network) and posteromedial cortex (PMC; a key region within default mode network). We tested two preregistered hypotheses: (H1) Ratings of arousal time-locked to daIC-activation trials are higher than ratings time-locked to non-daIC-activation trials; (H2) Ratings of external-attention time-locked to PMC-activation trials are lower than ratings time-locked to non-PMC-activation trials. After applying preregistered exclusion criteria, 42 participants (1243 trials) and 49 participants (1429 trials) were included in H1 and H2 analyses, respectively. We did not find evidence in support of H1, but we did find evidence in support of H2, as external-attention ratings were significantly lower for trials triggered by PMC activation compared to other trial types. Taken together, we successfully developed and validated the rt-fMRI-ES method, offering a novel technique to efficiently capture spontaneous thoughts based on ongoing neural activity. Preregistered Stage 1 Recommendationhttps://osf.io/sd4hu (Date of in-principle acceptance: 07/24/2024; under temporary private embargo)