Neuroscience & Biobehavioral Reviews

Importance: Glucose metabolic dysregulation in brain is a common feature of late-onset age-associated neurodegenerative disease (A2ND). Prior meta-analyses have identified disease-specific effects compared to healthy, unimpaired individuals. Yet, a unifying A2ND glucose dysregulation spatial signature remains undescribed. Objective: To determine the common signature of dysregulated glucose metabolism on FDG-PET using activation likelihood estimation (ALE) meta-analyses across A2ND. Data Sources: Searches were conducted using MEDLINE, Embase, PsycINFO, Scopus, and Cochrane from inception through July 2025. The search terms included controlled vocabulary and keywords for four neurodegenerative diseases Parkinson Disease, Amyotrophic Lateral Sclerosis, Alzheimer Disease, and Multiple Sclerosis, Fluorodeoxyglucose F18, glucose, and positron-emission tomography (PET). Study Selection: Studies comparing adults with late-onset neurodegenerative diseases to non-diseased controls using FDG-PET to quantify brain glucose uptake and reporting whole-brain coordinate findings in either Talairach or Montreal Neurological Institute space were included. Data Extraction and Synthesis: Three researchers, assisted by an AI screening tool, screened 7275 potential titles and abstracts for inclusion. Full texts were then retrieved for potentially relevant articles and were evaluated by three researchers using prespecified inclusion/exclusion criteria. Main Outcomes and Measures: Cluster peak and subpeak coordinates, cluster-wise t- or Z- values, and annotations indicating the disease of interest, whether the outcome was for hyper- (disease group > control) or hypometabolism (disease group < control), were extracted from included texts and analyzed using ALE. Results: A total of 130 FDG-PET studies were included in the meta-analysis, with a combined sample of 5412 individuals with A2ND and 3549 controls. Meta-analyses revealed dysregulated glucose metabolism as a unifying feature across A2ND which included both hypo- and hypermetabolic patterns. Neuroanatomical metabolic pattern was unique and disease specific. Each A2ND metabolic phenotype was associated with unique and complex patterns of neurological functionalities. Conclusions and Relevance: These data demonstrate dysregulated glucose metabolism as a common A2ND feature, suggesting responsive remodeling of neural bioenergetics. While hypometabolism is a common research focus, due to functional relevance, hypermetabolism may reflect a compensatory, maladaptive, or neuroinflammatory signal, that requires focused investigation. A2ND prevention and treatment efficacy may depend on addressing bidirectional metabolic dysregulation in addition to disease-specific drivers of pathology.

The impact of social parameters on brain health among people with traumatic brain injury (TBI) has been extensively documented. However, translation of this evidence into policy and clinical practice remains limited. This may reflect a lack of coordinated and equity-driven approaches to brain health that integrate diverse stakeholder perspectives, limiting progress toward equity-oriented research and service delivery models. We conducted a convergent parallel mixed-methods study guided by the REporting guideline for PRIority SEtting of health research (REPRISE). We utilized the PROGRESS-Plus framework (Place of residence, Race/ethnicity, Occupation, Gender/sex, Religion, Education, Socioeconomic status, Social capital, and context-specific parameters) to ensure systematic consideration of social parameters in the study. For Objective 1, we synthesized existing evidence on social parameters and brain health outcomes. For Objective 2, we surveyed people with lived experience of TBI, family members/friends, clinicians, researchers, and community leaders across the globe to assess their prioritization of social parameters relevant to brain health. For Objective 3, we integrated evidence synthesis and stakeholder input through a structured Round Robin consensus activity to prioritize actionable areas for feasibility and impact. The activity culminated in the development of a knowledge mobilization agenda designed to inform equity-centred policy, research, and clinical practice. In Objective 1, we identified 59 publications with evidence on the effect of PROGRESS-Plus parameters on brain health outcomes following TBI. Meta-research highlighted that education, age, and country-level indicators are prognostic for brain health after TBI. In Objective 2, the highest-ranked priorities of 113 stakeholders across four continents (North America, Europe, Africa, and Oceania) were education, access to benefits, and income. These priorities were at the centre of discussion in Objective 3, which comprised idea sharing, refinement and thematic clustering, and a final prioritization poll. The resulting final 15 priorities were organized into two tracks: Track A, actions feasible in the short term, and Track B, longer-term implementation priorities. Building on this priority-setting process, co-created with stakeholders around the globe, the findings provide a roadmap for integration of social parameters in TBI research, knowledge exchange, policy, and practice.

RATIONALEEnvironmental enrichment (EE) paradigms in rodents have long demonstrated that enhanced sensory, cognitive, social, and motor stimulation positively impacts brain function, improving learning, memory, and neuroplasticity. These effects have significant implications for understanding cognitive development and mitigating cognitive decline and brain aging. While numerous transcriptomic studies have explored EE-induced molecular changes, a unified view of the genes and pathways consistently modulated remains lacking. METHODSTo address this gap, we performed a systematic review and meta-analysis. We conducted a comprehensive PubMed search for all studies published up to February 2025 that matched all the following inclusion criteria: (1) employed EE paradigms; (2) were conducted on rodents; (3) utilized genome-wide transcriptomic methods; (4) examined brain regions or neuronal populations. The 323 retrieved articles were manually screened for relevance to the study aims and data availability. Datasets from 20 eligible RNA-seq reports were reprocessed using a unified analysis pipeline and subjected to a meta-analysis with three complementary statistical methods. RESULTSDespite considerable heterogeneity across studies, our integrative analysis identified consistent gene expression signatures linked to synaptic function, plasticity and their transcriptional regulation. These molecular insights advance our understanding of how EE impacts on neuronal and behavioural outcomes, and may inform therapeutic strategies aimed at replicating or enhancing EE benefits. To promote open science and foster further research, we developed an accessible web application, mEEtaBrain, that enables the neuroscience community to navigate and interrogate our meta-analysis results.

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.

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.

Cognitive control is fundamental to goal-directed behavior, and its protracted maturation is a hallmark of adolescent brain development. In adulthood, the inferior frontal junction (IFJ) is functionally characterized as a critical region for updating task representations to guide the implementation of cognitive control. Yet, how its domain-general control functions emerge and mature across development remains largely underexplored. Specifically, it is unclear whether the IFJs capacity for cognitive control enhances uniformly as a single construct, or if this region matures asynchronously for distinct control processes like inhibition, switching, and working memory. To address this gap, we conducted a combined systematic review and coordinate-based neuroimaging meta-analysis. Applying multilevel kernel density analyses to fMRI studies of inhibition, switching, and working memory in youth and adults, we synthesized data from 72 contrasts (779 foci; N = 1,913). The results revealed a staggered developmental trajectory for IFJ recruitment. While adults showed consistent convergence of activation in the IFJ across all three domains, youth exhibited robust bilateral IFJ convergence exclusively during inhibitory control tasks. This suggests inhibition may be a developmentally foundational process localized to this region earlier in the lifespan. Furthermore, adults demonstrated hemispheric specialization absent in youth: left IFJ was uniquely sensitive to switching and working memory in adults, but not in youth. Together, these findings support a model where the IFJ does not mature as a static, monolithic node, but rather acts as a dynamic hub that integrates fractionated cognitive processes at different stages of development.

Dopamine signaling plays critical roles in postnatal brain development, yet the molecular consequences of early dopaminergic disturbance remain incompletely understood. Here, we investigated transcriptomic alterations in the prefrontal cortex (PFC) and striatum (STR) of mice subjected to early postnatal dopaminergic disturbance by 6-hydroxydopamine (6-OHDA) treatment. Using bulk RNA sequencing (RNA-seq) and weighted gene co-expression network analysis (WGCNA), we identified 369 differentially expressed genes (DEGs) in the PFC, 493 DEGs in the STR, and 32 co-expression modules with region-specific expression patterns. Functional enrichment analyses showed that PFC DEGs were associated with cortical development, plasma membrane signaling, and transcriptional regulation, whereas STR DEGs were enriched for striatal development, locomotion, extracellular matrix organization, and amphetamine response. Co-expression network analysis further identified module-specific enrichments related to developmental, synaptic, metabolic, immune-related, and transcriptional programs. DEG sets from both regions also overlapped with genes implicated in attention-deficit/hyperactivity disorder (ADHD) and other neuropsychiatric disorders. Together, these findings reveal region-specific cortico-striatal transcriptomic remodeling following early postnatal dopaminergic disturbance and identify molecular programs that may link developmental dopaminergic perturbation to later behavioral phenotypes. HighlightsO_LIEarly dopaminergic disturbance reshapes cortico-striatal transcriptomes C_LIO_LIPFC changes were linked to developmental and transcriptional programs C_LIO_LISTR changes were linked to locomotion and extracellular matrix programs C_LIO_LINetwork analysis revealed region-specific developmental and synaptic programs C_LI

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.

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.

Patients with brain tumors involving language-critical regions face surgical limitations when balancing resection with preservation of function. Non-invasive neuromodulation-induced prehabilitation (NIP) aims to guide preoperative neuroplastic reorganization, potentially facilitating larger resections while preserving function. We investigated whether NIP selectively modulates the targeted language network compared with control networks, and whether such modulation is behaviorally safe. We enrolled 26 patients (mean age = 55.9 {+/-} 11.8 years) from the Prehabilita project (Clinical Trial: NCT05844605) with operable brain tumors affecting language or motor regions. Eleven received language-targeted NIP, combining transcranial magnetic stimulation and/or transcranial direct current stimulation with intensive language training. Fourteen patients with NIP targeting non-language networks, primarily motor networks, served controls. Assessments included task-based functional magnetic resonance imaging (tb-fMRI) and a neuropsychological battery assessing language and cognitive domains before and after prehabilitation. Results indicated a group-specific NIP effect on the language network. In the language-targeted group, tb-fMRI revealed reduced overlap between a region of interest centered on the stimulation target and fMRI-derived language activation maps, whereas no comparable changes were observed in controls. No significant modulation effects were detected in the motor network in either group. These findings indicate that NIP can selectively reorganize the language network, with modulation patterns differing in sensorimotor networks. Importantly, language network modulation occurred while preserving language and cognitive performance. These results support NIP targeting higher-order functions such as language as a safe preoperative strategy that may reduce functional constraints on surgery and enable larger and safer resections in patients with tumors involving language-critical regions.

Background. Meningiomas exhibit well-established hormonal biology, yet no study has examined whether myeloid immune infiltration interacts with estrogen-responsive transcription in this tumor type. Methods. We applied three-method consensus immune deconvolution (EPIC, MCPcounter, CIBERSORTx) to 968 harmonized meningioma RNA-seq transcriptomes from five public datasets, stratified by Thirimanne et al. (2024) transcriptomic subtypes. Competitive gene set enrichment compared macrophage-high versus macrophage-low tertiles with sex-adjusted, purity-adjusted, and method-independent sensitivity analyses. Survival modeling tested both total macrophage burden and a decomposed microglia-to-macrophage ratio validated against single-cell ground truth (pseudo-bulk r = 0.77). Results. Macrophage-high tumors showed significant suppression of estrogen response gene sets (FDR = 4.9 x 10-5) despite paradoxical ESR1 upregulation (log2FC = +0.40, FDR = 2.5 x 10-26) and PGR downregulation (log2FC = -0.34, FDR = 2.7 x 10-3), indicating post-receptor transcriptional disruption. This signal strengthened after sex adjustment (FDR = 1.9 x 10-6) and was confirmed across a multi-layer sensitivity battery (eleven analyses including reference-matrix-independent, purity-adjusted, rotation-based self-contained, and empirical-null tests; all FDR < 3 x 10-4 in the relevant convergent tests). Myeloid infiltration was strongly subtype-dependent (Kruskal-Wallis p = 7.4 x 10-16) but grade-independent (p = 0.399), with CSF1R enriched in the macrophage-dominant Cluster B. Neither total macrophage score (HR = 0.90, p = 0.53; N = 102) nor a decomposed microglia/macrophage ratio (HR = 0.92, p = 0.46; N = 101) predicted recurrence-free survival. Conclusions. The pre-registered primary endpoint - macrophage infiltration score predicting recurrence-free survival - was not supported; the estrogen-immune dissociation emerged from secondary exploratory gene-set analysis and requires independent validation. Macrophage-infiltrated meningiomas exhibit a previously unreported dissociation between maintained ESR1 expression and suppressed estrogen-responsive transcription, with implications for hormonal therapy stratification.

BackgroundMindfulness-based interventions (MBIs) have been increasingly adopted in educational settings to support cognitive development in youth. Executive function (EF)--encompassing inhibitory control, working memory, and cognitive flexibility--is a plausible target of MBI given its reliance on attention regulation. However, prior reviews have yielded mixed conclusions, partly due to inconsistent construct definitions and the pooling of heterogeneous outcome measures. ObjectivesTo (1) estimate the pooled effect of MBI on EF in youth aged 3-18 years using only construct-validated, direct EF measures, (2) examine potential moderators including age group, EF domain, and risk of bias, and (3) test dose-response relationships via meta-regression on intervention duration. MethodsWe searched PubMed, PsycINFO, CINAHL, Scopus, and Web of Science from inception to March 2026, supplemented by reference-list searches from two existing systematic reviews and a scoping review. Only English-language publications were eligible. Eligible studies were randomised controlled trials (RCTs) or quasi-RCTs of MBI (excluding yoga-only interventions) in typically developing youth, with at least one direct behavioural or computerised EF outcome. Risk of bias was assessed using Cochrane RoB 2. Hedges g was computed for each study, and pooled using a DerSimonian-Laird random-effects model. Subgroup analyses by age group, EF domain, and risk of bias were conducted, alongside leave-one-out sensitivity analyses, Eggers regression test, trim-and-fill, and Knapp-Hartung-adjusted meta-regression on intervention duration. Evidence certainty was rated using GRADE. ResultsThirteen RCTs (nine school-age, four preschool; total N = 1,560) met inclusion criteria. The pooled effect was g = 0.365 (95% CI 0.264 to 0.465; p < .00001), with negligible heterogeneity (I2 = 0.0%; Q = 6.76, p = .87). Effects were consistent across age groups (school-age g = 0.389; preschool g = 0.318) and EF domains (inhibitory control, working memory, cognitive flexibility; pbetween = .60). Meta-regression on intervention duration (4-20 weeks) was non-significant (p = .79). The effect was robust in leave-one-out analyses, in the low risk-of-bias subgroup (g = 0.361; k = 8), and after trim-and-fill adjustment (g = 0.354). The 95% prediction interval (0.252 to 0.477) was entirely positive. GRADE certainty was rated MODERATE, downgraded once for risk of bias. ConclusionsMBIs appear to produce a small, statistically significant improvement in EF in youth aged 3-18 years, with moderate certainty of evidence per the GRADE framework. The effect is consistent across preschool and school-age samples and across EF domains, with no significant dose-response relationship within the 4-20 week range studied. Emerging mediation evidence suggests that EF improvement may serve as an important pathway through which MBI supports emotion regulation, though this requires replication. Further large-scale, pre-registered RCTs with active control conditions and longitudinal follow-up are warranted.

3,4-methylenedioxymethamphetamine (MDMA) has emerged as a potential treatment for post-traumatic stress disorder (PTSD), generating considerable enthusiasm in the field. However, rapidly changing evidence in a fast-moving field can be challenging to integrate. Here, we present a living systematic review and open-data meta-analytic resource on MDMA treatment for PTSD. In this initial release, six randomized controlled trials comprising 286 participants are included in the database. Our primary model uses inverse-variance random-effects meta-analysis of standardized mean differences on primary outcomes of PTSD. Compared to control conditions, MDMA showed a greater reduction in PTSD symptoms (Hedges' g = -0.71). Meta-regression on both the number of dosing sessions and cumulative dose showed that a higher number of dosing sessions and a higher cumulative dose was related to larger effects of MDMA. Treatment with MDMA as compared to placebo also resulted in higher response (risk ratio (RR) = 1.35) and remission (RR = 2.25) rates. Most studies included in the database had a low risk of bias according to Cochrane guidelines, though these fail to capture pertinent challenges in the field such as expectancy, functional unblinding, potential issues with study conduct, and safety. The current findings were assigned an overall low certainty rating using the GRADE approach. Together, this systematic review and meta-analysis suggests that MDMA-assisted therapy results in short-term decreases in PTSD symptoms across studies to date, though more trials are needed. This living systematic review, meta-analysis, database, and online dashboard (sypres.io) will continue to be updated as evidence emerges, providing a valuable, open, and transparent resource for researchers in a rapidly evolving field.

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

Background: Obsessive-compulsive disorder (OCD) is characterized by disturbing thoughts (obsessions) that initiate anxiety-reducing thoughts or behaviors (compulsions). For patients with treatment-resistant OCD (tr-OCD), neuromodulation techniques, like capsulotomy (a lesion in the anterior limb of the internal capsule) and deep brain stimulation (DBS), have emerged as interventions that likely regulate connectivity between the prefrontal cortex (PFC) and subcortical targets. Three patients (Cap-DBS1-3) underwent a failed capsulotomy followed by successful DBS. Here, we aimed to understand the brain connections disrupted by failed capsulotomy vs modulated by successful DBS. Methods: We used diffusion-weighted magnetic resonance imaging (dMRI) tractography in a control cohort with tr-OCD (n=12) and in two of the Cap-DBS patients themselves to determine connectivity profiles of the capsulotomy, volume of tissue activated (VTA), and potentially necessary tracts (VTA minus capsulotomy tracts). We used whole-brain, PFC-focused, and subcortically-focused tractography algorithms to fully explore the space of possible connections. Results: Capsulotomy regions-of-interest (ROIs) connected with a variety of PFC and subcortical regions. VTA ROIs and potentially necessary tracts had limited and inconsistent PFC connectivity but substantial subcortical connectivity. While correlated to the average OCD connectome (r = 0.214, 95% CI [0.177, 0.251]; r = 0.756, 95% CI [0.739, 0.772]), the Cap-DBS connectomes had many edges that were stronger (z-score > 3). Conclusions: The connectivity profile of potentially necessary tracts for successful DBS treatment after failed capsulotomy revealed a surprising proportion of subcortical regions and inconsistent PFC involvement, highlighting an often-ignored set of connections that may be critical to effective DBS.

ObjectiveTo conduct de novo meta-analyses quantifying the association of five biopsychosocial risk factor domains with chronic pain or related treatment outcomes, and to construct a composite risk index with formal uncertainty propagation for interventional pain medicine. MethodsUmbrella review with de novo random-effects meta-analyses (DerSimonian-Laird and REML with Knapp-Hartung adjustment) across PubMed/MEDLINE, Scopus, and the Cochrane Library through March 2026. Five risk factor domains were evaluated: (1) sleep disturbance, (2) pain catastrophizing, (3) metabolic/obesity, (4) preoperative opioid exposure, and (5) benzodiazepine co-prescription. Publication bias was assessed via Eggers test and PET-PEESE regression. Primary study overlap was quantified using the Corrected Covered Area (CCA). We constructed a primary three-domain composite (sleep, catastrophizing, metabolic) and a secondary expanded six-domain composite (adding opioid, BZD, smoking), using the logistic link function with binary risk factor inputs (present/absent); composite score 95% confidence intervals were computed via delta method variance propagation. Risk of bias of the composite was assessed using PROBAST [Wolff RF et al., Ann Intern Med 2019]; TRIPOD+AI compliance is reported in Supplementary S6 [Collins GS et al., BMJ 2024]. Reviewer process (per registered protocol PROSPERO CRD420261360881): screening, data extraction, risk-of-bias assessment (AMSTAR-2/PROBAST/ROBINS-I), and GRADE certainty rating are conducted independently by at least two reviewers -- SPM (confirmed co-reviewer, registered in PROSPERO) as primary rater, with an external third reviewer to be identified and confirmed prior to peer-reviewed submission; JAD acts as guarantor and does not perform primary review tasks. All quantitative outputs reported here are preliminary estimates pending completion of the external third-reviewer audit; a triple-validated version will be posted as a subsequent preprint update before peer-reviewed submission. ResultsAdopted odds ratios: sleep disturbance 1.39 (95% CI 1.21-1.59; k=16; I{superscript 2}=51%), pain catastrophizing 2.10 (1.49-2.95; k=8; I{superscript 2}=0%), metabolic/obesity 1.43 (1.28-1.60; k=33), preoperative opioid exposure 5.32 (2.94-9.64; k=33; I{superscript 2}=99.96%; outcome: prolonged opioid use), and BZD co-prescription 1.77 (1.31-2.39; k=27; outcome: persistent opioid use). REML/Knapp-Hartung estimates produced wider confidence intervals for all loops (opioid: 1.87-15.13). PET-PEESE analysis suggested no substantial small-study effects for the sleep or catastrophizing loops. CCA=3.2% (slight overlap). Primary three-domain composite (sleep + catastrophizing + metabolic): delta method 95% confidence intervals for the composite score spanned 10-15 percentage points; PROBAST risk of bias: moderate. Secondary expanded six-domain composite (adding opioid, BZD, smoking): confidence intervals spanned 12-18 percentage points, crossing risk tier boundaries in moderate-risk patients; PROBAST risk of bias: high (driven by outcome heterogeneity in pharmacological domains). ConclusionsFive biopsychosocial risk factor domains are independently associated with chronic pain or related treatment outcomes. The PALF composite index is presented as a structured analytical framework for future prospective validation, not as a deployable clinical tool. The primary three-domain composite (sleep, catastrophizing, metabolic) achieves outcome homogeneity at the cost of reduced domain coverage; the expanded six-domain composite encompasses the pharmacological burden at the cost of outcome heterogeneity. Both composites carry wide confidence intervals that preclude clinical application without individual patient data validation. No claim to clinical validity is made in the absence of prospective individual-patient-data validation.

Self-referential processing is a fundamental cognitive function, and abnormalities in its neural implementation have been reported across a range of psychiatric disorders, leading to the proposal that such alterations may constitute a transdiagnostic neurobiological feature. Yet claiming transdiagnostic requires rigorous evidence. Here, we examined the evidence for such a hypothesis by conducting a systematic review and coordinate-based meta-analysis of psychiatric neuroimaging studies that employed self-referential tasks. The systematic review identified 36 neuroimaging studies across 9 broad categories of psychiatric disorders, suggesting that the neural aberrancy of self-referential processing is indeed of great interest across different diagnosis. Of these, 27 studies were eligible for the ALE meta-analysis. The ALE results revealed hypoactivation of the right precuneus in psychiatric groups relative to health controls, alongside hyperactivation of the right triangular part of the inferior frontal gyrus (IFGtri) during self-referential processing in psychiatric groups. Notably the precuneus and IFGtri are core nodes of the default mode network and the frontal-parietal control network, respectively, suggesting that aberrant self-referential processing across psychiatric disorders may be characterized by disrupted default mode network engagement accompanied by compensatory or maladaptive recruitment of control-related frontal regions. Together, our findings revealed a strong research interest in neural aberrancy of self-referential processing as a transdiagnostic feature. However, available evidence only provided preliminary evidence for such statement. To move forward, the field needs coordinated efforts to systematically accumulate data and collecting new datasets.

Aim: To systematically evaluate evidence on the effects of post-discharge early developmental intervention programs (EI) on behavioral development, quality of life, participation, executive functioning, parent-child interaction, and use of medical services from infancy through adolescence in children born preterm. Method: Four bibliographic databases and one trial registry were systematically searched for randomized controlled trials up to April 23, 2024. Two reviewers independently screened studies and extracted data. In clinically and methodologically comparable studies, random-effects meta-analysis were performed. Risk of bias was assessed with the Cochrane RoB 2 tool, and certainty of evidence with the GRADE approach. Results: Twenty-six studies met inclusion criteria, eleven studies including 2,315 preterm born infants reported relevant outcomes, and seven contributed to meta-analyses. Most reported results showed some concerns or high risk of bias; certainty of evidence ranged from very low to moderate across outcomes. EI may offer small benefits for selective attention, behavioral problems and parent-child interaction. Little to no effect was found for special educational needs, language skills, executive functioning and the use of medical services. No included studies evaluated the effect of EI on ADHD, quality of life, or participation related to mobility or leisure activities. Interpretation: EI may improve problems typically seen in preterm children and should be offered especially to those with additional medical or social risk factors. High-quality, contemporary trials are needed to establish reliable clinical recommendations regarding EI strategies and complementary interventions throughout childhood.

Background Chronic pain is associated with structural and functional brain alterations, particularly within prefrontal, insular, and cingulate cortices. The dorsolateral prefrontal cortex (DLPFC) shows consistent structural abnormalities across chronic pain conditions, whereas findings on intrinsic functional connectivity (FC) remains inconsistent. Anchoring FC analyses to structural alterations may help identify consistent patterns across chronic pain conditions. Methods We employed a voxel-based morphometry (VBM)-guided, seed-based resting-state FC approach. Structural and functional MRI data were obtained from patients with chronic neck pain (CNP; n=21) and healthy controls (HC; n=25). Regions showing significant gray matter volume (GMV) differences were used as seeds for whole-brain FC analysis. Associations with pain intensity and pain-related fear were examined. Findings were further evaluated in an independent cohort with chronic primary pain (CPP; n=38). Results VBM revealed reduced GMV in the left DLPFC in CNP compared with HC, replicated in CPP. Seed-based FC analysis demonstrated reduced connectivity between the left DLPFC and the right hippocampus in CNP, with a similar pattern in CPP. In CNP, GMV in the DLPFC was positively associated with DLPFC-hippocampal connectivity (r = 0.45, 95% CI 0.02 to 0.74, p = 0.043). Reduced DLPFC-hippocampal connectivity was associated with higher activity avoidance (r = -0.50, 95% CI -0.77 to -0.09, p = 0.021), whereas no associations were observed with pain intensity. Conclusions These findings indicate consistent structural and functional alterations across chronic pain cohorts. Reduced DLPFC-hippocampal connectivity may reflect altered interactions between prefrontal and hippocampal circuits involved in pain-related cognitive and affective processes.

BackgroundEarly-life adversity (ELA) is a risk factor for enduring pain in youth and is associated with alterations in brain morphology and function. However, it remains unclear whether ELA-related neurobiological changes contribute to the development of enduring pain in early adolescence. MethodsUsing data from the Adolescent Brain Cognitive Development (ABCD) Study, we examined multimodal magnetic resonance imaging (MRI) markers in children assessed at baseline (ages 9-11 years) and at 2-year follow-up (ages 11-13 years). ELA exposure was defined at baseline to maximise temporal separation between early adversity and later enduring pain. Participants with enduring pain at follow-up (n = 322) were compared to matched pain-free controls (n = 644). Structural MRI, diffusion MRI (fractional anisotropy, mean diffusivity), and resting-state functional connectivity data were analysed. Linear models tested main effects of enduring pain, ELA, and their interaction on brain metrics, controlling for relevant covariates. ResultsELA exposure was associated with smaller caudate and nucleus accumbens volumes, and reduced surface area of the left rostral middle frontal gyrus. No significant effects of enduring pain or ELA-by-enduring pain interaction were observed across grey matter, white matter, or functional connectivity measures. ConclusionsELA was associated with alterations in fronto-striatal regions in late childhood, but these changes were not linked to enduring pain in early adolescence. These findings suggest that ELA-related neurobiological alterations may represent early markers of vulnerability rather than concurrent correlates of enduring pain. Longitudinal follow-up is needed to determine whether these alterations contribute to later chronic pain risk.