Cognitive Outcomes After Hip Fracture Surgery: The Association of Postoperative Delirium on Previously Cognitively Normal Older Adults.

Fluctuations in attentional states, such as mind-wandering (MW), are associated with critical variability in task performance. While fMRI studies highlight the opposing roles of task-positive (e.g., dorsal attention network) and task-negative (e.g., default mode network) systems, the electrophysiological mechanisms underlying these dynamics remain poorly understood. Using intracranial electrocorticography in humans performing a sustained attention task, we identified global oscillatory dynamics linked to attentional shifts. MW was characterized by (1) reduced theta (θ) and alpha (α) power, (2) decreased aperiodic signal components, indicating a shift toward cortical inhibition, (3) enhanced phase synchronization across networks, and (4) strengthened θ phase-behavior correlations (ρ). These features support a non-network-specific framework in which low-frequency θ dynamics-captured by both θ power and ρ-are associated with attentional fluctuations, while aperiodic offset relates to attentional state indirectly through its association with ρ (structural equation modeling: power → state β = - 0.118, p = 0.002; ρ → state β = 0.246, p < 0.001; offset → ρ β = - 0.222, p < 0.001). Our study provides a unified neurophysiological framework for understanding how spontaneous neural activity can drive attentional fluctuations and performance variability, with implications for research on attention, learning, and neuropsychiatric disorders.

Gamma oscillations (30-100 Hz) have long been theorized to play a key role in sensory processing and attention by coordinating neural firing across distributed neurons. Gamma oscillations can be generated internally by neural circuits during attention or exogenously by stimuli that turn on and off at gamma frequencies. However, it remains unknown if driving gamma activity via exogenous sensory stimulation affects attention. We tested the hypothesis that non-invasive audiovisual stimulation in the form of flashing lights and sounds (flicker) at 40 Hz improves attention in an attentional vigilance task and affects neural oscillations associated with attention. We recorded scalp EEG activity of healthy adults (n = 62) during 1 hour of either 40 Hz audiovisual flicker, no flicker as control, or randomized flicker as sham stimulation, while subjects performed a psychomotor vigilance task. Participants exposed to 40 Hz flicker stimulation had better accuracy and faster reaction times than participants in the control groups. The 40 Hz group showed increased 40 Hz activity compared to the control groups in agreement with previous studies. Surprisingly, 40 Hz subjects had significantly lower delta power (2-4 Hz), which is associated with arousal, and higher functional connectivity in lower alpha (8-10 Hz), which is associated with attention processes. Furthermore, decreased delta power and increased lower alpha functional connectivity were correlated with better attention task performance. This study reveals how 40 Hz audiovisual stimulation improves attention performance with potential implications for therapeutic interventions for attention disorders and attention improvement.

Background: It is more difficult to concentrate when switching attention from rest to a task than when performing a task continuously. The anterior insular cortex (AIC) plays a role in the mechanisms underlying attention disorders such as attention deficit hyperactivity disorder. The AIC is activated by cues that demand attentional switching; however, it is unclear whether this activity correlates with performance. Furthermore, it is not clear whether the AIC is important during task execution as well as task preparation. Purpose: This study examined the role of the AIC in attentional switching. Research Design: In this study, we created a shortened version of the cued-switching task, which is a cognitive test that assesses the maintenance of focus during task repetition and refocusing on a task after an unexpected interruption or short rest, and assessed brain activity during the task using functional magnetic resonance imaging. Study Sample: Thirty-two healthy adults participated in the study. Data Collection and/or Analysis: We measured brain activity and analyzed its relation to network activity and reaction time. Results: The results revealed that the AIC was also important during task execution and was active together with the prefrontal cortex. AIC activity promoted activity in the salience network, prefrontal cortex, and motor areas. Furthermore, AIC activity during task execution was negatively correlated with reaction time in the absence of attentional switching. Conclusions: These findings suggest that AIC activity is important for switching attention and for completing tasks with or without attentional switching. This study shows the possibility of the AIC becoming an effective target for attention training in the future.

ABSTRACT This study aims to address the knowledge gap regarding the prevalence and types of sleep disturbances and impairments in children with NF1 and their association with cognitive difficulties. An anonymous survey was conducted as part of a larger investigation into sleep disturbances and cognitive difficulties in NF1. The survey, distributed through the Children’s Tumor Foundation NF Registry, included PROMIS Sleep Disturbance and Sleep-Related Impairment questionnaires and the Child and Adolescent Sleep Checklist (CASC) and comorbidities that may impact sleep. Sleep disturbance interferes with the quality of sleep, while sleep impairment is the resultant functional consequences of poor sleep. Data was collected from caregivers of children with NF1. A total of 202 parents participated. Sleep disturbances were reported in 60.4% of children, and sleep impairment in 42.6%. Children with comorbid ADHD had significantly higher rates of sleep disturbance (F2,199 = 10.40, p < .001, Eta2 = 0.10) and impairment (F(2,199) = 6.01, p < .003, Eta2 = 0.06) than those without ADHD. No significant differences were found based on sex, anxiety, or depression. Learning disorders were significantly associated with sleep impairment (F(2, 199) = 3.68, p = <.03, Eta2 = 0.04) but not with sleep disturbances. This study highlights the high prevalence of sleep disturbances and impairments in children with NF1, particularly among those with reported ADHD. These findings underscore the need for regular screening and multidisciplinary management of sleep problems in this population. Future research should include comparison groups to better understand these trends.

Cluttering is a fluency disorder marked by a rapid and irregular speech rate and articulation difficulties such as "slurred" speech and sound omissions. These speech disruptions reduce intelligibility and negatively impact communication. Treatment for individuals with cluttering typically focuses on improving their speech clarity and fluency. In contrast, while addressing speech disruptions, treatment for stuttering, a related fluency disorder, extends to include psychological and emotional aspects. This broader approach is based on research linking stuttering to mental health indicators such as depression, anxiety, and attention disorders, as well as to psychological flexibility. These emotional and psychological aspects and their associations remain underexplored in the context of cluttering. To examine mental well-being, emotional-cognitive processing, and attention abilities in individuals with cluttering and to explore the relationships between these measures. Thirty-one adults diagnosed with cluttering completed questionnaires designed to assess mental well-being (i.e., anxiety, depression, somatic complaints), emotional-cognitive processing (alexithymia, psychological flexibility), and attention skills. High rates of anxiety symptoms, somatic complaints, reduced emotional-cognitive processing (high alexithymia), and attention difficulties were found among the study participants. Typical levels of psychological flexibility were observed. Alexithymia was associated with lower well-being. Our results suggest that lower mental well-being levels and higher rates of alexithymia symptoms and attention difficulties characterize individuals with cluttering. Accordingly, we recommend including an assessment of these factors in cluttering diagnosis. In treating cluttering, similar to stuttering treatment, it is advisable to address emotional aspects, specifically by methods designed to enhance emotional-cognitive processing.

Do generalized epilepsies exhibit more attentional or executive disorders?

Various motor and cognitive functions affect dressing skill. Evaluating the hierarchy of factors that influence performance in daily dressing and predicting this performance are crucial for effective rehabilitation. This study aims to clarify the interrelationships among motor function, cognitive function, dressing skill, speed of dressing, and performance of dressing in daily living, and to predict the latter using a convolutional neural network (CNN) model. We conducted a retrospective study. A total of 243 stroke patients were enrolled in this study, which comprised 2 rounds of data analysis. The first round involved all 243 patients and aimed to identify the hierarchical structure in the performance of dressing in daily living. The second round focused on 153 of these patients to predict dressing performance among those able to dress themselves in a rehabilitation setting. In the first round, path analysis was used to examine the interrelationships among motor function, cognitive function, dressing skills, speed of dressing, and performance of dressing in daily living. In the second round, a predictive algorithm for dressing in daily living was developed using a CNN. The model's performance was evaluated using the area under the receiver operating characteristic curve. The model analyzing the performance of dressing in daily living revealed statistically significant causal relationships among the path coefficients for the severity of paresis, unilateral spatial neglect, attention disorder, dressing skill, and speed of dressing. Speed of dressing directly influenced the performance of dressing in daily living, exhibiting the highest standardized path coefficient in each of the path models. The CNN model, which predicts the speed of dressing and the performance of dressing in daily living, performed well, achieving the highest area under the receiver operating characteristic curve of 0.939 ± 0.015. The severity of paresis, unilateral spatial neglect, attention disorder, and dressing skill had indirect effects on the performance of dressing in daily living by influencing the speed of dressing. The speed of dressing could predict the performance of dressing in daily living with high accuracy. Our results suggest that the performance of dressing in daily living strongly depends on the speed of dressing.

Attention impairments are common in children with epilepsy and widely impact their quality of life. Interictal epileptiform discharges (IEDs) may induce subtle dysfunctions of various cognitive processes, but data regarding the impact of IEDs on sustained attention remain limited. The objective of the present study was to evaluate the impact of IEDs on continuous undivided attention in children with epilepsy, controlling for the number of treatments, type of epilepsy, frequency of seizures in the past year, age at onset, and comorbid attention disorder. Using a computerized sustained attention test synchronized with the electroencephalogram in 61 children with diverse epilepsy syndromes, reaction time (RT), errors, attention stability over time, and the event-related potential (ERP) in Pz (related to attentional engagement) were collected. The cumulative impact of IEDs was evaluated using multivariate models controlling for epilepsy-related factors. The transient impact of IEDs was assessed by comparing responses in trials with and without IEDs. IEDs were associated with attention fluctuations independently from other epilepsy-related factors. In terms of cumulative impact, a higher IED rate was associated with a poorer sustained attention performance over the entire task. In terms of transient impact, trials disrupted by IEDs were characterized by longer RT and a lower amplitude of the ERP extending over a long time window that included attentional processing (P300). These results suggest that IEDs may negatively impact sustained attention, independently of other epilepsy-related features. These findings support the hypothesis that IEDs could contribute to subtle attentional deficits and serve as potential biomarkers of abnormal brain function.

ObjectiveAutism spectrum disorder (ASD) can affect vision both directly through central nervous system involvement and indirectly by complicating ophthalmological examinations due to limited eye contact and poor cooperation. Visual impairments may exacerbate social interaction difficulties and affect motor development in individuals with ASD. Previous studies reported ophthalmological involvement in 27-71% of children with ASD, including refractive errors, strabismus, and amblyopia. The purpose of this study was to investigate visual impairments in children with ASD and examine their relationship with ASD severity, anxiety levels, and attention disorders, while highlighting the importance of routine ophthalmological examinations.MethodParticipants were 57 children aged 7-18years diagnosed with ASD. All except for 2 participants underwent comprehensive ophthalmological examinations and were assessed using the Childhood Autism Rating Scale (CARS), Turgay DSM-IV-based Child and Adolescent Behavior Disorders Screening Scale (T-DSM-IV-S), Strengths and Difficulties Questionnaire (SDQ), Screen for Child Anxiety Related Emotional Disorders (SCARED), and Repetitive Behaviors Scale-Revised (RBS-R).ResultsVisual impairment was detected in 24 (42.1%) participants, with exotropia (21%), stereopsis deficits (15.8%), and convergence insufficiency (5.3%) being the most common findings. The visually impaired group showed significantly higher scores in attention deficit (P < .001), peer relationship problems (P = .003), social phobia (P < .001), stereotypic behaviors (P < .001), and self-injurious behaviors (P < .001) compared to those without visual impairment.ConclusionsVisual impairments significantly impact attention, peer relationships, social anxiety, and repetitive behaviors in children with ASD. Early identification and treatment of visual disorders through routine ophthalmological screening may improve overall outcomes in this population.

Altered mental status (AMS) refers to changes in cognitive function or consciousness, encompassing cognitive, attention, arousal, and consciousness disorders. The Glasgow Coma Scale (GCS) and full outline of unresponsiveness (FOUR) score are tools used to evaluate patients with altered consciousness. Few studies have compared the interobserver reliability of these scales. This study aimed to assess interobserver variability between GCS and FOUR scores in predicting outcomes of critically ill patients with altered sensorium. This hospital-based forecasting experimental study included 200 patients who were admitted to the critical care unit at King Edward Memorial (KEM) Hospital, Pune. Patients were randomly selected and scored once within 24 hours of admission using both GCS and FOUR scores by two independent observers, a critical care resident (CCR) and a critical care consultant (CCC), with a 5-minute interval between assessments. Interrater reliability was measured using kappa values, with outcomes focused on agreement within ±1 score point for both scales. Statistical analysis was conducted using Epi Info. Demographics showed males (62%) outnumbered females (38%). The largest age-group was 51-70 years (38 %). GCS and FOUR scores showed no significant differences between CCR and CCC in mean GCS (CCR: 8.2 ± 2.9; CCC: 8.5 ± 3.0; p = 0.249) or FOUR score (CCR: 10.74 ± 3.2; CCC: 10.9 ± 3.1; p = 0.6118). A close to borderline difference was observed in GCS for females (p = 0.0423). Interrater agreement showed kappa values for GCS components eye-openings (0.78291), verbal responses (0.64858), and motor responses (0.38867). For FOUR scores, kappa values were eye-openings (0.81014), motor responses (0.77721), brainstem reflexes (0.89801), and respirations (0.91623). The study found very good interobserver reliability for GCS eye and verbal components but poor agreement for motor responses due to confusion with localization and abnormal movements. The FOUR score demonstrated good to excellent reliability across all components and provided more detailed neurologic assessments, especially in intubated patients and those with brainstem dysfunction. It is more efficient in predicting outcomes, making it a preferred tool in intensive care units (ICUs). Larger studies are recommended to incorporate the FOUR score as a standard neuromonitoring tool in the intensive care unit.

Cognitive and subjective effects of psilocybin microdosing: Results from two double-blind placebo-controlled longitudinal trials.

To study the features of oculomotor reactions when presenting emotionally charged stimuli in patients with a non-psychotic depressive episode as part of a recurrent depressive disorder (RDD). The one-stage cross-sectional non-randomized clinical and psychophysiological study included 46 patients with verified DDR and 40 patients without mental disorders (control group, CG). All DDR patients underwent inpatient treatment for a current non-psychotic depressive episode (ICD-10 code: F33.0-F33.2). In the DDR group, a decrease in the total fixation time on joyful faces was observed, as well as a decrease in the number of fixations on any stimuli, along with an increase in the average duration of a single fixation, which was not found in the CG. Oculographic study makes it possible to diagnose recurrent depressive disorder with satisfactory accuracy.

Postoperative delirium (POD) is an acute disorder of attention and cognition, frequently observed as a complication in elderly individuals undergoing major surgery. Patients undergoing laparoscopic radical prostatectomy (LRP) are particularly vulnerable due to advanced age and comorbidities. Electroacupuncture (EA), as a non-pharmacological intervention, may attenuate neuroinflammation and cerebral injury, potentially reducing the risk of POD. This study aims to evaluate the efficacy of EA in reducing the incidence of POD among elderly patients undergoing LRP. This is a double-center, prospective, randomized, patient- and assessor-blinded, sham-controlled trial. A total of 212 eligible participants will be enrolled and allocated in a 1:1 ratio to either the EA group or the sham EA (SEA) group. Participants in the EA group will receive intervention at the acupoints Zusanli (ST36) and Baihui (GV20), initiated 30 min prior to anesthesia induction and maintained for 25-30 min. The primary outcome is the incidence of POD assessed using the 3D-CAM during the first three postoperative days. Secondary endpoints include the duration and severity of delirium, delirium subtypes, pain scores, opioid consumption, catheter-related bladder discomfort, adverse events, and plasma levels of neuroinflammatory biomarkers. Currently, evidence regarding the efficacy of EA in preventing POD specifically in elderly patients undergoing LRP is limited. This randomized controlled trial is designed to address this research gap. If the hypothesis is confirmed, this study will provide evidence for a safe, non-pharmacological strategy to improve postoperative cognitive outcomes in this population. https://www.chictr.org.cn/showproj.html?proj=240562, Identifier: ChiCTR2500097337.

The global rise in psychological stress has significantly affected cognitive and emotional health across all age groups, particularly among children. The increasing prevalence of anxiety, behavioral disturbances, learning disabilities, and attention disorders highlights the need for safe, preventive, and holistic approaches to mental health care. Ayurveda offers a unique concept known as Medhya Rasayana, which refers to intellect-promoting rejuvenative therapies that enhance cognitive functions and support mental stability. Among the classical Ayurvedic texts, Kashyapa Samhita gives special importance to Kashyapokt Medhya Rasayana, a group of herbal preparations designed to nourish the brain and nervous system and promote healthy mental development in children. The principal Medhya Dravyas described include Mandukaparni (Centella asiatica), Yashtimadhu (Glycyrrhiza glabra), Guduchi (Tinospora cordifolia), and Shankhapushpi (Convolvulus pluricaulis). These herbs are traditionally believed to enhance Dhi (intellect), Dhriti (retention), and Smriti (memory) while strengthening Majja Dhatu and promoting Ojas, the vital essence responsible for immunity and vitality. The Rasayana principles underlying these therapies emphasize longevity, clarity of mind, and the balancing of Vata and Pitta Doshas, which are considered key factors in mental well-being. This review study was conducted by analyzing classical Ayurvedic texts such as Charaka Samhita, Sushruta Samhita, Ashtanga Hridaya, and Kashyapa Samhita, along with relevant modern scientific literature sourced from PubMed, Google Scholar, and cross-referenced articles. Findings from both traditional descriptions and contemporary research indicate that these Medhya herbs possess adaptogenic, neuroprotective, and anxiolytic properties that may help improve cognitive performance and enhance resilience to stress.

Neurofeedback gaming leverages electroencephalography (EEG) signals to provide real-time brain activity feedback through interactive gaming environments, offering innovative therapeutic and clinical applications. Recent advancements in EEG signal processing, machine learning algorithms, and immersive game design have enabled personalized interventions for cognitive rehabilitation, attention disorders, and stress management. This review explores the current state of EEG-based game design, highlighting methodologies, effectiveness, and challenges in clinical settings. Key considerations include signal acquisition, feature extraction, game mechanics, and patient engagement strategies. Future directions point toward more adaptive, multimodal, and remote neurofeedback gaming solutions, emphasizing their potential to enhance patient outcomes and expand accessibility in healthcare.

Maintaining a healthy social network is a pervasive challenge among individuals with schizophrenia spectrum disorders (SSD), profoundly influencing mental health outcomes and social functioning. While social adversities such as social isolation may not be a direct cause of criminal behavior, they may act as a significant risk factor. Previous results from offenders with SSD indicated that attention disorder, alogia, crime motivated by ego disturbances, overall symptom severity, and a history of negative symptoms were the most influential factors in predicting social isolation in this population. The present study aims to examine whether specific social determinants can distinguish between forensic and non-forensic patients with SSD, thereby addressing the research question of whether these factors are associated with an increased risk of offending in this population. The comparative pattern analysis was conducted using a variety of machine learning models. A history of social isolation, relationship status upon discharge from the institution, social marginalization during childhood, complete compulsory schooling, and contact with the mental health services through family members demonstrated the highest capacity to distinguish between these two groups. Factors related to psychopathology however were statistically outperformed in the prediction model, which yielded an AUC of 0.83. The study's results highlight determinants of offending related to social integration/isolation as an outcome of SSD and possibly indicating potential preventative measures regarding offending SSD patients.

SUMMARY Alexander Crichton’s Inquiry (1798) was one of the first systematic English-language works on mental disorder. Although a general physician rather than a specialist, Crichton sought to explain how emotions, attention and the nervous system interacted to produce disturbance. His description of inattention is now regarded as the earliest English medical account of what we would call an attention disorder. He drew extensively on German case reports, vivid accounts of melancholy, delusion and violence. He highlighted how delusion could coexist with calm, purposeful behaviour, influencing both medical and legal views of responsibility. Modern historians see Crichton as a synthesiser rather than an originator, but his Inquiry remains an ambitious attempt to ground the study of mental disorder in physiology, observation and compassion.

Background: Opioid use disorder (OUD) and associated overdose deaths have reached epidemic proportions worldwide over the past two decades, with death rates for men consistently reported at twice the rate for women. We have recently reported sex-specific differences in electrocortical activity in persons with OUD in a visual object recognition task. The mesolimbic dopamine (DA) system is implicated in OUD but also plays a critical role in some disorders of visual attention and a modulatory role in the processing of visual stimuli in the blue cone pathway of the retina. We hypothesized that electrocortical responses to color stimuli would be affected differentially in men and women with OUD. Methods: Using a controlled, cross-sectional, age-matched (18-56 years) design, we evaluated color processing in male and female subjects recruited from a community-based, high-intensity residential substance abuse and detoxification treatment program. We evaluated electroencephalogram (EEG) event-related potentials (ERPs) and reaction time (RT), in male and female participants with OUD (n = 38) vs. sex- and age-matched non-OUD control participants (n = 37) in a simple color recognition Go/No-Go task, as well as perceptual and behavioral responses in physiological and neuropsychological tests. Results: N200, P300, and late potential (LP) Relevant stimulus-induced ERPs were evoked by the task and were well-differentiated from Irrelevant distractor stimuli. P300 amplitudes were significantly greater and N200 and LP latencies were significantly shorter in male vs. female non-OUD controls in this task. There were significant sex differences in N200, P300, and LP amplitudes and latencies between male vs. female non-OUD subjects and OUD differences with blue color as the Relevant stimulus. In the Binocular Rivalry Test, there were shorter dwell times for perceiving a blue stimulus in male OUD subjects and there were significant sex and OUD differences in neuropsychological tests including Finger Tapping, Trails A/B, and Symbol Digit Modalities Test. Conclusions: These findings suggest that there are significant sex-related physiological, perceptual, and cognitive differences in color processing that may result from deficits in DA production in the retina that mirror deficits in mesolimbic DA transmission correlating with OUD, suggesting that blue color processing has the potential to be an effective biomarker for brain DA and for diagnosis and monitoring of treatment efficacy in substance use disorders.

Internet gaming disorder and anemia are associated with attention disorders in elementary school children in Yogyakarta, Indonesia