Clinical Neuroscience Research Articles

White Matter Dissection: Lessons from the United Kingdom National Neuroanatomy Undergraduate Competition 2023

Abstract Objective This narrative highlights a student-led initiative that explored white matter dissection techniques within the framework of the National Undergraduate Neuroanatomy Competition 2023. Materials and Methods The project aimed to enhance neuroanatomical education by developing a novel approach to dissection that deviates from the traditional Klingler’s method. Instead, it incorporated contemporary techniques, including diffusion tensor imaging and other radiological tools, to ensure greater anatomical precision and enrich the learning experience. Results The dissections focused on key white matter structures, such as the uncinate fasciculus and the inferior longitudinal fasciculus, and outlined a step-by-step methodology for creating high-quality specimens. These specimens are designed to serve as educational resources, particularly for students with limited access to formal neuroanatomy courses. Conclusion This study emphasizes the critical role of hands-on dissection in neuroanatomy education, showcasing its ability to enhance student engagement, deepen anatomical understanding, and inspire interest in clinical neuroscience careers. By introducing innovative educational tools and methodologies, this initiative makes a meaningful contribution to addressing the issue of “neurophobia” in medical education.

Combined T1-weighted MRI and diffusion MRI tractography of paraventricular, locus coeruleus, and dorsal vagal complex connectivity in brainstem-hypothalamic nuclei

Background: Current multimodal neuroimaging plays a critical role in studying clinical conditions such as cardiovascular disease, major depression, and other disorders related to chronic stress. These conditions involve the brainstem-hypothalamic network, specifically the locus coeruleus (LC), dorsal vagal complex (DVC), and paraventricular nucleus (PVN) of the hypothalamus, collectively referred to as the “DVC-LC-PVN circuitry.” This circuitry is strongly associated with the norepinephrine (NE) and epinephrine (E) neurotransmitter systems, which are implicated in the regulation of key autonomic functions, such as cardiovascular and respiratory control, stress response, and cognitive and emotional behaviors. Objectives: To develop a methodology for delineating the DVC-LC-PVN circuitry in the human brain using multimodal neuroimaging. Methods: We combined structural T1-weighted morphometric magnetic resonance imaging (MRI) and diffusion MRI-based tractography to map the DVC-LC-PVN circuitry in the human brain. This methodology was applied to a pilot sample of brain datasets from five healthy adult subjects obtained from the publicly available Human Connectome Project repository and to one post-mortem human dataset. Results: The DVC-LC-PVN circuitry was delineated in vivo in five human subjects and one ultra-high resolution post-mortem dataset, allowing for refined anatomical observations. Conclusion: NE and E neurotransmitter systems engender substantial interest in both basic and clinical neuroscience due to their roles in the regulation of key autonomic functions, such as cardiovascular and respiratory control, stress responses, and cognitive and emotional behaviors. As demonstrated in this study, multimodal neuroimaging techniques provide a valuable approach for mapping small brainstem and hypothalamic structures and complex circuitries such as the DVC-LC-PVN circuitry.

Editorial: Women in brain health and clinical neuroscience volume II: 2023

Editorial: Women in brain health and clinical neuroscience volume II: 2023

The emerging field of non-invasive brain stimulation in Alzheimer's disease.

Treating cognitive impairment is a holy grail of modern clinical neuroscience. In the past few years, non-invasive brain stimulation is increasingly emerging as a therapeutic approach to ameliorate performance in patients with cognitive impairment and as an augmentation approach in persons whose cognitive performance is within normal limits. In patients with Alzheimer's disease, better understanding of brain connectivity and function has allowed for the development of different non-invasive brain stimulation protocols. Recent studies have shown that transcranial stimulation methods enhancing brain plasticity with several modalities have beneficial effects on cognitive functions. Amelioration has been shown in preclinical studies on behaviour of transgenic mouse models for Alzheimer's pathology and in clinical studies with variable severity of cognitive impairment. While the field is still grappling with issues related to the standardization of target population, frequency, intensity, treatment duration and stimulated region, positive outcomes have been reported on cognitive functions and on markers of brain pathology. Here we review the most encouraging protocols based on repetitive transcranial magnetic stimulation, transcranial direct current stimulation, transcranial alternating current stimulation, visual-auditory stimulation, photobiomodulation and transcranial focused ultrasound, which have demonstrated efficacy to enhance cognitive functions or slow cognitive decline in patients with Alzheimer's disease. Beneficial non-invasive brain stimulation effects on cognitive functions are associated with the modulation of specific brain networks. The most promising results have been obtained targeting key hubs of higher-level cognitive networks, such as the frontal-parietal network and the default mode network. The personalization of stimulation parameters according to individual brain features sheds new light on optimizing non-invasive brain stimulation protocols for future applications.

Can angiogenesis be reliably determined on digital subtraction angiography in cerebral arteriovenous malformations?

Background Angiogenesis and nascent blood vessel formation is thought to be important in cerebral arteriovenous malformation (cAVM) development and maintenance, of which little is known. Digital subtraction angiogram (DSA) features of angiogenesis in cAVMs are poorly described and the aim of this study was to describe the frequency of angiogenesis in patients who had a DSA showing a cAVM. We also sought to evaluate the intra- and inter-observer agreement of a diagnosis of angiogenesis and explore which angioarchitectural features were associated with angiogenesis. Method Patients that underwent a DSA were identified from the database of referred cAVM patients at the Manchester Centre for Clinical Neurosciences. Data were collected from 100 patients (102 cAVMs). cAVM angioarchitecture, including the presence of angiogenesis, was described after reviewing cAVM patient angiograms. The association of angioarchitectural features with angiogenesis was determined using univariate analysis. Ten cases were distributed amongst two other observers for reporting (inter-observer agreement). Twenty cases (including the previous 10) were reported twice by the first author, after a six-month interval (intra-observer agreement). Results Angiogenesis was observed in 39 cAVMs (38.2%), with 12 having a complete border (11.8%). Most intra-observer agreement was strong (ranging from κ = 1 to 0.2), but inter-observer agreement was moderate (κ = 1 to −0.316). There was a significant association between angiogenesis and venous reflux (OR 2.52 [95% CI = 1.08–5.88]), venous congestion (OR 4.47 [95% CI = .671–2.52]), arterial ectasia (OR 16.6 [95% CI = 4.65–59.6]), and artery: vein ratio (4.28 [95% CI = .956–19.15]). Conclusion We have demonstrated perinidal angiogenesis can be visualised on angiograms with moderate reliability, and that it may be related to angioarchitectural characteristics associated with venous hypertension.

Validité écologique : origines du concept et application pour les neurosciences cognitives et cliniques

ContextThe ecological validity of observations derived from clinical and experimental studies has become a central parameter in cognitive neuroscience research. However, this concept rooted in the ecological psychology theories, finds its contemporary definition and use reduced to the external validity criterion of laboratory experimentation. This misapplication of the concept of ecological validity, in which ecological conditions are assumed to be replicated, leads to theoretical ambiguity in all disciplines involved in the study of cognition and behavior. ObjectiveWe propose to explore the concept of ecological validity for cognitive and clinical neuroscience in its original formulation derived from functionalist theories and further developed by theories of direct perception and theories of enaction. This highlights the limitations of experimental and clinical studies in achieving this quality in their observations and results. In the first part, we will describe the origins of contemporary problems of ecological validity in behavioral and cognitive sciences, stemming from the adaptation of Fisher's experimental design for experimental psychology. Then we will address the fundamental importance of the concept of ecological validity in neuroscience and mental health research. DiscussionFinally, we will discuss possible solutions in cognitive and clinical neuroscience to improve ecological validity and enable better transferability of experimental results to various everyday situations.

The hierarchical taxonomy of psychopathology and the search for neurobiological substrates of mental illness: A systematic review and roadmap for future research.

Understanding the neurobiological mechanisms involved in psychopathology has been hindered by the limitations of categorical nosologies. The Hierarchical Taxonomy of Psychopathology (HiTOP) is an alternative dimensional system for characterizing psychopathology, derived from quantitative studies of covariation among diagnoses and symptoms. HiTOP provides more promising targets for clinical neuroscience than traditional psychiatric diagnoses and can facilitate cumulative integration of existing research. We systematically reviewed 164 human neuroimaging studies with sample sizes of 194 or greater that have investigated dimensions of psychopathology classified within HiTOP. Replicated results were identified for constructs at five different levels of the hierarchy, including the overarching p-factor, the externalizing superspectrum, the thought disorder and internalizing spectra, the distress subfactor, and the depression symptom dimension. Our review highlights the potential of dimensional clinical neuroscience research and the usefulness of HiTOP while also suggesting limitations of existing work in this relatively young field. We discuss how HiTOP can be integrated synergistically with neuroscience-oriented, transdiagnostic frameworks developed by the National Institutes of Health, including the Research Domain Criteria, Addictions Neuroclinical Assessment, and the National Institute on Drug Abuse's Phenotyping Assessment Battery, and how researchers can use HiTOP to accelerate clinical neuroscience research in humans and other species. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Shared principles for disentangling heterogeneity in neuroscience and psychopathology.

A primary goal of clinical neuroscience is to identify associations between individual differences in psychopathology and the brain. However, despite a significant amount of resources invested in this endeavor, few reliable neural correlates of psychopathology have been identified. A common suspect for this lack of success is the significant heterogeneity in symptoms observed in psychiatric disorders. However, this is not the only potential source of heterogeneity, as substantial heterogeneity is also observed in brain structure and function. Thus, for clinical neuroscience to identify reliable neural correlates of psychopathology, it will be necessary to better understand heterogeneity in both psychopathology and the brain. In this commentary, we suggest four shared principles that can help disentangle heterogeneity in both of these domains: (a) the brain and behavior should both be treated as complex measures, (b) a priori assumptions should be viewed with caution unless they can be replicated robustly in individuals, (c) complex models of individual differences require appropriate data to estimate them, and (d) the field would benefit from an increased focus on extensively measuring individuals, such as through the use of personalized models of psychopathology and neuroimaging data. Together, these shared principles can aid in better characterizing-and separating relevant and irrelevant-heterogeneity in measures of psychopathology and neuroimaging. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Correlates of Transitioning from In-Person to Telemedicine Outpatient Neurology Clinic Visits.

Introduction: The COVID-19 pandemic accelerated telemedicine adoption, impacting appointment no-show rates. This study examines neurology appointment preferences among individuals with previous no-shows. Methods: We analyzed transitions between in-person and telemedicine modalities at the Tulane Center for Clinical Neurosciences from August 2020 to February 2021 by race, sex, and insurance type. Logistic regression was used to assess which individual characteristics were associated with switching modalities. Results: A total of 118 patients were included. Transitions to telemedicine visits were significantly higher for female (odds ratio [OR] = 1.868, p = 0.051), Medicaid (OR = 0.433, p = 0.035), and Medicare (OR = 0.228, p = 0.001) beneficiaries compared with males and those with private coverage. Telemedicine to in-person transitions were significantly higher for Medicaid compared with private coverage (OR = 8.133, p = 0.018). Discussion: Females are more likely to switch to telemedicine following an in-person no-show, whereas Medicare beneficiaries are less likely. Medicaid beneficiaries are more likely to revert to in-person appointments. Telemedicine may enhance equitable neurological care, particularly because of its high utilization among females.

An Evidence-Based Comprehensive Review of Laughter Therapy in Depression Management

Abstract: Depression is a widespread mental health challenge, necessitating diverse therapeutic approaches. Emerging research suggests that laughter may offer a valuable adjunctive intervention for individuals grappling with depressive symptoms. This review systematically investigates the multifaceted relationship between laughter and depression, elucidating the underlying mechanisms and potential therapeutic benefits. A comprehensive literature search was conducted across multiple electronic databases, including PubMed, PsycINFO, Scopus, and Google Scholar. Keywords used in the search included “laughter therapy,” “humor,” “depression,” “mental health,” and “psychological well-being.” The search was limited to articles published in English and included both peer-reviewed journal articles and relevant gray literature. Relevant data were extracted from each study, including the study design, sample size, participant characteristics, type of laughter intervention, duration and frequency of the intervention, outcome measures, and key findings. The extracted data were organized into tables to facilitate comparison across studies. By synthesizing findings from clinical studies, neuroscience research, and anecdotal evidence, this review examines the physiological, psychological, and social dimensions of laughter's impact on depression. Special attention is given to neurochemical pathways, stress modulation, cognitive restructuring, and social dynamics. The physiological effects of laughter on depression encompass neurochemical regulation (endorphins, serotonin, dopamine), stress reduction, and immune system modulation. Psychologically, laughter contributes to cognitive reframing, enhanced coping mechanisms, and mood regulation. Socially, it strengthens social bonds, mitigates social isolation, and fosters a positive social environment. In conclusion, this review synthesizes current knowledge on the healing potential of laughter in mitigating depression, providing a holistic understanding of its multifaceted impact. The findings underscore the importance of integrating laughter-based interventions into mental health care practices and highlight avenues for future research and clinical applications in the realm of depression treatment.

Neuroanatomy teaching in the flipped classroom: Attitudes and effect on medical students' performance.

Neuroanatomy is essential to clinical neurosciences and is one of the most difficult components of the anatomy curriculum. Flipped classrooms are one of the pedagogical approaches that have been found to enhance students' abilities and encourage in-depth learning. The current study aims to assess the attitudes and effects of flipped classrooms on neuroanatomy teaching among medical students compared to traditional classrooms. A quasi-experimental study was carried out during the period January through June 2023. The effectiveness of teaching neuroanatomy in flipped classrooms versus traditional classrooms was assessed using formative assessment and a pre-designed structured questionnaire. The questionnaire was composed of four sections assessing different domains on a Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). The total sample reached 214 students. Most students' attitude statements covering skills, knowledge and learning process, and length of time were significantly in favor of flipped teaching at the expense of traditional teaching. Then mean examination grades were significantly higher for pre-test flipped and post-test flipped in comparison to pre-test and post-test traditional examination. Although the flipped classroom is an effective method of learning neuroanatomy as compared to traditional classes, it faces some challenges in its implementation. Such challenges need awareness and solutions from educational institutions.

P09.02.A A WINDOW TO THE BRAIN: MONITORING THE HUMAN BRAIN USING FUNCTIONAL ULTRASOUND (FUS)-IMAGING IN FREELY MOVING SUBJECTS WITH AN ACOUSTICALLY FAVORABLE SKULL IMPLANT

Abstract BACKGROUND To this day, the mainstay of human neuroimaging remains (functional) Magnetic Resonance Imaging (fMRI), where subjects are asked to lie completely still and silent in a noisy scanner. Many key questions in clinical care and neuroscience remain poorly studied because of fMRI’s inability to facilitate natural behavior such as locomotion or even verbal speech. What is more, due to the cost and size of an (f)MRI-machine, monitoring of morphological (i.e. tumor regrowth) or functional changes in the human brain, pre- and post-tumor resection, is often spread out over intervals of many months, leaving patients in suspense about possible tumor regrowth.With the advent of ultrafast ultrasound imaging, a new high-resolution, depth-resolved and mobile neuro-imaging technique called functional Ultrasound (fUS) has emerged. In the last decade, fUS has been applied successfully in awake neurosurgical contexts to map out hemodynamics-based functional brain activity as well as tumor tissue at a mesoscopic scale. However, given the significant aberration of ultrasound signal through human skull bone, fUS is not available outside of OR as of yet. As a first step outside of the OR, we aimed to apply fUS in freely moving subjects with a skull bone defect covered by PEEK, an acoustically favorable material. MATERIAL AND METHODS Two subjects with PEEK-implants were repeatedly imaged over a period of >1 year. One of the subjects received a PEEK-implant after infection of the autologous bone, post-resection of an astrocytoma. Each subject received a custom-fitted 3D-printed helmet based on their MRI to fixate the probe and to attach the geometry needed for optical tracking. Using an optical tracking camera, the position of the Power Doppler Image (PDI) relative to CT/(f)MRI-volumes of the subject could be determined in real-time. Images were acquired using an experimental research system (Vantage-256, Verasonics) interfaced with a 9L-D linear array (GE, 5.3 MHz). All scans were acquired with a PRF of 800 Hz. The PDIs and angle compounded beamformed frames were stored for offline processing, consisting of 3D-vascular reconstructions and functional mapping. Functional tasks focused on the sensorimotor area of the lip. For measurements outside of the lab, the acquisition system was transformed into a mobile cart, which could be pushed by the subject itself. RESULTS Trans-PEEK imaging resulted in PDIs with highly detailed vasculature of healthy brain tissue and the resection cavity, up to several centimeters in-depth, reproduced reliably over a period of >12 months. In sedentary, standing and walking conditions, we were able to produce consistent functional maps of the human brain. CONCLUSION Our current work demonstrates how fUS has the potential to become a powerful window to the brain, both in terms of vascular monitoring of tumor regrowth, as well as functional brain mapping, outside of the operating room.

Deep brain stimulation for Parkinson's disease: bibliometric analysis of the top 100 cited literature.

Deep Brain Stimulation (DBS) has been widely applied and accepted in the treatment of neurological and psychiatric disorders. Despite numerous studies exploring the effects of DBS on the progression of neurodegenerative diseases and the treatment of advanced Parkinson's disease (PD), there is a limited number of articles summarizing this research. The purpose of this study is to investigate the current trends, hot topics, and potential in research surrounding DBS therapy for PD, as well as to anticipate the challenges of such research. We searched the Web of Science Core Collection database (WoSCC) for DBS research literature related to PD published from January 2014 to January 2024, utilized CiteSpace, VOS viewer, the bibliometric online analysis platform, Scimago Graphica, Microsoft Excel 2021, and R software version 4.2.3 for data analysis. And we conducted quantitative research on publications, citations, journals, authors, countries, institutions, keywords, and references, visualized the results in network graphs. From 2014 to 2024, papers from 39 journals from 11 countries were among the top 100 cited. Most papers were published in Neurology, with the highest average citations per paper in Nature Neuroscience. The United States (US) contributed the most publications, followed by the United Kingdom (UK) and Germany. In terms of total publications, University College London (UCL) contributed the most papers. The primary classifications of articles were Clinical Neurology, Neurosciences, and Surgery. The top five keywords were subthalamic nucleus, DBS, PD, medical therapy, and basal ganglia. Cluster analysis indicates that DBS research focus on improving quality of life and applying computational models. Through bibliometric analysis, researchers could quickly and clearly understand the hotspots and boundaries of their research field, thus guiding their research direction and scope to improve research efficiency and the quality of outcomes. Although studies indicate that DBS is currently a crucial method for treating advanced PD, in the long run, creating a personalized, low-cost treatment regimen with precise targeting and long-term efficacy poses a challenge.

Carlos A. Zarate, Jr.: Using clinical translational neuroscience to develop the next generation of antidepressant treatments that act more rapidly and effectively

Carlos A. Zarate, Jr., MD, spearheads transformative research in psychiatry and neuroscience. As a National Institutes of Health (NIH) Distinguished Investigator, he leads the Experimental Therapeutics and Pathophysiology Branch and the Section on the Neurobiology and Treatment of Mood Disorders at the National Institute of Mental Health (NIMH). His additional role as Clinical Professor of Psychiatry and Behavioral Sciences at George Washington University underscores his commitment to research and education. Dr. Zarate's pioneering work focuses on decoding the pathophysiology of treatment-resistant mood disorders and suicide while developing novel therapeutics that are reshaping approaches to patient care. His research integrates cutting-edge techniques from neuropsychopharmacology, electrophysiology, neuropsychology, neuroimaging, and genomics to forge new pathways in treating mood disorders. Perhaps most notably, Dr. Zarate's team has been instrumental in demonstrating that ketamine, an NMDA receptor antagonist, can produce rapid and long-lasting antidepressant and anti-suicidal effects. This discovery has catalyzed a paradigm shift in psychiatry, proving that antidepressant response within hours, not weeks, is achievable. Dr. Zarate's innovative approach extends beyond the lab. He employs a bi-directional translational strategy, seamlessly integrating clinical, behavioral, and imaging technologies with basic science collaborations. This holistic method has led to numerous breakthroughs in mood disorders research, addressing critical issues such as the speed and efficacy of current treatments. His exceptional contributions to the field have earned him numerous accolades, including election to the National Academy of Medicine in 2020. These honors recognize his research excellence, his innovative spirit, and his dedication to mentoring the next generation of scientists. We are privileged to feature Dr. Zarate in this Genomic Press interview. His insights promise to offer our readers a glimpse into the cutting edge of psychiatry and the tangible hope his work brings to millions suffering from mood disorders.

Translational Neuroscience Contributes to Understanding Neurodevelopmental Outcomes of Dostoyevsky's "Brothers Karamazov" With Treatment Implications.

Dostoyevsky's novels raise profound ethical, moral, philosophical and theological issues and, as a result, both he and his novels serve as fertile subjects of scholarly inquiry across a variety of academic disciplines. In particular, major characters in "The Brothers Karamazov" lend themselves to classical psychodynamic formulations, such as the influence of adverse childhood experiences on adult social and occupational outcomes, which in the case of Dmitry, the eldest son of Fyodor Pavlovich Karamazov, are considered in exquisitely fine detail. Prosecutor and defense attorney provide differing interpretations of how early traumas, largely due to paternal neglect and abuse, affected Dmitry's adult outcome in the climactic trial over his alleged patricide. The novel also captures an extreme, and perhaps fanciful, description of an Oedipal rivalry between Dmitry and his father for the affection of a love interest leading to tragic and unpredictable consequences for both. The novel has been dissected by scholars across a variety of diverse and seemingly unrelated disciplines and continues to serve as a springboard for collaborative discussion. Re-reading the novel led the authors to wonder if translational developments in clinical neuroscience could further understanding of poor developmental trajectories of the novel's characters, as well as offer therapeutic recommendations for promoting more favorable occupational and social outcomes. Advances in basic neuroscience have been translated into actionable individualized, interdisciplinary, multimodal treatment plans leading to improved functional outcomes for children like Dmitry, Ivan, and Smerdyakov. Translational neuroscience enriches understanding of neurodevelopmental outcomes of characters in Dostoyevsky's novel "The Brothers Karamazov," especially in the context of genetic risk and in utero environmental insults.

Clinical Neuroscience Research in Saudi Arabia: A Comparative Evaluation of Performance at Country and Worldwide Levels Based on the Relative Specialization Index.

This review is an appraisal of the performance of clinical neuroscience research in Saudi Arabia based on the measurement of the Relative Specialization Index (RSI). The latter is an established quantitative performance indicator that determines whether a country has a relatively higher or lower share in world publications in a specialty than its overall part in the world total publications. The study aimed to assess the trends in the specialty's RSI, comparing it to other medical specialties in Saudi Arabia and to that of the top 50 countriesworldwide in clinical neuroscience. SCImago Journal and Country Rank were used to determine the total articles and total citations for 46 medical specialties in Saudi Arabia and clinical neuroscience in the worldwide top 50 countries during 1996‑ 2023. The RSI was calculated for each medical specialty and each country. A positive or negative RSI implied that the specialty's share in the country's total documents or total citations was higher or lower than the average for the specialty worldwide. A steady increase in Saudi Arabia's total articles and total citations in clinical neuroscience was observed over the last 28 years. The RSI values, however, remained negative throughout except for limited periods (2003-2006 for total articles) and (1996 and 1998 for total citations). Compared to other medical specialties in Saudi Arabia, the specialization performance for clinical neuroscience was within the mid-range in total articles (ranking 30th out of 46 specialties) and the low range in total citations (ranking 39th out of 46 specialties). Saudi Arabia's worldwide ranking in clinical neuroscience based on total citations was 39;however, the country's ranking dropped to 45when the RSI values were applied. Furthermore, clinical neuroscience was considered to have had a strong relative contribution (RSI ≥ 0.1) to the total articles in five countries (Italy, Austria, Germany, Japan, and Canada) and total citations in six countries (Luxembourg, Austria, Germany, Canada, Italy, and Finland). In conclusion, despite an increase in Saudi Arabia's total articles and total citations in clinical neuroscience over the years, the specialty's relative share of the total productivity in the country remains lower than the overall for the specialty worldwide. The performance of the specialty was within the mid-to-low range compared to the other 45 medical specialties in Saudi Arabia. In addition, the country's worldwide ranking based on total citations in the specialty dropped when the RSI was used. Clinical neuroscience researchers in Saudi Arabia are encouraged to improve the quality and quantity of their research productivity to be one of the leading medical specialties in Saudi Arabia.

P29: Anti-dementia drugs and Repetitive Transcranial Magnetic Stimulation in neurocognitive disorders

Objectives: The Objectives of this study is to demonstrate the response of patients with neurocognitive disorders to a combination of antidementia drugs and repetitive transcranial magnetic stimulation (rTMS).Methods: We conducted a descriptive and retrospective study with a sample of 13 geriatric patients, randomly selected from the private psychogeriatric clinic at the Nina Institute of Clinical Neurosciences in Santo Domingo. These patients were presented with various neurocognitive disorders: 3 with mild cognitive impairment, 3 with Alzheimer’s dementia, 2 with vascular dementia, and 5 with mixed dementia. All patients signed an informed consent form. Prior to starting rTMS treatment, they underwent EEG, laboratory analysis, and neuropsychological testing using the Mini-Mental State Examination (MMSE). Additionally, they were medicated with rivastigmine (12 mg) and memantine (20 mg). The rTMS parameters for the 20-session protocol were as follows: for mild cognitive impairment, 110% motor threshold (MT), 10 Hz, and 2,000 pulses; for Alzheimer’s diagnosis, 80% MT, 20 Hz, 1,200 pulses, 80% MT, 5 Hz, 600 pulses, and theta wave at 10 Hz, 110% MT, and 2,500 pulses. The results were tabulated, and consistent were drawn.Results: Our findings showed that all the patients improved their levels of cognitive impairment.Conclusions: Patients improved their cognitive impairment level with the combination treatment of antidementia drugs: cholinesterase inhibitors and memantine, along with repetitive transcranial magnetic stimulation (rTMS). Repetitive transcranial magnetic stimulation (rTMS) is a developing treatment, and further clinical studies are needed to confirm its potential in treating Alzheimer’s disease and other neurocognitive disorders alongside antidementia medications.

Neuropsychology and Politics Collide in the 2024 US Presdiential Election: Pitfalls of attacks on age, language, and memory.

Public perception of dementia has emerged as a key factor in the 2024 United States presidential election. The first televised presidential debate (27 June 2024) evoked a groundswell of concern about the neuropsychological health and political viability of President Joseph R. Biden, Jr. A rapid erosion of public support ensued, culminating in the collapse of the reelection campaign the following month. Political attacks on the cognitive fitness of world leaders create dissonance for clinical neuroscientists. We are ethically prohibited from remotely diagnosing public figures. Yet, we are also citizens with the right to feel and express personal concerns. In this commentary, I will address an often-uneasy relationship between politics and neuropsychology with a focus on the history and rationale for ethical guidelines such as the Goldwater Rule. I will also discuss lessons learned from recent events in the 2024 US election cycle about neurological health literacy (e.g. How is dementia diagnosed?) and broader impacts of age-based political attacks on global public health initiatives that target stigma reduction and improved early detection of dementia.

BOLD Cerebrovascular Reactivity and NOVA Quantitative MR Angiography in Adult Patients with Moyamoya Vasculopathy Undergoing Cerebral Bypass Surgery.

Revascularization surgery for the symptomatic hemisphere with hemodynamic impairment is effective for Moyamoya vasculopathy patients. However, careful patient selection is crucial and ideally supported by advanced quantitative hemodynamic imaging. Recently, blood oxygenation level-dependent cerebrovascular reactivity (BOLD-CVR) and quantitative magnetic resonance angiography with non-invasive optimal vessel analysis (qMRA-NOVA) have gained prominence in assessing these patients. This study aims to present the results of BOLD-CVR and qMRA-NOVA imaging along with the changes in cerebral hemodynamics and flow status following flow augmentation with superficial temporal artery-middle cerebral artery (STA-MCA) bypass in our Moyamoya vasculopathy patient cohort. Symptomatic patients with Moyamoya vasculopathy treated at the Clinical Neuroscience Center of the University Hospital Zurich who underwent hemodynamic and flow imaging (BOLD-CVR and qMRA-NOVA) before and after bypass were included in the analysis. Reduced hemispheric volume flow rates, as well as impaired BOLD-CVR, were measured in all 12 patients with Moyamoya vasculopathy before STA-MCA bypass surgery. Following the surgical procedure, post-operative BOLD-CVR demonstrated a non-significant increase in BOLD-CVR values within the revascularized, symptomatic middle cerebral artery territory and cerebral hemisphere. The results of the statistical tests should be viewed as indicative due to the small sample size. Additionally, post-operative qMRA-NOVA revealed a significant improvement in the hemispheric volume flow rate of the affected hemisphere due to the additional bypass flow rate. Our findings affirm the presence of hemodynamic and flow impairments in the symptomatic hemisphere of the Moyamoya vasculopathy patients. Bypass surgery proves effective in improving both BOLD-CVR impairment and the hemispheric volume flow rate in our patient cohort.

Daniel H. Wolf: Understanding motivation impairment from clinical, behavioral, and neurobiological perspectives to pave the way for better treatments

Dr. Daniel Wolf grew up in Los Angeles, completed his BA at Harvard College, MD-PhD at Yale University, psychiatry residency at MGH-McLean, and neuropsychiatry fellowship at UPenn. He is an Associate Professor of Psychiatry at UPenn's Perelman School of Medicine. As head of the Laboratory for Motivation in Psychiatry, Dr. Wolf uses functional neuroimaging to study the neural mechanisms of amotivation and other symptom dimensions in psychosis and at-risk states, aiming to develop novel assessment biomarkers for early-stage drug development. Dr. Wolf also provides outpatient care to individuals with psychosis while supervising clinical trainees. As Director of the Clinical Neurosciences Training Program and Co-Director of the Psychosis T32, he provides seminars and mentoring to medical and graduate students and postdoctoral fellows; he earned the School of Medicine's teaching awards in both Basic Science and Translational Science. He is also an ACNP Fellow and member of the Neuropsychopharmacology editorial board. Dr. Wolf answered the Genomic Press Interview, providing our readers with reflections on his life and career.