Late-onset multiple sclerosis (LOMS, onset > 50years) is increasingly recognized and may differ from adult-onset MS (AOMS). To compare clinical, motor, and cognitive features of LOMS vs. AOMS, and explore the influence of fatigue and depression on cognitive impairment. In this case-control study, 41 LOMS patients and 82 disease duration- and sex-matched AOMS patients underwent neurological evaluation (including recording of vascular risk factors), neuropsychological evaluations (including fatigue and depression), and motor function assessment (9-Hole Peg and Timed 25-Foot Walk tests). Group differences were FDR-corrected. Logistic regressions tested associations and interactions of fatigue and depression with cognitive impairment. A p < 0.05 was considered statistically significant. Compared to AOMS, LOMS patients more frequently presented with motor onset and progressive phenotypes, had higher EDSS, higher prevalence of patients with EDSS ≥ 4, and were less often treated (pFDR ≤ 0.011). No differences emerged in vascular risk factor prevalence and motor task performance. Compared to AOMS, LOMS showed more frequent cognitive impairment (36% vs 17%), with worse performance in attention, verbal fluency, and global cognition (pFDR ≤ 0.049). LOMS patients were also more frequently fatigued (63% vs 32%) and had higher fatigue severity scores (pFDR ≤ 0.033). Depression did not differ between groups. Fatigue was associated with cognitive impairment only in LOMS (OR = 1.13, 95% confidence interval = 1.05-1.22, p = 0.002), with a significant group × fatigue interaction (p = 0.014), independent of age and disability. No association was found between depression and cognitive impairment. LOMS showed a worse clinical and cognitive profile than AOMS, with fatigue playing a significant role in cognitive vulnerability.

Task-specific effects of sleep deprivation on cognitive function and EEG brain network in night-shift nurses.

Identifying cognitive vulnerability in school-aged children born preterm: The role of neonatal and early-life factors.

Dizziness is common in later life and may signal early cognitive vulnerability, but its long-term implications are not well-understood. Data from six waves of the Health and Retirement Study (2000-2020) were used to examine the association of persistent dizziness, defined as dizziness reported in ≥2 waves on cognitive outcomes including longitudinal cognitive score trajectories, dementia risk, and incidence, with age, sex, education, multimorbidity, and polypharmacy controlled. Individuals with persistent dizziness had lower baseline cognitive scores and significantly faster decline over time (β = -0.24, p < .001). Persistent dizziness was associated with a faster rise in dementia risk over time (OR = 1.23, p < .001) and a 36% higher hazard of incident dementia (HR = 1.36, p = 0.004). Persistent dizziness is linked to steeper cognitive decline and elevated dementia risk. These findings support dizziness as a potential early indicator of cognitive vulnerability and highlight its value for screening and preventive care in aging populations.

Frailty and the brain: A narrative review of functional and pathological correlates.

Background: Cognitive decline is a common complication of cardiac surgery, linked to reduced quality of life and increased mortality. Even early, transient deficits are associated with long-term cognitive decline. While several perioperative risk factors have been studied, the role of preoperative physical activity, specifically daily step count, remains underexplored. We evaluated whether a lower preoperative daily step count is associated with postoperative cognitive decline. Hypothesis: Lower preoperative step count is associated with greater risk of cognitive decline following cardiac surgery. Methods: Patients ≥50 years undergoing elective cardiac surgery with cardiopulmonary bypass were prospectively and consecutively enrolled at a single academic medical center between September 2023 and March 2025. Daily step count was measured preoperatively and for the first 90 days after surgery using a commercially available activity tracker. Patients were categorized into two groups based on median preoperative step count: low steps (&lt;6,500 steps/day) and high steps (≥6,500 steps/day). Cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA) preoperatively, at discharge, at 30 days, and 90 days postoperatively. The primary outcome was a decrease in cognitive performance, defined as a MoCA score of ≥1 standard deviation below baseline. Group comparisons were conducted using Wilcoxon rank sum tests for continuous variables and Fisher’s exact tests for categorical variables. Results: We enrolled 24 participants (mean age 66.6±8.7 years; 54% male; 96% white). The median preoperative step count was 5,876 [IQR 4,763–8,781] steps/day, with 58% classified to be in the low steps group. Participants in the low steps group were more likely to be female (p = 0.047), with no other significant demographic or operative differences. Decrease in cognitive performance from baseline at discharge occurred in 50% of participants in the low steps group, compared to 0% in the high steps group (p=0.019), despite similar baseline MoCA scores. No significant group differences were observed in cognitive decline at 30 or 90 days postoperatively, or in recovery of step count by 90 days. Conclusion: Lower preoperative daily step count was associated with increased risk of postoperative cognitive decline at discharge. Daily step count may serve as a simple, scalable target for preoperative intervention to reduce cognitive vulnerability after cardiac surgery.

Subclinical neurovascular injury and cognitive outcomes in adults with sickle cell disease: Prevalence and imaging correlates

The role of perseverative cognition and heart rate variability in high trait anxiety.

Transcranial near-infrared therapy restores synaptic resilience by reshaping signaling landscapes in sleep-deprived tauopathy.

Forgotten lives: A mixed-methods study on cognitive decline associated with discrimination among elderly transgender individuals in India.

Latent multimodal profiles associated with psychosis-like experiences at follow-up.

Objectives: Intolerance of uncertainty (IU) is a transdiagnostic factor implicated in emotional disorders and has recently been linked to maladaptive eating attitudes. Body dissatisfaction, a core risk factor for maladaptive eating, may represent a key pathway through which IU exerts its effects. This study examined whether body dissatisfaction has an indirect effect on the association between IU and disordered eating attitudes in female university students, controlling for body mass index (BMI) and trait anxiety. Methods: A cross-sectional study was conducted with 141 female psychology students aged 18–35 years (M = 21.23, SD = 2.31). Participants completed self-report measures of IU (Intolerance of Uncertainty Scale–Short Form), body dissatisfaction (Body Shape Questionnaire), disordered eating attitudes (Eating Attitudes Test-26), trait anxiety (State–Trait Anxiety Inventory), and reported weight and height to calculate BMI. Indirect effects were tested using bootstrapped mediation models. Results: IU was positively associated with body dissatisfaction (β = 1.139, p = 0.001), which in turn significantly predicted dieting (β = 0.126, p < 0.001) and bulimia/food preoccupation (β = 0.033, p < 0.001), but not oral control. Bootstrapped analyses showed significant indirect effects of IU on dieting (β = 0.144, 95% CI [0.047, 0.251]) and bulimia/food preoccupation (β = 0.037, 95% CI [0.010, 0.074]) via body dissatisfaction. Direct effects of IU on eating attitudes were not significant. Conclusions: IU to be associated with disordered eating attitudes primarily through body dissatisfaction, independently of BMI and anxiety. These findings extend evidence of IU as a cognitive vulnerability for eating-related psychopathology to non-clinical populations, highlighting the need for preventive interventions addressing both body image concerns and IU in female university students.

BackgroundEffective preoperative digital health education (DHE) is critical for patients undergoing knee arthroplasty (KA), particularly older adults who face age-related cognitive vulnerabilities. Cognitive Load Theory suggests that presentation modality and learning motivation strongly influence cognitive processing, yet their combined effects in clinical education remain underexplored.ObjectiveThis study investigated how learning motivation and presentation modality (text-only, text-graphic composite, and video-based) affect cognitive load and learning performance in older adult patients preparing for KA.MethodsA 2×3 factorial psychobehavioral experiment was conducted with 62 patients (≥60 y) stratified by learning motivation (high vs low). Each participant completed 6 DHE modules delivered across the 3 modalities. Cognitive load was measured using subjective ratings (Chinese National Aeronautics and Space Administration Task Load Index) and objective eye-tracking indicators (average fixation duration, number of fixations, and time to first fixation). Learning performance was assessed through knowledge retention and transfer tests (30 items). Data were analyzed using general linear models, analysis of covariance, and correlation analyses, with covariates including knee function, prior knowledge, eHealth literacy, and psychological distress.ResultsHigh-motivation learners demonstrated significantly lower cognitive load (National Aeronautics and Space Administration Task Load Index; large effect size) and superior learning performance (medium effect size) compared to low-motivation learners. Video-based materials consistently yielded the lowest extraneous load and supported efficient knowledge acquisition (medium effect size). Text-graphic composites elicited higher cognitive load but facilitated deeper processing and schema construction, particularly for highly motivated learners (medium-to-large effect sizes). Eye tracking confirmed these dynamics: high-motivation participants showed shorter fixation durations and more efficient allocation of attention across modalities, whereas low-motivation learners displayed scattered fixation patterns, especially in text-graphic conditions. Across the sample, cognitive load was negatively correlated with learning performance (large effect size), reinforcing its role as a key mediator of digital learning outcomes.ConclusionsBoth learning motivation and modality exert significant, though partly independent, influences on preoperative DHE outcomes in patients with KA. Video-based content enhances cognitive efficiency, while text-graphic formats may promote germane load among motivated learners. These findings highlight the importance of motivational scaffolding, adaptive modality selection, and the integration of real-time cognitive monitoring in DHE design. Beyond informing digital education for KA, the study demonstrates the feasibility of applying psychobehavioral experimental methods with older surgical patients, offering a framework for optimizing cognitive alignment in clinical education.

From the diagnosis and management through to determining recovery, the clinical pathway for concussions and postconcussion syndrome (PCS) is reliant on symptom reporting. Under-reporting or over-reporting bias necessitates the need for more objective measures. Exercise intolerance has shown to be a strong predictor of adolescent concussion patients likely to have protracted recoveries. Its role in predicting outcomes for adults is less clear. In addition to physiological measures, event-related potentials (ERPs) have demonstrated altered cognitive processing across the concussion recovery stages in various demographics. The aim of the present study was to assess the relationship between baseline exercise tolerance and ERPs on the degree of improvement in symptoms postrehabilitation in adults with persistent postconcussion symptoms (PPCS). Forty participants (mean age ± SD, 39 ± 13.5 years) with PPCS (mean duration ± SD, 5 ± 3 months) took part in this 6-week clinical trial. Participants were randomized at baseline to a customized rehabilitation (CR) program or standard, symptom-based care (SC). At baseline, participants underwent a standard exam inclusive of an exercise tolerance test and completed a quantitative electroencephalogram to examine three auditory ERPs (N100 for sensory processing, P300 for attention, and N400 for cognitive processing). To examine the association of exercise tolerance and ERPs on recovery, linear regression was done to compare participants' pre-post Rivermead Postconcussion Questionnaire scores (RPQ) with baseline delta heart rate (ΔHR), heart rate thresholds (HRt), and ERPs (amplitude and latency). The CR group showed significant and clinically meaningful improvements in reported symptoms (RPQ-3 and RPQ-13) and exercise tolerance (ΔHR, HRt). Notably, no baseline variables predicted outcomes in the CR group. Conversely, the SC group experienced no clinically meaningful symptom changes. For this group, baseline measures significantly correlated with symptom improvement. Exercise tolerance: Lower baseline ΔHR and HRt significantly correlated with less RPQ-3 (ΔHR: p = 0.01, R2 = 0.28, coefficient = 0.03 || HRt: p = 0.006, R2 = 0.36, coefficient = 0.04) and RPQ-13 improvement (ΔHR: p = 0.03, R2 = 0.24, coefficient = 0.15 || HRt: p = 0.02, R2 = 0.28, coefficient = 0.19). ERPs: Reduced N400 amplitude correlated with less improvement in RPQ-3 (RPQ-3: p = 0.05, R2 = 0.19, coefficient = 0.55). Baseline exercise tolerance and ERPs were significant prognostic indicators for symptom improvement in adults with PPCS undergoing standard, symptom-based care. Participants with lower baseline exercise tolerance showed less improvement in postconcussion symptoms (RPQ-3 and RPQ-13), while reduced N400 amplitude was associated with poorer symptom outcomes. These baseline measures did not predict outcomes for patients receiving the customized rehabilitation program, suggesting that a comprehensive program may overcome initial physiological and cognitive vulnerabilities, leading to more robust recovery regardless of baseline presentation.

BACKGROUNDAlthough extensive research has investigated attentional biases based on the looming vulnerability model of anxiety, the characteristics of attentional biases in individuals with looming cognitive styles (LCS) remain incompletely elucidated. No prior eye-tracking studies have examined the spatiotemporal dynamics of their threat-related attentional preferences.AIMTo investigate the nature and temporal pattern of attentional biases toward threat stimuli in individuals exhibiting different levels of LCS using eye-tracking technology.METHODSA total of 212 participants were stratified according to their Looming Maladaptive Style Questionnaire scores. From the high and low scoring subgroups, 35 participants were randomly selected for an eye-tracking experiment using a classic dot-probe paradigm featuring threat and neutral images. Four eye-tracking metrics, including first fixation latency, first fixation duration, total fixation duration, and fixation count, were analyzed to assess detection speed, attentional orienting, initial maintenance/avoidance, and overall engagement.RESULTSDistinct attentional bias patterns were observed between high and low LCS groups. High LCS individuals exhibited a vigilance-avoidance pattern characterized by initial vigilance toward threat stimuli (evidenced by faster detection and preferential orienting), followed by attentional avoidance, alongside sustained attention maintenance to threat.CONCLUSIONThese findings reveal a temporal dissociation between early vigilance and later avoidance during threat processing in high LCS individuals, providing novel empirical evidence to refine models of cognitive vulnerability and attentional dynamics in threat perception.

This study aims to explore the association between the magnesium depletion score (MDS), a newly developed indicator of magnesium levels, and cognitive function in older adults residing in the United States. We analyzed data from 768 participants aged ≥ 60 years in the 2011 to 2014 National Health and Nutrition Examination Survey. Participants were stratified by MDS levels: none-to-low (0–1), moderate (2), and high (3–5). Cognitive function was assessed through digit symbol substitution test (DSST), animal fluency test (AFT), and Consortium to Establish a Registry for Alzheimer’s Disease Word Learning subtest. Using National Health and Nutrition Examination Survey mobile examination center weights, sample-weighted multivariable linear regression models calculated β coefficients (95% confidence intervals) for MDS–cognition associations, adjusting for age, sex, race, education, income, body mass index, smoking, and hypertension. In fully-adjusted models, high MDS group showed significantly lower cognitive scores versus none-to-low group: DSST: β = −4.91 (−7.73, −2.08), P = .0007, AFT: β = −2.09 (−3.25, −0.93), P = .0004. No significant association with Consortium to Establish a Registry for Alzheimer Disease scores (β = −0.96 [−2.25, 0.33], P = .1445). Stratified analyses revealed stronger associations in obese (body mass index > 30 kg/m²) and current smoking subgroups. Participants meeting magnesium recommended dietary allowance showed attenuated cognitive risks in DSST (interaction P = .022) and AFT (interaction P = .015). Higher MDS is independently associated with poorer processing speed and executive function in older Americans, particularly among obese individuals and smokers. Achieving dietary magnesium recommended dietary allowance may mitigate these low cognitive function. In our cross-sectional study, MDS was found to be associated with cognitive vulnerability.

Worry, shyness, and preference for solitude represent interconnected facets of emotional and social functioning. This study examined whether shyness mediates the relationship between worry and the motivation to spend time alone. A sample of 150 adults completed the Worry Domains Questionnaire, the Cheek and Buss Shyness Scale, and the Preference for Solitude Scale. Results revealed that worry predicted higher shyness, which in turn predicted greater preference for solitude, whereas the direct path from worry to solitude was nonsignificant. Mediation remained robust when controlling age and gender. Exploratory analyses indicated that confidence- and future-oriented worry were most strongly associated with shyness while future and relationship worry were most associated with solitude. These findings highlight shyness as a key psychological mechanism linking cognitive vulnerability to social withdrawal tendencies. Implications for understanding adaptive versus avoidant solitude within individual differences research are discussed.

Locus Coeruleus Microstructure and Connectivity as Novel Markers of Depression and Cognitive Dysfunction in Older Adults.

Background Cyberbullying poses serious risks to adolescent well-being, with cognitive vulnerabilities such as paranoid ideation increasing susceptibility. Moral disengagement may enable such youth to rationalise harmful behaviour, while gendered norms can shape these processes. Objective Guided by Social Cognitive Theory and Ecological Systems Theory, this study tested a moderated mediation model linking paranoid ideation to cyberbullying via moral disengagement, with gender as a moderator. Methods A total of 1,092 junior high school students in Liaoning Province, China, completed validated questionnaires on paranoid ideation, moral disengagement, and cyberbullying. Mediation and moderated mediation analyses were conducted. Results Paranoid ideation significantly predicted cyberbullying, with moral disengagement partially mediating this relationship. Gender moderated both direct and indirect effects, with stronger pathways for males. Conclusions Findings highlight the need for gender-responsive, AI-assisted interventions to reduce cyberbullying by addressing cognitive risk factors and moral reasoning.

To assess the feasibility and safety of cochlear implantation (CI) under local anesthesia (LA) with minimal conscious sedation, and to present institution-specific criteria for anesthesia selection in high-risk adult patients. Between January 2021 and February 2025, a total of 980 ears underwent CI at a single tertiary referral hospital. Of these, 17 ears from 16 adult patients (mean age, 65y; range, 35 to 87) were selected for CI under LA based on predefined clinical indications. CI procedures were performed under LA with minimal sedation following a standardized institutional protocol, which included preoperative patient counseling, targeted anesthetic administration, restricted operative time, and strategies to minimize cognitive impact. Primary outcomes included the completion rate of CI under LA, rate of conversion to general anesthesia (GA), and perioperative complication rates. CI was successfully completed under LA in 16 of 17 ears (94.12%). One case required intraoperative conversion to GA due to behavioral issues associated with preexisting cognitive impairment. No perioperative mortality or major complications were observed. The most frequent indication for LA was mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome due to the m.3243A>G variant, which accounted for 29.41% of LA cases. CI under LA is a viable and safe alternative for selected high-risk patients. Implementation of tailored anesthesia protocols, particularly for individuals with mitochondrial disorders or cognitive vulnerability, facilitates optimized patient outcomes. These findings support a personalized approach to anesthesia selection in auditory rehabilitation.