The cover image is based on the Original Article Markers of too little effort or too much alertness during neuropsychological assessment: Demonstration with perioperative changes by Dana Baron-Shahaf et al., https://doi.org/10.1002/brb3.3649.
The cover image is based on the Original Article Markers of too little effort or too much alertness during neuropsychological assessment: Demonstration with perioperative changes by Dana Baron-Shahaf et al., https://doi.org/10.1002/brb3.3649.
Background: Cryptogenic stroke (CS), a subtype of ischemic stroke with undetermined etiology, accounts for approximately 25% of the cases. Patent foramen ovale (PFO) is an important potential cause of CS via paradoxical embolism. While transesophageal echocardiography (TEE) is the current gold standard for PFO detection, transcranial Doppler (TCD) ultrasound offers a noninvasive alternative with potential advantages in sensitivity for right-to-left shunt (RLS) detection. This study's main goal is to evaluate the diagnostic performance of TCD compared to TEE for PFO detection in CS patients.
Methods: We prospectively enrolled 110 patients aged 18-65 years with confirmed CS from 2020 to 2024. All underwent TCD screening for RLS using a standardized protocol. Subsequently, they were categorized based on a simplified version of the Spencer Logarithmic Scale, followed by confirmatory TEE. Clinical characteristics, imaging findings, TCD results, and indications for PFO closure were analyzed.
Results: The mean age of the cohort was 45 years, with 58.2% being males. TEE identified PFO in 44.5% (49/110) of subjects. TCD accurately detected RLS in 42 of the 49 PFO cases (85.7%) confirmed by TEE. For PFO detection, TCD demonstrated a sensitivity of 85.4%, specificity of 88.5%, PPV of 85.4%, and Youden's index of 0.73. Notably, of the seven PFO cases missed by TCD, none received percutaneous closure based on clinical criteria.
Conclusions: TCD exhibited high diagnostic accuracy for detecting high-risk PFO in patients with CS when compared to the gold-standard TEE. As a noninvasive modality, TCD may serve as an effective screening tool to identify CS patients who could potentially benefit from confirmatory TEE and subsequent PFO closure intervention. The findings support the use of TCD as a screening tool to triage CS patients for confirmatory TEE and potential PFO closure.
Introduction: A smartphone is a device with various functions, including wifi, application functions, mobile networks, ease of mobility, and the capability of using mobile data. Because of the aforementioned functions, people may use smartphones frequently. The Smartphone Application-Based Addiction Scale (SABAS) is a six-item questionnaire assessing smartphone addiction with promising psychometric properties. However, it is unclear if the SABAS possesses the strong psychometric properties across Asian regions. The present study aimed to examine the factor structure of the SABAS across nine Asian regions.
Methods: Using datasets collected from Asian regions of Bangladesh, China, Indonesia, Iran, Malaysia, Pakistan, Taiwan, Thailand, and Vietnam, data from 10,397 participants (mean age = 22.40 years; 44.8% men) were used for analyses. All participants completed the SABAS using an online survey or paper-and-pencil mode.
Results: Findings from confirmatory factor analysis, Rasch analysis, and network analysis all indicate a one-factor structure for the SABAS. Moreover, the one-factor structure of the SABAS was measurement invariant across age (21 years or less vs. above 21 years) and gender (men vs. women) in metric, scalar, and strict invariance. The one-factor structure was invariant across regions in metric but not scalar or strict invariance.
Conclusion: The present study findings showed that the SABAS possesses a one-factor structure across nine Asian regions; however, noninvariant findings in scalar and strict levels indicate that people in the nine Asian regions may interpret the importance of each SABAS item differently. Age group and gender group comparisons are comparable because of the invariance evidence for the SABAS found in the present study. However, cautions should be made when comparing SABAS scores across Asian regions.
Introduction: Short post-learning breaks, lasting from 5 to 30 min, transiently enhance procedural motor memory performance in adults. However, the impact of activity type (active vs. passive) during the offline break on sequential motor performance remains poorly investigated in children.
Method: This study examined the impact of active versus passive post-learning breaks on procedural motor memory in 116 healthy participants (58 children, aged 9.03 ± 1.19; 58 adults, aged 22.89 ± 1.77 years). Participants practiced a Finger Tapping Task, reproducing a five-element keypress sequence as fast and accurately as possible. The task included two sessions (S1 and S2) separated by either a short (30 min) or long (4 h) break. The first 30-min of the post-learning break included either a passive (remaining still) or an active (engaging in daily activities) condition.
Results: Repeated-measures ANOVA revealed significant Session × Age group × Break duration and Session × Break type interaction effects (ps < 0.05). Post hoc analyses indicated Session effects in adults after both Break types, but only after short Break duration (S1 < S2, p < 0.001; long delay p = 0.1). In children, Session effects were observed after both short and long breaks, but only in the active Break type (S1 < S2, ps < 0.001; passive condition p = 0.1).
Conclusion: These results revealed spontaneous post-learning motor performance improvements at both short and long delays in children, but only in the active post-training condition, unlike adults who showed improvements only at short delays, regardless of activity type. This suggests developmental differences in offline conditions (duration and activity) linked to plasticity mechanisms underlying procedural motor memory consolidation.
Background: Meta-analyses (MAs) provide up-to-date, quantified evidence on treatment effects, which may be useful for clinical and policy decision-making. However, the quality of MAs varies, and methodological flaws can limit their reliability.
Aims: This review evaluated the methodological quality of MAs on sleep disorder treatments.
Methods: We searched MEDLINE, EMBASE, and PsycINFO for eligible MAs on randomized controlled trials of sleep disorder treatments published between 2018 and 2023. We extracted MAs' bibliographical characteristics with a predesigned form and appraised their methodological quality using AMSTAR (A Measurement Tool to Assess Systematic Reviews) 2. We explored the associations between bibliographical characteristics and methodological quality ratings using Kruskal-Wallis tests and Spearman's rank correlation coefficients.
Results/outcomes: Among the 104 MAs, the majority (n = 82; 78.9%) had critically low quality, 19 (18.3%) had low quality, and only 3 (2.9%) had high quality. Regarding AMSTAR 2 critical domains, 97 (93.3%) MAs did not provide a list of excluded studies and justify the exclusions, 75 (72.1%) did not use a comprehensive literature search strategy, and 56 (53.9%) lacked a registered protocol and did not justify protocol deviations. Cochrane reviews (p = 0.018), MAs with European corresponding authors (p < 0.001), and MAs receiving European funding (p < 0.001) performed better than their counterparts.
Conclusions/interpretation: The methodological quality of recent MAs on sleep disorder treatments is unsatisfactory. Future reviewers should address the identified critical methodological issues. In addition, substantial resources and funding should be allocated to support training in evidence synthesis and critical appraisal for researchers and clinicians.
The abnormal central glucose metabolism in Alzheimer's disease (AD) is related to the brain–gut axis. This study aims to explore the target of Danggui-Shaoyao-San (DSS) in improving cognitive impairment.
This study analyzed the differences in mice intestinal flora by 16S rRNA sequencing. The cognitive protective effects of DSS were observed through the Morris water maze and the new object recognition. The mitigation effects of DSS on Aβ and p-tau, regulatory effects on glucose metabolism targets, and intestinal structure effects were observed through brain and colon slices staining. The differences in neural ultrastructure were compared by transmission electron microscopy.
The results showed that DSS affected the composition of intestinal dominant bacteria and bacteria genera and regulated the abundance of intestinal bacteria in AD mice. DSS improved the behavior of AD mice, alleviated the deposition of AD pathological products in the brain and colon, regulated the expression of glycometabolism-related proteins, and improved the colon barrier structure and neural ultrastructure in the brain of mice with AD.
Our findings suggest that DSS may affect AD central glucose metabolism and improve cognition by regulating the gut–brain axis.
Upper limb rehabilitation robot is a relatively new technology, but its effectiveness remains debatable due to the inconsistent results of clinical trials. This article intends to assess how upper limb rehabilitation robots help the functional recovery of stroke patients.
PubMed, Embase, Cochrane Library, and Web of Science databases were searched for eligible studies to explore the effect of upper limb rehabilitation robots on upper limb motor function, muscle tone, and daily living activities.
Eighteen trials with 573 stroke patients met the inclusion criteria. The results showed that compared to conventional rehabilitation training, patients who received upper limb robotic therapy (RT) had significantly improved Fugl-Meyer Upper Extremity Motor Assessment (FMA-UE) scores (weighted mean differences [WMD]: 5.27, 95% confidence intervals [CI]: 3.36, 7.17), Action Research Arm Test (ARAT) scores (WMD: 4.07, 95% CI: −4.14, 12.28), Modified Barthel Index (MBI) scores (WMD: 9.55, 95% CI: 6.37, 12.73), and modified Ashworth Scale (MAS) scores (WMD: −0.28, 95% CI: −0.50, 0.06), with no significant heterogeneity.
Upper limb robot–assisted training is superior to conventional training in terms of improving upper limb motor impairment, ability to perform daily living activities, and muscle tone recovery, which supports the application of robots in clinical practice.
Dexmedetomidine, a highly specific α2 agonist, has been extensively utilized in clinical sedation and surgical anesthesia since its introduction in 2000 due to its excellent sympatholytic, sedative, and analgesic effects. This review aimed to identify new approaches for the treatment of patients with brain disorders by thoroughly describing the mechanism of action of dexmedetomidine and examining its neuroprotective effects from the standpoints of basic and clinical research.
The PubMed and Web of Science databases were searched using the keywords dexmedetomidine and related brain diseases, although relevant articles from the last decade were included for detailed summarization and analysis.
Dexmedetomidine has shown strong neuroprotective effects, such as protection of the blood-brain barrier, decreased neuronal death, maintained hemodynamic stability, and reduced postoperative agitation and cognitive dysfunction. Furthermore, dexmedetomidine has been shown to exert various neuroprotective effects, including anti-inflammatory and antioxidative stress effects, modulation of autophagy, and reduction of apoptosis in cerebral diseases.
Dexmedetomidine acts as a neuroprotective agent against brain diseases during all phases of treatment. However, clinical trials with larger sample sizes are required to optimize dosage and dosing strategies.
It is still not fully explained what kind of cognitive sources the methods used in the assessment of listening effort are more sensitive to and how these measurement results are related to each other. The aim of the study is to ascertain which neural resources crucial for listening effort are most sensitive to objective measurement methods using differently degraded speech stimuli.
A total of 49 individuals between the ages of 19 and 34 with normal hearing participated in the study. In the first stage, simultaneous pupillometry, electroencephalogram (EEG), and single-task paradigm reaction time (RT) measurements were made during the challenging listening and repetition task with noise-vocoded speech. Two speech reception thresholds (SRT) (50% and 80%) for two vocoding conditions (16 and 6 channels) were collected, resulting in 4 conditions. In the second stage, the Rey Auditory Verbal Learning Test (RAVLT) and the test of attention in listening (TAIL) were applied. Stepwise linear regression analyses were conducted to examine the predictors of listening effort measurements.
A significant difference was found between 6 and 16 channel stimuli in both pupil dilation change and EEG alpha band power change. In the hardest listening condition, whereas RAVLT scores are significant predictors of pupil dilation change, TAIL scores are significant predictors of EEG alpha power. As the stimulus difficulty decreased, the factors that predicted both EEG and pupillometry results decreased. In the single-task paradigm, a significant regression model could not be obtained at all four difficulty levels.
As a result of the study, it was found that the pupil dilation change was more sensitive to auditory memory skills and the EEG alpha power change was more sensitive to auditory attention skills. To our knowledge, this study is the first to investigate the sensitivity of different listening effort measurement methods to auditory cognitive skills.
Cognitive decline is a common challenge faced by older individuals with presbycusis; their performance on dual-task (DT) activities is generally lower compared to those without hearing loss. However, the influence of hearing aids on nonauditory cognitive decline in this population remains unclear. This study aims to investigate the effect of hearing aids on nonauditory DT performance in older adults with presbycusis.
This study included older people with presbycusis who used hearing aids (P&HA group), those with presbycusis who did not use hearing aids (PoHA group), and a control group of healthy adults. Forward and backward digit span tests and timed up and go test (TUG) were administered to all individuals. TUG and motor and cognitive (forward and backward digit span) tasks were applied simultaneously to evaluate the participants' DT performance.
The study comprised 60 individuals with presbycusis (19 females, 41 males; mean age: 73.23 ± 6.49 years) and 30 healthy adults (15 females, 15 males; mean age: 35.93 ± 8.57 years). Healthy adults performed better than the P&HA and PoHA groups in all the administered tests (p < 0.05). There was a moderate negative relationship between the severity of hearing loss and the forward and backward digit span test performances (p < 0.05). The P&HA group performed better than the PoHA group on the DT cognitive forward and backward digit span tests.
The use of hearing aids and their proper fitting are important not only for improving communication skills and reducing listening effort but also for supporting nonauditory cognitive functions, minimizing the risk of falls during DT activities, and enhancing the overall quality of life.
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