Brain Sciences最新文献

{"title":"Intradialytic Hemodynamic Instability and Delirium in Critically Ill Patients Receiving Renal Replacement Therapy: A Retrospective Cohort Study.","authors":"Erdem Baran","doi":"10.3390/brainsci16101091","DOIUrl":"10.3390/brainsci16101091","url":null,"abstract":"<p><p><b>Background:</b> Acute kidney injury (AKI) requiring renal replacement therapy (RRT) is common in critically ill patients and is frequently accompanied by delirium. Intradialytic hemodynamic instability, particularly hypotension, may impair cerebral perfusion; however, its quantitative relationship with delirium remains unclear. This study investigated the association between intradialytic hemodynamic instability and Confusion Assessment Method for the Intensive Care Unit (CAM-ICU)-defined delirium in critically ill patients receiving RRT. <b>Methods:</b> This single-center retrospective study included 87 adult intensive care unit (ICU) patients undergoing RRT between September 2025 and May 2026. Delirium was assessed using the CAM-ICU. Intradialytic hemodynamic burden was quantified by the cumulative duration of mean arterial pressure (MAP) < 65 mmHg and the number of hypotensive episodes during RRT. Multivariable logistic regression analyses adjusted for age, sex, and admission SOFA score were performed to evaluate the associations between hemodynamic parameters and delirium, while receiver operating characteristic (ROC) analyses were used to assess their discriminative ability. <b>Results:</b> Of 87 patients, 46 (52.9%) were classified as CAM-ICU-positive for delirium. Patients with delirium had a longer cumulative duration of MAP < 65 mmHg (median, 36.0 vs. 5.0 min; <i>p</i> = 0.048) and more hypotensive episodes (median, 3.0 vs. 1.0; <i>p</i> = 0.032). These differences were no longer significant after normalization to the number of RRT sessions (<i>p</i> = 0.153 and <i>p</i> = 0.249). In addition, neither parameter showed a statistically significant association with delirium after adjustment for age, sex, and admission SOFA score. ROC analysis demonstrated limited discriminative ability (AUC, 0.62 and 0.63, respectively). Mechanical ventilation duration, ICU length of stay or ICU mortality did not show a statistically significant association with CAM-ICU positivity in the adjusted models. Sensitivity analyses using alternative functional forms for cumulative MAP < 65 mmHg duration, including log-transformed, categorical, and natural cubic spline models, did not show statistically significant associations with CAM-ICU positivity. <b>Conclusions:</b> Critically ill patients with delirium had greater cumulative intradialytic hypotensive burden; however, these differences were attenuated after accounting for the number of RRT sessions, and the hemodynamic parameters did not show statistically significant associations with delirium in the adjusted regression models. These findings suggest a potential relationship between intradialytic hemodynamic burden and delirium but do not establish an independent or causal association.</p>","PeriodicalId":9095,"journal":{"name":"Brain Sciences","volume":"16 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13702392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149262602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Head-Mounted Augmented Reality in the Planning of Cerebral Cavernous Malformation Resections: Demonstrating Feasibility Through an Initial Case Series.","authors":"Luke L Jouppi, Clifford A Pierre, Matias Luis Costa, Radwan I Takroni, Nicholas Caffes, Stepan Capek, Aaron J Gustin, Majid Aljoghaiman, Zane A Tymchak, Akshal S Patel, Stephen J Monteith","doi":"10.3390/brainsci16101094","DOIUrl":"10.3390/brainsci16101094","url":null,"abstract":"<p><strong>Objectives: </strong>Lesion localization, associated vascular structures, and corticotomy selection pose key challenges when planning cerebral cavernous malformation (CCM) resections in eloquent areas. Head-mounted augmented reality (HMAR) may improve visualization without the gaze disruptions imposed by conventional neuronavigation. This study investigated the preoperative feasibility of HMAR in surgical plan modifications and educational value.</p><p><strong>Methods: </strong>We performed a single-center retrospective review of all CCM patients with HMAR-assisted preoperative planning from 1 September, 2022, to 31 August, 2024. Three-dimensional reconstructions of patients' magnetic resonance imaging were viewed preoperatively using HMAR. Registration accuracy was confirmed against conventional neuronavigation. Surgical plan modifications entailed alterations of the operative goal, trajectory, or steps. Educational value of HMAR was appraised by trainees as \"not helpful\" when only confirming existing plans, \"helpful\" when facilitating a greater understanding of the lesion, and \"very helpful\" when spurring additional positioning or plan modifications.</p><p><strong>Results: </strong>Of 19 patients with CCM resections, 14 patients with HMAR-assisted preoperative planning were included. The average age was 38.6 ± 14.5 years, with 6 males and 8 females. Three of 14 (21%) surgical approaches were modified following HMAR use: two to minimize cortical disruption and one to avoid injuring an associated developmental venous anomaly. Registration was accurate in all cases. Between registration and utilization, HMAR added an average of 2.7 ± 1.0 min in the operating room. The mean appraisal of the educational value of HMAR was \"helpful.\"</p><p><strong>Conclusions: </strong>Preoperative planning with HMAR prompted surgical plan modifications and often improved trainees' understanding without introducing significant workflow disruptions. Three-dimensional visualization offered dynamic spatial details beyond traditional two-dimensional multiplanar MRI.</p>","PeriodicalId":9095,"journal":{"name":"Brain Sciences","volume":"16 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13702605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149262646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Cortical Signatures: Measurement Gaps Across Theories of Consciousness.","authors":"Maria Svet, Arosh S Perera Molligoda Arachchige","doi":"10.3390/brainsci16101087","DOIUrl":"10.3390/brainsci16101087","url":null,"abstract":"<p><p>Adversarial testing has strengthened the empirical standards of consciousness science, but recent results also expose a measurement problem: competing theories frequently make predictions about the same neural quantities and can therefore be challenged without being decisively discriminated. This evaluative review incorporates a purposive structured audit of contemporary theories and theory-relevant experiments rather than a systematic census. The audit separates trial-level from origin-level frameworks, explicit from interpreted commitments, and positive from stated-null predictions. Policy count and incompatibility remain sparsely occupied coordinates, whereas organism-wide cortical-autonomic coherence is not explicitly formulated as an access criterion by the trial-level accounts and is therefore treated as a sensitivity-dependent gap rather than an unqualified absence. Importantly, an unoccupied coordinate is not itself a discriminating prediction: direct theoretical adjudication requires opposed commitments. In the baseline theory-addressed content-bearing sample, valenced content is absent; under the most permissive sensitivity rule, it rises to 6 of 57 experiment rows (4 of 30 publications). The crossed conflict-by-valence experiment specified here can be run now, but it does not discriminate among theories that are silent on those coordinates; the autonomic-only condition that would generate a genuinely opposed test cannot yet be run because a validated report-independent measure of interoceptive access is lacking.</p>","PeriodicalId":9095,"journal":{"name":"Brain Sciences","volume":"16 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13702712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149262597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of High-Intensity Gait Training in the Acute Care Setting on Length of Stay and Functional Status in Patients with Stroke.","authors":"Michael J Shoemaker, Kaitlyn R Batchelor, Jozlyn A Gilman, Rachel S Miller, Tarah F Nicholson","doi":"10.3390/brainsci16101082","DOIUrl":"10.3390/brainsci16101082","url":null,"abstract":"<p><p><b>Background/Objectives</b>: The feasibility of high-intensity gait training (HIGT) in the acute care setting has only been demonstrated in two studies and its impact on functional status and length of stay (LOS) is not clear. The purpose of the present study was to further examine the impact of HIGT on acute care LOS and change in Activity Measurement for post-acute care (AM-PAC 6-Clicks). <b>Methods</b>: This was a retrospective medical record review of a cohort of patients in the acute care setting who received HIGT following implementation of a quality improvement project. Historical conventional care patients were identified and matched to the HIGT group using propensity score matching. Linear mixed models were used to examine the effect of group on acute care LOS and change in AM-PAC 6-Clicks. <b>Results</b>: 36 HIGT patients with one matched control and 22 with two matched controls were analyzed. After controlling for unbalanced covariates using a linear mixed model, acute care LOS was 1.2 days shorter in the HIGT group compared to the conventional care control group (<i>p</i> = 0.031, 95% CI 0.11, 2.29). There was no difference in change in AM-PAC 6-Clicks (<i>p</i> = 0.575, 95% CI -1.36, 0.76). <b>Conclusions</b>: Receiving HIGT in the acute care setting was associated with a 1.2-day-shorter LOS compared to conventional care in this study cohort; however, exposure to HIGT does not appear to improve the functional status during acute hospitalization post-stroke in this cohort. The mechanism underlying the association with the shorter LOS remains unclear and may reflect increased confidence in the patient's readiness for discharge, unmeasured differences between cohorts, or changes in a variety of factors that influence discharge disposition given the cohorts were from two different time periods.</p>","PeriodicalId":9095,"journal":{"name":"Brain Sciences","volume":"16 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13702758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149262570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Antithrombotic Exposure and Postoperative Outcomes Following Nontraumatic Subdural Hematoma Evacuation: A Multicenter Electronic Health Record Analysis with Single-Center Context.","authors":"Noah B Drewes, Lara Koutah, Rishi Jain, Hannah E Johnson, Jack Carnduff, Khizar R Nandoliya, Kayla Chin, Ava Hoeft, Savannah Kidd, Alexander C Kowalski, Kevin Lu, Hannah Roberts, Yixuan Ma, Guadalupe Ruiz, Kyle Struck, Jessica Sheelam, Dylan J Thompson, Faris Shaikh, Krish Patel, Kristin R Delfino, Bruce M Frankel","doi":"10.3390/brainsci16101084","DOIUrl":"10.3390/brainsci16101084","url":null,"abstract":"<p><p><b>Background/Objectives</b>: Preoperative antithrombotic therapy is common among patients undergoing subdural hematoma (SDH) evacuation. However, the association with postoperative outcomes remains uncertain. We evaluated this potential association using a multicenter electronic health record cohort and a single-center cohort. <b>Methods</b>: We performed a retrospective cohort study using TriNetX, a multicenter electronic health record (EHR) database, and a single-center cohort. TriNetX was used to identify adults undergoing evacuation of nontraumatic subdural hematoma between 2005 and 2025. The exposed cohort was defined as documented oral anticoagulant or antiplatelet exposure within 7 days before surgery, after which patients were propensity-score matched 1:1. The single-center cohort included surgically treated subdural hematoma patients with clinical, radiographic, laboratory, and operative data. Postoperative outcomes included 30-day mortality, short-term thrombotic complications, and 90-day repeat subdural hematoma surgery. <b>Results</b>: In TriNetX, 15,651 eligible patients were identified. Matched cohorts included 1455 exposed and 1455 unexposed patients. Preoperative antithrombotic exposure was associated with higher 90-day repeat surgery (9.7% vs. 6.5%; hazard ratio [HR] 1.52; <i>p</i> = 0.001), whereas 30-day mortality and 14-day thrombotic complications did not differ significantly. The single-center cohort included 164 surgically treated patients, including 103 exposed and 61 unexposed patients. The reoperation association was not reproduced. However, exposed patients had higher unadjusted 30-day and overall mortality that attenuated after multivariable Cox adjustment. <b>Conclusions</b>: Preoperative antithrombotic exposure was associated with repeat surgery in the TriNetX cohort but not in the single-center cohort. Together, these findings suggest that antithrombotic exposure may identify a medically complex surgical SDH population requiring individualized postoperative surveillance.</p>","PeriodicalId":9095,"journal":{"name":"Brain Sciences","volume":"16 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13702731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149262737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fronto-Parietal Brain Metabolites Following Traumatic Brain Injury-A Proton MR Spectroscopy Study.","authors":"Ping-Hong Yeh, Chen-Haur Yeh, Terrence R Oakes, John Ollinger, Gerard Riedy","doi":"10.3390/brainsci16101088","DOIUrl":"10.3390/brainsci16101088","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background:&lt;/b&gt; Conventional structural CT and MRI may be normal after mild traumatic brain injury (mTBI), while magnetic resonance spectroscopic imaging (&lt;sup&gt;1&lt;/sup&gt;H-MRSI) can provide regional measures of brain metabolites. We examined supracallosal fronto-parietal metabolite ratios in active-duty service members with military-related TBI and non-TBI military controls, including comparisons by injury mechanism and exploratory clinical associations. &lt;b&gt;Methods&lt;/b&gt;: The study used a retrospective cross-sectional cohort. Participants underwent 3T 2D multivoxel &lt;sup&gt;1&lt;/sup&gt;H-MRSI covering a 6 × 8 × 1 cm&lt;sup&gt;3&lt;/sup&gt; supracallosal fronto-parietal PRESS/CSI volume of interest. Regional N-acetylaspartate (NAA), choline-containing compounds (Cho), and creatine/phosphocreatine (Cr) measures were processed with SIVIC and summarized as NAA/Cr and Cho/Cr ratios. Linear mixed-effects models were adjusted for age and sex, with Bonferroni correction for regional group comparisons. Male-only analyses were performed as a sensitivity analysis. Associations with clinical and neurocognitive measures were exploratory. &lt;b&gt;Results&lt;/b&gt;: The final analytic cohort reported in the manuscript comprised 741 service members with TBI (34.3 ± 8.1 years old; M/F = 711/30; mean 327.4 ± 226.8 days post-injury) and 75 non-TBI controls (M/F = 53/22; mean age: 33.1 ± 10.0 years). TBI participants showed lower Cho/Cr area ratios in multiple fronto-parietal regions, including right precuneus (estimate = -0.0781, SE = 0.0176, t = -4.43, pBonf &lt; 0.0001, Cohen's d = -0.36, 95% CI [-0.1127, -0.0435]), left superior frontal gyrus (estimate = -0.0715, SE = 0.0163, t = -4.38, pBonf &lt; 0.0001, Cohen's d = -0.36, 95% CI [-0.1035, -0.0394], and bilateral fronto-parietal WM (right: estimate = -0.0741, SE = 0.0169, t = -4.39, pBonf &lt; 0.0001, Cohen's d = -0.35, 95% CI [-0.1072, -0.0410]; left: estimate = -0.0656, SE = 0.0161, t = -4.08, Cohen's d = -0.33, pBonf = 0.0011, 95% CI [-0.0971, -0.0340]). Injury mechanism stratification revealed a widespread reduction in Cho/Cr area in individuals with blast-related TBI relative to unexposed non-TBI controls over the left superior frontal gyrus (estimate = -0.0941, SE = 0.0176, t = -5.35, pBonf &lt; 0.0001, Cohen's d = -0.44, 95% CI [-0.1287, -0.0596]), right precuneus (estimate = -0.0900, SE = 0.0193, t = -4.66, Cohen's d = -0.38, pBonf = 0.0010, 95% CI [-0.1279, -0.0521]), and right fronto-parietal WM (estimate = -0.0895, SE = 0.0182, t = -4.91, Cohen's d = -0.39, pBonf &lt; 0.0001, 95% CI [-0.1253, -0.0537]). Twelve regional differences remained significant in the primary analysis, and the principal pattern was substantially preserved in the male-only sensitivity analysis. Blast-related and multiple-blast comparisons also showed regional Cho/Cr differences; individuals with multiple blast exposures mainly drove Cho/Cr reduction. Exploratory clinical analyses found inverse associations between Cho/Cr and Post-Traumatic Stress Checklist-Civilian vers","PeriodicalId":9095,"journal":{"name":"Brain Sciences","volume":"16 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13702281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149262598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond a Universal Cut-Off: [¹⁸F]FET-PET Metrics for Distinguishing High-Grade Glioma Recurrence from Treatment-Related Changes.","authors":"Pier Paolo Berti, Alessandro Spimpolo, Leda Lorenzon, Davide Drusiani, Matteo Presa, Luca Zavatto, Paolo Cipriano Cecchi, Davide Costazza, Vania Pirillo, Matteo Bonatti, Francesco Erdini, Nadia Oberhofer, Giuseppe Maria Della Pepa, Francesco Doglietto, Andreas Schwarz, Mohsen Farsad","doi":"10.3390/brainsci16101085","DOIUrl":"10.3390/brainsci16101085","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Differentiating tumour recurrence from treatment-related changes (TRC) after multimodal treatment of high-grade gliomas (HGGs) remains challenging because of the overlap in imaging findings on conventional magnetic resonance. This study compared the diagnostic performance of the main static semiquantitative O-(2-[¹⁸F]fluoroethyl)-L-tyrosine positron emission tomography ([¹⁸F]FET-PET) parameters and assessed the diagnostic contribution of qualitative tracer uptake. <b>Methods:</b> This retrospective single-centre study included 77 scans from 61 adult patients with previously resected and chemoradiotherapy-treated HGGs undergoing [¹⁸F]FET-PET for suspected recurrence. Standardised uptake values (SUVs), tumour-to-background ratios (TBRs), and metabolic tumour volume (MTV) were analysed. Recurrence was determined using a composite histopathological and clinical-radiological reference standard. Diagnostic performance was assessed using receiver operating characteristic analysis, Youden-derived cut-offs and DeLong comparisons. Internal validation was performed by using patient-grouped five-fold cross-validation, in which cut-offs were re-derived within each training partition and applied to the held-out partition. <b>Results:</b> Forty-nine scans were classified as recurrence and 28 as TRC. All semiquantitative parameters except MTV were significantly higher in recurrent disease after false-discovery-rate correction. TBR mean ratio showed the highest accuracy (AUC, 0.80; cut-off, 1.85; sensitivity, 77.6%; specificity, 75.0%), followed by SUV max (AUC, 0.793). Neither prespecified comparison among TBR parameters was significant. The presence of pathological uptake achieved 100% sensitivity, 42.9% specificity, 100% NPV, and 79.2% accuracy. MTV was non-discriminative (AUC, 0.499). SUV max differed significantly between scanners (<i>p</i> = 0.008). <b>Conclusions:</b> Static semiquantitative [¹⁸F]FET-PET parameters, except MTV, showed comparable moderate-to-good performance for distinguishing recurrence from TRC. TBRmean may represent a pragmatic primary marker due to its background normalisation reduction of scanner-related variability. Guideline-recommended thresholds should be regarded as reference values requiring local validation and, when appropriate, centre- and protocol-specific calibration.</p>","PeriodicalId":9095,"journal":{"name":"Brain Sciences","volume":"16 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13702475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149262472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do People Dream of Sex with Androids? Neuroscience Behind Cybersex and Technosexual Behaviour.","authors":"Rafał Gerymski","doi":"10.3390/brainsci16101083","DOIUrl":"10.3390/brainsci16101083","url":null,"abstract":"<p><p>Technology-mediated sexual behaviours, including cybersex and technosex, are becoming increasingly prevalent as digital technologies, virtual reality, artificial intelligence, and interactive devices continue to develop. Although these behaviours may offer numerous benefits, such as facilitating sexual exploration, supporting individuals with disabilities, and enabling long-distance intimacy, they may also contribute to problematic patterns of use in some individuals. This review synthesises current knowledge on the psychological and neurobiological mechanisms underlying cybersex and technosexual behaviour. The article discusses conceptual and definitional issues, epidemiological data, and theoretical frameworks, including the Triple A model and the \"quasi-necrophilia\" framework, to explain the characteristics and motivations behind technology-mediated sexual activities. Furthermore, it summarises psychological factors associated with both adaptive and maladaptive use, emphasising the role of emotion regulation, personality traits, neurodevelopmental conditions, mental health, and sexual motivations. The review also presents current evidence on the neurobiology of cybersex and technosex, highlighting the involvement of dopaminergic reward pathways and similarities to other reward-related behaviours. Finally, available approaches to the treatment of problematic technology-mediated sexual behaviour are discussed, including pharmacotherapy, as well as psychoeducation and psychotherapy, with particular attention to the importance of addressing underlying psychological conditions. The article argues that cybersex and technosex should not be inherently pathologised-instead, they should be understood within a biopsychosocial framework that distinguishes between healthy sexual expression and clinically significant impairment.</p>","PeriodicalId":9095,"journal":{"name":"Brain Sciences","volume":"16 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13702473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149262541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Noninvasive Neuromodulation for Cognitive Dysfunction in Parkinson's Disease: A Scoping Review.","authors":"Shelby Chase Loftis, Morgan McClellan, Anna Lise Sheridan, Cynthia Rando, Reginald B O'Hara","doi":"10.3390/brainsci16101086","DOIUrl":"10.3390/brainsci16101086","url":null,"abstract":"<p><strong>Background/objectives: </strong>Parkinson's disease with mild cognitive impairment (PD-MCI) represents a critical early-intervention window before progression to dementia. However, non-pharmacological cognitive treatment options are poorly characterized. This scoping review maps noninvasive neuromodulation interventions evaluated for cognitive outcomes in PD-MCI and in broader PD populations.</p><p><strong>Methods: </strong>Following JBI scoping review methodology and PRISMA-ScR guidelines, PubMed, Scopus and Google Scholar were searched for empirical studies published between May 2006 and September 2026 that applied noninvasive neuromodulation in adults with PD-MCI or broader PD populations and reported cognitive outcomes. Studies were classified as direct PD-MCI evidence (diagnosis confirmed using Movement Disorder Society Task Force criteria) or adjacent PD cognitive evidence.</p><p><strong>Results: </strong>Eleven studies across five modalities were included: tDCS (<i>n</i> = 6), iTBS (<i>n</i> = 2), TPS (<i>n</i> = 1), tcVNS (<i>n</i> = 1), and taVNS (<i>n</i> = 1). Only four studies (two tDCS and two iTBS) enrolled participants with confirmed PD-MCI; the remaining seven enrolled broader PD populations. Favorable findings came mainly from small samples, and protocols, outcome measures, and populations were heterogeneous.</p><p><strong>Conclusions: </strong>Evidence specific to PD-MCI is limited and mixed. Several studies pairing stimulation with cognitive training reported favorable outcomes, but this pattern was inconsistent and does not establish superiority over stimulation alone. No VNS trial enrolled participants with confirmed PD-MCI or used cognition as a primary endpoint.</p>","PeriodicalId":9095,"journal":{"name":"Brain Sciences","volume":"16 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13702581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149262665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Pharmacological Trigger to Manic State: Convergent Neurobiological Mechanisms of Drug-Induced Mania.","authors":"Ji Hyun Park","doi":"10.3390/brainsci16101081","DOIUrl":"10.3390/brainsci16101081","url":null,"abstract":"<p><p>Manic and hypomanic states are precipitated by pharmacologically diverse agents, including corticosteroids and antidepressants, and carry serious clinical consequences. Since the last cross-class review in 1995, the literature has fragmented into class-specific reviews lacking a shared mechanistic account. I hypothesize that chemically unrelated drugs perturb a few proximal systems-dopaminergic gain, glutamatergic synaptic potentiation, sleep and circadian timing, glucocorticoid signaling, and neuroimmune signaling-that converge on ventral prefrontal-amygdala-striatal circuitry implicated in secondary mania. Inverting the classical lesion-convergence logic, I treat pharmacological exposures as reversible, dose-graded probes of this network, accommodating withdrawal reversibility, dose dependence, and the affected minority. Evidence is appraised by study design rather than drug class, distinguishing experimentally supported associations from case series lacking exposure denominators. Across 15.4 million post-marketing reports containing 11,698 manic or hypomanic events, which cannot establish incidence or causality, median reported latency ranged from one day (glutamatergic agents) to three to four weeks (antidepressants), a contrast preserved at the drug level. A descriptive temporal-concentration flag identified signals warranting cautious interpretation. Rather than a universal pathway, this untested framework links proximal mechanism to phenotype and time course, generating testable predictions for studies combining exposure measurement, actigraphic sleep monitoring, and repeated activation ratings.</p>","PeriodicalId":9095,"journal":{"name":"Brain Sciences","volume":"16 10","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13702241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149262592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}