搜索结果：Journal of cognition

Health-professions education has moved beyond traditional lecture-based instruction toward competency-based and student-centred learning approaches, such as Problem-Based and Case-Based Learning. While pedagogy has evolved, the structured integration of artificial intelligence (AI) into medical and health-professions education remains limited. Current curricula provide minimal exposure to AI fundamentals, data literacy, and ethics, leaving future clinicians underprepared for AI-enabled practice. This paper extends the Learning, Cognition, AI, and Pedagogy (L-CAP) framework, originally introduced in a continuing-professional-development programme for educators, to health-professions education. Grounded in cognitive science, pedagogy, and software-architecture principles, L-CAP provides a structured, human-centred model for embedding AI through four interdependent layers: Learning, Cognition, AI, and Pedagogy, linked by a Plan-Orchestrate-Assess-Reflect workflow. The framework supports applications in clinical reasoning, inter-professional learning, and ethics education. Early exploratory feedback from the United Kingdom and South Korea suggests that L-CAP is clear, adaptable, and suitable for integration across medical and allied-health curricula. L-CAP thus offers a practical bridge between pedagogy and technology, supporting more integrated, AI-informed, and cognitively grounded health-professions education.

Cognitive impairment is a common, yet underrecognized, feature of bipolar disorder (BD). While cognition has emerged as a contributing factor to poor functioning in BD, previous reviews did not examine the role of cognitive domains (i.e., social cognition, nonsocial cognition) or the role of key potential moderators, including age and sex. A systematic literature search identified studies that included assessments of cognition and functioning in BD (103 reports, 2,200 effect sizes, 9,323 BD participants). Multilevel models tested the association between cognition and functioning, as well as moderation by cognitive domain, functional domain, biological factors, and clinical factors. Better overall cognitive performance was associated with better overall functioning (r = .20, p < .001). In contrast to the schizophrenia literature, nonsocial cognition was more strongly related to functioning (r = .21, p < .001) than social cognition (r = .16, p < .001). The magnitude of the relationship differed across cognitive and functional domains and was moderated by age, sex, clinical factors, and risk of bias. Social and nonsocial cognition make small, but statistically significant, contributions (i.e., 4% variance) to daily functioning in people with BD. This finding supports cognition as a viable treatment target to improve functioning in BD, with appropriate consideration of key moderators. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Treatment for women with endometriosis is only partially or temporarily effective. Moreover, medical hormonal treatment is associated with debilitating side effects and interferes with fertility, while surgery has a relatively high risk of complications. Meanwhile, women with endometriosis show increasing interest in implementing lifestyle interventions to alleviate symptoms and improve health-related quality of life (HRQoL). Integrating these lifestyle interventions can provide a holistic approach to the treatment of this debilitating disease. However, scientific evidence supporting the effectiveness of these interventions is limited. This study is designed to investigate the effectiveness of two lifestyle interventions and the combination of both: an anti-inflammatory diet intervention (AIDI) could improve immune cell function and reduce inflammation, resulting in improved HRQoL and alleviating pain. In addition, the integration of cognitive behavioural therapy (CBT) aims to provide insight into pain mechanisms and coping with pain, and to assist in sustaining dietary adjustments. The Pain in Endometriosis And the Relation to Lifestyle (PEARL) study is a five-arm randomised controlled trial with a pre-post factorial design with two factors: an AIDI and CBT. The study population will consist of 250 premenopausal women, of whom 200 are diagnosed with endometriosis and experience pain symptoms and 50 are healthy controls (HC). Women with endometriosis will be recruited from one academic tertiary and five secondary hospitals in the Netherlands. They will be randomised (1:1:1:1) among four intervention groups: standard care (SC) (SC group), SC and an AIDI (SC + AIDI group), SC and CBT (SC + CBT group), and SC, AIDI and CBT (SC + AIDI + CBT group). Women with endometriosis will visit the hospital twice during the intervention period, at the start (T0) and end (T2) of the 13-week intervention period. HC will not undergo any of the interventions and will have one hospital visit (T0). Participants will complete questionnaires regarding pain symptoms, HRQoL, physical activity level, sleep, diet quality, pain cognitions, and stress at T0 and T2. Furthermore, they are instructed to collect menstrual effluent, a vaginal swab and a faecal sample. During the study visits, peripheral blood will be drawn and scalp hair samples will be taken. The primary outcome is average pain, measured using a numerical rating scale. Secondary outcomes focus on HRQoL, inflammation, immune system characteristics, vaginal- and gut microbiome, and hair cortisol levels. These are considered to reflect potentially underlying mechanisms of the effect of both interventions on the primary outcome. Biological samples and questionnaires of women with endometriosis and HC will be compared to establish the differences in secondary outcomes. This study protocol has been approved (approval number: NL86247.091.24) by the METC Oost-Nederland from Radboud University Medical Centre on July 11, 2024. Prior to participation, participants are required to provide informed consent. The results will be widely disseminated through scientific peer-reviewed journals, and presentation to a broad audience in scientific meetings, congresses, patient meetings, as well as in policy-relevant forums. NCT06332560.

Older adults experience the highest rates of traumatic brain injury (TBI) related hospitalizations and deaths of any age group, yet TBI remains understudied in this population. To improve understanding of recovery over the year following TBI among older adults, we designed the RETRO-TBI study. This manuscript reports the protocol for RETRO-TBI, a prospective cohort study of older adults (65 years and older) with mild TBI (mTBI) with planned enrollment of 250 participants. The study is designed to evaluate recovery across four key domains: physical function, cognitive function, psychological function, and sleep quality. Participants are followed for 12 months after injury, with in-home study visits conducted at approximately 2 weeks and 3, 6, and 12 months post-injury. Blood samples are collected at all visits. The specific aims are to: (1) identify trajectories of recovery in physical function and predictors of poorer physical recovery; (2) identify trajectories of recovery in cognitive function, psychological function, and sleep quality and predictors of poorer recovery in these domains; and (3) examine associations among recovery trajectories across domains. The RETRO-TBI study represents an important step in addressing the knowledge gap on recovery following TBI among older adults and is expected to result in identification of sub-groups of individuals more likely to have poor recovery, informing individualized treatment plans and development of future domain-based rehabilitation strategies. The study has several strengths including its focus on older adults, evaluation of recovery across four domains of function, and longitudinal assessments will permit evaluation of heterogeneity in recovery trajectories.

There is a need for ecologically valid measures of real-life cognitive functioning. We investigated: (I) the sensitivity of the Cognition Assessment in Virtual Reality (CAVIR) test, which assesses daily-life cognitive skills in an immersive virtual reality kitchen scenario, to capture cognitive impairments in a Spanish sample of patients with bipolar disorder (BD) compared to healthy controls (HCs); (II) the convergent validity of CAVIR against standard neuropsychological tests and functional measures. Patients with BD in full/partial remission (n&#x2009;=&#x2009;40) and HCs (n&#x2009;=&#x2009;40) completed the CAVIR-Spanish version and standard neuropsychological tests; the Hamilton Depression Rating Scale (HRDS-17), the Young Mania Rating Scale (YMRS), the Functioning Assessment Short-Test (FAST) and the Brief University of California Performance-based Skills Assessment (UPSA-B). Between-group comparisons of CAVIR global and subtask scores were conducted, together with correlation and linear regression analyses adjusting for age and mood symptoms. CAVIR was sensitive to cognitive impairments in BD, with patients showing poorer performance than HCs on CAVIR global composite (BD&#x2009;=&#x2009;-1.09, 95% CI [-1.44, 0.74] vs. HCs&#x2009;=&#x2009;-0.19, 95% CI [-0.53, 0.15]) (F(1,72)&#x2009;=&#x2009;9.52, p&#x2009;=&#x2009;0.003, &#x3b7; p 2 $$ {\eta}_p^2 $$ &#x2009;=&#x2009;0.12) and subtasks of sustained attention (BD&#x2009;=&#x2009;-1.25, 95% CI [-1.83, -0.70] vs. HCs&#x2009;=&#x2009;-0.14, 95% CI [-0.66, 0.37]) (F(1,69)&#x2009;=&#x2009;6.12, p&#x2009;=&#x2009;0.016, &#x3b7; p 2 $$ {\eta}_p^2 $$ &#x2009;=&#x2009;0.08), processing speed (BD&#x2009;=&#x2009;-1.64, 95% CI [-2.11, -1.18] vs. HCs&#x2009;=&#x2009;-0.20, 95% CI [-0.66, 0.25]) (F(1,68)&#x2009;=&#x2009;13.67, p&#x2009;<&#x2009;0.001, &#x3b7; p 2 $$ {\eta}_p^2 $$ &#x2009;=&#x2009;0.17) and working memory (BD&#x2009;=&#x2009;-0.91, 95% CI [-1.42, -0.41] vs. HCs&#x2009;=&#x2009;0.05, 95% CI [-0.42, 0.52]) (F(1,71)&#x2009;=&#x2009;5.50, p&#x2009;=&#x2009;0.022, &#x3b7; p 2 $$ {\eta}_p^2 $$ &#x2009;=&#x2009;0.07). The global CAVIR composite and subtasks scores were associated with standard global neurocognitive composite and domains, respectively (&#x3c3;&#x2009;=&#x2009;0.50-0.74, p&#x2009;<&#x2009;0.001). The global CAVIR and all subtasks scores were associated with both observed/interview-based (FAST; &#x3c3;&#x2009;=&#x2009;-0.29 to -0.55, p&#x2009;<&#x2009;0.001) and performance-based (UPSA-B; &#x3c3;&#x2009;=&#x2009;0.29-0.49, p&#x2009;<&#x2009;0.05) functional outcomes. The CAVIR-Spanish version is a sensitive and valid instrument for measuring real-life cognitive skills in BD and may be implemented in clinical settings and treatment trials targeting cognition following further studies.

Evidence indicates females may be more susceptible to sports-related concussion with worse and prolonged symptom severity according to menstrual cycle phase. We investigated whether menstrual cycle phases influence non-concussive heading kinematics in elite female footballers, and whether these impacts affect an athlete's cognition. Five eumenorrheic elite female footballers (Mage&#x2009;=&#x2009;23&#x2009;&#xb1;&#x2009;4&#xa0;years) participated in a 16-week proof-of-concept study wherein menstrual cycle phases were tracked, and cognition was monitored. Participants performed a weekly controlled heading drill by heading a ball thrown from 5&#xa0;m away. Head accelerations were measured using custom-moulded PROTECHT instrumented mouthguards. 256 headers revealed no significant differences in head acceleration across the various phases of the menstrual cycle. However, change in cognitive performance was related to heading completion and menstrual phase. Hormonal fluctuations during the menstrual cycle may influence cognition independent of head impact biomechanics among elite female athletes, under controlled conditions. We note that our study also demonstrated the safety and efficacy of the mouthguard equipment employed here, as well as the ease with which the protocol was received by the athletes. These outcomes should be considered when implementing future research with larger cohorts and the inclusion of match-related heading.

Digital cognitive assessments are increasingly used in large-scale studies to assess brain health, offering scalable, standardized, and self-directed testing solutions. Cognitive function remains a concern for people with HIV despite antiretroviral therapy. The BRACE (BrainBaseline Assessment of Cognition and Everyday Functioning) is a validated tablet-based screener for cognition in people with HIV. Preliminary pilot norms were established in a small sample (n=144), but full regression-based normative data have not yet been developed. Consequently, HIV serostatus differences based on standardized BRACE scores and cognitive correlates have not been systematically examined. This study aims to develop regression-based normative data for BRACE performance in people without HIV who were demographically and behaviorally comparable to people with HIV within biological sex; to examine differences in cognitive performance by HIV status and biological sex; and to evaluate sociodemographic, behavioral, and clinical correlates of BRACE performance. A total of 2937 participants (1063 people without HIV [499 women] and 1874 people with HIV [1053 women]) in the Multicenter AIDS Cohort Study/Women's Interagency HIV Study Combined Cohort Study completed BRACE once between November 2020 and March 2025. BRACE includes the Trail Making Test (A and B), Stroop-Color, and visual spatial learning. Regression-based norms were derived from people without HIV using multiple demographic models (eg, age-only, age + education, and age + education + sex). The age + education model was selected for primary analyses because it provided the best balance of interpretability, parsimony, and generalizability while avoiding race-based corrections. HIV serostatus and sex differences were examined using ANOVA and &#x3c7;2 tests, with effect sizes calculated using Cohen's d. Cognitive performance was largely comparable between people with HIV and people without HIV across all BRACE outcome measures. Statistically significant differences were very small in magnitude (all effect sizes<0.11) and primarily observed among men on Stroop-Color. Across groups, older age and fewer years of education were associated with poorer raw BRACE performance, although these associations attenuated after demographic adjustment using T-scores. Most clinical and behavioral factors (eg, hypertension, smoking, and noncannabis substance use) were related to poorer raw scores but not standardized performance. However, diabetes and cannabis use remained independently associated with T-scores across multiple measures-diabetes with poorer scores and cannabis use with higher scores, an association that should be interpreted cautiously. HIV-specific clinical factors, such as nadir CD4 count and antiretroviral therapy duration, were linked primarily to raw scores. This study establishes the first regression-based normative data for BRACE, derived from a large, demographically diverse people without HIV, and demonstrates its applicability for evaluating cognitive function in people with HIV. Findings indicate minimal cognitive differences between people with HIV and people without HIV and highlight the influence of common sociodemographic and metabolic factors. These results support BRACE as a scalable, reliable, and self-administered digital tool for assessing cognitive health in diverse populations and underscore its potential for longitudinal monitoring and precision phenotyping in both research and clinical contexts.

Dopamine (DA) is essential for motor control, motivation, and cognition, and its dysregulation is associated with neurological and psychiatric disorders such as Parkinson's disease, schizophrenia, and addiction. Accurate and selective DA quantification in complex biological matrices is important, but remains challenging because of coexisting interferents and the low physiological concentration of DA. Here, we report a disposable electrochemical DA sensor based on screen-printed carbon electrodes (SPCEs) modified with metal-organic framework-derived gold nanocomposites (MOFD-AuNCs). The optimal material, synthesized with a 60 min NaBH4 reduction step (MOFD-AuNC-60), exhibited superior electron-transfer kinetics compared with materials prepared at other reduction times. A single coating of MOFD-AuNC-60 on SPCEs enabled DA oxidation at a low potential (~0.05 V) with high selectivity in the presence of ascorbic acid and uric acid. In undiluted porcine serum, the sensor exhibited a dynamic range of 2.5-500 nM with a calculated detection limit of 0.5 nM. In undiluted human serum, it exhibited a dynamic range of 5-100 nM with a calculated detection limit of 4.4 nM. The MOFD-AuNC-60/SPCEs further demonstrated excellent reproducibility (relative standard deviation, 3%) and stability (7.5% current loss over 7 days). These results demonstrate that the proposed sensor provides a disposable, robust, and reliable sensing platform for direct DA detection in undiluted serum, showing promise for practical applications.

Managing mood, cognition and fatigue are top unmet needs reported by stroke survivors, which impact quality of life. There is currently no standardised UK care pathway to support post-stroke psychological outcomes. The ENhanced Reviews of PsychologIcal Changes (ENRICH) programme, an intervention co-designed with stroke survivors, carers and healthcare professionals, aims to fill this gap. Here, we describe the protocol for evaluating the feasibility and acceptability of ENRICH. ENRICH reviews comprise cognition, mood and fatigue assessment, personalised psychoeducation and tools to communicate results and discuss self-management strategies, delivered at 1, 3 and 6&#x2009;months post-stroke. N=140 participants (N=80 patients who had a stroke, N=45 carers, N=15 healthcare professionals) will be recruited to a single-arm multicentre feasibility study.Patients who had a stroke and carers will complete demographics at baseline (T1) questionnaires of quality of life, mood and healthcare resource use at 6 months post-stroke (T2) and an optional interview on experiences of ENRICH. Process evaluation will include fidelity assessment via audio recordings. Descriptive statistics will be calculated for study outcomes.Key qualitative acceptability outcomes are sought on intervention delivery by clinicians, patients and carers.Key intervention delivery feasibility outcomes relate to training clinicians (including competency and fidelity delivering ENRICH), and review completion rates. Study feasibility outcomes will include site and participant recruitment and retention rates and completion of candidate primary outcome measures on quality of life. The ENRICH study was approved by a UK Research Ethics Committee (reference: 24/LO/0341). Consent procedures include a waiver of consent to the intervention itself due ENRICH's service-level design and written informed consent/consultee advice for participants providing research data. Results will be disseminated through peer-reviewed publications, conferences and lay summaries for study participants and healthcare professionals. Results will inform whether ENRICH is acceptable to delivering clinicians and receiving patients who had a stroke and carers, and provide key insights to inform a future randomised trial to determine effectiveness. ISRCTN16018388.

Confrontational naming is an important part of many neuropsychological evaluations. Yet, data on the feasibility and psychometric properties of telephone-based confrontational verbal naming tests (VNTs) are quite limited. The current study conducted a preliminary, exploratory examination of the psychometrics and correlates of an abbreviated version of the 50-item VNT administered via telephone. Participants were 220 healthy adults, including 110 younger adults (ages 18-35) and 110 middle-aged to older adults (ages 50-85). Participants completed a 15-item version of the VNT as part of a broader telephone-based cognitive battery. Confirmatory factor analysis suggested support for a 12-item model of the VNT (VNT-T12) with acceptable fit. VNT-T12 scores were negatively skewed and demonstrated good internal consistency. A quantile regression predicting VNT-T12 from domain-level cognitive variables showed that executive functions (e.g., verbal fluency) and fund of verbal knowledge were significantly and positively associated with VNT-T12 scores at most percentile ranges. The VNT-T12 scores were also significantly associated with race/ethnicity and English as a second language at higher quantiles of performance. Demographically-adjusted coefficients and an associated calculator are provided as a normative resource. Findings provide mixed and preliminary support for the feasibility, psychometrics, and validity of a 12-item VNT administered via telephone. Future research on the psychometrics and validity of the VNT-T12 is warranted in samples with lower levels of education and in clinical populations.

This study aimed to examine the associations between cognitive function, physical activity, and vitamin D with dysmobility syndrome (DMS), and to assess the mediation effects of physical activity and vitamin D. This cross-sectional study included 181 community-dwelling older women. Cognitive function was assessed using the Korean version of the Mini-Mental State Examination. Physical activity was measured using the International Physical Activity Questionnaire and categorized as active or inactive. Serum vitamin D was analyzed and classified as either '&#x2265;20 ng/mL' or '<20 ng/mL'. DMS was defined as meeting at least three of six clinical criteria, including low muscle mass, high body fat, osteoporosis, slow gait speed, low hand-grip strength and history of fall. Mediation analysis revealed mediation effects for both physical activity (Indirect effect = -0.0091) and vitamin D (Indirect effect = -0.0066) on the relationship between cognitive function and DMS through independent paths. Additionally, the sequential path of physical activity &#x2192; vitamin D showed partial mediation (Indirect effect = -0.0013). This study suggested that regular physical activity and adequate vitamin D levels can contribute to the prevention and management of cognitive impairment-related DMS in older Korean women.

Biomarkers reflecting neuroplasticity, inflammation, and vascular integrity may explain variability in post-stroke recovery. This exploratory substudy of the PRACTISE trial (NCT05355831) examined longitudinal biomarker changes during stroke rehabilitation and their associations with upper-extremity (UE) motor recovery. A total of 24 patients with subacute ischemic stroke (21 completers) received patient-tailored transcranial direct current stimulation (TDCS) or sham during four weeks of UE rehabilitation. UE motor function (FMA-UE) and clinical outcomes - including cognition (MoCA), depression (BDI-II), and quality of life (EQ-5D-5L) - were assessed at baseline, end-of-treatment, and at 12-weeks along with the biomarkers plasma Cathepsin-B, Cathepsin-S, E-selectin, and high-sensitivity C-reactive protein (hsCRP). Baseline MRI was rated for small-vessel-disease (SVD) burden using STRIVE criteria. Longitudinal biomarker changes were evaluated using mixed-effects regression. Despite substantial interindividual variability, increases in hsCRP were associated with less FMA-UE improvement from baseline to end-of-treatment (&#x3b2; = -0.75&#x202f;&#xb1;&#x202f;0.26, p&#x202f;=&#x202f;0.01). The remaining biomarkers were not significantly associated to FMA-UE improvement. Four participants who later experienced major adverse cardiovascular events showed high levels of hsCRP and Cathepsin-S at baseline. Sensitivity analyses revealed no significant associations with changes in cognition, depression, or quality-of-life, although a trend-level positive association was observed between E-selectin and MoCA-score. Inflammatory activation-particularly increased hsCRP and Cathepsin-S levels-was associated with reduced motor recovery and characterized individuals who subsequently had major adverse cardiovascular events. These findings support further investigation of inflammatory biomarkers as indicators of both recovery potential and vascular risk during subacute stroke rehabilitation.

Cognitive-communication disorder (CCD) is common after acquired brain injury (ABI), reported in about two-thirds of people who sustain an injury. Quantitative studies have found that the disorder can negatively impact a person's ability to socially re-integrate into the community, return to work or education and achieve a good quality of life. However, little is known about how the disorder impacts people with ABI and the family. Therefore, the aim of this qualitative evidence synthesis was to provide a detailed exploration of the lived experience of CCD for people with ABI and their family members. A systematic literature search was conducted across eight databases (CINAHL Ultimate, PsycINFO, PsycARTICLES, Medline, EMBASE, AMED, Scopus, PubMed) to August 2025. Studies were included if they reported on people with ABI who present with CCD (or similar term) and/or familiar communication partners whereby the impact of the disorder was described. Relevant data were extracted, and studies were critically appraised using the Critical Appraisal Skills Programme (CASP) qualitative checklist and the confidence of the findings was assessed using GRADE-CERQual tool. The final included studies were synthesised using thematic analysis. 13 articles met the eligibility criteria and reported on 103 people with ABI with CCD and 66 familiar communication partners including spouses, parents, friends, carers, siblings and children. Methodologies comprised interviews (n&#x2009;=&#x2009;10), focus groups (n&#x2009;=&#x2009;1), spoken discourse samples (n&#x2009;=&#x2009;1) and online survey (n&#x2009;=&#x2009;1). Eight main analytic themes were identified centred around the experiences of both people with ABI: (1) communicating is not easy; (2) lack of awareness and feeling tired; (3) anxiety, embarrassment and isolation; (4) connecting with others; and (5) participation and identity; and their familiar communication partner: (6) adjusting to giving increased support; (7) emotional toll of supporting; (8) relationship and life role changes. This review highlights the broad and unique impacts of CCD for both people with ABI and their familiar communication partners. People with ABI require tolerance to manage their communication difficulties; and communication partners require education, support and training to manage the change in relationship. These findings underpin the need for interventions to include partners in rehabilitation and for therapists to consider the diverse needs of people with ABI including emotions, relationships, social participation and changes to identity.

Although motor symptoms are the defining feature of dystonia, increasing evidence indicates that non-motor symptoms substantially affect patients' quality of life. Among these, social cognition remains insufficiently explored, particularly in relation to global cognitive functioning and affective-behavioral dimensions. In this study, 25 patients diagnosed with Idiopathic Focal Dystonia (IFD) and 25 healthy controls (HCs) underwent assessments of social cognition (cognitive and affective Theory of Mind [ToM] and empathy), global cognitive functioning (MoCA), depression (BDI) and apathy (DAS). Patients diagnosed with IFD performed significantly worse than HCs on cognitive and affective ToM tasks, whereas no group differences were observed for the remaining measures. Within the IFD group, cognitive ToM performance correlated with global cognitive functioning, and affective ToM correlated with apathy but not with depression. These findings demonstrate specific impairments in social cognition and suggest links between ToM deficits, cognitive dysfunction and motivational disturbance. By identifying a pattern of social cognition deficit in IFD patients, this study advances understanding of its non-motor symptoms and underscores the need for further research on its impact on daily functioning and quality of life.

Essential tremor (ET) is a common movement disorder characterized by heterogeneous features, though the rate and pattern of worsening are variable. Longitudinal data combining clinical and objective motor measures remain limited, resulting in uncertainty regarding trajectories and predictors of progression in ET. Twenty-two patients from a previously established ET/ET-plus cohort underwent a third clinical and kinematic evaluation almost seven years after baseline. Kinematic analysis assessed postural, kinetic, rest tremor, and finger-tapping performance. Longitudinal changes were evaluated using non-parametric statistics and linear mixed-effects models adjusting for clinical covariates. Over time, tremor worsened overall. Kinematic measures indicated a selective increase in kinetic tremor severity, while rest and postural tremor amplitude remained stable. Clinically, tremor spread to a greater number of body regions. Soft neurological signs increased over time and were associated with greater tremor spread. Cognitive performance showed only a mild decline, partly related to age and affective symptoms. Higher baseline tremor severity was associated with greater worsening of kinetic tremor, and lower baseline cognitive scores with changes in postural tremor. ET progression is heterogeneous and often non-linear. Kinematic measures were particularly sensitive in capturing worsening of kinetic tremor, the most disabling clinical feature. The accumulation of soft neurological signs and their association with tremor spread support the notion of ET-plus as a more advanced disease stage with broader cerebral involvement. Independent of disease progression, there were strong aging-related effects. Future multimodal longitudinal studies may clarify how aging interacts with disease trajectories in essential tremor.

Mild cognitive impairment (MCI) is an intermediate state between normal cognitive aging and dementia, with a global geriatric prevalence of 23.7%. Multisensory stimulation (MSS) has emerged as a promising approach to improve cognitive impairment. However, relevant research is heterogeneous, and the evidence has not yet been systematically synthesized. This study aims to systematically review the evidence on the effectiveness of MSS on cognitive function in older adults with MCI, appraise different MSS interventions, identify limitations in study design and implementation, and provide recommendations for future trials. A comprehensive search will be conducted in PubMed, Embase, PsycInfo, Web of Science Core Collection, and the Cochrane Library, with manual screening of reference lists and gray literature. Eligible studies are randomized controlled trials that involve adults aged 60 years or older with confirmed MCI and evaluate intentional MSS with reported parameters. Two reviewers will independently select the studies, extract the data, and assess risk of bias using version 2 of the Cochrane risk-of-bias tool for randomized trials. The primary outcomes are global cognitive function, memory, executive function, and attention; secondary outcomes include quality of life, adherence, and safety. A meta-analysis will be performed using mean differences or standardized mean differences if the studies are sufficiently comparable in population, interventions, and outcomes; otherwise, a narrative synthesis will be conducted. This protocol has been registered in PROSPERO, and the methodological frameworks were finalized on October 5, 2025. The systematic literature search was completed between November 1, 2025, and December 31, 2025, followed by study screening and data extraction between January 1, 2026, and February 28, 2026. Data synthesis and final manuscript preparation are expected to be completed by April 30, 2026. The systematic review is expected to provide a comprehensive synthesis of the evidence on MSS for older adults with MCI and will help identify the optimal intervention parameters and implementation strategies. The findings may help inform future trial design and the optimization of nonpharmacological interventions for cognitive health in older adults with MCI.

Approximately 80% of individuals with Parkinson disease (PD) experience impaired balance and mobility, contributing to freezing of gait, an increased risk of falls, and reduced health-related quality of life. Mind-body interventions, such as mindfulness and yoga, may address both motor and nonmotor symptoms by enhancing mind-body coordination and reducing stress, thereby offering a scalable approach to balance rehabilitation in PD. This study aims to evaluate the effects and acceptability of Mindfulness Yoga-Practice Awareness through Cognitive-Based Exercise (MY-PACE), a mobile health-delivered, home-based intervention, on balance, mobility, and psychological well-being in individuals with PD and balance impairment. This assessor-blinded, 2-arm, randomized waitlist-controlled trial enrolled 132 individuals with PD and balance impairment, randomized to either the MY-PACE group (n=66, 50%) or the control group receiving routine outpatient care (n=66, 50%). The MY-PACE group will complete a 12-week, Zoom-delivered program incorporating mindfulness, yoga, and mindful walking practices. The control group will receive the intervention after study completion. The primary outcome is functional balance, as measured by the Berg Balance Scale. Secondary outcomes include functional mobility, gait patterns, balance confidence, freezing of gait severity, motor symptoms, anxiety and depressive symptoms, cognitive function, mindfulness, health-related quality of life, and fall incidence. Assessments will occur at baseline, 3 months (T1), and 6 months (T2). Data will be analyzed using linear mixed-effects models under the intention-to-treat principle. Ethics approval was obtained on September 18, 2019. A preliminary feasibility study with 10 participants was conducted between May and June 2020. The full randomized controlled trial was funded in January 2022 by the Early Career Scheme 2021-2022 of the Research Grants Council, Hong Kong. The trial was prospectively registered on December 10, 2021. Recruitment began in April 2022. As of manuscript submission, 132 participants have been enrolled. Data analysis has not yet commenced. The study protocol and statistical analysis plan follow the original prespecified design. The results are expected to be published in 2026. This trial will evaluate a telehealth-delivered mindful yoga intervention for improving balance and mobility in individuals with PD. By integrating cognitive-based mindful awareness and motor training, MY-PACE targets both motor and nonmotor contributors to balance impairment. If effective, it may represent a scalable intervention for individuals with PD and other populations with mobility limitations. Chinese Clinical Trial Registry ChiCTR2100054145; https://tinyurl.com/4j8f8zvn. DERR1-10.2196/97781.

In individuals with rheumatoid arthritis (RA), inflammatory bowel disease (IBD), or primary depressive or anxiety disorders without RA or IBD (DEP/ANX) we aimed to evaluate between-person and within-person changes in physical and mental health-related quality of life (HRQoL) over time. We also aimed to compare the impacts of depression and anxiety symptoms on HRQoL, and to examine the roles of physical and cognitive functioning, fatigue, physical comorbidities, and disease activity, on HRQoL over time. As part of a single centre prospective cohort study, individuals with RA (n&#x2009;=&#x2009;154), IBD (n&#x2009;=&#x2009;247), or DEP/ANX (n&#x2009;=&#x2009;306) recruited between November 2014 and July 2016 were seen annually for 3 years. Participants reported symptoms of depression and anxiety (Hospital Anxiety and Depression Scale), fatigue (Daily Fatigue Impact Scale), HRQoL (RAND-36), and completed functional assessments (physical: nine-hole peg test, timed 25-foot walk test; cognition: Symbol Digit Modalities Test). Generalized linear models with generalized estimating equations tested between-person and within-person associations of depression and anxiety with HRQoL in covariate-adjusted models that included socio-demographic characteristics, health status and medication use. Physical (PCS-36) and mental (MCS-36) HRQoL were assessed separately and comparatively for RA, IBD and DEP/ANX. RA participants were older than IBD or DEP/ANX participants [mean age&#x2009;=&#x2009;59.49(11.66), 47.45(14.80), 43.87(12.94)]. Most participants (>85%) reported meaningful changes in HRQoL. After adjustment, within-person increased depressive and anxiety symptoms were associated with reduced MCS-36 [depression: -7.91 (-9.45, -6.36), anxiety: -5.62 (-6.85, -4.39)]. Increased fatigue and worse cognition were associated with reduced PCS-36 [-0.33 (-0.38, -0.28); -0.31 (-0.64, 0.022)]. After adjustment, increased physical function, IBD or DEP/ANX diagnosis were associated with higher PCS-36 [1.47 (0.63, 2.30); 2.84 (1.60, 4.08); 5.23 (3.92, 6.55)]. Variations in depression, anxiety, fatigue, cognition, and physical function are associated with HRQoL fluctuations in people with RA, IBD and DEP/ANX, highlighting the importance of addressing these issues while treating disease.

Cancer-related cognitive impairment (CRCI) is a common consequence of cancer and its treatments, with mild but significant deficits in memory, attention or executive function. These symptoms negatively affect survivors' quality of life, daily functioning, and return to work. Physical exercise is a promising non-pharmacological intervention, but current evidence remains methodologically heterogeneous. This umbrella review synthesized evidence on the effects of physical exercise on cognitive function, both self-reported and objectively measured, in patients with cancer. An umbrella review was conducted following PRIOR and PRISMA guidelines. Searches were performed in MEDLINE/PubMed, Scopus, Web of Science, and SPORTDiscus. Inclusion criteria, using the PICOS framework, targeted systematic reviews (with or without meta-analysis) evaluating exercise interventions and cognitive outcomes in cancer populations. Data were extracted on intervention characteristics, cognitive domains, and effect sizes. Methodological quality was appraised using GRADE and AMSTAR-2. Eight systematic reviews were included with 80 primary articles and a total sample of 7536 participants. Six of the eight reviews analyzed various types of physical exercise, usually supervised 12-week programs, mostly assessing self-reported cognitive function. Exercise was associated with beneficial cognitive outcomes, though magnitude and consistency varied. The main improvements were in self-reported function, with participants reporting fewer complaints and enhanced perceptions of memory, attention, and executive function. Objective assessments revealed smaller but significant effects, particularly in executive function and processing speed. The most consistent interventions were 12-week aerobic programs at moderate intensity. Methodological heterogeneity and limited adherence to ICCTF standards were key sources of variability. Physical exercise improves self-reported and objectively measured cognitive function in cancer populations, supporting its role as a complementary strategy for CRCI. However, evidence certainty is limited, requiring longitudinal studies with neuropsychological, neuroimaging, and biomarker approaches to refine recommendations.