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1.
Nat Methods ; 21(5): 804-808, 2024 May.
Article in English | MEDLINE | ID: mdl-38191935

ABSTRACT

Neuroimaging research requires purpose-built analysis software, which is challenging to install and may produce different results across computing environments. The community-oriented, open-source Neurodesk platform ( https://www.neurodesk.org/ ) harnesses a comprehensive and growing suite of neuroimaging software containers. Neurodesk includes a browser-accessible virtual desktop, command-line interface and computational notebook compatibility, allowing for accessible, flexible, portable and fully reproducible neuroimaging analysis on personal workstations, high-performance computers and the cloud.


Subject(s)
Neuroimaging , Software , Neuroimaging/methods , Humans , User-Computer Interface , Reproducibility of Results , Brain/diagnostic imaging
2.
Res Sq ; 2023 Mar 13.
Article in English | MEDLINE | ID: mdl-36993557

ABSTRACT

Neuroimaging data analysis often requires purpose-built software, which can be challenging to install and may produce different results across computing environments. Beyond being a roadblock to neuroscientists, these issues of accessibility and portability can hamper the reproducibility of neuroimaging data analysis pipelines. Here, we introduce the Neurodesk platform, which harnesses software containers to support a comprehensive and growing suite of neuroimaging software (https://www.neurodesk.org/). Neurodesk includes a browser-accessible virtual desktop environment and a command line interface, mediating access to containerized neuroimaging software libraries on various computing platforms, including personal and high-performance computers, cloud computing and Jupyter Notebooks. This community-oriented, open-source platform enables a paradigm shift for neuroimaging data analysis, allowing for accessible, flexible, fully reproducible, and portable data analysis pipelines.

4.
Neuropsychol Rev ; 33(1): 192-220, 2023 03.
Article in English | MEDLINE | ID: mdl-35194692

ABSTRACT

Despite a growing body of research, there is yet to be a cohesive synthesis of studies examining differences in brain morphology according to patterns of cognitive function among both schizophrenia-spectrum disorder (SSD) and bipolar disorder (BD) individuals. We aimed to provide a systematic overview of the morphological differences-inclusive of grey and white matter volume, cortical thickness, and cortical surface area-between cognitive subgroups of these disorders and healthy controls, and between cognitive subgroups themselves. An initial search of PubMed and Scopus databases resulted in 1486 articles of which 20 met inclusion criteria and were reviewed in detail. The findings of this review do not provide strong evidence that cognitive subgroups of SSD or BD map to unique patterns of brain morphology. There is preliminary evidence to suggest that reductions in cortical thickness may be more strongly associated with cognitive impairment, whilst volumetric deficits may be largely tied to the presence of disease.


Subject(s)
Bipolar Disorder , Cognitive Dysfunction , Schizophrenia , White Matter , Humans , Bipolar Disorder/complications , Schizophrenia/complications , Cognition
5.
J Psychiatr Res ; 148: 325-331, 2022 04.
Article in English | MEDLINE | ID: mdl-35193036

ABSTRACT

Sex differences in symptoms and executive control across schizophrenia spectrum disorders (SSD) are consistently reported. Similarly, these findings of sex differences are also observed in schizotypy, that is, schizophrenia-like features occurring in healthy individuals in the absence of a clinical diagnosis. This study aimed to examine the relationships between performance on three major domains of executive control: performance monitoring, response inhibition, and cognitive set-shifting, and schizotypy factor scores in both SSD patients and healthy controls (HCs), and whether sex moderated any relationships observed. A total of 111 (67 males and 44 females) patients with SSD and 258 (129 males and 129 females) HCs were included in this study. Schizotypal personality traits (in both SSD and HC) was assessed using the Oxford-Liverpool Inventory of Feelings and Experiences (O-LIFE). Executive control performance was assessed using seven tasks. Stepwise linear regressions revealed that performance on cognitive set-shifting tasks was significantly associated with the introvertive anhedonia, cognitive disorganisation, and unusual experiences subscales of the O-LIFE. When sex was examined as a moderator, it was not a significant moderator of any of the relationships between cognitive set-shifting tasks and schizotypy factors. The results suggest that independent of sex, cognitive set-shifting ability is associated to an increased vulnerability to schizotypal personality traits, although performance monitoring and response inhibition did not.


Subject(s)
Schizophrenia , Schizotypal Personality Disorder , Cognition , Executive Function , Female , Humans , Male , Schizophrenia/complications , Schizotypal Personality Disorder/psychology
6.
Neurosci Biobehav Rev ; 131: 663-687, 2021 12.
Article in English | MEDLINE | ID: mdl-34517037

ABSTRACT

It has been documented that individuals who hear auditory verbal hallucinations (AVH) exhibit diminished capabilities in processing external speech. While functional neuroimaging studies have attempted to characterise the cortical regions and networks facilitating these deficits in a bid to understand AVH, considerable methodological heterogeneity has prevented a consensus being reached. The current systematic review investigated the neurobiological underpinnings of external speech processing deficits in voice-hearers in 38 studies published between January 1990 to June 2020. AVH-specific deviations in the activity and lateralisation of the temporal auditory regions were apparent when processing speech sounds, words and sentences. During active or affective listening tasks, functional connectivity changes arose within the language, limbic and default mode networks. However, poor study quality and lack of replicable results plague the field. A detailed list of recommendations has been provided to improve the quality of future research on this topic.


Subject(s)
Hallucinations , Speech , Auditory Perception , Functional Neuroimaging , Hallucinations/diagnostic imaging , Humans , Language , Magnetic Resonance Imaging
7.
Behav Brain Res ; 386: 112586, 2020 05 27.
Article in English | MEDLINE | ID: mdl-32194187

ABSTRACT

Previous neuroimaging studies have reported differences in regional brain activation between males and females during stop signal task performance, suggesting the presence of sex-linked differences in brain network organization of inhibitory ability. Despite a growing literature on sex differences during stop signal task performance, a consensus still has not been reached due to variations in task design and analysis methods. Due to these disparate findings we used up to date stop signal task methods to compare behavioral performance and associated brain activation between males and females using an event-related functional magnetic resonance imaging design. We observed that males were faster in inhibiting their responses, but females exhibited marked increased in stopping network activation, in addition to increased activation of the anterior insula and left amygdala. These findings suggest that males and females process stop signals differently.


Subject(s)
Executive Function/physiology , Psychomotor Performance/physiology , Adult , Amygdala/physiology , Brain/physiology , Brain Mapping/methods , Cerebral Cortex/physiology , Female , Humans , Inhibition, Psychological , Magnetic Resonance Imaging/methods , Male , Neuropsychological Tests , Sex Factors
8.
Nutr Neurosci ; 23(2): 139-148, 2020 Feb.
Article in English | MEDLINE | ID: mdl-29847303

ABSTRACT

Objectives: Schizophrenia is a debilitating psychiatric illness associated with positive and negative symptoms as well as significant impairments in cognition. Current antipsychotic medications do not alleviate these cognitive deficits, and more effective therapeutic options are required. Increased oxidative stress and altered antioxidant levels, including glutathione (GSH) have been observed both in individuals with cognitive impairment and in people with schizophrenia. A GSH precursor, the antioxidant N-acetylcysteine (NAC) has been investigated as a novel treatment for the cognitive symptoms of schizophrenia, and recent research suggests that NAC may be a promising adjunctive treatment option. However, the current literature lacks integration as to why NAC may effectively improve cognition in schizophrenia. The present theoretical synthesis aimed to address this gap by examining the processes by which NAC may improve cognitive function in schizophrenia. Methods: The schizophrenia literature was reviewed in three key domains: cognitive impairment, the relationship between oxidative stress and cognition, and the efficacy of NAC as a novel treatment. This led to a theoretical analysis of the neurobiological processes by which NAC may improve cognition in schizophrenia. Results: This theoretical review concluded that improved cognition may result from a combination of factors, including decreased oxidative stress, neuroprotection of cognitive networks and an increase in glutamatergic modulation of the N-methyl-d-aspartate receptor system. Whilst a number of mechanisms by which NAC may improve cognition and symptoms in schizophrenia have been proposed, there is still limited understanding of the specific metabolic pathways involved and how they interrelate and modify specific symptomology. Discussion: Exploration of how NAC treatment may act to improve cognitive function could guide clinical trials by investigation of the specific neurotransmitter systems and processes involved, allowing for targeted neurological outcome measures. Future research would benefit from the investigation of both in vivo cortical GSH concentration and peripheral plasma GSH in a population of individuals with chronic schizophrenia.


Subject(s)
Acetylcysteine/therapeutic use , Cognition/drug effects , Schizophrenia/drug therapy , Schizophrenia/physiopathology , Cognition/physiology , Cognitive Dysfunction/drug therapy , Cognitive Dysfunction/physiopathology , Glutathione/physiology , Humans , Neuroprotective Agents , Oxidative Stress/drug effects , Oxidative Stress/physiology , Receptors, N-Methyl-D-Aspartate/drug effects , Receptors, N-Methyl-D-Aspartate/physiology
10.
Biol Psychol ; 144: 99-102, 2019 05.
Article in English | MEDLINE | ID: mdl-30946872

ABSTRACT

Growing evidence indicates that anxiety impairs cognitive control processes, including inhibitory functioning. However, there are reports of anxiety state-related improvements in response inhibition performance in a go/nogo (GNG) task. Here we employed the stop-signal task (SST) to examine in complementary fashion the link between anticipatory anxiety and inhibitory control. Participants (N = 45) completed the SST under threat of unpredictable shocks and safe conditions while physiological activity (skin conductance and heart rate) was monitored. In addition to increased physiological activity, we found that stop-signal reaction time (SSRT), a robust measure of stopping efficiency, was prolonged during threat compared to safe without any difference in choice reaction times to go stimuli. This finding supports the claim of impaired inhibitory control in anxiety, and by consideration of differences between the SST and GNG tasks, can be reconciled with evidence of improved response inhibition on the latter under similar threat conditions.


Subject(s)
Anxiety/physiopathology , Anxiety/psychology , Inhibition, Psychological , Reaction Time/physiology , Task Performance and Analysis , Adult , Cognition , Female , Galvanic Skin Response/physiology , Heart Rate/physiology , Humans , Male , Young Adult
11.
Front Psychiatry ; 10: 60, 2019.
Article in English | MEDLINE | ID: mdl-30890968

ABSTRACT

People with depression have shown alterations in processing emotional information and working memory functionality. There is some evidence that emotional content may interact with working memory update processes, however neurological correlates are current unknown. In this preliminary study we utilized a novel version of the emotional variant of the n-back working memory task in fMRI. We examined BOLD response of 14 healthy controls and 13 depressed participants in response to happy, sad, and neutral displays of facial affect. No accuracy or reaction time differences were found between the two groups. The depressed group showed significantly decreased BOLD response to happy faces compared to the control group areas of the dorsal striatum and anterior cingulate. Significant, moderate, positive associations were found between right caudate activation with anxiety score and anterior cingulate activation with depression score in those with depression. Our novel task was able to elicit group level differences in emotional processing during working memory update. These results suggest those with depression fail to differentiate between positive emotional stimuli and stimuli with no emotional content.

12.
JMIR Res Protoc ; 7(10): e174, 2018 Oct 26.
Article in English | MEDLINE | ID: mdl-30368434

ABSTRACT

BACKGROUND: Older adults with postlingual sensorineural hearing loss (SNHL) exhibit a poor prognosis that not only includes impaired auditory function but also rapid cognitive decline, especially speech-related cognition, in addition to psychosocial dysfunction and an increased risk of dementia. Consistent with this prognosis, individuals with SNHL exhibit global atrophic brain alteration as well as altered neural function and regional brain organization within the cortical substrates that underlie auditory and speech processing. Recent evidence suggests that the use of hearing aids might ameliorate this prognosis. OBJECTIVE: The objective was to study the effects of a hearing aid use intervention on neurocognitive and psychosocial functioning in individuals with SNHL aged ≥55 years. METHODS: All aspects of this study will be conducted at Swinburne University of Technology (Hawthorn, Victoria, Australia). We will recruit 2 groups (n=30 per group) of individuals with mild to moderate SNHL from both the community and audiology health clinics (Alison Hennessy Audiology, Chelsea Hearing Pty Ltd). These groups will include individuals who have worn a hearing aid for, at least, 12 months or never worn a hearing aid. All participants would be asked to complete, at 2 time points (t) including baseline (t=0) and follow-up (t=6 months), tests of hearing and psychosocial and cognitive function and attend a magnetic resonance imaging (MRI) session. The MRI session will include both structural and functional MRI (sMRI and fMRI) scans, the latter involving the performance of a novel speech processing task. RESULTS: This research is funded by the Barbara Dicker Brain Sciences Foundation Grants, the Australian Research Council, Alison Hennessy Audiology, and Chelsea Hearing Pty Ltd under the Industry Transformation Training Centre Scheme (ARC Project #IC140100023). We obtained the ethics approval on November 18, 2017 (Swinburne University Human Research Ethics Committee protocol number SHR Project 2017/266). The recruitment began in December 2017 and will be completed by December 2020. CONCLUSIONS: This is the first study to assess the effect hearing aid use has on neural, cognitive, and psychosocial factors in individuals with SNHL who have never used hearing aids. Furthermore, this study is expected to clarify the relationships among altered brain structure and function, psychosocial factors, and cognition in response to the hearing aid use. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12617001616369; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12617001616369 (Accessed by WebCite at http://www.webcitation.org/70yatZ9ze). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/9916.

13.
J Exp Neurosci ; 12: 1179069518785151, 2018.
Article in English | MEDLINE | ID: mdl-30013388

ABSTRACT

Cerebrovascular reactivity (CVR) reflects the response of brain blood vessels to vasoactive stimuli, such as neural activity. The current research assessed age-related changes in regional CVR to 5% CO2 inhalation in younger (n = 30, range: 21-45 years) and older (n = 29, range: 55-75 years) adults, and the contribution of regional CVR to cognitive performance using blood-oxygen-level dependent contrast imaging (BOLD) functional magnetic resonance imaging (fMRI) at 3T field strength. CVR was measured by inducing hypercapnia using a block-design paradigm under physiological monitoring. Memory and attention were assessed with a comprehensive computerized aging battery. MRI data analysis was conducted using MATLAB® and SPM12. Memory and attention performance was positively associated with CVR in the temporal cortices. Temporal lobe CVR influenced memory performance independently of age, gender, and education level. When analyzing age groups separately, CVR in the hippocampus contributed significantly to memory score in the older group and was also related to subjective memory complaints. No associations between CVR and cognition were observed in younger adults. Vascular responsiveness in the brain has consequences for cognition in cognitively healthy people. These findings may inform other areas of research concerned with vaso-protective approaches for prevention or treatment of neurocognitive decline.

14.
PLoS One ; 13(5): e0197055, 2018.
Article in English | MEDLINE | ID: mdl-29787609

ABSTRACT

BACKGROUND: Understanding how vascular and metabolic factors impact on cognitive function is essential to develop efficient therapies to prevent and treat cognitive losses in older age. Cerebral metabolic rate of oxygen (CMRO2), cerebral blood flow (CBF) and venous oxygenation (Yv) comprise key physiologic processes that maintain optimum functioning of neural activity. Changes to these parameters across the lifespan may precede neurodegeneration and contribute to age-related cognitive decline. This study examined differences in blood flow and metabolism between 31 healthy younger (<50 years) and 29 healthy older (>50 years) adults; and investigated whether these parameters contribute to cognitive performance. METHOD: Participants underwent a cognitive assessment and MRI scan. Grey matter CMRO2 was calculated from measures of CBF (phase contrast MRI), arterial and venous oxygenation (TRUST MRI) to assess group differences in physiological function and the contribution of these parameters to cognition. RESULTS: Performance on memory (p<0.001) and attention tasks (p<0.001) and total CBF were reduced (p<0.05), and Yv trended toward a decrease (p = .06) in the older group, while grey matter CBF and CMRO2 did not differ between the age groups. Attention was negatively associated with CBF when adjusted (p<0.05) in the older adults, but not in the younger group. There was no such relationship with memory. Neither cognitive measure was associated with oxygen metabolism or venous oxygenation in either age group. CONCLUSION: Findings indicated an age-related imbalance between oxygen delivery, consumption and demand, evidenced by a decreased supply of oxygen with unchanged metabolism resulting in increased oxygen extraction. CBF predicted attention when the age-effect was controlled, suggesting a task- specific CBF- cognition relationship.


Subject(s)
Cerebral Cortex/blood supply , Cerebrovascular Circulation/physiology , Cognition/physiology , Healthy Aging/physiology , Oxygen Consumption , Oxygen/metabolism , Adult , Aged , Cerebral Cortex/physiology , Female , Gray Matter/blood supply , Humans , Male , Middle Aged , Young Adult
15.
BMC Neurosci ; 19(1): 21, 2018 04 12.
Article in English | MEDLINE | ID: mdl-29649969

ABSTRACT

BACKGROUND: Cerebrovascular reactivity (CVR) refers to the responsiveness of cerebral vasculature to vasoactive stimuli. CVR is an indicator of brain health and can be assessed using vasodilatory techniques and magnetic resonance imaging (MRI). Using such approaches, some researchers have explored the relationship between CVR and cognition; here we systematically review this work. RESULTS: We extracted information pertaining to: (1) study location and design, participant characteristics, sample sizes, (2) design of vascular challenge, end-tidal CO 2 (etCO 2 ) concentrations (if applicable), (3) MRI protocol, (4) cognitive assessment, (5) CVR values, and outcomes of statistical analyses with cognitive tests. Five studies assessed participants with cognitive impairment compared to controls, one studied patients with multiple sclerosis with or without cognitive impairment compared to controls, one examined patients with moyamoya disease with or without cognitive impairment, two investigated patients with Type 2 diabetes mellitus (T2DM), and one was a cross-sectional study with younger and older healthy adults. Cognition was typically probed using the MMSE and tests of executive function, while a number of vasodilatory techniques were employed. CONCLUSION: CVR was associated with cognition in six of ten studies, but heterogeneity of study samples, designs and vasodilatory methods may have a role in the inconsistent findings. We make recommendations for future research that includes use of a multi-domain cognitive assessment and standardised hypercapnic challenge with MRI.


Subject(s)
Brain/physiopathology , Cerebrovascular Circulation/physiology , Cognition/physiology , Diabetes Mellitus, Type 2/metabolism , Magnetic Resonance Imaging , Humans , Hypercapnia/physiopathology , Magnetic Resonance Imaging/methods
17.
J Neurosci ; 37(37): 8895-8900, 2017 09 13.
Article in English | MEDLINE | ID: mdl-28842409

ABSTRACT

Reward function appears to be modulated by the circadian system, but little is known about the neural basis of this interaction. Previous research suggests that the neural reward response may be different in the afternoon; however, the direction of this effect is contentious. Reward response may follow the diurnal rhythm in self-reported positive affect, peaking in the early afternoon. An alternative is that daily reward response represents a type of prediction error, with neural reward activation relatively high at times of day when rewards are unexpected (i.e., early and late in the day). The present study measured neural reward activation in the context of a validated reward task at 10.00 h, 14.00 h, and 19.00 h in healthy human males. A region of interest BOLD fMRI protocol was used to investigate the diurnal waveform of activation in reward-related brain regions. Multilevel modeling found, as expected, a highly significant quadratic time-of-day effect focusing on the left putamen (p < 0.001). Consistent with the "prediction error" hypothesis, activation was significantly higher at 10.00 h and 19.00 h compared with 14.00 h. It is provisionally concluded that the putamen may be particularly important in endogenous priming of reward motivation at different times of day, with the pattern of activation consistent with circadian-modulated reward expectancies in neural pathways (i.e., greater activation to reward stimuli at unexpected times of day). This study encourages further research into circadian modulation of reward and underscores the methodological importance of accounting for time of day in fMRI protocols.SIGNIFICANCE STATEMENT This is one of the first studies to use a repeated-measures imaging procedure to explore the diurnal rhythm of reward activation. Although self-reported reward (most often operationalized as positive affect) peaks in the afternoon, the present findings indicate that neural activation is lowest at this time. We conclude that the diurnal neural activation pattern may reflect a prediction error of the brain, where rewards at unexpected times (10.00 h and 19.00 h) elicit higher activation in reward brain regions than at expected (14.00 h) times. These data also have methodological significance, suggesting that there may be a time of day influence, which should be accounted for in neural reward studies.


Subject(s)
Brain Waves/physiology , Brain/physiology , Choice Behavior/physiology , Circadian Rhythm/physiology , Nerve Net/physiology , Reward , Brain Mapping , Humans , Male , Reference Values , Time Factors
18.
Front Aging Neurosci ; 8: 288, 2016.
Article in English | MEDLINE | ID: mdl-27994548

ABSTRACT

This study explored the neurocognitive effects of 4 weeks daily supplementation with a multi-vitamin and -mineral combination (MVM) in healthy adults (aged 18-40 years). Using a randomized, double-blind, placebo-controlled design, participants underwent assessments of brain activity using functional Magnetic Resonance Imaging (fMRI; n = 32, 16 females) and Steady-State Visual Evoked Potential recordings (SSVEP; n = 39, 20 females) during working memory and continuous performance tasks at baseline and following 4 weeks of active MVM treatment or placebo. There were several treatment-related effects suggestive of changes in functional brain activity associated with MVM administration. SSVEP data showed latency reductions across centro-parietal regions during the encoding period of a spatial working memory task following 4 weeks of active MVM treatment. Complementary results were observed with the fMRI data, in which a subset of those completing fMRI assessment after SSVEP assessment (n = 16) demonstrated increased BOLD response during completion of the Rapid Visual Information Processing task (RVIP) within regions of interest including bilateral parietal lobes. No treatment-related changes in fMRI data were observed in those who had not first undergone SSVEP assessment, suggesting these results may be most evident under conditions of fatigue. Performance on the working memory and continuous performance tasks did not significantly differ between treatment groups at follow-up. In addition, within the fatigued fMRI sample, increased RVIP BOLD response was correlated with the change in number of target detections as part of the RVIP task. This study provides preliminary evidence of changes in functional brain activity during working memory associated with 4 weeks of daily treatment with a multi-vitamin and -mineral combination in healthy adults, using two distinct but complementary measures of functional brain activity.

19.
J Autism Dev Disord ; 46(3): 954-63, 2016 Mar.
Article in English | MEDLINE | ID: mdl-26520145

ABSTRACT

The medial prefrontal cortex (mPFC) and the right temporo-parietal junction (rTPj) are highly involved in social understanding, a core area of impairment in autism spectrum disorder (ASD). We used fMRI to investigate sex differences in the neural correlates of social understanding in 27 high-functioning adults with ASD and 23 matched controls. There were no differences in neural activity in the mPFC or rTPj between groups during social processing. Whole brain analysis revealed decreased activity in the posterior superior temporal sulcus in males with ASD compared to control males while processing social information. This pattern was not observed in the female sub-sample. The current study indicates that sex mediates the neurobiology of ASD, particularly with respect to processing social information.


Subject(s)
Autism Spectrum Disorder/physiopathology , Mental Processes/physiology , Neurons/pathology , Neurons/physiology , Parietal Lobe/physiopathology , Prefrontal Cortex/physiopathology , Sex Characteristics , Temporal Lobe/physiopathology , Adult , Autism Spectrum Disorder/pathology , Case-Control Studies , Female , Functional Neuroimaging , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Parietal Lobe/cytology , Prefrontal Cortex/cytology , Temporal Lobe/cytology , Young Adult
20.
Psychophysiology ; 53(2): 229-36, 2016 Feb.
Article in English | MEDLINE | ID: mdl-26481459

ABSTRACT

For 30 years, the independent race model has been used to account for the attempt to reactively inhibit on-going responses in the stop-signal task (reactive behavioral inhibition). The success of the race model derives in part by assuming that motor response activation speed is not different on inhibition trials compared to trials where inhibition is not required. To date, neurophysiological evidence supporting this assumption (context independence) has been limited, especially in human participants. In this study, we used EEG to investigate stop-signal task performance in human participants, focusing on lateralized readiness potentials (LRPs) to examine context independence in human primary motor cortex (M1). The current results provided support for the context independence assumption, and further showed that successful inhibition was largely contingent upon the timing of response activation in M1 relative to stop-signal onset. These data afford a valuable insight into how stop-signal response inhibition is effected in the human brain.


Subject(s)
Evoked Potentials/physiology , Inhibition, Psychological , Motor Cortex/physiology , Reaction Time/physiology , Adult , Brain Mapping , Electroencephalography , Female , Humans , Male , Nerve Net/physiology , Neuropsychological Tests , Psychomotor Performance/physiology , Young Adult
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