{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T08:44:35Z","timestamp":1791535475763,"version":"4.3.4"},"reference-count":19,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100017959","name":"Health Commission of Hebei Province","doi-asserted-by":"publisher","award":["20241036"],"award-info":[{"award-number":["20241036"]}],"id":[{"id":"10.13039\/100017959","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Brain and Behavior"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Narcolepsy Type 1 (NT1) results from loss of hypothalamic orexin neurons, leading to unstable sleep\u2013wake transitions. However, how this manifests as dynamic whole\u2010brain functional state instability remains poorly characterized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We applied Hidden Markov Modeling (HMM) to resting\u2010state functional magnetic resonance imaging (fMRI) data from 30 patients with NT1 and 30 age\u2010 and sex\u2010matched healthy controls to identify recurrent brain states, quantify their fractional occupancy (FO), and examine associations with clinical symptoms\u2014specifically excessive daytime sleepiness (Epworth Sleepiness Scale, ESS) and hallucinations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Five distinct dynamic brain states were identified. Compared to controls, NT1 patients showed significantly reduced FO in State 1 (thalamocortical arousal\/sensory gating;\n                      <jats:italic>p<\/jats:italic>\n                      <jats:sub>FDR<\/jats:sub>\n                      &lt; 0.001) and elevated FO in State 4 (basal ganglia\u2013limbic\u2013sensorimotor integration;\n                      <jats:italic>p<\/jats:italic>\n                      <jats:sub>FDR<\/jats:sub>\n                      &lt; 0.001) and State 5 (reward\u2010introspection;\n                      <jats:italic>p<\/jats:italic>\n                      <jats:sub>FDR<\/jats:sub>\n                      = 0.036). Notably, within the NT1 group, patients with hallucinations exhibited higher FO in State 1 than those without (\n                      <jats:italic>p<\/jats:italic>\n                      <jats:sub>FDR<\/jats:sub>\n                      = 0.042), suggesting aberrant recruitment of this state during sleep\u2013wake transitions. Additionally, State 4 FO showed a moderate positive correlation with ESS scores (Spearman's\n                      <jats:italic>\u03c1<\/jats:italic>\n                      = 0.38,\n                      <jats:italic>p<\/jats:italic>\n                      <jats:sub>FDR<\/jats:sub>\n                      = 0.078).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>NT1 is associated with reduced stability of a thalamocortical alertness state and increased expression of REM\u2010like limbic\u2010subcortical network configurations. State 1 occupancy is relatively elevated in patients with hallucinations, while State 4 shows a positive association with excessive daytime sleepiness and features of REM dissociation. These findings support a dynamic, whole\u2010brain systems\u2010level framework for understanding symptom heterogeneity in NT1.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/brb3.71338","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T10:05:33Z","timestamp":1774951533000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Dynamic Brain State Alterations in Narcolepsy: A Hidden Markov Model Approach to Thalamocortical Instability and Symptom\u2010Specific Neural Correlates"],"prefix":"10.1002","volume":"16","author":[{"given":"Wenyi","family":"Li","sequence":"first","affiliation":[{"name":"Department of Neurology The Second Hospital of Hebei Medical University  Shijiazhuang Hebei P.R. China"},{"name":"The Key Laboratory of Neurology (Hebei Medical University), Ministry of Education  Shijiazhuang Hebei P.R. China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lijing","family":"Jia","sequence":"additional","affiliation":[{"name":"Department of Neurology The Second Hospital of Hebei Medical University  Shijiazhuang Hebei P.R. China"},{"name":"The Key Laboratory of Neurology (Hebei Medical University), Ministry of Education  Shijiazhuang Hebei P.R. China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingyu","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging The Second Hospital of Hebei Medical University  Shijiazhuang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanhui","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging The Second Hospital of Hebei Medical University  Shijiazhuang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenzhong","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurology The Second Hospital of Hebei Medical University  Shijiazhuang Hebei P.R. China"},{"name":"The Key Laboratory of Neurology (Hebei Medical University), Ministry of Education  Shijiazhuang Hebei P.R. China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zuojun","family":"Geng","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging The Second Hospital of Hebei Medical University  Shijiazhuang China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,31]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41582\u2010019\u20100226\u20109"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2017.09.065"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/33.12.1589"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnhum.2016.00369"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/ejn.15386"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/zsaa018"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroscience.2007.05.018"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/cns.14660"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/hbm.25714"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102869.2006.00533.x"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.3389\/fncir.2021.649417"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41467\u2010019\u201008934\u20103"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1152\/jn.00338.2011"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2024.101976"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41593\u2010020\u201000711\u20106"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neures.2018.03.005"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11682\u2010017\u20109706\u2010y"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph192315482"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/hbm.24770"}],"container-title":["Brain and Behavior"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/brb3.71338","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/brb3.71338","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/brb3.71338","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T08:23:23Z","timestamp":1780907003000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/brb3.71338"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,31]]},"references-count":19,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1002\/brb3.71338"],"URL":"https:\/\/doi.org\/10.1002\/brb3.71338","archive":["Portico"],"relation":{},"ISSN":["2162-3279","2162-3279"],"issn-type":[{"value":"2162-3279","type":"print"},{"value":"2162-3279","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,31]]},"assertion":[{"value":"2025-06-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-09","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-31","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e71338"}}