{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T08:55:50Z","timestamp":1790844950844,"version":"4.1.0"},"reference-count":64,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["U24A20702"],"award-info":[{"award-number":["U24A20702"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["32300869"],"award-info":[{"award-number":["32300869"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003995","name":"Natural Science Foundation of Anhui Province","doi-asserted-by":"publisher","award":["2308085QH267"],"award-info":[{"award-number":["2308085QH267"]}],"id":[{"id":"10.13039\/501100003995","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["CNS Neurosci Ther"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Adolescents with non\u2010suicidal self\u2010injury (NSSI) frequently exhibit severe sleep disturbances and heterogeneous cognitive impairments, yet the underlying neurophysiological basis remains unclear. The glymphatic system, a sleep\u2010dependent macroscopic clearance network, is critical for metabolic waste removal and neurocognitive homeostasis. Therefore, this study aimed to investigate the physiological role of glymphatic function in linking sleep burden to distinct cognitive performances in adolescents with NSSI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We assessed 44 NSSI adolescents and 33 healthy controls (HCs). Using resting\u2010state functional magnetic resonance imaging (rs\u2010fMRI), glymphatic function was quantified by calculating the coupling strength between global blood\u2010oxygen\u2010level\u2010dependent (gBOLD) signals and cerebrospinal fluid (CSF) flow. To capture the heterogeneity in their cognitive profiles, we evaluated \u201chot\u201d affective decision\u2010making via the Iowa Gambling Task (IGT) and \u201ccold\u201d executive function via the Wisconsin Card Sorting Test (WCST). Subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In the NSSI group, poorer sleep quality was positively correlated with stronger gBOLD\u2010CSF coupling (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.317,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.036), and stronger gBOLD\u2010CSF coupling predicted better IGT performance, especially during the high\u2010load strategy phase (Block 3) (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.447,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). Furthermore, glymphatic function fully mediated the relationship between sleep quality and affective decision\u2010making performance (indirect effect\u2009=\u20090.682, 95% CI [0.062, 1.515]). Interaction analyses confirmed this physiological\u2010behavioral coupling was disease\u2010specific (present only in NSSI; interaction\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.011) and domain\u2010specific (supporting \u201chot\u201d affective cognition rather than \u201ccold\u201d executive function).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In NSSI adolescents, sleep\u2010associated glymphatic upregulation reflects a stress\u2010induced compensatory response. This mechanism domain\u2010specifically preserves high\u2010load affective decision\u2010making against severe psychopathological stress. These findings highlight brain metabolic clearance as a novel physiological target for bolstering cognitive resilience in high\u2010risk youth.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cns.71159","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T08:04:18Z","timestamp":1790841858000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Role of Glymphatic Clearance in Affective Decision\u2010Making in Adolescents with Non\u2010Suicidal Self\u2010Injury"],"prefix":"10.1002","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-3158-6000","authenticated-orcid":false,"given":"Hongping","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Neurology The Second Affiliated Hospital of Anhui Medical University  Hefei China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiahua","family":"Zhang","sequence":"additional","affiliation":[{"name":"The School of Mental Health and Psychological Sciences Anhui Medical University  Hefei China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruizi","family":"Pan","sequence":"additional","affiliation":[{"name":"Department of Neurology The Second Affiliated Hospital of Anhui Medical University  Hefei China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1652-3864","authenticated-orcid":false,"given":"Xiaoqian","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Neurology The Second Affiliated Hospital of Anhui Medical University  Hefei China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rong","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Radiology The Second Affiliated Hospital of Anhui Medical University  Hefei China"},{"name":"Medical Imaging Research Center Anhui Medical University  Hefei China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ke","family":"Lv","sequence":"additional","affiliation":[{"name":"Department of Neurology The Second Affiliated Hospital of Anhui Medical University  Hefei China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Neurology The First Affiliated Hospital of Anhui Medical University  Hefei China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qianqian","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Psychology and Sleep Medicine The Second Affiliated Hospital of Anhui Medical University  Hefei China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Psychiatry The First Affiliated Hospital of Anhui Medical University  Hefei China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4451-9544","authenticated-orcid":false,"given":"Dongpeng","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Psychology and Sleep Medicine The Second Affiliated Hospital of Anhui Medical University  Hefei China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dai","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Radiology The Second Affiliated Hospital of Anhui Medical University  Hefei China"},{"name":"Medical Imaging Research Center Anhui Medical University  Hefei China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5038-0599","authenticated-orcid":false,"given":"Yanghua","family":"Tian","sequence":"additional","affiliation":[{"name":"Department of Neurology The Second Affiliated Hospital of Anhui Medical University  Hefei China"},{"name":"The School of Mental Health and Psychological Sciences Anhui Medical University  Hefei China"},{"name":"Division of Life Sciences and Medicine, Department of Neurology, The First Affiliated Hospital of USTC University of Science and Technology of China  Hefei China"},{"name":"Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders  Hefei China"},{"name":"Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health  Hefei China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.lanwpc.2023.100794","article-title":"Non\u2010Suicidal Self\u2010Injury in Chinese Population: A Scoping Review of Prevalence, Method, Risk Factors and Preventive Interventions","volume":"37","author":"Qu D.","year":"2023","journal-title":"Lancet Regional Health\u2013Western 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