{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T16:36:04Z","timestamp":1780331764303,"version":"3.54.1"},"reference-count":65,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,9,2]],"date-time":"2022-09-02T00:00:00Z","timestamp":1662076800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Hum. Neurosci."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Sexual minority (SM) older adults experience mental health disparities. Psychiatric disorders and neuropsychiatric symptoms (NPS) are risk factors for cognitive decline. Although older people in same-sex (SSR) compared to mixed-sex relationships (MSR) perform more poorly on cognitive screening tests, prior studies found no differences in rates of dementia diagnosis or neuropsychological profiles. We sought to explore the role of NPS on neurocognitive outcomes for SM populations. We compared cognitive performance and structural brain parameters of older adults in SSR and MSR.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data were originally collected at Alzheimer's Disease Research Centers (ADRCs). Inclusion criteria were: age of 55+ years, a study partner identified as a spouse\/partner, and availability of T1-MRI brain volumes\/thickness. Participants were labeled as either SSR or MSR based on their\/their co-participant's reported sex. We identified 1,073 participants (1,037 MSR\u2212555 cognitively unimpaired [CU]; 36 SSR\u221223 CU) with structural MRI data, Mini-Mental State Exam (MMSE), and Neuropsychiatric Inventory Questionnaire (NPI-Q) scores. A subset of the overall sample completed comprehensive neuropsychological assessment (<jats:italic>n<\/jats:italic> = 939; 908 MSR\u2212494 CU; 31 SSR\u221222 CU). Covariates included in statistical models were age, sex, education, total intracranial volume, and apolipoprotein E genotype.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Multivariate general linear models showed significant diagnosis-by-relationship interaction effects on the left parahippocampal gyrus volume. After stratification by relationship group, only cognitively impaired (CI) MSR had significantly smaller left parahippocampal volumes than MSR-CU. The SSR group showed better episodic memory performance. Severity of neuropsychiatric symptoms was negatively associated with volume\/thickness of bilateral fronto-temporal areas and with MMSE scores, predominantly in the MSR group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In our study, MSR participants presented with a more compromised cognitive profile than SSR participants. MSR-CI participants showed significantly smaller left medio-temporal volumes, a neural signature of AD. Neuropsychiatric symptoms predicted smaller fronto-temporal volumes in the MSR more consistently than in the SSR group. These findings may be due to unexplored protective factors against cognitive decline in SM elders. Indeed, social support has been proposed as a protective factor warranting future investigation.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fnhum.2022.909868","type":"journal-article","created":{"date-parts":[[2022,9,2]],"date-time":"2022-09-02T09:31:06Z","timestamp":1662111066000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Divergent patterns of cognitive deficits and structural brain alterations between older adults in mixed-sex and same-sex relationships"],"prefix":"10.3389","volume":"16","author":[{"given":"Riccardo","family":"Manca","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"II","given":"Anthony N.","family":"Correro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Gauthreaux","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason D.","family":"Flatt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,9,2]]},"reference":[{"key":"B1","unstructured":"2021 Alzheimer's disease facts and figures. Alzheimers Dement. 172021"},{"key":"B2","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1097\/WAD.0b013e318142774e","article-title":"The National Alzheimer's Coordinating Center (NACC) database: the Uniform Data Set","volume":"21","author":"Beekly","year":"2007","journal-title":"Alzheimer Dis. Assoc. Disord."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1233","DOI":"10.1093\/brain\/awaa068","article-title":"Medial temporal lobe connectivity and its associations with cognition in early Alzheimer's disease","volume":"143","author":"Berron","year":"2020","journal-title":"Brain"},{"key":"B4","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1097\/WAD.0000000000000279","article-title":"Version 3 of the National Alzheimer's Coordinating Center's uniform data set","volume":"32","author":"Besser","year":"2018","journal-title":"Alzheimer Dis. Assoc. Disord."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1343","DOI":"10.3233\/JAD-190612","article-title":"Brain volume predicts behavioral and psychological symptoms in Alzheimer's disease","volume":"73","author":"Boublay","year":"2020","journal-title":"J. Alzheimer's Dis."},{"key":"B6","doi-asserted-by":"publisher","first-page":"2455","DOI":"10.1093\/brain\/awn151","article-title":"Neuroanatomical correlates of neuropsychiatric symptoms in Alzheimer's disease","volume":"131","author":"Bruen","year":"2008","journal-title":"Brain"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e13","DOI":"10.2105\/AJPH.2016.303630","article-title":"A systematic review of cardiovascular disease in sexual minorities","volume":"107","author":"Caceres","year":"2017","journal-title":"Am. J. Public Health"},{"key":"B8","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1093\/phr\/117.5.426","article-title":"What is a \u2018health disparity'?","volume":"117","author":"Carter-Pokras","year":"2002","journal-title":"Public Health Rep."},{"key":"B9","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1097\/00001756-200303030-00015","article-title":"Memory impairment in humans after bilateral damage to lateral temporal neocortex","volume":"14","author":"Cheung","year":"2003","journal-title":"Neuroreport"},{"key":"B10","doi-asserted-by":"publisher","first-page":"e054864","DOI":"10.1002\/alz.054864","article-title":"Cognitive aging with dementia, mild cognitive impairment (MCI), or no impairment: a comparison of same- and other-sex couples","volume":"17","author":"Correro","year":"2021","journal-title":"Alzheimers Dement."},{"key":"B11","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1080\/19359705.2019.1644570","article-title":"A review of minority stress as a risk factor for cognitive decline in lesbian, gay, bisexual, and transgender (LGBT) elders","volume":"24","author":"Correro","year":"2019","journal-title":"J. Gay Lesbian Ment. Health"},{"key":"B12","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1177\/1090198118818240","article-title":"A population study of health status among sexual minority older adults in select U.S. geographic regions","volume":"46","author":"Dai","year":"2019","journal-title":"Health Educ. Behav."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1049","DOI":"10.1038\/79871","article-title":"Subcortical and cortical brain activity during the feeling of self-generated emotions","volume":"3","author":"Damasio","year":"2000","journal-title":"Nat. Neurosci."},{"key":"B14","doi-asserted-by":"publisher","first-page":"867","DOI":"10.1016\/j.neuroimage.2008.12.016","article-title":"Registration based cortical thickness measurement","volume":"45","author":"Das","year":"2009","journal-title":"Neuroimage"},{"key":"B15","doi-asserted-by":"publisher","first-page":"119","DOI":"10.3233\/JAD-132225","article-title":"Modifiable lifestyle factors in dementia: a systematic review of longitudinal observational cohort studies","volume":"42","author":"Di Marco","year":"2014","journal-title":"J. Alzheimer's Dis."},{"key":"B16","doi-asserted-by":"publisher","first-page":"2247","DOI":"10.1007\/s10508-019-1428-3","article-title":"The rejection sensitivity model as a framework for understanding sexual minority mental health","volume":"49","author":"Feinstein","year":"2020","journal-title":"Arch. Sex. Behav."},{"key":"B17","first-page":"12197","article-title":"Subjective cognitive decline higher among sexual and gender minorities in the United States, 2015\u20132018","volume-title":"Alzheimers Dement.: Transl. Res. Clinic. Interv.","author":"Flatt","year":"2021"},{"key":"B18","doi-asserted-by":"publisher","first-page":"91","DOI":"10.3233\/JAD-171061","article-title":"Correlates of subjective cognitive decline in lesbian, gay, bisexual, and transgender older adults","volume":"64","author":"Flatt","year":"2018","journal-title":"J. Alzheimer's Dis."},{"key":"B19","doi-asserted-by":"publisher","first-page":"488","DOI":"10.1093\/geront\/gnt021","article-title":"Physical and mental health of transgender older adults: an at-risk and underserved population","volume":"54","author":"Fredriksen-Goldsen","year":"","journal-title":"The Gerontologist"},{"key":"B20","doi-asserted-by":"publisher","first-page":"664","DOI":"10.1093\/geront\/gns123","article-title":"The physical and mental health of lesbian, gay male, and bisexual (LGB) older adults: the role of key health indicators and risk and protective factors","volume":"53","author":"Fredriksen-Goldsen","year":"","journal-title":"The Gerontologist"},{"key":"B21","doi-asserted-by":"publisher","first-page":"8982643211046466","DOI":"10.1177\/08982643211046466","article-title":"Disparities in subjective cognitive impairment by sexual orientation and gender in a national population based study of US adults, 2013\u20132018","volume":"14","author":"Fredriksen-Goldsen","year":"2021","journal-title":"J. Aging Health"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1332","DOI":"10.2105\/AJPH.2017.303922","article-title":"Chronic health conditions and key health indicators among lesbian, gay, and bisexual older US adults, 2013\u20132014","volume":"107","author":"Fredriksen-Goldsen","year":"2017","journal-title":"Am. J. Public Health"},{"key":"B23","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1016\/j.jalz.2014.05.1756","article-title":"The EADC-ADNI harmonized protocol for manual hippocampal segmentation on magnetic resonance: Evidence of validity","volume":"11","author":"Frisoni","year":"2015","journal-title":"Alzheimers Dement."},{"key":"B24","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1037\/a0016441","article-title":"How does sexual minority stigma \u2018get under the skin'? A psychological mediation framework","volume":"135","author":"Hatzenbuehler","year":"2009","journal-title":"Psychol. Bull."},{"key":"B25","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1002\/ajcp.12138","article-title":"The mental health of transgender older adults: General and minority stress","volume":"59","author":"Hoy-Ellis","year":"2017","journal-title":"Am. J. Commun. Psychol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"352","DOI":"10.1093\/geront\/gnaa136","article-title":"Elevated risk of cognitive impairment among older sexual minorities: do health conditions, health behaviors, and social connections matter?","volume":"61","author":"Hsieh","year":"2021","journal-title":"The Gerontologist"},{"key":"B27","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1176\/jnp.12.2.233","article-title":"Validation of the NPI-Q, a brief clinical form of the neuropsychiatric inventory","volume":"12","author":"Kaufer","year":"2000","journal-title":"J. Neuropsychiatry Clinic. Neurosci."},{"key":"B28","doi-asserted-by":"publisher","first-page":"548","DOI":"10.1093\/geront\/gnu083","article-title":"Living arrangement and loneliness among lesbian, gay, and bisexual older adults","volume":"56","author":"Kim","year":"2016","journal-title":"The Gerontologist"},{"key":"B29","doi-asserted-by":"publisher","first-page":"776","DOI":"10.1162\/jocn.2007.19.5.776","article-title":"Neural correlates of positive and negative emotion regulation","volume":"19","author":"Kim","year":"2007","journal-title":"J. Cogn. Neurosci."},{"key":"B30","doi-asserted-by":"publisher","first-page":"901","DOI":"10.1016\/S0028-3932(98)00017-7","article-title":"Memory impairments associated with hippocampal versus parahippocampal-gyrus atrophy: an MR volumetry study in Alzheimer's disease","volume":"36","author":"K\u00f6hler","year":"1998","journal-title":"Neuropsychologia"},{"key":"B31","doi-asserted-by":"publisher","first-page":"783","DOI":"10.1016\/0895-4356(96)00009-1","article-title":"Healthy volunteer effect in a cohort study: temporal resolution in the Adventist Health Study","volume":"49","author":"Lindsted","year":"1996","journal-title":"J. Clinic. Epidemiol."},{"key":"B32","doi-asserted-by":"publisher","first-page":"1388","DOI":"10.1093\/geronb\/gbaa202","article-title":"Same-sex couples and cognitive impairment: evidence from the Health and Retirement Study","volume":"76","author":"Liu","year":"2021","journal-title":"J. Gerontol.: B."},{"key":"B33","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1016\/j.yfrne.2018.02.001","article-title":"The effects of chronic stress on the human brain: from neurotoxicity, to vulnerability, to opportunity","volume":"49","author":"Lupien","year":"2018","journal-title":"Front. Neuroendocrinol."},{"key":"B34","doi-asserted-by":"publisher","first-page":"667","DOI":"10.1016\/S0306-4522(01)00108-7","article-title":"Remembering familiar people: the posterior cingulate cortex and autobiographical memory retrieval","volume":"104","author":"Maddock","year":"2001","journal-title":"Neuroscience"},{"key":"B35","doi-asserted-by":"publisher","first-page":"1102","DOI":"10.2174\/1567205018666210114111556","article-title":"A comparison of neurocognitive decline in older adults in same-sex and opposite-sex relationships","volume":"17","author":"Manca","year":"2020","journal-title":"Curr. Alzheimer Res."},{"key":"B36","doi-asserted-by":"publisher","first-page":"2093","DOI":"10.1001\/archinte.1993.00410180039004","article-title":"Stress and the individual: mechanisms leading to disease","volume":"153","author":"McEwen","year":"1993","journal-title":"Arch. Intern. Med."},{"key":"B37","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1016\/j.tics.2011.08.003","article-title":"Large-scale brain networks and psychopathology: a unifying triple network model","volume":"15","author":"Menon","year":"2011","journal-title":"Trends Cogn. Sci."},{"key":"B38","doi-asserted-by":"publisher","first-page":"674","DOI":"10.1037\/0033-2909.129.5.674","article-title":"Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence","volume":"129","author":"Meyer","year":"2003","journal-title":"Psychol. Bull."},{"key":"B39","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1177\/00031224221075776","article-title":"Intersecting the academic gender gap: the education of lesbian, gay, and bisexual America","volume":"87","author":"Mittleman","year":"2022","journal-title":"Am. Sociol. Rev."},{"key":"B40","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1097\/WAD.0000000000000111","article-title":"Results from the NACC uniform data set neuropsychological battery crosswalk study running head: neuropsychological battery crosswalk study results","volume":"30","author":"Monsell","year":"2016","journal-title":"Alzheimer Dis. Assoc. Disord."},{"key":"B41","doi-asserted-by":"publisher","first-page":"2412","DOI":"10.1212\/WNL.43.11.2412-a","article-title":"The clinical dementia rating (CDR): current version and scoring rules","volume":"43","author":"Morris","year":"1993","journal-title":"Neurology"},{"key":"B42","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1097\/01.wad.0000213865.09806.92","article-title":"The uniform data set (UDS): clinical and cognitive variables and descriptive data from Alzheimer Disease Centers","volume":"20","author":"Morris","year":"2006","journal-title":"Alzheimer Dis. Assoc. Disord."},{"key":"B43","doi-asserted-by":"publisher","first-page":"466","DOI":"10.1177\/2515245920928009","article-title":"Visualization of brain statistics with R packages ggseg and ggseg3d","volume":"3","author":"Mowinckel","year":"2020","journal-title":"Adv. Meth. Pract. Psychol. Sci."},{"key":"B44","doi-asserted-by":"publisher","first-page":"1282","DOI":"10.1093\/geront\/gnz187","article-title":"Does sexual orientation relate to health and well-being? Analysis of adults 50+ years of age","volume":"60","author":"Nelson","year":"2020","journal-title":"The Gerontologist"},{"key":"B45","doi-asserted-by":"publisher","first-page":"1019","DOI":"10.1016\/j.cpr.2010.07.003","article-title":"Internalized homophobia and internalizing mental health problems: a meta-analytic review","volume":"30","author":"Newcomb","year":"2010","journal-title":"Clinic. Psychol. Rev."},{"key":"B46","doi-asserted-by":"publisher","first-page":"102262","DOI":"10.1016\/j.nicl.2020.102262","article-title":"Classifying heterogeneous presentations of PTSD via the default mode, central executive, and salience networks with machine learning","volume":"27","author":"Nicholson","year":"2020","journal-title":"Neuroimage Clin"},{"key":"B47","doi-asserted-by":"publisher","first-page":"2002572","DOI":"10.1080\/20008198.2021.2002572","article-title":"A systematic review of the neural correlates of sexual minority stress: towards an intersectional minority mosaic framework with implications for a future research agenda","volume":"13","author":"Nicholson","year":"2022","journal-title":"Eur. J. Psychotraumatol."},{"key":"B48","doi-asserted-by":"publisher","first-page":"1843","DOI":"10.1007\/s10508-015-0480-x","article-title":"A transdiagnostic minority stress treatment approach for gay and bisexual men's syndemic health conditions","volume":"44","author":"Pachankis","year":"2015","journal-title":"Arch. Sex. Behav."},{"key":"B49","doi-asserted-by":"publisher","first-page":"828","DOI":"10.1002\/gps.5092","article-title":"Risk of dementia and mild cognitive impairment among older adults in same-sex relationships","volume":"34","author":"Perales-Puchalt","year":"2019","journal-title":"Int. J. Geriatric Psychiatry"},{"key":"B50","doi-asserted-by":"publisher","first-page":"367","DOI":"10.3109\/09540261.2015.1083949","article-title":"Mental health of sexual minorities. a systematic review","volume":"27","author":"Pl\u00f6derl","year":"2015","journal-title":"Int. Rev. Psychiatry"},{"key":"B51","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1016\/j.jalz.2012.10.001","article-title":"Comparative accuracies of two common screening instruments for classification of Alzheimer's disease, mild cognitive impairment, and healthy aging","volume":"9","author":"Roalf","year":"2013","journal-title":"Alzheimers Dement."},{"key":"B52","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1176\/appi.ps.202000940","article-title":"Health disparities between older lesbian, gay, and bisexual adults and heterosexual adults in the public mental health system","volume":"73","author":"Rowan","year":"2022","journal-title":"Psychiatric Serv."},{"key":"B53","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1016\/j.dr.2013.01.001","article-title":"Mostly heterosexual as a distinct sexual orientation group: a systematic review of the empirical evidence","volume":"33","author":"Savin-Williams","year":"2013","journal-title":"Dev. Rev."},{"key":"B54","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1007\/s13524-020-00857-9","article-title":"Does sexual orientation complicate the relationship between marital status and gender with self-rated health and cardiovascular disease?","volume":"57","author":"Solazzo","year":"2020","journal-title":"Demography"},{"key":"B55","doi-asserted-by":"publisher","first-page":"1380","DOI":"10.1126\/science.1896849","article-title":"The medial temporal lobe memory system","volume":"253","author":"Squire","year":"1991","journal-title":"Science"},{"key":"B56","doi-asserted-by":"publisher","first-page":"1305","DOI":"10.1016\/j.jalz.2018.07.219","article-title":"Whitepaper: defining and investigating cognitive reserve, brain reserve, and brain maintenance","volume":"16","author":"Stern","year":"2020","journal-title":"Alzheimers Dement."},{"key":"B57","doi-asserted-by":"publisher","first-page":"1105","DOI":"10.1093\/geronb\/gbab084","article-title":"Correlates of memory and executive function in middle-aged and older adults in the CLSA: a minority stress approach","volume":"77","author":"Stinchcombe","year":"2021","journal-title":"J. Gerontol.: B."},{"key":"B58","doi-asserted-by":"publisher","first-page":"749","DOI":"10.1017\/S1041610213002652","article-title":"The relationship between marital and parental status and the risk of dementia","volume":"26","author":"Sundstr\u00f6m","year":"2014","journal-title":"Int. Psychogeriatrics"},{"key":"B59","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1016\/j.whi.2021.07.001","article-title":"Health disparities among women by sexual orientation identity and same-sex or different-sex cohabiting partnership status","volume":"32","author":"Taylor","year":"2022","journal-title":"Women's Health Issues"},{"key":"B60","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1111\/jomf.12155","article-title":"Challenges and opportunities for research on same-sex relationships","volume":"77","author":"Umberson","year":"2015","journal-title":"J. Marriage Fam."},{"key":"B61","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1007\/s11682-017-9767-y","article-title":"Identify a shared neural circuit linking multiple neuropsychiatric symptoms with Alzheimer's pathology","volume":"13","author":"Wang","year":"2019","journal-title":"Brain Imaging Behav."},{"key":"B62","doi-asserted-by":"publisher","first-page":"316","DOI":"10.1016\/j.jalz.2019.09.003","article-title":"Leisure activity and social integration mitigate the risk of dementia related to cardiometabolic diseases: A population-based longitudinal study","volume":"16","author":"Wang","year":"2019","journal-title":"Alzheimers Dement."},{"key":"B63","first-page":"10","article-title":"Version 3 of the Alzheimer Disease Centers' neuropsychological test battery in the uniform data set (UDS)","volume-title":"Alzheimer Dis. Assoc. Disord.","author":"Weintraub","year":"2018"},{"key":"B64","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1097\/WAD.0b013e318191c7dd","article-title":"The Alzheimer's disease centers' uniform data set (UDS): the neuropsychological test battery","volume":"23","author":"Weintraub","year":"2009","journal-title":"Alzheimer Dis. Assoc. Disord."},{"key":"B65","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-319-24277-4","volume-title":"ggplot2: Elegant Graphics for Data Analysis","author":"Wickham","year":"2016"}],"container-title":["Frontiers in Human Neuroscience"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnhum.2022.909868\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,2]],"date-time":"2022-09-02T09:31:13Z","timestamp":1662111073000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnhum.2022.909868\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,2]]},"references-count":65,"alternative-id":["10.3389\/fnhum.2022.909868"],"URL":"https:\/\/doi.org\/10.3389\/fnhum.2022.909868","relation":{},"ISSN":["1662-5161"],"issn-type":[{"value":"1662-5161","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,2]]},"article-number":"909868"}}