{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T16:06:59Z","timestamp":1788278819146,"version":"build-2803163510"},"reference-count":55,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,3,27]],"date-time":"2025-03-27T00:00:00Z","timestamp":1743033600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Background: An increased risk of cognitive decline has been reported in patients with older age bipolar disorder (OABD); however, the underlying factors contributing to this association remain unclear. This cross-sectional study aims to identify the clinical features associated with cognitive impairment in OABD. Methods: A total of 152 participants, aged at least 50 years and diagnosed with bipolar disorder (BD) and related disorders in agreement with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision criteria, were included in the study and divided into two subgroups based on the presence\/absence of cognitive impairment, defined as a diagnosis of Mild Neurocognitive Disorder or Major Neurocognitive Disorder. Univariate comparisons and multivariate logistic regression models were performed to investigate the associations between clinical variables and cognitive impairment. Results: Cognitively impaired patients had a higher prevalence of otherwise specified BD\/cyclothymic disorder, while BD type 2 was more common in the cognitively unimpaired group. Additionally, the cognitively impaired group had a later onset of major mood episodes (p &lt; 0.05), fewer lifetime depressive episodes (p = 0.006), a higher prevalence of vascular leukoencephalopathy (p = 0.022) and dyslipidemia (p = 0.043), a lower prevalence of agoraphobia (p = 0.040), worse global functioning (p &lt; 0.001), and higher psychopathology severity (p &lt; 0.001). Late onset, vascular leukoencephalopathy, and dyslipidemia were all independently associated with cognitive impairment. Conclusions: Atypical BD, late onset of mood episodes, and somatic comorbidities like vascular leukoencephalopathy and dyslipidemia are associated with a higher risk of developing cognitive impairment and neurodegenerative disorders in OABD patients.<\/jats:p>","DOI":"10.3390\/brainsci15040349","type":"journal-article","created":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T04:36:48Z","timestamp":1743136608000},"page":"349","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Clinical Predictors of Cognitive Impairment in a Cohort of Patients with Older Age Bipolar Disorder"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3865-7975","authenticated-orcid":false,"given":"Camilla","family":"Elefante","sequence":"first","affiliation":[{"name":"Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4460-0406","authenticated-orcid":false,"given":"Giulio Emilio","family":"Brancati","sequence":"additional","affiliation":[{"name":"Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Francesca","family":"Beatino","sequence":"additional","affiliation":[{"name":"Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedetta Francesca","family":"Nerli","sequence":"additional","affiliation":[{"name":"Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2495-7759","authenticated-orcid":false,"given":"Giulia","family":"D\u2019Alessandro","sequence":"additional","affiliation":[{"name":"Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Fustini","sequence":"additional","affiliation":[{"name":"Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Marro","sequence":"additional","affiliation":[{"name":"Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"Pistolesi","sequence":"additional","affiliation":[{"name":"Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8752-0556","authenticated-orcid":false,"given":"Filippo","family":"Baldacci","sequence":"additional","affiliation":[{"name":"Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1412-9406","authenticated-orcid":false,"given":"Roberto","family":"Ceravolo","sequence":"additional","affiliation":[{"name":"Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Lattanzi","sequence":"additional","affiliation":[{"name":"Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1111\/bdi.12331","article-title":"A report on older-age bipolar disorder from the International Society for Bipolar Disorders Task Force","volume":"17","author":"Sajatovic","year":"2015","journal-title":"Bipolar Disord."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1001\/archpsyc.56.9.848","article-title":"Consensus statement on the upcoming crisis in geriatric mental health: Research agenda for the next 2 decades","volume":"56","author":"Jeste","year":"1999","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1111\/j.1399-5618.2004.00139.x","article-title":"Bipolar disorder in older adults: A critical review","volume":"6","author":"Depp","year":"2004","journal-title":"Bipolar Disord."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1038\/s41531-024-00794-z","article-title":"Prospective study of bipolar disorder and neurodegenerative diseases","volume":"10","author":"Xu","year":"2024","journal-title":"npj Park. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1111\/acps.13153","article-title":"Risk of dementia in bipolar disorder and the interplay of lithium: A systematic review and meta-analyses","volume":"141","author":"Velosa","year":"2020","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"4841","DOI":"10.1002\/alz.14049","article-title":"The risk of Alzheimer\u2019s disease and cognitive impairment characteristics in eight mental disorders: A UK Biobank observational study and Mendelian randomization analysis","volume":"20","author":"Liu","year":"2024","journal-title":"Alzheimer\u2019s Dement."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s40035-025-00465-w","article-title":"Second-generation anti-amyloid monoclonal antibodies for Alzheimer\u2019s disease: Current landscape and future perspectives","volume":"14","author":"Kim","year":"2025","journal-title":"Transl. Neurodegener."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/j.euroneuro.2024.12.001","article-title":"Contrasting genetic burden for bipolar disorder: Early onset versus late onset in an older adult bipolar disorder sample","volume":"92","author":"Montejo","year":"2025","journal-title":"Eur. Neuropsychopharmacol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1002\/(SICI)1520-6394(1998)7:2<76::AID-DA5>3.0.CO;2-3","article-title":"Age of first onset of bipolar disorder: Demographic, family history, and psychosocial correlates","volume":"7","author":"Hays","year":"1998","journal-title":"Depress. Anxiety"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"845","DOI":"10.2741\/E665","article-title":"Biomarkers of bipolar disorder: Specific or shared with schizophrenia?","volume":"5","author":"Bellivier","year":"2013","journal-title":"Front. Biosci. (Elite Ed.)"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"da Silva, M.N., de Gobbi Porto, F.H., Lopes, P.M.G., Sodr\u00e9 de Castro Prado, C., Frota, N.A.F., Alves, C.H.L., and Alves, G.S. (2021). Frontotemporal Dementia and Late-Onset Bipolar Disorder: The Many Directions of a Busy Road. Front. Psychiatry, 12.","DOI":"10.3389\/fpsyt.2021.768722"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/S0165-0327(99)00111-1","article-title":"Early and late onset bipolar disorders: Two different forms of manic-depressive illness?","volume":"58","author":"Bellivier","year":"2000","journal-title":"J. Affect. Disord."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1111\/j.1399-5618.2008.00621.x","article-title":"Increased rates of white matter hyperintensities in late-onset bipolar disorder","volume":"10","author":"Tamashiro","year":"2008","journal-title":"Bipolar Disord."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1111\/acps.12581","article-title":"Areas of controversy in neuroprogression in bipolar disorder","volume":"134","author":"Passos","year":"2016","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.1136\/jnnp.2003.031773","article-title":"Does the risk of developing dementia increase with the number of episodes in patients with depressive disorder and in patients with bipolar disorder?","volume":"75","author":"Kessing","year":"2004","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1111\/bdi.12204","article-title":"Neuroprogressive effects of lifetime illness duration in older adults with bipolar disorder","volume":"16","author":"Gildengers","year":"2014","journal-title":"Bipolar Disord."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association. [5th ed.]. text rev.","DOI":"10.1176\/appi.books.9780890425787"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1001\/archneur.56.3.303","article-title":"Mild cognitive impairment: Clinical characterization and outcome","volume":"56","author":"Petersen","year":"1999","journal-title":"Arch. Neurol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1985","DOI":"10.1001\/archneur.58.12.1985","article-title":"Current concepts in mild cognitive impairment","volume":"58","author":"Petersen","year":"2001","journal-title":"Arch. Neurol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Guy, W. (1976). Clinical Global Impressions. ECDEU Assessment Manual for Psychopharmacology, Revised, National Institute of Mental Health. (DHEW Publ. No. ADM 76-338).","DOI":"10.1037\/e591322011-001"},{"key":"ref_21","first-page":"221","article-title":"Brief Psychiatric Rating Scale Expanded version 4.0: Scales anchor points and administration manual","volume":"13","author":"Ventura","year":"1993","journal-title":"Int. J. Meth Psychiatr. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1192\/bjp.166.5.654","article-title":"A brief mental health outcome scale-reliability and validity of the Global Assessment of Functioning (GAF)","volume":"166","author":"Jones","year":"1995","journal-title":"Br. J. Psychiatry"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.psychres.2005.05.001","article-title":"Brief Psychiatric Rating Scale Expanded Version: How do new items affect factor structure?","volume":"135","author":"Velligan","year":"2005","journal-title":"Psychiatry Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/0022-3956(75)90026-6","article-title":"\u201cMini-mental state\u201d. A practical method for grading the cognitive state of patients for the clinician","volume":"12","author":"Folstein","year":"1975","journal-title":"J. Psychiatr. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/j.jad.2007.08.018","article-title":"A case series on the hypothesized connection between dementia and bipolar spectrum disorders: Bipolar type VI?","volume":"107","author":"Ng","year":"2008","journal-title":"J. Affect. Disord."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1176\/appi.ajp.161.2.262","article-title":"Cognitive function across manic or hypomanic, depressed, and euthymic states in bipolar disorder","volume":"161","author":"Vieta","year":"2004","journal-title":"Am. J. Psychiatry"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1007\/s11920-015-0605-x","article-title":"Neuroprogression and Cognitive Functioning in Bipolar Disorder: A Systematic Review","volume":"17","author":"Cardoso","year":"2015","journal-title":"Curr. Psychiatry Rep."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1007\/s10048-007-0100-6","article-title":"Evidence of shared risk for Alzheimer\u2019s disease and Parkinson\u2019s disease using family history","volume":"8","author":"Rosen","year":"2007","journal-title":"Neurogenetics"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1002\/ajmg.b.32399","article-title":"Influence of family history of dementia in the development and progression of late-onset Alzheimer\u2019s disease","volume":"171","author":"Scarabino","year":"2016","journal-title":"Am. J. Med. Genet. Part B Neuropsychiatr. Genet."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1002\/ana.410250511","article-title":"Assessment of genetic risk for Alzheimer\u2019s disease among first-degree relatives","volume":"25","author":"Farrer","year":"1989","journal-title":"Ann. Neurol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1097\/01.GIM.0000132679.92238.58","article-title":"Estimating risk curves for first-degree relatives of patients with Alzheimer\u2019s disease: The REVEAL study","volume":"6","author":"Cupples","year":"2004","journal-title":"Genet. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"659","DOI":"10.3233\/JAD-2012-120676","article-title":"Maternal family history is associated with Alzheimer\u2019s disease biomarkers","volume":"31","author":"Honea","year":"2012","journal-title":"J. Alzheimers Dis."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.euroneuro.2023.06.006","article-title":"Neuropsychological functioning of patients with major depression or bipolar disorder comorbid to substance use disorders: A systematic review","volume":"75","author":"Miguel","year":"2023","journal-title":"Eur. Neuropsychopharmacol."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Athanasaki, A., Melanis, K., Tsantzali, I., Stefanou, M.I., Ntymenou, S., Paraskevas, S.G., Kalamatianos, T., Boutati, E., Lambadiari, V., and Voumvourakis, K.I. (2022). Type 2 Diabetes Mellitus as a Risk Factor for Alzheimer\u2019s Disease: Review and Meta-Analysis. Biomedicines, 10.","DOI":"10.3390\/biomedicines10040778"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Flores-Cordero, J.A., P\u00e9rez-P\u00e9rez, A., Jim\u00e9nez-Cortegana, C., Alba, G., Flores-Barrag\u00e1n, A., and S\u00e1nchez-Margalet, V. (2022). Obesity as a Risk Factor for Dementia and Alzheimer\u2019s Disease: The Role of Leptin. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23095202"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Bidzan, L., Jurek, P., Olech, M., Bidzan-Wi\u0105cek, M., Bidzan-Bluma, I., and Bidzan, M. (2023). Somatic comorbidity and the progression of cognitive impairment. Front. Aging Neurosci., 15.","DOI":"10.3389\/fnagi.2023.1219449"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1710","DOI":"10.1016\/j.neurobiolaging.2008.09.011","article-title":"Contribution of vascular pathology to the clinical expression of dementia","volume":"31","author":"Strozyk","year":"2010","journal-title":"Neurobiol. Aging"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Sierra, C. (2020). Hypertension and the Risk of Dementia. Front. Cardiovasc. Med., 7.","DOI":"10.3389\/fcvm.2020.00005"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Cao, Y., Zhao, L.W., Chen, Z.X., and Li, S.H. (2024). New insights in lipid metabolism: Potential therapeutic targets for the treatment of Alzheimer\u2019s disease. Front. Neurosci., 18.","DOI":"10.3389\/fnins.2024.1430465"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1161\/CIRCRESAHA.118.313400","article-title":"Cerebrovascular Alterations in Alzheimer Disease","volume":"123","author":"Iadecola","year":"2018","journal-title":"Circ. Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/j.psc.2011.02.007","article-title":"Geriatric bipolar disorder","volume":"34","author":"Sajatovic","year":"2011","journal-title":"Psychiatr. Clin. N. Am."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2033","DOI":"10.1176\/appi.ajp.162.11.2033","article-title":"Secondary mania in older adults","volume":"162","author":"Brooks","year":"2005","journal-title":"Am. J. Psychiatry"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1007\/s11920-000-0030-6","article-title":"Mania in neurologic disorders","volume":"2","author":"Mendez","year":"2000","journal-title":"Curr. Psychiatry Rep."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"946","DOI":"10.1161\/01.STR.26.6.946","article-title":"Silent cerebral infarctions in patients with late-onset mania","volume":"26","author":"Fujikawa","year":"1995","journal-title":"Stroke"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1001\/archpsyc.1997.01830220033006","article-title":"\u201cVascular Depression\u201d Hypothesis","volume":"54","author":"Alexopoulos","year":"1997","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1136\/jnnp.2007.124651","article-title":"White matter hyperintensities in late-life depression: A systematic review","volume":"79","author":"Herrmann","year":"2008","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_47","unstructured":"Akiskal, H.S., Pinto, O.C., and Lara, D. (2025, February 06). \u201cBipolarity\u201d in the Setting of Dementia: Bipolar Type VI. Available online: http:\/\/www.medscape.com\/viewarticle\/495795."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1056\/NEJMoa2310168","article-title":"Biomarker Changes during 20 Years Preceding Alzheimer\u2019s Disease","volume":"390","author":"Jia","year":"2024","journal-title":"N. Engl. J. Med."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1007\/s11357-024-01359-x","article-title":"Monoamine alterations in Alzheimer\u2019s disease and their implications in comorbid neuropsychiatric symptoms","volume":"47","author":"Saggu","year":"2024","journal-title":"GeroScience"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1017\/S1041610213001609","article-title":"The course of neuropsychiatric symptoms in nursing-home patients with dementia over a 53-month follow-up period","volume":"26","author":"Selbaek","year":"2014","journal-title":"Int. Psychogeriatr."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.1017\/S1041610210000918","article-title":"Course of neuropsychiatric symptoms in residents with dementia in long-term care institutions: A systematic review","volume":"22","author":"Wetzels","year":"2010","journal-title":"Int. Psychogeriatr."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1628","DOI":"10.1212\/WNL.0000000000000378","article-title":"Structural MRI correlates of apathy symptoms in older persons without dementia: AGES-Reykjavik Study","volume":"82","author":"Grool","year":"2014","journal-title":"Neurology"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1590\/S1980-57642010DN40300007","article-title":"Apathy in Alzheimer\u2019s disease: Contribution to a clinical view on progression of dementia","volume":"4","author":"Stella","year":"2010","journal-title":"Dement. Neuropsychol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1192\/bjp.133.5.429","article-title":"A rating scale for mania: Reliability, validity and sensitivity","volume":"133","author":"Young","year":"1978","journal-title":"Br. J. Psychiatry"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1136\/jnnp.23.1.56","article-title":"A rating scale for depression","volume":"23","author":"Hamilton","year":"1960","journal-title":"J. Neurol. Neurosurg. Psychiatry"}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/15\/4\/349\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:03:44Z","timestamp":1760029424000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/15\/4\/349"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,27]]},"references-count":55,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["brainsci15040349"],"URL":"https:\/\/doi.org\/10.3390\/brainsci15040349","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,27]]}}}