BackgroundWeather conditions have been linked to adverse mental health outcomes, and rising concern about climate change has increased interest in these associations. However, most existing research focuses on extreme weather events, such as heatwaves, or on acute clinical outcomes, such as suicide. Evidence is more limited regarding population-level variations in mental health–related healthcare utilisation across the full range of daily weather conditions.ObjectiveTo examine associations between daily weather conditions and unscheduled mental health–related healthcare contacts in England using large-scale national surveillance data.MethodsWe conducted a retrospective observational study across nine English regions from 1 January 2014 to 31 December 2022. Outcomes were daily counts of unscheduled mental health–related contacts to emergency departments (EDs), general practice out-of-hours (GP OOH) services, and the NHS 111 telephone advice line. Weather exposures included mean daily temperature (°C), hours of full sunshine, and total daily rainfall (mm). Associations were estimated using distributed lag non-linear models at regional level and combined through two-stage multivariate meta-analysis. Models were adjusted for seasonality, long-term trends, day of week, public holidays, and population size.ResultsMental health–related unscheduled healthcare contacts showed modest but consistent associations with temperature and sunshine. Across services, relative risks (demand) increased with rising temperatures up to around 18 °C and were higher on days with fewer hours of sunshine. Sunshine demonstrated the clearest pattern, with increased utilisation on low-sunshine days across all healthcare settings. Rainfall was not consistently associated with healthcare contacts. Age-stratified analyses showed a U-shaped relationship between temperature and ED attendances among adults aged over 64 years, with higher utilisation during both colder and warmer conditions. Overall variations in daily healthcare demand were modest, typically within ±10–20% of baseline levels.ConclusionIn England, short-term variations in temperature and sunshine are associated with changes in unscheduled mental health–related healthcare utilisation, whereas rainfall shows little consistent effect. Although effect sizes were modest, these findings highlight the role of everyday weather conditions in influencing mental health–related healthcare demand and may support planning and preparedness efforts for mental health services under current and future climate conditions.
Associations of TNF-α, MIF, and cortisol with cognitive function in patients with bipolar disorder during acute manic episodes: a short-term follow-up study
BackgroundBipolar disorder (BD) is frequently accompanied by cognitive impairment, and growing evidence suggests that immune-inflammatory activation and hypothalamic-pituitary-adrenal axis dysregulation may contribute to its pathophysiology. This study aimed to examine the associations of tumor necrosis factor-α (TNF-α), macrophage migration inhibitory factor (MIF), and cortisol (COR) with cognitive function in patients with BD during manic episodes and to characterize their short-term changes.MethodsIn this short-term follow-up study, 53 patients with BD during manic episodes and 53 healthy controls (HCs) were enrolled. Plasma TNF-α, MIF, and COR levels were measured using enzyme-linked immunosorbent assay. Cognitive function was assessed using the Chinese Brief Cognitive Test, including information processing speed (IPS), executive function (EF), sustained attention (SAT), and working memory (WM). Patients were evaluated at baseline and after 8 weeks of treatment, whereas HCs were assessed once at baseline. Group comparisons and biomarker–cognition correlation analyses were performed. Multiple testing in the correlation analyses was controlled using the Benjamini–Hochberg false discovery rate (FDR) procedure.ResultsAt both baseline and follow-up, patients with BD had significantly lower IPS, EF, SAT, and WM scores, but significantly higher plasma TNF-α, MIF, and COR levels, than HCs. After 8 weeks of treatment, cognitive scores in the BD group improved significantly, whereas reductions in TNF-α, MIF, and COR did not reach statistical significance. In exploratory unadjusted Pearson analyses, several biomarker–cognition associations survived FDR correction. However, in the primary adjusted partial correlation analyses, only the negative association between TNF-α and WM remained significant after adjustment for covariates and FDR correction at both baseline and follow-up.ConclusionPatients with BD during manic episodes exhibited widespread cognitive impairment accompanied by elevated inflammatory and neuroendocrine markers. TNF-α showed the most robust association with working memory after adjustment for covariates and correction for multiple comparisons. Associations involving MIF or cortisol and executive function should be interpreted as exploratory and require validation in larger longitudinal studies.
Real-World Engagement With a Generative AI Conversational Agent for Mental Health Support: Retrospective Descriptive Study
Background: Generative artificial intelligence (GenAI) conversational agents are increasingly integrated within digital mental health interventions (DMHIs). However, empirical data on real-world engagement, usage patterns, and satisfaction with GenAI conversational agents remain limited. Objective: This study examined real-world engagement among users who interacted with the GenAI conversational agent within Mental, a DMHI designed to support mental health. We aimed to (1) characterize users engaging with Mental’s GenAI conversational agent, (2) examine real-world usage patterns, (3) examine satisfaction and user feedback following sessions, and (4) explore preliminary predictors of engagement with Mental’s GenAI conversational agent. Methods: This retrospective study analyzed naturalistic user data from 5082 paid subscribers who engaged with Mental’s GenAI conversational agent between October 2024 and March 2026. Users’ onboarding characteristics (ie, sex, mindset, distress level, desire for greater discipline, and primary stressors) and session satisfaction were collected via optional app-native items; session-level engagement metrics were captured through backend app usage data. Descriptive statistics were used to characterize user demographics and usage patterns. Session satisfaction was compared across temporal engagement variables using ANOVAs and independent-samples tests. As an exploratory aim, session-level mixed-effects logistic regression was used to estimate predictors of session-to-session return, with session satisfaction as the primary predictor and moderation by self-reported mindset. Results: Among users reporting onboarding data, 78.8% (2610/3312) identified as male and 90.0% (2667/2964) reported moderate-to-high distress on an app-native item. A total of 59,602 sessions were recorded (mean 11.8 sessions per user), most frequently occurring in the evening (17,206/59,602, 28.9%) and outside traditional business hours (37,181/59,602, 62.4%). Mean session satisfaction was high (mean 4.5, SD 0.9) and did not differ by time of day or day of the week. The most commonly selected session descriptors were “Insightful” (9236/19,883, 46.5%), “Felt seen” (7974/19,883, 40.1%), and “Good advice” (7510/19,883, 37.8%). The session-to-session return rate was 92.6%, and 69.4% (3528/5082) of users returned after their first session. In an exploratory analysis, session satisfaction was a significant predictor of return (odds ratio 1.35, 95% CI 1.14-1.60; <.001), although this finding should be interpreted as hypothesis-generating. Conclusions: Users engaged with a GenAI conversational agent within the Mental app outside of traditional care hours and presented with high return rates. Objective behavioral engagement data (eg, session frequency, timing, and session-to-session return rate) provide novel evidence that GenAI conversational agents may sustain real-world engagement, including among individuals who face barriers to traditional mental health services. Future research should determine whether these engagement patterns translate into clinically meaningful outcomes.
Blood Protein May Signal Dementia Risk Decades Before Symptoms Appear
A blood protein long associated with dementia in older adults may also identify people at increased risk decades before symptoms develop, according to a large international study published in Science Advances.
Analyzing data from six large longitudinal cohorts, researchers from the National Institute on Aging found that elevated levels of growth differentiation factor-15 (GDF15)—a circulating cytokine involved in inflammation and cellular stress responses—in adults younger than 55 years were associated with a significantly greater risk of developing dementia later in life, particularly vascular dementia. The findings suggest that molecular changes associated with neurodegeneration may be detectable years before cognitive symptoms emerge.
“Our findings extend existing evidence by demonstrating that elevated GDF15 levels are detectable in midlife—before age 55—in individuals who later develop dementia,’” the authors write.
The study included approximately 500,000 participants from the UK Biobank, more than 15,000 from the Atherosclerosis Risk in Communities (ARIC) study, nearly 5,700 from the AGES-Reykjavik Study, and three additional cohorts. Participants were followed for 15 to 25 years, enabling investigators to determine whether plasma GDF15 levels measured in midlife predicted future dementia.
Across nearly all cohorts, elevated plasma GDF15 was associated with increased risk for all-cause dementia. However, the relationship was strongest for vascular dementia, with effect sizes approximately two to five times greater than those observed for Alzheimer’s disease.
The distinction suggests GDF15 may be particularly useful for identifying individuals at risk for vascular cognitive impairment rather than the amyloid-driven pathology typically associated with Alzheimer’s disease. As the authors note, “the association was particularly pronounced for vascular dementia,” supporting the protein’s potential as an early marker of vascular brain injury.
To investigate whether GDF15 might play a biological role in disease rather than simply reflect ongoing pathology, the researchers performed Mendelian randomization analyses using genetic data. The analyses supported a potential causal relationship between elevated circulating GDF15 and Alzheimer’s disease and related dementias.
Additional analyses linked higher plasma GDF15 concentrations with several established indicators of neurodegeneration, including cerebral small vessel disease, elevated phosphorylated tau (pTau-181) in both plasma and cerebrospinal fluid, and increased neurofilament light, a marker of neuronal injury. In contrast, GDF15 was not associated with amyloid pathology, suggesting that it may reflect alternative disease mechanisms.
Instead, multiple lines of evidence pointed toward inflammation and immune dysregulation. Individuals with elevated GDF15 exhibited cerebrospinal fluid protein signatures consistent with neuroimmune activation, including complement activation, inflammatory signaling pathways, and disease-associated microglial responses.
To better understand these mechanisms, the investigators exposed cultured human macrophages to recombinant GDF15. The protein altered cellular pathways involved in interferon signaling, energy metabolism, and heme scavenging—processes that have all been implicated in dementia risk. Together, the experimental and clinical findings suggest that GDF15 may actively influence neurodegeneration through immune and vascular pathways rather than acting solely as a marker of biological aging.
The authors conclude that “these findings support circulating GDF15’s role as an early biomarker—particularly for vascular dementia and neuroinflammation—and identify the mechanisms by which it may drive dementia risk.”
The post Blood Protein May Signal Dementia Risk Decades Before Symptoms Appear appeared first on Inside Precision Medicine.
Rhythm-Based Video Games: Exploring the Cognitive and Learning Potential
By Florencia Assaneo, PhD, Research Fellow, Stavros Niarchos Foundation (SNF) Global Center for Child and Adolescent Mental Health at the Child Mind Institute
Educational challenges for Latin American children
Primary education in Latin America has faced a steady decline over recent decades, contributing to what many organizations now describe as an educational crisis. International institutions such as the Economic Commission for Latin America and the Caribbean (ECLAC), the United Nations Educational, Scientific and Cultural Organization (UNESCO), as well as the World Bank Group have all called for urgent action to address worsening learning outcomes across the region. The situation is particularly concerning in Mexico. Results from the 2022 Programme for International Student Assessment showed that Mexico scored well below the Organization for Economic Co-operation and Development (OECD) average in reading, mathematics, and science — placing the country among the lower-performing educational systems evaluated globally.
The consequences of this crisis extend far beyond the classroom. Educational difficulties during childhood are closely linked to long-term social and mental health outcomes. Research has shown that additional years of basic education are associated with lower rates of depression and anxiety (Kondirolli & Sunder, 2022), as well as higher levels of resilience and perceived control over one’s life (Niemeyer et al. 2019). In this sense, poor academic performance in primary school can have lasting effects that continue into adulthood, limiting employment opportunities, increasing vulnerability, and negatively affecting overall well-being.
Can rhythm-based video games improve learning?
Open-access interventions that strengthen children’s cognitive and academic abilities could have enormous value in low- and middle-income countries, where educational resources are often limited. Our work explores whether the ability to coordinate movements with rhythmic sounds — such as clapping, tapping, or dancing to music — can be leveraged to support children’s learning and cognitive development through engaging digital tools.
Over the last decade, multiple studies have shown that children who are better at synchronizing their movements to rhythm also tend to perform better on a wide range of cognitive and language-related tasks. These include reading, phonological awareness, processing speed, rapid naming, and other foundational abilities linked to academic success. Researchers have assessed these rhythmic coordination skills in multiple ways, from walking to the beat of music to tapping along with a steady rhythm or coordinating movements while playing musical instruments. Across these different approaches, one result consistently emerges: children who are better at aligning movement with sound also tend to show stronger cognitive performance.
Building on these study findings, my current fellowship project, supported by the Stavros Niarchos Foundation (SNF) Global Center for Child and Adolescent Mental Health at the Child Mind Institute, seeks to better understand how these rhythm synchronization abilities develop during childhood and whether they could eventually be strengthened through interactive digital interventions. Specifically, we are studying the developmental stage at which these abilities become established in children, and whether individuals with stronger rhythmic coordination also show advantages in attention and language-related skills. Understanding when these abilities emerge is particularly important because it may help identify the developmental window during which they are most malleable and therefore most responsive to training or intervention.
In parallel, we are using functional magnetic resonance imaging (fMRI) — a non-invasive brain imaging technique that allows us to observe which brain regions become active during different tasks — to explore the relationship between rhythmic synchronization and the brain’s reward system. Importantly, these same reward-related regions are also strongly engaged during video game play. If the pathways within this reward system are similarly activated during rhythmic coordination, this could mean that children who initially struggle to synchronize movements with sound may be able to strengthen these abilities through a carefully designed video game experience. One possible future application could involve an open-access mobile game in which children synchronize taps or hand movements to musical rhythms while progressing through increasingly challenging levels and unlocking rewards or visual customizations.
Overall, the current project seeks to generate the scientific evidence necessary to determine whether rhythm-based digital interventions could become a viable tool for supporting children’s cognitive development. This work has the potential to contribute to the future development of accessible and scalable tools that can strengthen foundational cognitive skills linked to academic performance in children. These tools can be applied to children in Mexico and, more broadly, across low- and middle-income countries (LMICs), expanding access to education resources and interventions.
The power of collaboration between the SNF Global Center and UNAM
Our laboratory at Universidad Nacional Autónoma de México (UNAM) is primarily dedicated to basic neuroscience research. Based at UNAM’s campus in Querétaro, our team brings together researchers and students from different disciplines — including neuroscience, psychology, physics, engineering, and data analysis — united by a shared interest in understanding how rhythm and brain dynamics shape human cognition and behavior. Here, we have access to excellent infrastructure for fundamental research, including neuroimaging facilities and high-performance computational resources. However, translating basic scientific discoveries into interventions capable of improving people’s daily lives is often much more challenging and requires strong cross-sector collaboration.
The work I’m conducting as part of the SNF Global Center Research Fellowship has encouraged us to begin thinking beyond the laboratory. This current fellowship has given us the opportunity to test the core scientific assumptions behind our proposed open-access intervention. If the pilot project proves successful, the next stages of the work will become considerably more ambitious, involving both the technological development of the intervention and its large-scale implementation and evaluation in school settings. Advancing toward those goals will likely require the support of larger international organizations and cross-sector collaborations. In this context, the opportunities provided by the SNF Global Center at the Child Mind Institute to share, disseminate, and give visibility to our work are extremely valuable, helping create the connections and momentum necessary to move from foundational research toward real-world impact.
More broadly, this kind of collaboration highlights the importance of building bridges between global institutions and local research communities. By combining international support with local expertise and close engagement with schools and communities, it becomes possible to develop solutions that are both scientifically rigorous and genuinely connected to the realities of the populations they aim to serve.
Learn more about the Research Fellowship
The post Rhythm-Based Video Games: Exploring the Cognitive and Learning Potential appeared first on Child Mind Institute.
The Download: brain-melting heatwaves and unprecedented OpenAI restrictions
This is today’s edition of The Download, our weekday newsletter that provides a daily dose of what’s going on in the world of technology.
Heat waves mess with your brain. Scientists are trying to figure out why.
—Jessica Hamzelou
It’s been hot in London this week. Really hot. A dangerous heat wave has hit Western Europe. On Wednesday, the UK recorded its highest ever June temperature at 36.1 °C (about 97 °F). But as the weather app on my phone confirmed, it felt like 39 °C.
Much of Western Europe is suffering, bringing awful consequences for agriculture, infrastructure, and the health system. But heat can also affect the brain.
Studies have confirmed that as temperatures rise, people seem to get more irritable and more violent. And they have shown that firefighters find it harder to focus immediately after heat exposure. Rising temperatures can also have particularly disastrous outcomes for children and people with mental health disorders.
Research on lab animals suggests that excessive heat can alter the function of chemical signals in our brains. But we still need a better understanding of the mechanisms behind these effects.
Here’s what scientists are learning about extreme heat’s impact on the brain.
This story is from The Checkup, our weekly biotech newsletter. Sign up to receive it in your inbox every Thursday.
For more on Europe’s heat wave, read our stories on why soaring temperatures are shutting down power plants and what they mean for the grid.
The must-reads
I’ve combed the internet to find you today’s most fun/important/scary/fascinating stories about technology.
1 The Trump administration has asked OpenAI to limit its next model release
It wants to vet the first GPT 5.6 users before a wider launch. (Bloomberg $)
+ OpenAI said each of the initial partners will be government-approved. (FT $)
+ It’s the first US firm to be told to restrict an AI model before release. (Axios)
+ Anthropic is also still feuding with Washington. (MIT Technology Review)
2 Apple and Xbox have hiked prices, blaming AI-driven chip costs
Some MacBooks, iPads, and Xboxes are going up in price by over 20%. (BBC)
+ Apple’s shares plummeted after the announcement. (NBC)
+ AI data center demand has pushed up memory and storage prices. (WSJ $)
+ The shortages have been dubbed “RAMaggedon.” (The Verge)
3 Colossal and the US are building an endangered species “biovault”
It aims to cryptopreserve over 2,300 plant and animal samples. (Wired $)
+ It comes amid growing threats to endangered species protections. (NYT $)
+ Colossal is also growing chickens in artificial eggshells. (MIT Technology Review)
4 The US has banned Polestar from selling its EVs due to anti-China rules
The Sweden-based company is majority-owned by China’s Geely. (CNN)
+ The ban is because its connected-vehicle tech is linked to China. (Reuters $)
+ What happened to China’s overseas EV factory boom? (Rest of World)
5 China is betting on humanoids to beat its demographic decline
It wants the robots to narrow the labour gap. (FT $)
+ Gig workers are training humanoids at home. (MIT Technology Review)
6 The “fingerprints” of a black hole’s event horizon have been detected
The discovery was made by studying ripples in space-time. (AFP)
7 OpenAI is now expected to delay its IPO until next year
It’s been spooked by choppy global markets and SpaceX’s slump. (NYT $)
8 Data centers have moved to the forefront of environmental lawsuits
The litigation is linked to energy sources, water consumption, and air pollution. (Guardian)
9 A master gene that turns on human development has been uncovered
It results in cells forming a human body. (New Scientist $)
10 Grok’s most popular feature? Smut
It accounts for “well over half” of the chatbot’s traffic. (The Information $)
Quote of the day
“The most advanced AI is built by a handful of American companies, on American soil, under American law, and what the rest of us are permitted to do with it can change on a Friday afternoon.”
—Nathan Benaich, AI investor at London-based venture firm Air Street Capital, tells the Financial Times about the geopolitical reality of US AI dominance.
One More Thing
MAX-O-MATIC
How technology helped archaeologists dig deeper
In 1991, construction workers in Manhattan unearthed hundreds of coffins. Further investigation revealed that the remains were between 200 and 300 years old, and they were all African and African American.
This discovery came at an inflection point in scientific history. Breakthroughs in chemical and genetic analysis allowed researchers to figure out where many of these people were born, the physical challenges they faced, and even the routes they took from Africa to North America.
Today, archaeologists are using techniques they could only dream of then: lasers, 3D photography, lidar, satellite imagery, and more. These tools are revealing where people came from, how ancient cities were built, and the lives of those who built them.
Read the full story on how archaeology is changing our understanding of the past.
—Annalee Newitz
We can still have nice things
A place for comfort, fun, and distraction to brighten up your day. (Got any ideas? Drop me a line.)
+ Tantalise your taste buds with this culinary tour of the planet’s rarest fruits.
+ This Daft Punk and Justice mashup is the French EDM collab that fans never got.
+ Daredevils have delightfully transformed playground equipment into a series of terrifying oversized rides.
+ The gadget department of your childhood dreams comes to life in this rocket-powered pen disguised as a spy weapon.
Top image credit: Sarah Rogers/MITTR | Photos Getty
Please send your childhood dreams to hi@technologyreview.com.
You can follow me on LinkedIn. Thanks for reading!
—Thomas
The impact of amblyopia, reduced viewing conditions and binocular vision on reading ability: a narrative review
Amblyopia is a neurodevelopmental disorder of the visual cortex which leads to issues in visual acuity, contrast sensitivity and eye movement patterns, all characteristics which, along with other deficits may negatively influence reading skills. Individuals with reduced reading capabilities due to amblyopia or other binocular vision disorders may have difficulties navigating various social aspects of daily life including employment and academics. Reading is an active viewing task which involves multiple oculomotor and cognitive processes. In this review, we introduce how a lack of binocular vision or other low vision issues such as blur, low illumination or altered contrast sensitivity may contribute to impaired reading performance. These impairments, particularly in amblyopia, include changes to reading speed, eye movements and crowding. Though reading is such an important daily skill, and is known to be impacted in amblyopia, there are no known treatments for this condition which are specifically designed to improve reading. Binocular therapies may be leveraged to address these issues. This narrative review provides available evidence on alterations to reading ability in amblyopia and why this may be relevant for developing novel amblyopia therapies.
Elevated NHHR at admission is independently associated with elevated post-stroke depressive symptoms
BackgroundElevated post-stroke depressive symptoms are common among acute ischemic stroke (AIS) survivors and are associated with poor functional recovery. However, readily available biomarkers reflecting lipid–inflammation status remain limited. The ratio of non–high-density lipoprotein cholesterol to high-density lipoprotein cholesterol (NHHR) may integrate atherogenic burden and inflammatory status and thus be associated with depressive symptom burden after stroke.MethodsWe retrospectively analyzed a cohort of 518 Chinese AIS patients. Admission NHHR was calculated from routine lipid panels. Depressive symptoms at 90 days were assessed using the Hamilton Depression Rating Scale (HAMD), and elevated post-stroke depressive symptoms were defined according to the prespecified HAMD threshold. Multivariable logistic regression, restricted cubic spline (RCS) analysis, and subgroup analyses were conducted to examine the association between NHHR and elevated depressive symptoms.ResultsAmong the 518 patients, 179 exhibited elevated post-stroke depressive symptoms at 90 days. Higher NHHR levels were independently associated with increased odds of elevated depressive symptoms after adjustment for demographics, stroke severity, cognitive function, inflammatory markers, and coagulation parameters (OR = 1.35, P = 0.029). Dose–response trends were observed, and RCS analysis suggested a linear relationship without significant nonlinearity. No significant interactions were found across sex, smoking, alcohol use, hypertension, or diabetes subgroups.ConclusionsElevated NHHR at admission was independently associated with elevated post-stroke depressive symptoms at 90 days in Chinese AIS patients. As a simple, cost-effective, and readily obtainable biomarker, NHHR may facilitate early risk stratification and guide individualized interventions.
Efficacy and predictors of cognitive stimulation therapy combined with pharmacotherapy for mild-to-moderate Alzheimer’s disease: a randomized controlled trial
IntroductionAlzheimer’s disease (AD) is associated with progressive cognitive decline, functional impairment, and reduced quality of life. Although pharmacological treatments such as cholinesterase inhibitors and memantine are commonly used, their clinical benefits remain limited and heterogeneous. Cognitive stimulation therapy (CST) may provide additional benefits when combined with standard pharmacotherapy. This randomized controlled trial (RCT) aimed to evaluate the clinical efficacy of modified CST combined with standard drug therapy on cognitive function, activities of daily living, and quality of life in patients with mild-to-moderate AD and to explore key predictors of CST efficacy using a multivariate regression model.MethodsThis evaluator-blinded randomized controlled trial enrolled 80 patients with mild-to-moderate Alzheimer’s disease (AD), who were randomly assigned in a 1:1 ratio to either the modified CST plus standard pharmacotherapy group (study group, n = 40) or the standard pharmacotherapy-alone group (control group, n = 40).The modified CST program comprised 14 weekly 45-minute sessions. The primary endpoint was the change in the Alzheimer’s Disease Assessment Scale–Cognitive Subscale (ADAS-Cog) score from baseline to post-intervention. Secondary measures included the Activities of Daily Living (ADL) scale and the Quality of Life in Alzheimer’s disease (QOL-AD) questionnaire. Data were analyzed using an intention-to-treat (ITT) approach. Independent predictors of treatment efficacy were identified using a two-stage screening strategy (univariate screening and stepwise regression).ResultsA total of 75 patients completed the study, and 80 were included in the ITT analysis. After 14 weeks of intervention, baseline-adjusted ANCOVA showed that the study group had significantly better post-intervention ADAS-Cog scores than the control group. The adjusted mean difference in ADAS-Cog score was -3.28 points (95% CI: -3.72 to -2.83; P < 0.001), favoring the study group. Significant baseline-adjusted between-group differences were also observed for ADL (adjusted mean difference = -4.93, 95% CI: -8.39 to -1.47; P = 0.006) and QOL-AD (adjusted mean difference = 2.69, 95% CI: 1.01 to 4.37; P = 0.002), both favoring the study group. Higher years of education (β = -0.54, P < 0.001), regular physical activity (β = -0.28, P = 0.003), higher baseline Mini-Mental State Examination (MMSE) scores (β = -0.22, P = 0.001), and active hobbies (β = -0.20, P = 0.002) were significant independent predictors of CST efficacy.DiscussionModified CST combined with medication significantly delays cognitive decline and improves QOL-AD in patients with mild-to-moderate AD. Educational attainment, lifestyle factors, and cognitive reserve are key determinants of CST efficacy. Relevant institutions should develop targeted enhancement protocols for patients with lower educational levels or insufficient cognitive reserves when implementing CST.Trial RegistrationChinese Clinical Trial Registry, identifier ChiCTR2600118654, https://www.chictr.org.cn.
Suicide and suicidal behavior in the gulf cooperation council countries: a Systematic Review of behavioral patterns, sociocultural determinants, and structural vulnerabilities
Suicide and suicidal behavior in the Gulf Cooperation Council (GCC) countries remain underrepresented in empirical research, largely due to cultural stigma, legal prohibitions, and systematic underreporting. The behavioral and sociocultural determinants of suicidal behavior in these contexts—where rapid modernization intersects with Islamic normative frameworks and large-scale labor migration—have received particularly limited systematic attention. This review synthesizes available evidence on the prevalence, behavioral patterns, risk factors, and structural determinants of suicidal behavior across Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. Following PRISMA 2020 guidelines, we searched PubMed, Scopus, ScienceDirect, Web of Science, and Google Scholar for primary research published between 2000 and 2025. Fifty studies (34 GCC-specific and 16 contextual/comparative) met the inclusion criteria. Methodological quality was appraised using the Newcastle–Ottawa Scale, JBI checklists, the Mixed Methods Appraisal Tool, and the AACODS checklist. The review protocol was registered on the Open Science Framework (DOI: 10.17605/OSF.IO/RZXY7; URL: https://osf.io/rzxy7/). The findings were organized into six dimensions: (1) suicide prevalence, risk factors, and associated behaviors; (2) cultural and religious influences; (3) mental health of specific at-risk populations; (4) healthcare and support services; (5) migrant worker vulnerabilities; and (6) research trends. Reported suicide rates in the GCC range from 1.5 to 4.2 per 100,000 but likely underestimate the true prevalence due to forensic misclassification and stigma. Migrant workers constitute a high-risk subgroup, with suicidal ideation reaching 68% among those facing acute financial distress. Islamic religiosity is associated with lower suicide mortality but simultaneously deters help-seeking by stigmatizing mental distress. Interpreted through a Durkheimian lens, these findings position suicidal behavior in the GCC as a social fact shaped by weakened social integration and normative fragmentation under rapid modernization. Effective prevention requires culturally adapted behavioral interventions that integrate labor welfare reforms with community-based mental health strategies.