Management of patients with neurological diseases considering post-pandemic coronavirus disease 2019 (COVID-19) related risks and dangers - An updated European Academy of Neurology consensus statement.

BACKGROUND AND PURPOSE: In October 2020, the European Academy of Neurology (EAN) consensus statement for management of patients with neurological diseases during the coronavirus disease 2019 (COVID-19) pandemic was published. Due to important changes and developments that have happened since then, the need has arisen to critically reassess the original recommendations and address new challenges. METHODS: In step 1, the original items were critically reviewed by the EAN COVID-19 Task Force. In addition, new recommendations were defined. In step 2, an online survey with the recommendations forged in step 1 was sent to the Managing Groups of all Scientific and Coordinating Panels of EAN. In step 3, the final set of recommendations was made. RESULTS: In step 1, out of the original 36 recommendations, 18 were judged still relevant. They were edited to reflect the advances in knowledge and practice. In addition, 21 new recommendations were formulated to address the new knowledge and challenges. In step 2, out of the 39 recommendations sent for the survey, nine were approved as they were, whilst suggestions for improvement were given for the rest. In step 3, the recommendations were further edited, and some new items were formed to accommodate the participants' suggestions, resulting in a final set of 41 recommendations. CONCLUSION: This revision of the 2020 EAN Statement provides updated comprehensive and structured guidance on good clinical practice in people with neurological disease faced with SARS-CoV-2 infection. It now covers the issues from the more recent domains of COVID-19-related care, vaccine complications and post-COVID-19 conditions.

The COVID-19 pandemic and neurology: A survey on previous and continued restrictions for clinical practice, curricular training, and health economics.

BACKGROUND AND PURPOSE: The COVID-19 pandemic has significantly impacted health systems worldwide. Here, we assessed the pandemic's impact on clinical service, curricular training, and financial burden from a neurological viewpoint during the enforced lockdown periods and the assumed recovery by 2023. METHODS: An online 18-item survey was conducted by the European Academy of Neurology (EAN) NeuroCOVID-19 Task Force among the EAN community. The survey was online between February and March 2023. Questions related to general, demographic, clinical, work, education, and economic aspects. RESULTS: We collected 430 responses from 79 countries. Most health care professionals were aged 35-44 years, with >15 years of work experience. The key findings of their observations were as follows. (i) Clinical services were cut back in all neurological subspecialties during the most restrictive COVID-19 lockdown period. The most affected neurological subspecialties were services for patients with dementia, and neuromuscular and movement disorders. The levels of reduction and the pace of recovery were distinct for acute emergencies and in- and outpatient care. Recovery was slow for sleep medicine, autonomic nervous system disorders, neurorehabilitation, and dementia care. (ii) Student and residency rotations and grand rounds were reorganized, and congresses were converted into a virtual format. Conferences are partly maintained in a hybrid format. (iii) Affordability of neurological care and medication shortage are emerging issues. CONCLUSIONS: Recovery of neurological services up to spring 2023 has been incomplete following substantial disruption of neurological care, medical education, and health economics in the wake of the COVID-19 pandemic. The continued limitations for the delivery of neurological care threaten brain health and call for action on a global scale.

The European Academy of Neurology NeuroCOVID-19 Task Force: A lesson for the future.

BACKGROUND: The COVID-19 pandemic has made its mark on world history forever causing millions of deaths, and straining health systems, economies, and societies worldwide. The European Academy of Neurology (EAN) reacted promptly. A special NeuroCOVID-19 Task Force was set up at the beginning of the pandemic to promote knowledge, research, international collaborations, and raise awareness about the prevention and treatment of COVID-19-related neurological issues. METHODS: Activities carried out during and after the pandemic by the EAN NeuroCOVID-19 Task Force are described. The main aim was to review all these initiatives in detail as an overarching lesson from the past to improve the present and be better prepared in case of future pandemics. RESULTS: During the pandemic, the Task Force was engaged in several initiatives: the creation of the EAN NEuro-covid ReGistrY (ENERGY); the launch of several surveys (neurological manifestations of COVID-19 infection; the pandemic's impact on patients with chronic neurological diseases; the pandemic's impact of restrictions for clinical practice, curricular training, and health economics); the publication of position papers regarding the management of patients with neurological diseases during the pandemic, and vaccination hesitancy among people with chronic neurological disorders; and the creation of a dedicated "COVID-19 Breaking News" section in EANpages. CONCLUSIONS: The EAN NeuroCOVID-19 Task Force was immediately engaged in various activities to participate in the fight against COVID-19. The Task Force's concerted strategy may serve as a foundation for upcoming global neurological emergencies.

Perspectives on the diagnosis and management of functional cognitive disorder: An international Delphi study.

BACKGROUND: Current proposed criteria for functional cognitive disorder (FCD) have not been externally validated. We sought to analyse the current perspectives of cognitive specialists in the diagnosis and management of FCD in comparison with neurodegenerative conditions. METHODS: International experts in cognitive disorders were invited to assess seven illustrative clinical vignettes containing history and bedside characteristics alone. Participants assigned a probable diagnosis and selected the appropriate investigation and treatment. Qualitative, quantitative and inter-rater agreement analyses were undertaken. RESULTS: Eighteen diagnostic terminologies were assigned by 45 cognitive experts from 12 countries with a median of 13 years of experience, across the seven scenarios. Accurate discrimination between FCD and neurodegeneration was observed, independently of background and years of experience: 100% of the neurodegenerative vignettes were correctly classified and 75%-88% of the FCD diagnoses were attributed to non-neurodegenerative causes. There was <50% agreement in the terminology used for FCD, in comparison with 87%-92% agreement for neurodegenerative syndromes. Blood tests and neuropsychological evaluation were the leading diagnostic modalities for FCD. Diagnostic communication, psychotherapy and psychiatry referral were the main suggested management strategies in FCD. CONCLUSIONS: Our study demonstrates the feasibility of distinguishing between FCD and neurodegeneration based on relevant patient characteristics and history details. These characteristics need further validation and operationalisation. Heterogeneous labelling and framing pose clinical and research challenges reflecting a lack of agreement in the field. Careful consideration of FCD diagnosis is advised, particularly in the presence of comorbidities. This study informs future research on diagnostic tools and evidence-based interventions.

The effects of offline and online prefrontal vs parietal transcranial direct current stimulation (tDCS) on verbal and spatial working memory.

Working memory (WM) is a limited-capacity system or set of processes that enables temporary storage and manipulation of information essential for complex cognitive processes. The WM performance is supported by a widespread neural network in which fronto-parietal functional connections have a pivotal role. Transcranial direct current stimulation (tDCS) is rapidly emerging as a promising tool for understanding the role of various cortical areas and their functional networks on cognitive performance. Here we comprehensively evaluated the effects of tDCS on WM by conducting three cross-over counterbalanced sham-controlled experiments in which we contrasted the effects and interactions of the anodal (i.e. facilitatory) tDCS across anterior-posterior (i.e. DLPFC vs PPC) and left-right (i.e. the lateralization) axes, and across online and offline protocols using both verbal and spatial WM (3-back) tasks as outcomes. In the offline protocols, left DLPFC stimulation affected neither verbal nor spatial WM, while left PPC stimulation increased spatial WM. When applied offline over right DLPFC, tDCS improved verbal WM task and marginally enhanced spatial WM; while when tDCS was applied over the right PPC, facilitatory effects were observed on verbal WM. In the online protocol, tDCS did not modulate WM regardless of the task modality or stimulation loci. In summary, the study did not replicate the left DLPFC tDCS effect on WM, found in some of the previous studies, but demonstrated positive effects of stimulation of the right DLPFC as well as PPC bilaterally. The observed effects varied across modality of the 3-back task, and tDCS protocol applied. The results of this study argue for moving towards targeting the lesser-explored stimulation sites within the fronto-parietal network, such as PPC, to gain a better understanding of the usefulness of tDCS for WM neuromodulation.

Transcranial direct current stimulation (tDCS) over parietal cortex improves associative memory.

Associative memory plays a key role in everyday functioning, but it declines with normal ageing as well as due to various pathological states and conditions, thus impairing quality of life. Associative memory enhancement via neurostimulation over frontal areas resulted in limited success, while posterior stimulation sites seemed to be more promising. We hypothesized that anodal transcranial direct current stimulation (tDCS) of parietal areas would lead to higher performance in associative memory due to high connectivity between posterior parietal cortex (PPC) and hippocampus. Forty-two healthy adults participated in two sham-controlled cross-over experiments. Anodal electrode (20 min, 1.5 mA) was placed over P3 in Experiment 1 and over P4 in Experiment 2. During tDCS participants played a simple computer game. After each stimulation session, participants completed parallel forms of an associative memory task (Experiment 1: face-word memory; Experiment 2: object-location memory) and a control task (verbal fluency). In both experiments, associative memory was improved after anodal stimulation compared to sham stimulation, while no differences were observed in the control task. Additionally, memory performance was higher in the second than in the first trial, but the increase in performance between the two trials did not differ between stimulation conditions. It can be concluded that a single-session anodal tDCS over posterior parietal cortex can improve associative memory performance. The specificity, robustness, and reproducibility of the effect suggest that PPC is a promising target for brain stimulation aiming to enhance memory functions.

Sport-Specific Warm-Up Attenuates Static Stretching- Induced Negative Effects on Vertical Jump But Not Neuromuscular Excitability in Basketball Players.

The purpose of this study was to examine the acute effects of static stretching (SS) and dynamic stretching (DS), alone and in combination with specific basketball warm-up (SBWU), on the neuromuscular excitability and vertical jump height in basketball players. Twelve healthy young male basketball players participated in the study (18 ± 0.42 years; 17.4 - 18.6 age range; 188 ± 9 cm; 76.5 ± 9 kg). All participants completed two different stretching treatments (static and dynamic), performed on different days at least seven days apart, in the same period of training microcycle, in a counterbalanced order. Each session consisted of a self-paced jogging warm-up, followed by a 10-minute testing period (T0), which involved eliciting H reflex and M waves, followed by three trials of a vertical jump test. Participants then performed one of the treatment protocols. After another test (T1), participants conducted 8-minute specific basketball warm-up and then one more test (T2). Combined 3 (time) x 2 (stretching protocol) analysis of variance with repeated measures on both factors revealed that SS significantly decreased spinal excitability (H/M ratio) (p = 0.015, d = -0.38, percentage of change = -20.55%) and vertical jump height (p = 0.007, d = -1.91, percentage of change = -2.6%), but after SBWU, vertical jump height increased (p = 0.006, d = 1.13, percentage of change = 3.01%), while H/M ratio continued decreasing (p = 0.019, d = -0.45, percentage of change = -30.23%). Acute effects of DS, alone and in combination with SBWU were not significant. It seems that SBWU attenuates negative acute effects of SS on vertical jump performance in young basketball players, while DS appears to cause no significant acute effect for this population.

Pain and executive functions: a unique relationship between Stroop task and experimentally induced pain.

There is a growing body of evidence that a higher level of cognitive inhibition is associated with lower experimental pain sensitivity. However, a systematic examination of the association between executive functions, which include not only inhibition but also updating and shifting, and experimental pain sensitivity is lacking. This study aimed to overcome this limitation by exploring the relationship between a range of executive functions and different measures of experimentally induced cold pain in healthy participants. In a group of 54 healthy participants (age 21-24 years), executive functions (EF) were investigated in a systematic manner following a well-established framework developed by Miyake and collaborators. The investigation included multiple tests of inhibition (Stroop, Stop-signal, and Left-right), updating (Keep-track, Letter-memory, and Spatial n-back), and set-shifting (Plus-minus, Number-letter, and Local-global). The cold pressor test was used to obtain measures of pain threshold (the first sensation of pain), sensitivity to pain (the moment when substantial pain was reported), and pain tolerance (the moment when pain became unbearable). Results showed no relationship between pain measures and measures of updating and shifting. All pain measures were related to Stroop interference inhibition score, but not to other two inhibition tasks. Further analyses confirmed the unique relationship between Stroop-type of inhibition and response to pain. We argue that there is a fundamental relationship between cognitive inhibition and pain experience, which relies on one's ability to suppress automatic processes.

Effect of type of language therapy on expressive language skills in patients with post-stroke aphasia.

BACKGROUND: Constraint-induced (language) aphasia therapy (CIAT), based on constraint usage of the language channel only, massed practice and shaping through therapeutic language games, has been suggested as a more efficient therapy approach than traditional aphasia therapies. AIMS: To examine the comparative efficacy of CIAT and a traditional therapy approach on expressive language ability, with the intensity of therapy controlled and matched, in the treatment of post-stroke aphasia. METHODS & PROCEDURES: Two successive 4-week blocks of intense (1 h, 5 days a week) of aphasia therapy programmes were delivered in a randomized within-subject crossover design: one therapy block consisted of stimulation aphasia therapy (SAT, a common traditional therapy approach), another of CIAT. Twenty consecutive patients, up to 1 year after stroke, were randomly assigned either to have SAT followed by CIAT (S1C2 group) or to have CIAT followed by SAT (C1S2 group). Measurements of naming (Boston Naming Test) and spontaneous sentence production (Cookie Theft Picture description task) were carried at the baseline, following the first therapy block, following the second therapy block and 4 weeks following the last therapy block. OUTCOMES & RESULTS: Both groups of patients significantly improved in all variables of expressive language skills; the improvement was maintained 1 month post-treatment. However, patients who started with CIAT and continued with SAT (C1S2 group) tended to have higher final improvement than the patients who started with SAT and continued with CIAT (S1C2 group). This was particularly pronounced for naming. Moreover, when CIAT was the first therapy (the C1S2 group) the improvement achieved in naming following CIAT significantly exceeded the improvements achieved following SAT, not only in the same group (when SAT was the second) but also in the S1C2 group (when SAT was the first). In addition, the improvement in naming following CIAT in the C1S2 group exceeded the one in the S1C2 group, too. Similarly, the improvement in the total number of sentences produced following each therapy was quite clear and significant in the C1S2 group (when CIAT was the first), while in the S1C2 group it was much more modest and not significant. CONCLUSIONS & IMPLICATIONS: Results suggest that the maximization of quantity and frequency of language therapy have a significant impact on the improvement of expressive language ability. Moreover, if practised early in aphasia therapy, the constrained usage of the language modality, as practised in CIAT, confers an additional benefit to massed practice, particularly on naming ability.

Improvement of language functions in a chronic non-fluent post-stroke aphasic patient following bilateral sequential theta burst magnetic stimulation.

In chronic non-fluent aphasia patients, inhibition of the intact right hemisphere (RH), by transcranial magnetic stimulation (TMS) or similar methods, can induce improvement in language functions. The supposed mechanism behind this improvement is a release of preserved left hemisphere (LH) language networks from RH transcallosal inhibition. Direct stimulation of the damaged LH can sometimes bring similar results too. Therefore, we developed a novel treatment approach that combined direct LH (Broca's area (BA)) stimulation, by intermittent theta burst stimulation (TBS), with homologue RH area's inhibition, by continuous TBS. We present the results of application of 15 daily sessions of the described treatment approach in a right-handed patient with chronic post-stroke non-fluent aphasia. The intervention appeared to improve several language functions, but most notably propositional speech, semantic fluency, short-term verbal memory, and verbal learning. Bilateral TBS modulation of activation of the language-related areas of both hemispheres seems to be a feasible and promising way to induce recovery in chronic aphasic patients. Due to potentially cumulative physiological effects of bilateral stimulation, the improvements may be even greater than following unilateral interventions.

Current opinions and practices in post-stroke movement disorders: Survey of movement disorders society members.

BACKGROUND: Post-stroke movement disorders (PSMD) encompass a wide array of presentations, which vary in mode of onset, phenomenology, response to treatment, and natural history. There are no evidence-based guidelines on the diagnosis and treatment of PSMD. OBJECTIVES: To survey current opinions and practices on the diagnosis and treatment of PSMD. METHODS: A survey was developed by the PSMD Study Group, commissioned by the International Parkinson's and Movement Disorders Society (MDS). The survey, distributed to all members, yielded a total of 529 responses, 395 (74.7%) of which came from clinicians with experience with PSMD. RESULTS: Parkinsonism (68%), hemiballismus/hemichorea (61%), tremor (58%), and dystonia (54%) were by far the most commonly endorsed presentation of PSMD, although this varied by region. Basal ganglia stroke (76% of responders), symptoms contralateral to stroke (75%), and a temporal relationship (59%) were considered important factors for the diagnosis of PSMD. Oral medication use depended on the phenomenology of the PSMD. Almost 50% of respondents considered deep brain stimulation and ablative surgeries as options for treatment. The lack of guidelines for the diagnosis and treatment was considered the most important gap to address. CONCLUSIONS: Regionally varying opinions and practices on PSMD highlight gaps in (and mistranslation of) epidemiologic and therapeutic knowledge. Multicenter registries and prospective community-based studies are needed for the creation of evidence-based guidelines to inform the diagnosis and treatment of patients with PSMD.

The consequences of the new European reclassification of non-invasive brain stimulation devices and the medical device regulations pose an existential threat to research and treatment: An invited opinion paper.

A significant amount of European basic and clinical neuroscience research includes the use of transcranial magnetic stimulation (TMS) and low intensity transcranial electrical stimulation (tES), mainly transcranial direct current stimulation (tDCS). Two recent changes in the EU regulations, the introduction of the Medical Device Regulation (MDR) (2017/745) and the Annex XVI have caused significant problems and confusions in the brain stimulation field. The negative consequences of the MDR for non-invasive brain stimulation (NIBS) have been largely overlooked and until today, have not been consequently addressed by National Competent Authorities, local ethical committees, politicians and by the scientific communities. In addition, a rushed bureaucratic decision led to seemingly wrong classification of NIBS products without an intended medical purpose into the same risk group III as invasive stimulators. Overregulation is detrimental for any research and for future developments, therefore researchers, clinicians, industry, patient representatives and an ethicist were invited to contribute to this document with the aim of starting a constructive dialogue and enacting positive changes in the regulatory environment.

Transcranial application of near-infrared low-level laser can modulate cortical excitability.

BACKGROUND AND OBJECTIVE: Near-infrared low-level laser (NIR-LLL) irradiation penetrates scalp and skull and can reach superficial layers of the cerebral cortex. It was shown to improve the outcome of acute stroke in both animal and human studies. In this study we evaluated whether transcranial laser stimulation (TLS) with NIR-LLL can modulate the excitability of the motor cortex (M1) as measured by transcranial magnetic stimulation (TMS). METHODS: TLS was applied for 5 minutes over the representation of the right first dorsal interosseal muscle (FDI) in left primary motor cortex (M1), in 14 healthy subjects. Motor evoked potentials (MEPs) from the FDI, elicited by single-pulse TMS, were measured at baseline and up to 30 minutes after the TLS. RESULTS: The average MEP size was significantly reduced during the first 20 minutes following the TLS. The pattern was present in 10 (71.5%) of the participants. The MEP size reduction correlated negatively with the motor threshold at rest. CONCLUSIONS: TLS with NIR-LLL induced transitory reduction of the excitability of the stimulated cortex. These findings give further insights into the mechanisms of TLS effects in the human cerebral cortex, paving the way for potential applications of TLS in treatment of stroke and in other clinical settings.

Effects of Transcranial Electrical Stimulation on Gambling and Gaming: A Systematic Review of Studies on Healthy Controls, Participants with Gambling/Gaming Disorder, and Substance Use Disorder.

Gambling disorder (GD) and internet gaming disorder (IGD) are formally recognized behavioral addictions with a rapidly growing prevalence and limited treatment options. Recently, transcranial electrical stimulation (tES) techniques have emerged as potentially promising interventions for improving treatment outcomes by ameliorating cognitive functions implicated in addictive behaviors. To systematize the current state of evidence and better understand whether and how tES can influence gambling and gaming-related cognitive processes, we conducted a PRISMA-guided systematic review of the literature, focusing on tES effects on gaming and gambling in a diverse range of population samples, including healthy participants, participants with GD and IGD, as well as participants with substance abuse addictions. Following the literature search in three bibliographic databases (PubMed, Web of Science, and Scopus), 40 publications were included in this review, with 26 conducted on healthy participants, 6 focusing on GD and IGD patients, and 8 including participants with other addictions. Most of the studies targeted the dorsolateral prefrontal cortex, using transcranial direct current stimulation (tDCS), and assessed the effects on cognition, using gaming and gambling computerized cognitive tasks measuring risk taking and decision making, e.g., balloon analogue risk task, Iowa gambling task, Cambridge gambling task, etc. The results indicated that tES could change gambling and gaming task performances and positively influence GD and IGD symptoms, with 70% of studies showing neuromodulatory effects. However, the results varied considerably depending on the stimulation parameters, sample characteristics, as well as outcome measures used. We discuss the sources of this variability and provide further directions for the use of tES in the context of GD and IGD treatment.

Transcranial Electrical Stimulation for Associative Memory Enhancement: State-of-the-Art from Basic to Clinical Research.

Associative memory (AM) is the ability to bind new information into complex memory representations. Noninvasive brain stimulation (NIBS), especially transcranial electric stimulation (tES), has gained increased interest in research of associative memory (AM) and its impairments. To provide an overview of the current state of knowledge, we conducted a systematic review following PRISMA guidelines covering basic and clinical research. Out of 374 identified records, 41 studies were analyzed-twenty-nine in healthy young adults, six in the aging population, three comparing older and younger adults, as well as two studies on people with MCI, and one in people with Alzheimer's dementia. Studies using transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS) as well as oscillatory (otDCS) and high-definition protocols (HD-tDCS, HD-tACS) have been included. The results showed methodological heterogeneity in terms of study design, stimulation type, and parameters, as well as outcome measures. Overall, the results show that tES is a promising method for AM enhancement, especially if the stimulation is applied over the parietal cortex and the effects are assessed in cued recall paradigms.

Effects of online parietal transcranial electric stimulation on associative memory: a direct comparison between tDCS, theta tACS, and theta-oscillatory tDCS.

Associative memory (AM) is the ability to remember and retrieve multiple items bound together. Previous studies aiming to modulate AM by various transcranial electric stimulation (tES) techniques were inconclusive, although overall suggestive that tES could be a tool for AM enhancement. However, evidence from a direct comparison between different tES techniques is lacking. Here, in a sham-controlled cross-over experiment, we comparatively assessed the effects of three types of tES-anodal tDCS, theta-band transcranial alternating current stimulation (tACS), and theta-oscillatory tDCS (otDCS), delivered over the left posterior parietal cortex, during a short-term digit-color AM task with cued-recall. The effects were tested in 40 healthy young participants while both oscillatory tES were delivered at a previously determined individual theta frequency (4-8 Hz). All three active stimulations facilitated the overall AM performance, and no differences could be detected between them on direct comparison. However, unlike tDCS, the effects of which appeared to stem mainly from the facilitation of low-memory demand trials, both theta-modulated tACS and otDCS primarily promoted AM in high memory demand trials. Comparable yet differential effects of tDCS, theta tACS, and otDCS could be attributed to differences in their presumed modes of action.

Determining the Individual Theta Frequency for Associative Memory Targeted Personalized Transcranial Brain Stimulation.

Non-invasive brain stimulation (NIBS) methods have gained increased interest in research and therapy of associative memory (AM) and its impairments. However, the one-size-fits-all approach yields inconsistent findings, thus putting forward the need for electroencephalography (EEG)-guided personalized frequency-modulated NIBS protocols to increase the focality and the effectiveness of the interventions. Still, extraction of individual frequency, especially in the theta band, turned out to be a challenging task. Here we present an approach to extracting the individual theta-band frequency (ITF) from EEG signals recorded during the AM task. The method showed a 93% success rate, good reliability, and the full range of variability of the extracted ITFs. This paper provides a rationale behind the adopted approach and critically evaluates it in comparison to the alternative methods that have been reported in the literature. Finally, we discuss how it could be used as an input parameter for personalized frequency-modulated NIBS approaches-transcranial alternating current stimulation (tACS) and transcranial oscillatory current stimulation (otDCS) directed at AM neuromodulation.

Personalized Frequency Modulated Transcranial Electrical Stimulation for Associative Memory Enhancement.

Associative memory (AM) is the ability to remember the relationship between previously unrelated items. AM is significantly affected by normal aging and neurodegenerative conditions, thus there is a growing interest in applying non-invasive brain stimulation (NIBS) techniques for AM enhancement. A growing body of studies identifies posterior parietal cortex (PPC) as the most promising cortical target for both transcranial magnetic stimulation (TMS) and transcranial electrical stimulation (tES) to modulate a cortico-hippocampal network that underlines AM. In that sense, theta frequency oscillatory tES protocols, targeted towards the hallmark oscillatory activity within the cortico-hippocampal network, are increasingly coming to prominence. To increase precision and effectiveness, the need for EEG guided individualization of the tES protocols is proposed. Here, we present the study protocol in which two types of personalized oscillatory tES-transcranial alternating current stimulation (tACS) and oscillatory transcranial direct current stimulation (otDCS), both frequency-modulated to the individual theta-band frequency (ITF), are compared to the non-oscillatory transcranial direct current stimulation (tDCS) and to the sham stimulation. The study has cross-over design with four tES conditions (tACS, otDCS, tDCS, sham), and the comprehensive set of neurophysiological (resting state EEG and AM-evoked EEG) and behavioral outcomes, including AM tasks (short-term associative memory, face-word, face-object, object-location), as well as measures of other cognitive functions (cognitive control, verbal fluency, and working memory).

Knowledge, Attitudes, and Practices on Tick-Borne Encephalitis Virus and Tick-Borne Diseases within Professionally Tick-Exposed Persons, Health Care Workers, and General Population in Serbia: A Questionnaire-Based Study.

This study assessed the level of knowledge, attitudes, and practices (KAP) regarding tick-borne encephalitis virus (TBEV) and tick-borne diseases (TBDs) among different groups of people in Serbia. Professionally tick-exposed persons (PTEPs), health care workers (HCWs), and the general population (GP) were subjected to an anonymous, voluntary, online questionnaire using Microsoft Forms. A total of 663 questionnaire responses were collected (February-March 2021), while 642 were included in the analysis. The significant difference in knowledge in TBDs existed between GP and PTEPs, and HCWs (p < 0.001). The perception of risk-to-tick exposure and TBDs was generally high (42.4 (95% CI: 33.6-51.2) within GP, 44.9 (95% CI: 35.8-53.9) within PTEPs and 46.2 (95% CI: 38.0-54.5) within HCWs), while fear was low (13.7 (95% CI: 7.9-19.5) within GP, 12.6 (95% CI: 7.3-19.9) within PTEPs, and 13.5 (95% CI: 7.4-19.5) within HCWs). Protective practices differed across groups (F (2639) = 12.920, p < 0.001, η2 = 0.039), with both PTEPs (t = 3.621, Cohen d = 0.332, p < 0.001) and HCWs (t = 4.644, Cohen d = 0.468, p < 0.001) adhering to more protective practices than the GP, without differences between PTEPs and HCWs (t = 1.256, Cohen d = 0.137, p = 0.421). Further education about TBDs in Serbia is required and critical points were identified in this study.

Transcranial Direct Current Stimulation (tDCS) for Memory Enhancement.

Memory enhancement is one of the great challenges in cognitive neuroscience and neurorehabilitation. Among various techniques used for memory enhancement, transcranial direct current stimulation (tDCS) is emerging as an especially promising tool for improvement of memory functions in a non-invasive manner. Here, we present a tDCS protocol that can be applied for memory enhancement in healthy-participant studies as well as in aging and dementia research. The protocol uses weak constant anodal current to stimulate cortical targets within cortico-hippocampal functional network engaged in memory processes. The target electrode is placed either on the posterior parietal cortex (PPC) or the dorsolateral prefrontal cortex (DLPFC), while the return electrode is placed extracranially (i.e., on the contralateral cheek). In addition, we outline a more advanced method of oscillatory tDCS, mimicking a natural brain rhythm to promote hippocampus-dependent memory functions, which can be applied in a personalized and non-personalized manner. We present illustrative results of associative and working memory improvement following single tDCS sessions (20 minutes) in which the described electrode montages were used with current intensities between 1.5 mA and 1.8 mA. Finally, we discuss crucial steps in the protocol and methodological decisions that must be made when designing a tDCS study on memory.