1
|
Seitz-Holland J, Haas SS, Penzel N, Reichenberg A, Pasternak O. BrainAGE, brain health, and mental disorders: A systematic review. Neurosci Biobehav Rev 2024; 159:105581. [PMID: 38354871 PMCID: PMC11119273 DOI: 10.1016/j.neubiorev.2024.105581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/05/2024] [Accepted: 02/09/2024] [Indexed: 02/16/2024]
Abstract
The imaging-based method of brainAGE aims to characterize an individual's vulnerability to age-related brain changes. The present study systematically reviewed brainAGE findings in neuropsychiatric conditions and discussed the potential of brainAGE as a marker for biological age. A systematic PubMed search (from inception to March 6th, 2023) identified 273 articles. The 30 included studies compared brainAGE between neuropsychiatric and healthy groups (n≥50). We presented results qualitatively and adapted a bias risk assessment questionnaire. The imaging modalities, design, and input features varied considerably between studies. While the studies found higher brainAGE in neuropsychiatric conditions (11 mild cognitive impairment/ dementia, 11 schizophrenia spectrum/ other psychotic and bipolar disorder, six depression/ anxiety, two multiple groups), the associations with clinical characteristics were mixed. While brainAGE is sensitive to group differences, limitations include the lack of diverse training samples, multi-modal studies, and external validation. Only a few studies obtained longitudinal data, and all have used algorithms built solely to predict chronological age. These limitations impede the validity of brainAGE as a biological age marker.
Collapse
Affiliation(s)
- Johanna Seitz-Holland
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Shalaila S Haas
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nora Penzel
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Abraham Reichenberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ofer Pasternak
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
2
|
Diniz BS, Seitz-Holland J, Sehgal R, Kasamoto J, Higgins-Chen AT, Lenze E. Geroscience-Centric Perspective for Geriatric Psychiatry: Integrating Aging Biology With Geriatric Mental Health Research. Am J Geriatr Psychiatry 2024; 32:1-16. [PMID: 37845116 PMCID: PMC10841054 DOI: 10.1016/j.jagp.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/30/2023] [Accepted: 09/14/2023] [Indexed: 10/18/2023]
Abstract
The geroscience hypothesis asserts that physiological aging is caused by a small number of biological pathways. Despite the explosion of geroscience research over the past couple of decades, the research on how serious mental illnesses (SMI) affects the biological aging processes is still in its infancy. In this review, we aim to provide a critical appraisal of the emerging literature focusing on how we measure biological aging systematically, and in the brain and how SMIs affect biological aging measures in older adults. We will also review recent developments in the field of cellular senescence and potential targets for interventions for SMIs in older adults, based on the geroscience hypothesis.
Collapse
Affiliation(s)
- Breno S Diniz
- UConn Center on Aging & Department of Psychiatry (BSD), School of Medicine, University of Connecticut Health Center, Farmington, CT.
| | - Johanna Seitz-Holland
- Department of Psychiatry (JSH), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Psychiatry (JSH), Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Raghav Sehgal
- Program in Computational Biology and Bioinformatics (RS, JK), Yale University, New Haven, CT
| | - Jessica Kasamoto
- Program in Computational Biology and Bioinformatics (RS, JK), Yale University, New Haven, CT
| | - Albert T Higgins-Chen
- Department of Psychiatry (ATHC), Yale University School of Medicine, New Haven, CT; Department of Pathology (ATHC), Yale University School of Medicine, New Haven, CT
| | - Eric Lenze
- Department of Psychiatry (EL), School of Medicine, Washington University at St. Louis, St. Louis, MO
| |
Collapse
|
3
|
Dörfel RP, Arenas‐Gomez JM, Fisher PM, Ganz M, Knudsen GM, Svensson JE, Plavén‐Sigray P. Prediction of brain age using structural magnetic resonance imaging: A comparison of accuracy and test-retest reliability of publicly available software packages. Hum Brain Mapp 2023; 44:6139-6148. [PMID: 37843020 PMCID: PMC10619370 DOI: 10.1002/hbm.26502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/14/2023] [Accepted: 09/08/2023] [Indexed: 10/17/2023] Open
Abstract
Brain age prediction algorithms using structural magnetic resonance imaging (MRI) aim to assess the biological age of the human brain. The difference between a person's chronological age and the estimated brain age is thought to reflect deviations from a normal aging trajectory, indicating a slower or accelerated biological aging process. Several pre-trained software packages for predicting brain age are publicly available. In this study, we perform a comparison of such packages with respect to (1) predictive accuracy, (2) test-retest reliability, and (3) the ability to track age progression over time. We evaluated the six brain age prediction packages: brainageR, DeepBrainNet, brainage, ENIGMA, pyment, and mccqrnn. The accuracy and test-retest reliability were assessed on MRI data from 372 healthy people aged between 18.4 and 86.2 years (mean 38.7 ± 17.5 years). All packages showed significant correlations between predicted brain age and chronological age (r = 0.66-0.97, p < 0.001), with pyment displaying the strongest correlation. The mean absolute error was between 3.56 (pyment) and 9.54 years (ENIGMA). brainageR, pyment, and mccqrnn were superior in terms of reliability (ICC values between 0.94-0.98), as well as predicting age progression over a longer time span. Of the six packages, pyment and brainageR consistently showed the highest accuracy and test-retest reliability.
Collapse
Affiliation(s)
- Ruben P. Dörfel
- Neurobiology Research UnitCopenhagen University Hospital, RigshospitaletCopenhagenDenmark
- Centre for Psychiatry Research, Department of Clinical NeuroscienceKarolinska Institutet & Stockholm Health Care Services, Region StockholmStockholmSweden
| | - Joan M. Arenas‐Gomez
- Neurobiology Research UnitCopenhagen University Hospital, RigshospitaletCopenhagenDenmark
| | - Patrick M. Fisher
- Neurobiology Research UnitCopenhagen University Hospital, RigshospitaletCopenhagenDenmark
- Department of Drug Design and PharmacologyUniversity of CopenhagenCopenhagenDenmark
| | - Melanie Ganz
- Neurobiology Research UnitCopenhagen University Hospital, RigshospitaletCopenhagenDenmark
- Department of Computer ScienceUniversity of CopenhagenCopenhagenDenmark
| | - Gitte M. Knudsen
- Neurobiology Research UnitCopenhagen University Hospital, RigshospitaletCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Jonas E. Svensson
- Neurobiology Research UnitCopenhagen University Hospital, RigshospitaletCopenhagenDenmark
- Centre for Psychiatry Research, Department of Clinical NeuroscienceKarolinska Institutet & Stockholm Health Care Services, Region StockholmStockholmSweden
| | - Pontus Plavén‐Sigray
- Neurobiology Research UnitCopenhagen University Hospital, RigshospitaletCopenhagenDenmark
- Centre for Psychiatry Research, Department of Clinical NeuroscienceKarolinska Institutet & Stockholm Health Care Services, Region StockholmStockholmSweden
| |
Collapse
|
4
|
More S, Antonopoulos G, Hoffstaedter F, Caspers J, Eickhoff SB, Patil KR. Brain-age prediction: A systematic comparison of machine learning workflows. Neuroimage 2023; 270:119947. [PMID: 36801372 DOI: 10.1016/j.neuroimage.2023.119947] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 02/08/2023] [Accepted: 02/15/2023] [Indexed: 02/18/2023] Open
Abstract
The difference between age predicted using anatomical brain scans and chronological age, i.e., the brain-age delta, provides a proxy for atypical aging. Various data representations and machine learning (ML) algorithms have been used for brain-age estimation. However, how these choices compare on performance criteria important for real-world applications, such as; (1) within-dataset accuracy, (2) cross-dataset generalization, (3) test-retest reliability, and (4) longitudinal consistency, remains uncharacterized. We evaluated 128 workflows consisting of 16 feature representations derived from gray matter (GM) images and eight ML algorithms with diverse inductive biases. Using four large neuroimaging databases covering the adult lifespan (total N = 2953, 18-88 years), we followed a systematic model selection procedure by sequentially applying stringent criteria. The 128 workflows showed a within-dataset mean absolute error (MAE) between 4.73-8.38 years, from which 32 broadly sampled workflows showed a cross-dataset MAE between 5.23-8.98 years. The test-retest reliability and longitudinal consistency of the top 10 workflows were comparable. The choice of feature representation and the ML algorithm both affected the performance. Specifically, voxel-wise feature spaces (smoothed and resampled), with and without principal components analysis, with non-linear and kernel-based ML algorithms performed well. Strikingly, the correlation of brain-age delta with behavioral measures disagreed between within-dataset and cross-dataset predictions. Application of the best-performing workflow on the ADNI sample showed a significantly higher brain-age delta in Alzheimer's and mild cognitive impairment patients compared to healthy controls. However, in the presence of age bias, the delta estimates in the patients varied depending on the sample used for bias correction. Taken together, brain-age shows promise, but further evaluation and improvements are needed for its real-world application.
Collapse
Affiliation(s)
- Shammi More
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Georgios Antonopoulos
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Felix Hoffstaedter
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Julian Caspers
- Department of Diagnostic and Interventional Radiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Simon B Eickhoff
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Kaustubh R Patil
- Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Jülich, Germany; Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
| | | |
Collapse
|
5
|
Blake KV, Ntwatwa Z, Kaufmann T, Stein DJ, Ipser JC, Groenewold NA. Advanced brain ageing in adult psychopathology: A systematic review and meta-analysis of structural MRI studies. J Psychiatr Res 2023; 157:180-91. [PMID: 36473289 DOI: 10.1016/j.jpsychires.2022.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/14/2022] [Accepted: 11/12/2022] [Indexed: 11/16/2022]
Abstract
Evidence suggests that psychopathology is associated with an advanced brain ageing process, typically mapped using machine learning models that predict an individual's age based on structural neuroimaging data. The brain predicted age difference (brain-PAD) captures the deviation of brain age from chronological age. Substantial heterogeneity between studies has introduced uncertainty regarding the magnitude of the brain-PAD in adult psychopathology. The present meta-analysis aimed to quantify structural MRI-based brain-PAD in adult psychotic and mood disorders, while addressing possible sources of heterogeneity related to diagnosis subtypes, segmentation method, age and sex. Clinical factors influencing brain ageing in axis 1 psychiatric disorders were systematically reviewed. Thirty-three studies were included for review. A random-effects meta-analysis revealed a brain-PAD of +3.12 (standard error = 0.49) years in psychotic disorders (n = 16 studies), +2.04 (0.10) years in bipolar disorder (n = 5), and +0.90 (0.20) years in major depression (n = 7). An exploratory meta-analysis found a brain-PAD of +1.57 (0.67) in first episode psychosis (n = 4), which was smaller than that observed in psychosis and schizophrenia (n = 10, +3.87 (0.61)). Patient mean age significantly explained heterogeneity in effect size estimates in psychotic disorders, but not mood disorders. The systematic review determined that clinical factors, such as higher symptom severity, may be associated with a larger brain-PAD in psychopathology. In conclusion, larger structural MRI-based brain-PAD was confirmed in adult psychopathology. Preliminary evidence was obtained that brain ageing is greater in those with prolonged duration of psychotic disorders. Accentuated brain ageing may underlie the cognitive difficulties experienced by some patients, and may be progressive in nature.
Collapse
|
6
|
Wei R, Xu X, Duan Y, Zhang N, Sun J, Li H, Li Y, Li Y, Zeng C, Han X, Zhou F, Huang M, Li R, Zhuo Z, Barkhof F, H Cole J, Liu Y. Brain age gap in neuromyelitis optica spectrum disorders and multiple sclerosis. J Neurol Neurosurg Psychiatry 2023; 94:31-37. [PMID: 36216455 DOI: 10.1136/jnnp-2022-329680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/12/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the clinical significance of deep learning-derived brain age prediction in neuromyelitis optica spectrum disorder (NMOSD) relative to relapsing-remitting multiple sclerosis (RRMS). METHODS This cohort study used data retrospectively collected from 6 tertiary neurological centres in China between 2009 and 2018. In total, 199 patients with NMOSD and 200 patients with RRMS were studied alongside 269 healthy controls. Clinical follow-up was available in 85 patients with NMOSD and 124 patients with RRMS (mean duration NMOSD=5.8±1.9 (1.9-9.9) years, RRMS=5.2±1.7 (1.5-9.2) years). Deep learning was used to learn 'brain age' from MRI scans in the healthy controls and estimate the brain age gap (BAG) in patients. RESULTS A significantly higher BAG was found in the NMOSD (5.4±8.2 years) and RRMS (13.0±14.7 years) groups compared with healthy controls. A higher baseline disability score and advanced brain volume loss were associated with increased BAG in both patient groups. A longer disease duration was associated with increased BAG in RRMS. BAG significantly predicted Expanded Disability Status Scale worsening in patients with NMOSD and RRMS. CONCLUSIONS There is a clear BAG in NMOSD, although smaller than in RRMS. The BAG is a clinically relevant MRI marker in NMOSD and RRMS.
Collapse
Affiliation(s)
- Ren Wei
- Department of Radiology, Beijing Tiantan Hospital, Beijing, China
| | - Xiaolu Xu
- Department of Radiology, Beijing Tiantan Hospital, Beijing, China
| | - Yunyun Duan
- Department of Radiology, Beijing Tiantan Hospital, Beijing, China
| | - Ningnannan Zhang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Jie Sun
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Haiqing Li
- Department of Radiology, Huashan Hospital Fudan University, Shanghai, China
| | - Yuxin Li
- Department of Radiology, Huashan Hospital Fudan University, Shanghai, China
| | - Yongmei Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chun Zeng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuemei Han
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Fuqing Zhou
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Muhua Huang
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Runzhi Li
- Department of Neurology, Beijing Tiantan Hospital, Beijing, China
| | - Zhizheng Zhuo
- Department of Radiology, Beijing Tiantan Hospital, Beijing, China
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Centre Amsterdam, Amsterdam, The Netherlands
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
| | - James H Cole
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK
- Dementia Research Centre, Queen Square Institute of Neurology, University College London, London, UK
| | - Yaou Liu
- Department of Radiology, Beijing Tiantan Hospital, Beijing, China
| |
Collapse
|
7
|
Abstract
The predicted age difference (PAD) between an individual's predicted brain age and chronological age has been commonly viewed as a meaningful phenotype relating to aging and brain diseases. However, the systematic bias appears in the PAD achieved using machine learning methods. Recent studies have designed diverse bias correction methods to eliminate it for further downstream studies. Strikingly, here we demonstrate that bias still exists in the PAD of samples with the same age even after kind of correction. Therefore, current PAD may not be taken as a reliable phenotype and more investigations are needed to solve this fundamental defect. To this end, we propose an age-level bias correction method and demonstrate its efficacy in numerical experiments.
Collapse
Affiliation(s)
- Biao Zhang
- School of Mathematical Sciences, Fudan University, Shanghai 200433, China.
| | - Shuqin Zhang
- School of Mathematical Sciences, Fudan University, Shanghai 200433, China.
| | - Jianfeng Feng
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai 200433, China.
| | - Shihua Zhang
- NCMIS, CEMS, RCSDS, Academy of Mathematics and Systems Science, Chinese Academy of Sciences, Beijing 100190, China.
| |
Collapse
|
8
|
Jawinski P, Markett S, Drewelies J, Düzel S, Demuth I, Steinhagen-Thiessen E, Wagner GG, Gerstorf D, Lindenberger U, Gaser C, Kühn S. Linking Brain Age Gap to Mental and Physical Health in the Berlin Aging Study II. Front Aging Neurosci 2022; 14:791222. [PMID: 35936763 PMCID: PMC9355695 DOI: 10.3389/fnagi.2022.791222] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
From a biological perspective, humans differ in the speed they age, and this may manifest in both mental and physical health disparities. The discrepancy between an individual's biological and chronological age of the brain ("brain age gap") can be assessed by applying machine learning techniques to Magnetic Resonance Imaging (MRI) data. Here, we examined the links between brain age gap and a broad range of cognitive, affective, socioeconomic, lifestyle, and physical health variables in up to 335 adults of the Berlin Aging Study II. Brain age gap was assessed using a validated prediction model that we previously trained on MRI scans of 32,634 UK Biobank individuals. Our statistical analyses revealed overall stronger evidence for a link between higher brain age gap and less favorable health characteristics than expected under the null hypothesis of no effect, with 80% of the tested associations showing hypothesis-consistent effect directions and 23% reaching nominal significance. The most compelling support was observed for a cluster covering both cognitive performance variables (episodic memory, working memory, fluid intelligence, digit symbol substitution test) and socioeconomic variables (years of education and household income). Furthermore, we observed higher brain age gap to be associated with heavy episodic drinking, higher blood pressure, and higher blood glucose. In sum, our results point toward multifaceted links between brain age gap and human health. Understanding differences in biological brain aging may therefore have broad implications for future informed interventions to preserve mental and physical health in old age.
Collapse
Affiliation(s)
- Philippe Jawinski
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sebastian Markett
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Johanna Drewelies
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany.,Lise Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Berlin, Germany
| | - Sandra Düzel
- Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany
| | - Ilja Demuth
- Division of Lipid Metabolism, Department of Endocrinology and Metabolic Diseases, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BCRT-Berlin Institute of Health Center for Regenerative Therapies, Berlin, Germany
| | - Elisabeth Steinhagen-Thiessen
- Division of Lipid Metabolism, Department of Endocrinology and Metabolic Diseases, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gert G Wagner
- Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany.,German Socio-Economic Panel Study (SOEP), Berlin, Germany.,Federal Institute for Population Research (BiB), Berlin, Germany
| | - Denis Gerstorf
- Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany.,German Socio-Economic Panel Study (SOEP), Berlin, Germany
| | - Ulman Lindenberger
- Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany
| | - Christian Gaser
- Structural Brain Mapping Group, Department of Psychiatry and Neurology, Jena University Hospital, Jena, Germany
| | - Simone Kühn
- Lise Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Berlin, Germany.,Department of Psychiatry and Psychotherapy, University Clinic Hamburg Eppendorf, Hamburg, Germany
| |
Collapse
|