IMPORTANCE Schizophrenia and bipolar disorder are severe and complex brain disorders characterized by substantial clinical and biological heterogeneity. However, case-control studies often ignore such heterogeneity through their focus on the average patient, which may be the core reason for a lack of robust biomarkers indicative of an individual's treatment response and outcome.OBJECTIVES To investigate the degree to which case-control analyses disguise interindividual differences in brain structure among patients with schizophrenia and bipolar disorder and to map the brain alterations linked to these disorders at the level of individual patients. DESIGN, SETTING, AND PARTICIPANTSThis study used cross-sectional, T1-weighted magnetic resonance imaging data from participants recruited for the Thematically Organized Psychosis study from October 27, 2004, to October 17, 2012. Data were reanalyzed in 2017 and 2018. Patients were recruited from inpatient and outpatient clinics in the Oslo area of Norway, and healthy individuals from the same catchment area were drawn from the national population registry.MAIN OUTCOMES AND MEASURES Interindividual differences in brain structure among patients with schizophrenia and bipolar disorder. Voxel-based morphometry maps were computed, which were used for normative modeling to map the range of interindividual differences in brain structure. RESULTS Thisstudy included 218 patients with schizophrenia spectrum disorders (mean [SD] age, 30 [9.3] years; 126 [57.8%] male), of whom 163 had schizophrenia (mean [SD] age, 31 [8.7] years; 105 [64.4%] male) and 190 had bipolar disorder (mean [SD] age, 34 [11.3] years; 79 [41.6%] male), and 256 healthy individuals (mean [SD] age, 34 [9.5] years; 140 [54.7%] male). At the level of the individual, deviations from the normative model were frequent in both disorders but highly heterogeneous. Overlap of more than 2% among patients was observed in only a few loci, primarily in frontal, temporal, and cerebellar regions. The proportion of alterations was associated with diagnosis and cognitive and clinical characteristics within clinical groups. Patients with schizophrenia, on average, had significantly reduced gray matter in frontal regions, cerebellum, and temporal cortex. In patients with bipolar disorder, mean deviations were primarily present in cerebellar regions.CONCLUSIONS AND RELEVANCE This study found that group-level differences disguised biological heterogeneity and interindividual differences among patients with the same diagnosis. This finding suggests that the idea of the average patient is a noninformative construct in psychiatry that falls apart when mapping abnormalities at the level of the individual patient. This study presents a workable route toward precision medicine in psychiatry.

The brain's ability to alter its functional and structural architecture in response to experience and learning has been extensively studied. Mental stimulation might serve as a reserve mechanism in brain aging, but macrostructural brain changes in response to cognitive training have been demonstrated in young participants only. We examined the short-term effects of an intensive memory training program on cognition and brain structure in middle-aged and elderly healthy volunteers. The memory trainers completed an 8-week training regimen aimed at improving verbal source memory utilizing the Method of Loci (MoL), while control participants did not receive any intervention. Both the memory trainers and the controls underwent magnetic resonance imaging (MRI) scans and memory testing pre and post 8 weeks of training or no training, respectively. Cortical thickness was automatically measured across the cortical mantle, and data processing and statistical analyses were optimized for reliable detection of longitudinal changes. The results showed that memory training improved source memory performance. Memory trainers also showed regional increases in cortical thickness compared with controls. Furthermore, thickness change in the right fusiform and lateral orbitofrontal cortex correlated positively with improvement in source memory performance, suggesting a possible functional significance of the structural changes. These findings demonstrate that systematic mental exercise may induce short-term structural changes in the aging human brain, indicating structural brain plasticity in elderly. The present study included short-term assessments, and follow-up studies are needed in order to assess whether such training indeed alters the long-term structural trajectories.

A growing body of research indicates benefits of cognitive training in older adults, but the neuronal mechanisms underlying the effect of cognitive intervention remains largely unexplored. Neuroimaging methods are sensitive to subtle changes in brain structure and show potential for enhancing our understanding of both aging- and training-related neuronal plasticity. Specifically, studies using diffusion tensor imaging (DTI) suggest substantial changes in white matter (WM) in aging, but it is not known whether cognitive training might modulate these structural alterations. We used tract-based spatial statistics (TBSS) optimized for longitudinal analysis to delineate the effects of 8 weeks intensive memory training on WM microstructure. 41 participants (mean age 61 years) matched for age, sex and education were randomly assigned to an intervention or control group. All participants underwent MRI-scanning and neuropsychological assessments at the beginning and end of the study. Longitudinal analysis across groups revealed significant increase in frontal mean diffusivity (MD), indicating that DTI is sensitive to WM structural alterations over a 10-week interval. Further, group analysis demonstrated positive effects of training on the short-term changes. Participants in the training group showed a relative increase in fractional anisotropy (FA) compared with controls. Further, a significant relationship between memory improvement and change in FA was found, suggesting a possible functional significance of the reported changes. The training effect on FA seemed to be driven by a relative decrease in radial diffusivity, which might indicate a role for myelin-related processes in WM plasticity.

for the Karolinska Schizophrenia Project Consortium IMPORTANCE Between-individual variability in brain structure is determined by gene-environment interactions, possibly reflecting differential sensitivity to environmental and genetic perturbations. Magnetic resonance imaging (MRI) studies have revealed thinner cortices and smaller subcortical volumes in patients with schizophrenia. However, group-level comparisons may mask considerable within-group heterogeneity, which has largely remained unnoticed in the literature.OBJECTIVES To compare brain structural variability between individuals with schizophrenia and healthy controls and to test whether respective variability reflects the polygenic risk score (PRS) for schizophrenia in an independent sample of healthy controls. DESIGN, SETTING, AND PARTICIPANTSThis case-control and polygenic risk analysis compared MRI-derived cortical thickness and subcortical volumes between healthy controls and patients with schizophrenia across 16 cohorts and tested for associations between PRS and MRI features in a control cohort from the UK Biobank.

Although cerebellar involvement across a wide range of cognitive and neuropsychiatric phenotypes is increasingly being recognized, previous large-scale studies in schizophrenia (SZ) have primarily focused on supratentorial structures. Hence, the across-sample reproducibility, regional distribution, associations with cerebrocortical morphology and effect sizes of cerebellar relative to cerebral morphological differences in SZ are unknown. We addressed these questions in 983 patients with SZ spectrum disorders and 1349 healthy controls (HCs) from 14 international samples, using state-of-the-art image analysis pipelines optimized for both the cerebellum and the cerebrum. Results showed that total cerebellar grey matter volume was robustly reduced in SZ relative to HCs (Cohens's d=-0.35), with the strongest effects in cerebellar regions showing functional connectivity with frontoparietal cortices (d=-0.40). Effect sizes for cerebellar volumes were similar to the most consistently reported cerebral structural changes in SZ (e.g., hippocampus volume and frontotemporal cortical thickness), and were highly consistent across samples. Within groups, we further observed positive correlations between cerebellar volume and cerebral cortical thickness in frontotemporal regions (i.e., overlapping with areas that also showed reductions in SZ). This cerebellocerebral structural covariance was strongest in SZ, suggesting common underlying disease processes jointly affecting the cerebellum and the cerebrum. Finally, cerebellar volume reduction in SZ was highly consistent across the included age span (16-66 years) and present already in the youngest patients, a finding that is more consistent with neurodevelopmental than neurodegenerative etiology. Taken together, these novel findings establish the cerebellum as a key node in the distributed brain networks underlying SZ.

The striking homogeneity of cerebellar microanatomy is strongly suggestive of a corresponding uniformity of function. Consequently, theoretical models of the cerebellum's role in motor control should offer important clues regarding cerebellar contributions to cognition. One such influential theory holds that the cerebellum encodes internal models, neural representations of the context-specific dynamic properties of an object, to facilitate predictive control when manipulating the object. The present study examined whether this theoretical construct can shed light on the contribution of the cerebellum to language processing. We reasoned that the cerebellum might perform a similar coordinative function when the context provided by the initial part of a sentence can be highly predictive of the end of the sentence. Using functional MRI in humans we tested two predictions derived from this hypothesis, building on previous neuroimaging studies of internal models in motor control. First, focal cerebellar activation-reflecting the operation of acquired internal models-should be enhanced when the linguistic context leads terminal words to be predictable. Second, more widespread activation should be observed when such predictions are violated, reflecting the processing of error signals that can be used to update internal models. Both predictions were confirmed, with predictability and prediction violations associated with increased blood oxygenation level-dependent signal in the posterior cerebellum (Crus I/II). Our results provide further evidence for cerebellar involvement in predictive language processing and suggest that the notion of cerebellar internal models may be extended to the language domain.

Dimensional and heritable general cognitive and psychopathology factors are associated with specific patterns of white matter properties, suggesting that dysconnectivity is a transdiagnostic brain-based phenotype in individuals with increased susceptibility and symptoms of psychiatric disorders.

1Pregnancy and childbirth involve maternal brain adaptations that promote attachment to and protection 2 of the newborn. Using brain imaging and machine learning, we provide evidence for a positive relation-3 ship between number of childbirths and a 'younger-looking' brain in 12,021 women, which could not be 4 explained by common genetic variation. The findings demonstrate that parity can be linked to brain 5 health later in life. 6 Page 2 of 23Population-based neuroimaging reveals traces of childbirth in the maternal brain -de Lange et. al., 2019 During pregnancy and postpartum, fundamental biological processes are instigated to support maternal 7 adaptation and ensure protection of the offspring [1]. In rodents, brain adaptations across pregnancy 8 and postpartum include altered neurogenesis in the dentate gyrus [2], and changes in volume, dendritic 9 morphology, and cell proliferation in the hippocampus [1,3]. In humans, reduction in total brain vol-10 ume has been observed during pregnancy, with reversion occurring within six months of parturition [4]. 11Regional changes in brain structure are evident during the postpartum period, with effects depending 12 on region and time since delivery [5][6][7][8]. While some maternal brain changes revert postpartum, others 13 extend well beyond this phase [1,[7][8][9] and may influence the course of neurobiological aging later in 14 life. Some regional grey matter changes have been found to endure for at least 2 years post-pregnancy 15 in humans [1], and aged parous rats have increased hippocampal long-term potentiation and show fewer 16 signs of brain aging [1,10]. In addition to the direct and indirect bodily and environmental adaptations 17 in response to pregnancy and child-rearing, such long-lasting effects on brain health in humans could 18 also reflect genetic pleiotropy, as reproductive behaviors are complex, heritable traits with a polygenic 19 architecture that partly overlaps with a range of other traits that influence brain-health trajectories [11]. 20Based on the evidence of long-lasting effects of parity on the maternal brain, we investigated struc-21 tural brain characteristics in 12,021 women from the UK Biobank, hypothesizing that women who had 22 given (live) birth (n = 9568) would show less evidence of brain aging compared to their nulliparous peers 23 (n = 2453). We used machine learning and brain age prediction to test I) if a classifier could identify 24 women as parous or nulliparous based on morphometric brain characteristics, and II) whether brain age 25 gap (estimated brain age − chronological age) differed between parous and nulliparous women. Mean 26 age (± SD) was 54.72 (7.29) years for the full sample; 55.23 (7.22) years for parous and 52.79 (7.23) 27 years for nulliparous women. To investigate the impact of number of childbirths, we tested for associa-28 tions between number of births and the probabilistic scores from the group classification and brain age 29 gap, respectively, in addition to comparing women who had given 1-2 births, 3-...