# Intersection of Brain Complexity, Functional Connectivity, and Neuropsychology: A Systematic Review

## TL;DR

This systematic review explores how brain complexity and functional connectivity relate to cognitive functions like attention and memory, based on recent studies using fMRI.

## Contribution

The study systematically reviews the current state of research on brain complexity and functional connectivity in relation to neuropsychological functions.

## Key findings

- Functional connectivity studies outnumber those focused on brain complexity.
- Executive functions are the most studied neuropsychological domain in this context.
- The field is still in early stages with gaps in understanding neural-cognitive relationships.

## Abstract

The definition of brain complexity is based on the principal property of the coexistence of a high degree of integration and differentiation within a single neural system. Despite the fruitful scope of emerging studies involving the applicability of brain complexity metrics, there is a notable scarcity of research focusing on the qualitative characteristics of conscious systems, which are recognized for their high complexity. These qualitative characteristics are expressed in complex cognitive processes, reflecting the interaction between distinct neuropsychological domains, such as attention, memory, language, and executive functions (EFs). Cognitive flexibility and inhibitory control, for instance, emerge from the dynamic integration of distributed neural networks, underscoring the interdependence between brain complexity and cognitive functioning. In light of this, the present study aimed to evaluate how studies addressing measures of functional connectivity and brain complexity, obtained through resting-state functional magnetic resonance imaging (rs-fMRI), relate to neuropsychological aspects. To achieve this, a systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and based on the PICO (Patient, Intervention, Comparison, Outcome) strategy. Studies were searched in PubMed, CAPES Periodicals, and Virtual Health Library databases to identify relevant studies published between 2019 and March 2024. Articles were included based on study type, sample characteristics, methodological aspects, and specific listed variables. Exclusion criteria encompassed theoretical studies, animal research, and studies involving children/adolescents, as well as those addressing psychiatric conditions, psychoactive substance use, intervention evaluations (e.g., transcranial magnetic stimulation), and disorders of consciousness, due to limitations in applying neuropsychological measures. Possible limitations include the exclusion of studies with specific populations and clinical conditions, which may limit the generalizability of findings to broader, more diverse groups. After applying the selection criteria, 30 articles were chosen and fully analyzed. The results allowed for the establishment of characteristics of the research landscape in this area, initially highlighting a greater number of studies focused on functional connectivity compared to those directed at brain complexity. Additionally, EFs were identified as the most frequently addressed neuropsychological domain in the studies, consistent with the most commonly used evaluative measures in the research: Trail Making Test (TMT), Symbol Digit Modalities Test (SDMT), and verbal fluency tasks. The findings suggest that this is an area of study still in its early stages of development, with notable gaps in the in-depth understanding of the relationships between neural network complexity metrics and neuropsychological functioning.