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Alpha GPC vs Phosphatidylserine

Alpha GPC vs Phosphatidylserine

  • A Comprehensive Ingredient Comparison for Cognitive Health Formulations
  • Evidence-Based Analysis for Supplement Brands & Formulators

Table of Contents

  • Quick Answer: Which Ingredient Is Better?
  • What Is Alpha GPC?
  • What Is Phosphatidylserine?
  • Quick Comparison Table
  • Mechanism: How They Work Differently
  • Clinical Evidence Comparison
  • Application Scenarios for Formulators
  • Can They Be Taken Together?
  • Consumer Experiences & Real-World Feedback
  • Safety & Side Effects
  • Formulation Considerations for Brands
  • Market Trends
  • Final Recommendation
  • Frequently Asked Questions
  • Source Ingredients for Your Formula
  • References

Quick Answer: Which Ingredient Is Better?

Both Alpha-GPC and Phosphatidylserine (PS) are among the most clinically researched cognitive ingredients available to formulators today. However, they work through entirely different mechanisms and serve distinct formulation purposes.

Alpha GPC primarily increases acetylcholine production in the brain. It is commonly used for focus, reaction speed, and sports performance applications. Its effects are typically fast-acting and noticeable within hours of supplementation.

Phosphatidylserine is a structural phospholipid that supports neuronal membrane integrity, stress resilience (via cortisol modulation), and healthy cognitive aging. Its benefits build gradually over weeks of consistent use.

Choosing between them depends largely on your formulation goals. For acute cognitive enhancement and sports nutrition, Alpha GPC is the superior choice. For stress support, healthy aging, and long-term brain health, Phosphatidylserine offers stronger evidence. Many premium nootropic formulations now combine both ingredients for synergistic benefits.

What Is Alpha GPC?

Alpha GPC (L-alpha-glycerylphosphorylcholine, also known as choline alfoscerate) is a choline-containing phospholipid found naturally in small amounts in soy and other plants. As a supplement ingredient, it is typically produced synthetically or extracted and purified to achieve standardized concentrations of 50% or 99%.

Definition & Chemical Profile

  • Chemical name: L-alpha-glycerylphosphorylcholine (C8H20NO6P)
  • Molecular weight: 257.22 g/mol
  • Choline content: approximately 40% by weight (the highest among choline donors)
  • Available grades: 50% powder, 99% pure (crystalline)
  • Solubility: water-soluble with excellent bioavailability

Mechanism of Action

Alpha GPC operates through a well-defined cholinergic pathway:

  1. Rapid absorption: Following oral administration, Alpha GPC is rapidly absorbed in the small intestine and enters the bloodstream.
  2. Blood-brain barrier penetration: Due to its lipophilic glycerophosphate moiety, Alpha GPC efficiently crosses the blood-brain barrier — a key advantage over simpler choline salts.
  3. Acetylcholine synthesis: In the brain, Alpha GPC is metabolized into choline and glycerophosphate. The choline serves as substrate for choline acetyltransferase (ChAT) to produce acetylcholine.
  4. Neurotransmitter elevation: Increased acetylcholine levels enhance cholinergic neurotransmission, supporting attention, memory formation, and neuromuscular signaling.

Typical Applications

  • Nootropic supplements for focus and mental clarity
  • Pre-workout and sports nutrition formulations
  • Gaming supplements targeting reaction time
  • Cognitive support products for aging populations
  • Combination with racetams and other cholinergic compounds

Key Production Note: Alpha GPC is highly hygroscopic and requires careful handling during tableting and encapsulation. Moisture-controlled manufacturing environments (RH < 40%) are essential for maintaining product stability.

What Is Phosphatidylserine?

Phosphatidylserine (PS) is a phospholipid and a critical structural component of cell membranes, particularly concentrated in brain tissue where it constitutes 13–17% of total brain phospholipids. It plays essential roles in cell signaling, membrane fluidity, and apoptosis regulation.

Structural Phospholipid Function

As an amphipathic phospholipid, Phosphatidylserine is integral to the structure and function of neuronal membranes:

  • Maintains membrane fluidity and receptor function
  • Supports efficient neurotransmitter release and signal transduction
  • Facilitates nutrient transport across cell membranes
  • Plays a role in neuronal survival and synaptic plasticity

Source & Production Considerations

  • Historical source: Bovine brain cortex (phased out due to BSE/prion disease concerns)
  • Current primary sources: Soy lecithin, sunflower lecithin
  • Available specifications: 20%, 50%, 70% PS content
  • Sunflower-derived PS: Allergen-free, non-GMO, preferred for clean-label formulations
  • Soy-derived PS: Longer clinical track record, more cost-effective

Cortisol Modulation & Stress Response

One of the most distinctive benefits of PS is its documented effect on the hypothalamic-pituitary-adrenal (HPA) axis. Clinical research demonstrates that PS supplementation can attenuate cortisol responses to acute physical and psychological stress, supporting both cognitive function under pressure and recovery from exercise-induced stress.

Quick Comparison Table

This side-by-side comparison provides a rapid reference for formulators evaluating these ingredients:

FactorAlpha GPCPhosphatidylserine
CategoryCholine donor / Acetylcholine precursorStructural phospholipid
Primary MechanismIncreases acetylcholine synthesisSupports neuronal membrane integrity
Main BenefitFocus, attention, reaction speedStress resilience, memory, healthy aging
BBB PenetrationExcellent (crosses as intact molecule)Excellent (membrane integration)
Typical Dose300-600 mg (up to 1,200 mg clinical)100-300 mg
Onset of EffectsFast (30-60 minutes)Gradual (2-4 weeks)
Sports PerformanceStrong evidence (power output)Limited direct evidence
Stress / CortisolLimited effectStrong evidence (HPA axis modulation)
Healthy AgingModerate evidenceStrong evidence (elderly-specific trials)
Best ForAcute cognitive enhancementLong-term brain health & stress support
Formulation EaseChallenging (hygroscopic)Easy (stable powder)
Raw Material CostModerateHigher

Mechanism: How They Work Differently

Understanding the distinct biochemical pathways of Alpha GPC and Phosphatidylserine is essential for strategic formulation decisions.

Alpha GPC Pathway

Alpha GPC follows a linear cholinergic enhancement pathway:

  • Oral ingestion: Rapid GI absorption (Tmax: 0.5–2 hours)
  • BBB penetration: Enters brain intact or as metabolites
  • Choline release: Hydrolyzed to free choline + glycerophosphate
  • ACh synthesis: Choline acetyltransferase produces acetylcholine
  • Effects: Enhanced attention, faster processing, improved neuromuscular signaling

The glycerophosphate component also contributes to neuronal membrane phosphatidylcholine synthesis, providing secondary structural support.

Phosphatidylserine Pathway

Phosphatidylserine operates through membrane-centric mechanisms:

  • Oral ingestion: Absorbed and incorporated into cell membranes
  • Membrane integration: Becomes part of neuronal phospholipid bilayer
  • Fluidity maintenance: Optimizes receptor function and neurotransmission efficiency
  • HPA axis modulation: Blunts cortisol response to stress stimuli
  • Effects: Improved memory consistency, stress resilience, neuroprotection

PS does not directly increase acetylcholine, but optimizes the environment in which cholinergic signaling occurs.

Clinical Evidence Comparison

Both ingredients have decades of clinical research supporting their cognitive benefits. The following evidence summary is based on peer-reviewed studies and meta-analyses published in PubMed-indexed journals.

Memory & Cognitive Decline

Phosphatidylserine holds a slight advantage for memory support in aging populations. The landmark Cenacchi et al. (1993) multicenter study of 494 elderly patients demonstrated statistically significant improvements in both behavioral and cognitive parameters with 300 mg/day PS versus placebo over 6 months.

Alpha GPC also shows strong memory evidence. A 2023 systematic review and meta-analysis (PMC10041421) of 7 RCTs found that Alpha GPC significantly improved cognition as measured by MMSE (Mean Difference: 3.50, 95% CI: 0.36 to 6.63) compared to placebo or other medications in patients with dementia disorders.

Focus & Attention

Alpha GPC demonstrates stronger evidence for acute focus and attention enhancement. A single-blind RCT (PMC8235064) found that Alpha GPC supplementation significantly improved self-reported motivation levels in healthy volunteers. The acetylcholine-mediated enhancement of attentional networks produces noticeable effects within hours.

Stress & Cortisol Modulation

Phosphatidylserine is the clear winner for stress support. Multiple RCTs demonstrate cortisol-blunting effects:

  • Monteleone et al. (1992): 800 mg/day PS for 10 days significantly blunted ACTH and cortisol responses to physical exercise (P = 0.003 and P = 0.03)
  • Starks et al. (2008): 600 mg/day PS for 10 days significantly attenuated plasma cortisol during exhaustive bicycle exercise
  • Benton et al. (2001): PS supplementation improved mood and reduced heart rate response to acute stress

Sports Performance

Alpha GPC shows compelling evidence for athletic applications. A double-blind, placebo-controlled crossover study (PMC4650143) found that 600 mg/day Alpha GPC for 6 days significantly increased isometric mid-thigh pull peak force compared with placebo (p = 0.044).

Phosphatidylserine’s sports benefit is primarily indirect — through reduced exercise-induced cortisol and faster recovery, rather than direct performance enhancement.

Healthy Aging

Phosphatidylserine has stronger positioning for healthy aging formulations. Kato-Kataoka et al. (2010) demonstrated that soybean-derived PS (100 mg, 6 months) improved memory function in elderly Japanese subjects with memory complaints. The membrane-support mechanism aligns well with the structural changes associated with brain aging.

OutcomeAlpha GPCPSNotes
Attention / Focus★★★★★★★★A-GPC excels for acute focus demands
Memory (Aging)★★★★★★★★★PS has more elderly-specific RCTs
Stress / Cortisol★★★★★★★PS is the clear winner for HPA modulation
Athletic Performance★★★★★★★A-GPC shows direct power benefits
Healthy Aging★★★★★★★★PS aligns with age-related membrane needs
Sleep Quality★★★★★★PS may improve sleep via cortisol reduction

Application Scenarios for Formulators

The following application-specific recommendations are based on clinical evidence, market demand, and formulation practicality.

Nootropic Capsules

  • Recommended: Alpha GPC + PS Combination
  • A premium nootropic stack combining both ingredients covers both the cholinergic and membrane-support pathways. Typical formulation: Alpha GPC 300 mg + PS 100 mg + supporting ingredients (e.g., Lion’s Mane, Bacopa).

Gaming & eSports Supplements

  • Recommended: Alpha GPC
  • The fast-acting focus enhancement and potential reaction time benefits make Alpha GPC ideal for gaming formulations. Typical dose: 300–600 mg, often combined with caffeine and L-theanine.

Stress Support Products

  • Recommended: Phosphatidylserine
  • The HPA axis modulation and cortisol-blunting effects make PS the cornerstone ingredient for stress and adaptogenic formulations. Typical dose: 100–300 mg daily.

Healthy Aging Formulas

  • Recommended: Phosphatidylserine (with optional Alpha GPC)
  • PS’s membrane-support mechanism and extensive elderly-specific clinical data make it the primary choice. Sunflower-derived PS is preferred for allergen-sensitive senior demographics.

Pre-Workout Products

  • Recommended: Alpha GPC
  • The documented power output benefits and rapid onset align perfectly with pre-workout timing. Standard inclusion: 300–600 mg, 30–60 minutes before training.

Memory Supplements for Seniors

  • Recommended: Combination
  • Both the cholinergic (Alpha GPC) and phospholipid (PS) pathways decline with age. A combination approach addresses multiple mechanisms of age-related cognitive change.

Can Alpha GPC and Phosphatidylserine Be Taken Together?

Yes. Not only are these ingredients safe to combine, but they may offer synergistic benefits that exceed what either provides alone. This is one of the fastest-growing trends in premium brain health formulations.

Why the Combination Works

The two ingredients operate through complementary rather than competing mechanisms:

  • Alpha GPC increases acetylcholine production (chemical pathway)
  • Phosphatidylserine optimizes the membrane environment for neurotransmission (structural pathway)
  • PS’s cortisol modulation may enhance the cognitive environment for ACh function
  • Together, they address both the “signal” (ACh) and the “medium” (membrane)

Example Premium Formulation

IngredientsDosage per Serving
Alpha GPC (50% or 99%)300 mg
Phosphatidylserine (PS 50% or 70%)100 mg
Citicoline (CDP-Choline)250 mg
Lion’s Mane Extract (30% polysaccharides)500 mg
Bacopa Monnieri (50% bacosides)300 mg
Rhodiola Rosea (3% rosavins)200 mg

Formulation Notes

When combining these ingredients, consider the total choline load if your formula includes other choline sources (CDP-choline, choline bitartrate). For tableting, Alpha GPC’s hygroscopicity requires moisture barriers or enteric coating. PS is generally easier to formulate but has a higher ingredient cost per dose.

Consumer Experiences & Real-World Feedback

Consumer-reported experiences provide valuable context for formulation positioning. The following patterns are compiled from published user surveys and marketplace feedback analysis.

Alpha-GPC Users Frequently Report:

  • Better focus and mental clarity within 30–60 minutes
  • Increased motivation and drive
  • Faster reaction time (particularly in gaming/sports contexts)
  • Enhanced mind-muscle connection during training
  • Vivid dreams (a common marker of cholinergic activity)

Common Alpha GPC Complaints:

  • Headaches (often due to insufficient choline balancing or excessive dose)
  • Insomnia when taken late in the day
  • Tolerance concerns with daily high-dose use

PS Users Frequently Report:

  • Better stress resilience and emotional balance
  • Improved sleep quality (especially when taken in the evening)
  • Gradual but sustained memory improvement over 4–8 weeks
  • Less mental fatigue during demanding cognitive tasks

Common PS Complaints:

  • Effects take longer to become noticeable (2–4 weeks typical)
  • Less “stimulating” or immediately noticeable than cholinergic nootropics
  • Higher cost per effective dose

Safety & Side Effects

Important: This section provides information about reported side effects based on clinical literature. No disease-treatment claims should be inferred. All supplement formulations should include appropriate disclaimers and advise consumers to consult healthcare providers before use, especially those with pre-existing conditions or taking medications.

Alpha GPC Safety Profile

Alpha-GPC is generally well tolerated in clinical studies at doses up to 1,200 mg/day. The most commonly reported side effects include:

  • Headache (most common, often dose-related)
  • Nausea or gastrointestinal discomfort
  • Dizziness or fatigue at higher doses
  • Insomnia (avoid evening dosing)

Stroke Risk Consideration — Emerging Evidence

A large-scale Korean cohort study (Lee et al., 2021, PMC8613599) involving over 12 million individuals aged 50+ found that Alpha GPC use was associated with a 46% higher risk of stroke over 10 years in a dose-responsive manner. The proposed mechanism involves conversion to trimethylamine N-oxide (TMAO) via gut microbiota.

However, subsequent research has provided important context. A 2024 nationwide longitudinal study (PMC12184023) found that Alpha GPC use in MCI patients was associated with lower dementia conversion risk and did not increase stroke risk in the overall population. The initial findings may have been confounded by indication (patients prescribed Alpha GPC were already at higher baseline risk).

Formulator Guidance: Include appropriate cautionary language on product labels. Advise consultation with healthcare providers for individuals with cardiovascular risk factors or family history of stroke. Consider limiting recommended duration of continuous use.

Phosphatidylserine Safety Profile

Phosphatidylserine has an extensive safety record. The FDA has granted GRAS (Generally Recognized As Safe) status to PS derived from both soy and sunflower lecithin.

  • Generally well tolerated even with long-term daily use
  • Occasional reports of insomnia at higher doses (600+ mg)
  • Mild digestive discomfort in sensitive individuals
  • No significant drug interaction concerns documented

Note: The FDA issued a 2003 Qualified Health Claim for phosphatidylserine and cognitive dysfunction/dementia risk reduction in the elderly. This is a qualified claim acknowledging limited and preliminary evidence — appropriate disclaimer language is required.

Formulation Considerations for Brands

Alpha GPC Formulation Challenges & Solutions

Advantages:

  • Premium positioning with strong consumer awareness
  • High choline content per gram (40%)
  • Excellent bioavailability and BBB penetration
  • Strong clinical evidence for cognitive and sports applications

Challenges:

  • Highly hygroscopic — requires moisture-controlled manufacturing (RH < 40%)
  • Difficult tableting — may require special excipients or encapsulation
  • Higher raw material cost than basic choline sources
  •  emerging stroke risk discussion requires careful label language

Phosphatidylserine Formulation Considerations

Advantages:

  • Lower effective dose (100–300 mg)
  • Strong aging market appeal with FDA-recognized qualified health claim
  • Excellent safety profile with GRAS status
  • Stable and relatively easy to formulate

Challenges:

  • Higher ingredient cost per kilogram
  • Source differentiation required (soy vs. sunflower)
  • Slower onset of effects may require consumer education

Soy PS vs. Sunflower PS — Procurement Guide

FactorSoy-Derived PSSunflower-Derived PS
Clinical HistoryLonger track recordShorter but growing
Allergen StatusContains soy allergensSoy-free, allergen-free
GMO StatusTypically GMONon-GMO
Clean Label AppealStandardPremium positioning
CostLowerHigher
BioavailabilityEquivalentEquivalent
Regulatory StatusGRAS (FDA), Novel Food (EU)GRAS (FDA), Novel Food (EU)

Market Trends

The cognitive health supplement market continues to expand, driven by aging demographics, increased mental performance demands, and growing consumer awareness of nootropic ingredients.

Alpha GPC Market Position

  • Growing demand in gaming supplements and eSports nutrition
  • Increasing use in sports nutrition and pre-workout products
  • Expansion into functional beverages and energy drinks
  • Steady growth in professional/high-performance demographics

Phosphatidylserine Market Position

  • Strong growth in stress and adaptogenic formulations
  • Increasing demand in sleep support products
  • Healthy aging and senior nutrition markets expanding
  • Clean-label preference driving sunflower-source demand

Combination Products — Fastest Growing Segment

The most significant growth opportunity is in combination formulations that leverage the complementary mechanisms of Alpha GPC and Phosphatidylserine. Premium nootropic stacks, comprehensive brain health formulas, and “all-in-one” cognitive supplements are commanding higher price points and stronger customer loyalty.

Final Recommendation

Choose Alpha GPC If Your Formulation Targets:

  • Fast-acting cognitive enhancement
  • Sports performance and pre-workout applications
  • Gaming and eSports supplements
  • Academic and professional productivity
  • Cholinergic stack components

Choose Phosphatidylserine If Your Formulation Targets:

  • Stress support and cortisol management
  • Healthy aging and senior brain health
  • Long-term cognitive wellness
  • Sleep quality improvement
  • Post-exercise recovery

Choose Both If Your Formulation Targets:

  • Premium nootropic positioning
  • Comprehensive memory support
  • Brain longevity and neuroprotection
  • Multi-mechanism cognitive optimization
  • Maximum differentiation in competitive markets

Frequently Asked Questions

Q: Is Alpha GPC better than Phosphatidylserine? Neither is universally better — they serve different purposes. Alpha GPC is superior for acute cognitive enhancement, focus, and sports performance. Phosphatidylserine excels for stress support, healthy aging, and long-term brain health. The best choice depends on your specific formulation goals and target demographic.

Q: Can Alpha GPC and PS be taken together? Yes. They work through complementary mechanisms (cholinergic enhancement vs. membrane support) and many premium formulations combine both. A typical combination provides Alpha GPC 300 mg + PS 100 mg. No adverse interactions have been reported in the literature.

Q: Which ingredient is better for memory? For age-related memory decline, Phosphatidylserine has slightly stronger clinical evidence (Cenacchi 1993, Kato-Kataoka 2010). For general memory enhancement in younger adults, Alpha GPC may provide more noticeable acute effects. For comprehensive memory support, a combination approach is optimal.

Q: Which ingredient works faster? Alpha GPC produces noticeable effects within 30–60 minutes due to its rapid absorption and direct cholinergic action. Phosphatidylserine benefits typically build over 2–4 weeks of consistent use as membrane composition gradually improves.

Q: Which ingredient is better for older adults? Phosphatidylserine is generally preferred for older adults due to its extensive elderly-specific clinical data, excellent safety profile, and mechanism (membrane support) that directly addresses age-related brain changes. However, combination formulas with Alpha GPC can provide additional cholinergic support.

Q: Is Phosphatidylserine safer than Alpha GPC? Both have strong safety profiles. Phosphatidylserine has GRAS status from the FDA and a longer track record of safe use. Alpha GPC is generally well tolerated but requires attention to emerging stroke risk data in specific populations. For daily long-term use, PS may have a slight safety advantage.

Q: What is the optimal dose for each ingredient? Alpha GPC: 300–600 mg for sports/cognitive enhancement; 1,200 mg for clinical cognitive support. Phosphatidylserine: 100–300 mg for general use; up to 600 mg for exercise stress applications. Always start at the lower end and titrate based on individual response.

Q: Which source of PS is better — soy or sunflower? Scientifically, there is no meaningful difference in efficacy between soy-derived and sunflower-derived PS. They share identical structural characteristics and metabolic pathways. Sunflower PS is preferred for allergen-free, non-GMO, and clean-label formulations. Soy PS is more cost-effective and has longer clinical history.

Source Alpha GPC & Phosphatidylserine for Your Formula

KSNutripharma provides high-quality Alpha GPC and Phosphatidylserine for supplement brands, contract manufacturers, and R&D laboratories worldwide.

Available Specifications

SpecificationsAlpha GPCPhosphatidylserine
Standard Grades50% powder, 99% crystalline20%, 50%, 70% PS content
AppearanceWhite to off-white powder/crystalLight yellow to brown powder
SourceSynthetic or natural extractionSoy or sunflower lecithin
Mesh SizeAvailable upon requestAvailable upon request
Shelf Life24 months (sealed, dry storage)24 months (cool, dry storage)
MOQContact for detailsContact for details

Quality Assurance

  • Full COA (Certificate of Analysis) with every batch
  • Third-party HPLC purity verification
  • Heavy metals, microbial, and solvent residue testing
  • Non-GMO and allergen-free options available
  • Stability data and shelf-life documentation
  • Regulatory dossiers for US (FDA/GRAS), EU (Novel Food), and other markets

Customization & Services

  • Custom blending and pre-mix formulation
  • Private labeling and white-label options
  • Technical formulation support
  • Regulatory compliance consultation
  • Flexible MOQ for trial batches and scale-up

References

1. Cenacchi T, Bertoldin T, Farina C, Fiori MG, Crepaldi G. Cognitive decline in the elderly: a double-blind, placebo-controlled multicenter study on efficacy of phosphatidylserine administration. Aging (Milano). 1993;5(2):123-133.

2. De Jesus Moreno M. Cognitive improvement in mild to moderate Alzheimer’s dementia after treatment with the acetylcholine precursor choline alfoscerate: a multicenter, double-blind, randomized, placebo-controlled trial. Clin Ther. 2003;25(1):178-193.

3. Lee C, et al. Association of L-alpha glycerylphosphorylcholine with stroke risk: A nationwide cohort study. JAMA Network Open. 2021;PMC8613599.

4. Kim SH, et al. Association between L-alpha glycerylphosphorylcholine use and delayed dementia conversion: A nationwide longitudinal study in South Korea. 2024;PMC12184023.

5. Baccolo G, et al. Activity of choline alphoscerate on adult-onset cognitive dysfunctions: A systematic review and meta-analysis. 2023;PMC10041421.

6. Monteleone P, et al. Blunting by chronic phosphatidylserine administration of the stress-induced activation of the hypothalamo-pituitary-adrenal axis in healthy men. Eur J Clin Pharmacol. 1992;42(4):385-388.

7. Starks MA, Starks SL, Kingsley M, Purpura M, Jaeger R. The effects of phosphatidylserine on endocrine response to moderate intensity exercise. J Int Soc Sports Nutr. 2008;5:11.

8. Benton D, Donohoe RT, Sillance B, Nabb S. The influence of phosphatidylserine supplementation on mood and heart rate when faced with an acute stressor. Nutr Neurosci. 2001;4(3):169-178.

9. Bellar D, et al. The effect of 6 days of alpha glycerylphosphorylcholine on isometric strength. J Int Soc Sports Nutr. 2015;12(Suppl 1):P41.

10. Kato-Kataoka A, et al. Soybean-derived phosphatidylserine improves memory function of the elderly Japanese subjects with memory complaints. J Clin Biochem Nutr. 2010;47(3):246-255.

11. Kawamura T, et al. A Single-Blind, Randomized, Placebo-Controlled Human Study. 2018;PMC8235064.

12. FDA. GRAS Notice for Phosphatidylserine Derived from Sunflower Lecithin. GRN 000636.

13. Alzheimer’s Drug Discovery Foundation. Alpha-GPC (alfoscerate) Cognitive Vitality Report. Updated February 2020.

14. Gangitano G, et al. Comparison of the effects of choline alphoscerate and citicoline on cognitive deficits. Front Psychiatry. 2025;PMC12114635.

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