Management Of Cognitive Impairment Research Articles

Prevalence of Cognitive Impairment in Dialysis Patients in Gauteng Province, South Africa

Introduction: Cognitive impairment is defined as a new deficit in at least two areas of cognitive functioning. These may include disturbances in memory, executive functioning, attention or speed of information processing, perceptual motor abilities, or language. It has been shown that cognitive impairment is associated with the severity of kidney disease. Methods: The study was a descriptive research design, with participants purposively sampled from the general chronic kidney disease population which included haemodialysis and peritoneal dialysis patients at Steve Biko Academic Hospital in Pretoria, Gauteng Province, South Africa. Hundred and fifty-one participants (76 hemodialysis & 75 peritoneal dialysis patients), 58% were males, and 42% were females aged 19-61 years. To establish the prevalence of cognitive impairment by testing the level of cognition the Mini-Mental State Examination was utilized to provide a brief screening test to quantitatively assess the cognitive abilities and cognitive changes of patients while on dialysis. Results: Ninety-nine percent (99%) of the recruited population reported no cognitive impairment, irrespective of dialysis modality, demographic characteristics, and socio-economic status. Conclusion: Despite the findings highlighting that the majority of the chronic kidney disease population at Steve Biko Academic Hospital reported no cognitive impairment, it is crucial to increase awareness of the potential effects of cognitive impairment on daily activities, quality of life, and treatment adherence. Early detection and management of cognitive impairment can significantly impact the quality of life and adherence to treatment among these patients. Further research is needed to understand the prevalence and impact of cognitive impairment in different populations and to develop effective interventions for its prevention and management.

2251 Geriatric medicine competencies required by all hospital doctors caring for older adults: a scoping review

Abstract Introduction An ageing population globally has created an escalating demand for age-attuned healthcare services. Most older adults will continue to receive their medical care from doctors without specialised geriatric medicine training. It is important therefore that all doctors possess fundamental gerontological competencies. Which specific competencies and how they might best be integrated into medical education remain unclear. Our aim was to summarise the literature on the geriatric medical competencies required by all doctors caring for older adults. Methods We undertook a scoping review following Arksey and O’Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews (PRISMA-ScR). We systematically searched the electronic databases PubMed, Cochrane, Cinahl, PsycInfo, ERIC and Embase for eligible records from January 2012 to December 2022. Studies related to physician or doctor or resident and competencies or curriculum or education and geriatric medicine or gerontology were included. We also searched the websites of included countries’ medical specialty professional bodies for relevant competency frameworks. Results Eighty-seven sources were included in the review. The most common competencies identified were medication management, recognition and management of cognitive impairment and management of chronic disease and co-morbidities. Considerable heterogeneity existed among the remaining competencies identified including interprofessional communication skills, advanced care planning and discharge planning. Competencies addressing subspecialty areas including stroke, orthogeriatrics, movement disorders were less prominent. Conclusion Multiple attempts to create and implement competency frameworks on local, national, and international levels in addition to educational interventions to address competency gaps locally reflect the wide-ranging challenges faced by healthcare systems in caring for an ageing population. Significant variation in competencies exists among the sources included in this scoping review. An overarching competency framework is now necessary to define the required competencies for all hospital doctors caring for older adults.

ML-Based Quantitative Analysis of Linguistic and Speech Features Relevant in Predicting Alzheimer’s Disease

Alzheimer’s disease (AD) is a severe neurological condition that affects numerous people globally with detrimental consequences. Detecting AD early is crucial for prompt treatment and effective management. This study presents a novel approach for detecting and classifying six types of cognitive impairment using speech-based analysis, including probable AD, possible AD, mild cognitive impairment (MCI), memory impairments, vascular dementia, and control. The method employs speech data from DementiaBank’s Pitt Corpus, which is preprocessed and analyzed to extract pertinent acoustic features. The characteristics are subsequently used to educate five machine learning algorithms, namely k-nearest neighbors (KNN), decision tree (DT), support vector machine (SVM), XGBoost, and random forest (RF). The effectiveness of every algorithm is assessed through a 10-fold cross-validation. According to the research findings, the suggested method based on speech obtains a total accuracy of 75.59% concerning the six-class categorization issue. Among the five machine learning algorithms tested, the XGBoost classifier showed the highest accuracy of 75.59%. These findings indicate that speech-based approaches can potentially be valuable for detecting and classifying cognitive impairment, including AD. The paper also explores robustness testing, evaluating the algorithms’ performance under various circumstances, such as noise variability, voice quality changes, and accent variations. The proposed approach can be developed into a noninvasive, cost-effective, and accessible diagnostic tool for the early detection and management of cognitive impairment.

Neurophysiological and neuropsychological parameters in patients with temporal lobe epilepsy

Temporal lobe epilepsy (TLE) is the most common type of localization-related epilepsy (LRE) and has been extensively studied in the field of neuropsychology due to its significant association with cognitive impairments. Cognitive decline has long been recognized as a consequence of this form of epilepsy, with previous studies primarily focusing on neurophysiological measures. In this study, both neurophysiological and neuropsychological factors were analyzed in TLE patients compared to healthy control subjects. The Montreal Cognitive Assessment (MoCA) and Mini Mental State Examination (MMSE) tests were used to assess neuropsychological processes, while cognitive event-related potential (ERPs), particularly P300, were employed to analyze neurophysiological parameters. The study involved 21 TLE patients (mean age = 61.43) and 21 healthy control subjects. The results revealing that TLE patients scored significantly lower, indicating deficits in specific cognitive areas. The study also observed abnormalities in the ERPs, particularly in the assessment of P300 amplitude and latency, that may be indicative of underlying neural dysfunction related to attention and cognitive processing. In conclusion, the study provides compelling evidence of the association between TLE and a high incidence of cognitive deficits and decline. By considering both neurophysiological and neuropsychological factors, the study sheds light on the comprehensive impact of TLE on various cognitive domains and emphasizes the importance of early identification and management of cognitive impairments in TLE patients.

EARLY DETECTION AND MANAGEMENT OF COGNITIVE IMPAIRMENT PRACTICES AMONG PRIMARY CARE PROVIDERS

Abstract Primary care providers (PCPs) play a critical role in the early detection and management of cognitive impairment and dementia. Understanding their current practice patterns can help identify potential areas of need for additional support. Using 2022 DocStyles survey data (n=1,182), this study assessed US PCPs’ confidence levels in identifying symptoms of cognitive impairment and the actions they take when identifying a patient with cognitive impairment. In terms of their ability to identify symptoms of cognitive impairment, 22.3% of PCPs reported being very confident, 53.2% somewhat confident, 18.3% slightly confident, and 6.2% not at all confident or did not know. PCPs reported taking a variety of actions when they identify a patient with symptoms of cognitive impairment: 70.1% assess for potential underlying causes, 69.4% review medications, 65.7% conduct a cognitive assessment or test, 59.7% refer to a neurologist or other specialist, 43.3% coordinate with a care team, and 20.9% refer to community resources. Compared to PCPs who were very or somewhat confident, those who were slightly or not at all confident were less likely to report taking each action (e.g., 35.1% vs. 75.4% conduct a cognitive assessment or test, respectively), except for being more likely to refer to a neurologist or other specialist (68.8% vs. 56.9%) (p< 0.001). PCP practices in early detection and management of cognitive impairment vary by their confidence level. Findings can inform the development of resources to help increase PCPs’ confidence and support their practices in early detection and management of cognitive impairment and dementia.

MULTISECTOR COLLABORATION DRIVES THE DEVELOPMENT OF THE FOURTH HEALTHY BRAIN INITIATIVE ROAD MAP

Abstract Partnerships and collaboration across sectors played a critical role in the development of the fourth edition of the Healthy Brain Initiative Road Map (Road Map). The public health community, leaders in related fields, and people living with dementia contributed to the development and review. The Alzheimer’s Association and CDC invited 20 national leaders from public health, aging, academia, health care and health systems to guide the development of the fourth HBI Road Map as a part of the Leadership Committee. Their contributions included reviewing data, setting the overall direction of the review and leading five workgroups, composed of 68 subject-matter experts, who recommended actions on Risk Reduction of Cognitive Decline; Timely Detection, Diagnosis and Management of Cognitive Impairment; Dementia Caregiving; Health Equity; and Community Linkages. Health departments offered input through facilitated listening sessions and an open input period. Their feedback emphasized the importance increased information on health equity and partnerships in the Road Map. The Leadership Committee also advised continued partner engagement through the review process. This translated to review by the Alzheimer’s Association, CDC subject matter experts, external health equity experts, the Leadership Committee, workgroup members, the Healthy Brain Initiative Collaborative, the Alzheimer’s Association Early Stage Advisory Group and ultimately CDC leadership. This presentation will explore important themes that emerged throughout this process that shaped the design and evolution of the HBI Road Map series to its most recent iteration, as a guiding document with health equity and multi-sector collaboration action at its core.

Attitudes and Practices towards the use of technology‐screening tools, diagnosis, and management of cognitive impairment in primary care

AbstractBackgroundPrevious studies in the Cuban population suggest that Alzheimer’s Disease and related dementias (ADRD) are under‐diagnosed at primary care relative to population estimates. Recent interventions aimed to introduce the use of technology based cognitive assessments have been validated for primary care (e.g., Brain Health Assessment).However, the implementation of newly develop tools depends on the Primary care providers’ (PCPs) barrier and attitudes toward the diagnosis and management of patients with ADRD at a primary care level. Here we aimed to assess PCPs’ attitudes towards ADRD diagnosis, and the use of technology based cognitive assessments.Method84 PCPs were randomly selected form 10 primary care clinics. Sample size include a wide range of PCPs, including: family medicine (n = 54), neurologist (n = 2), psychiatrists(n = 13), psychologists(n = 10), clinicians (n = 3) and geriatricians (n = 2)). A questionnaire on Dementia assessment and management in primary care settings was administered to the participants. Descriptive statistics were employed for summarizing the data. Kruskal Wallis association test was utilized for determining associations between provider characteristics and outcomes.ResultsMost participants were female (n = 64, 76.2%), over 50 years old (n = 36, 52.9%) and family medicine practitioners (64.3%). The average number of patients consulted per month by PCPs were 250 (CI95% 250‐367) and over 60% of them were 55 years or older. Most of the PCPs (n = 63, 75.0%) will not refer patients with suspected ADRD if they had the training and instruments and technologies for the diagnosis at a primary care level. Lack of time (n = 59, 70.2%) and lack of confidence in their abilities (n = 68, 81.0%) were the most cited barriers for the diagnosis and management of ADRD . Around 80.0% of the interviewed practitioners considered the use of technology based cognitive assessments as important or very important tool for ADRD diagnosis. The positive attitudes of the PCPs for using technologies were correlated with the municipalities where they work (p = 0.01) and the continuous professional development of the PCPs (p = 0.03).ConclusionThere are still barriers for the diagnosis of ADRD at a primary care level. Though PCPs are willing to implement technology based cognitive assessments in their daily practice, addressing existing barriers is key for success

A new approach for cognitive impairment pattern in chronic kidney disease.

Chronic kidney disease (CKD) is associated with an elevated risk of neurocognitive disorders (NCDs). It remains unclear whether CKD-related NCDs have a specific cognitive pattern or are earlier-onset phenotypes of the main NCDs (vascular NCDs and Alzheimer's disease). We used the Mini Mental State Examination score (MMSE) to assess cognitive patterns in 3003 CKD patients (stage 3-4) followed up over 5 years in the Chronic Kidney Disease-Renal Epidemiology and Information Network (CKD-REIN) cohort. After normalizing MMSE scores to a 0-to-100 scale, the associations between the baseline estimated glomerular filtration rate (eGFR, using the Chronic Kidney Disease Epidemiology Collaboration creatinine formula) and changes in each MMSE domain score were assessed in linear mixed models. Patients (age: 67±13years old; males: 65%, mean eGFR: 33± 12mL/min/1.73m2) had a good baseline cognitive functions: the mean MMSE score was 26.9/30±2.9. After adjustment for age, sex, educational level, depression (past or present), cardiovascular risk factors and cerebrovascular disease, a lower baseline eGFR (per 10mL/min/1.73m2) was associated with a 0.53-point decrement [P<.001; 95% confidence interval (CI) (-0.98, -0.08)] for orientation, a 1.04-point decrement [P=.03; 95% CI (-1.96, -0.13)] for attention and calculation, a 0.78-point decrement [P=.003; 95% CI (-1.30, -0.27)] for language, and a 0.94-point decrement [P=.02; 95% CI (-1.75, -0.13)] for praxis. Baseline eGFR was not, however, associated with significant changes over time in MMSE domain scores. A lower eGFR in CKD patients was associated with early impairments in certain cognitive domains: praxis, language and attention domains before an obvious cognitive decline. Early detection of NCD in CKD patients must be performed before clinically cognitive decline using preferably tests assessing executive, attentional functions and language, rather than memory tests. This early cognitive screening could lead to a better management of cognitive impairment and their consequences on CKD management.

Systematic Review of the Association between Cancer-Related Dementia and Mality: Systematic Review and Meta-Analysis

Dementia caused by cancer is a significant health issue that affects cancer survivors, particularly those survivors who have undergone radiation therapy and chemotherapy. This condition can lead to cognitive impairment and a decline in quality of life. Furthermore, the influence of cancer-related dementia on mortality rates is not well understood. This systematic review and meta-analysis aimed to investigate the association between cancer-related dementia and mortality. Our findings suggest that cancer-related dementia is associated with increased mortality among cancer survivors. This highlights the need for improved screening and management of cognitive impairment among cancer patients, particularly those at higher risk of developing dementia.

Methodological challenges and biases in the field of cognitive function among patients with chronic kidney disease.

Chronic kidney disease (CKD) affects approximately 850 million people globally and is associated with an increased risk of cognitive impairment. The prevalence of cognitive impairment among CKD patients ranges from 30 to 60%, and the link between CKD and cognitive impairment is partially understood. Methodological challenges and biases in studying cognitive function in CKD patients need to be addressed to improve diagnosis, treatment, and management of cognitive impairment in this population. Here, we review the methodological challenges and study design issues, including observational studies' limitations, internal validity, and different types of bias that can impact the validity of research findings. Understanding the unique challenges and biases associated with studying cognitive function in CKD patients can help to identify potential sources of error and improve the quality of future research, leading to more accurate diagnoses and better treatment plans for CKD patients.

Feasibility of screening for cognitive impairment among older persons and referral by community health workers in Wakiso district, Uganda.

In Uganda, cognitive impairment in older persons aged ≥ 60 years is often undiagnosed due to inadequate appreciation of the condition compounded with limitations of trained human resource able to conduct appropriate cognitive evaluations. Use of Community Health Workers (CHWs) especially in hard-to-reach communities can be an important link for older persons to the health facilities where they can receive adequate evaluations and interventions for cognitive challenges. The aim of the study was to assess the feasibility of screening for cognitive impairment among older persons and referral by CHWs in Wakiso district, Uganda. This was a sequential explanatory mixed methods study. The CHWs received a one-day training on causes, signs and symptoms, and management of cognitive impairment and screened older persons ≥ 60 years for cognitive impairment using the Alzheimer's Disease scale 8 (AD8). Psychiatric clinical officers (PCOs) administered the AD8 and the Mini Mental State Examination to the older persons after assessment by the CHWs who then referred them for appropriate clinical care. We conducted Kappa statistic for agreement between the CHWs and PCOs and compared raw scores of the CHWs to Experts scores using Bland Altman and pair plots and corresponding analyses. We also conducted focus group discussions for the older persons, caregivers and CHWs. We collected data from 385 older persons. We involved 12 CHWs and 75% were females, majority were married (58.3%) with at least a secondary education (66.7%). There was 96.4% (CI 94.5-98.2%) agreement between PCOs and CHWs in identifying cognitive impairment with the PCOs identifying 54/385 (14.0: 95%CI 10.7-17.9%) older persons compared to 58/385 (15.1: 95%CI 11.6-19.0%) identified by CHWs. Of the 58 identified to have cognitive impairment by the CHWs, 93.1% were referred for care. The average difference between the score of the expert and that of the CHW was - 0.042 with a 95% CI of -1.335 to 1.252. Corresponding Bland Altman and pair plots showed high agreement between the measurements although CHWs scored higher values with increasing scores. CHWs can be trained to identify and refer older persons with cognitive impairment in the communities.

Cryptotanshinone ameliorates cladribine-induced cognitive impairment in rats

Objective: To evaluate the neuroprotective effect of cryptotanshinone against cladribine-induced cognitive impairment in rats. Methods: Rats were administered with cladribine (1 mg/kg, p.o.) and cryptotanshinone (10 and 20 mg/kg, i.p.) for four weeks. Behavioral tests such as Morris water maze and elevated plus maze were conducted to check memory impairment caused by cladribine. On day 29, all rats were sacrificed, and the brains were separated for estimation of neuroinflammatory factors, biochemical parameters, neurotransmitters, Aβ(1-42), blood-brain barrier permeability, nuclear factor erythroid 2-related factor 2 (Nrf2), and brain-derived neurotrophic factor (BDNF). Results: Treatment with cryptotanshinone dose-dependently enhanced spatial memory, improved the levels of neurotransmitter and antioxidant enzymes, and suppressed proinflammatory cytokine release. Cryptotanshinone also decreased Aβ(1-42) accumulation and increased the levels of Nrf2 and BDNF in the hippocampus. Additionally, the histopathological results showed that cryptotanshinone reduced cladribine-induced neuronal death in the hippocampus. Conclusions: Cryptotanshinone exhibits a promising neuroprotective effect against cladribine-induced cognitive impairment in preclinical studies, and may be a potential phytochemical for the treatment and management of cognitive impairment.

Cognitive Impairment in Patients With Cardiac Disease: Implications for Clinical Practice.

Cognitive impairment is common in patients with cardiovascular disease. One in 3 patients presenting at cardiology clinics have some degree of cognitive impairment, depending on the cardiac condition, comorbidities, and age. In up to half of these cases cognitive impairment may go unrecognized; however, it may affect self-management and treatment adherence. The high prevalence of cognitive impairment in patients with cardiac disease is likely due to shared risk factors, as well as direct consequences of cardiac dysfunction on the brain. Moreover, cardiac interventions may have beneficial as well as adverse effects on cognitive functioning. In this review, we describe prevalence and risk factors for cognitive impairment in patients with several common cardiac conditions: heart failure, coronary artery disease, and aortic valve stenosis. We discuss the potential effects of guideline-based treatments on cognition and identify open questions and unmet needs. Given the high prevalence of unrecognized cognitive impairment in cardiac patients, we recommend a stepwise approach to improve detection and management of cognitive impairment.

How are HIV services in the UK currently identifying and managing patients with cognitive impairment? Results of a national survey.

The 2018 British HIV Association (BHIVA) Standards of Care state that people living with HIV should be questioned annually for symptoms of cognitive or memory decline. If symptoms are identified, screening should be considered and services offered if impairment is detected. We examined the availability of services, along with current practices related to the screening and management of cognitive impairment in people living with HIV, in UK HIV services. A survey was distributed via email to all UK HIV services leads on the BHIVA audit mailing list. Questions related to screening practices, referral pathways, and the management of patients with suspected cognitive impairment. Descriptive analyses were conducted on all data returned. In total, 190 surveys were distributed. Of the respondents, 39 (60.6%) stated that they undertook screening for cognitive impairment in their HIV service, and 30 (47.6%) reported not offering a specific service or referral pathway. Awareness of BHIVA screening guidelines was high (49 [84.48%]), yet 15 (30.6%) respondents stated that they were not followed in their service and 41 (71.9%) felt there was a need for training on screening, assessment, and management of cognitive impairment in patients with HIV within their department. Despite no directive, a substantial number of HIV services surveyed are routinely screening patients for cognitive impairment without guidance on when to screen and which screening tools should be used. A UK consensus on screening, along with guidance and training for services, may help to resolve this gap in service provision.

Chinese expert consensus on digital therapeutics for cognitive impairment (2023 edition)

Benefitting from the rapid progress in cognitive neuroscience and digital technology, digital therapeutics have been widely applied in the prevention, diagnosis, intervention, and management of cognitive impairment in recent years. As a new emerging medical technique, there is an urgent demand for experts from clinical, scientific research, supervision and industry fields to jointly form recommendations on the application of cognitive digital therapeutics. This consensus systematically reviewed and evaluated the current status of the research and application of digital therapeutics, summarized the opinions of the experts from all fields, put forward eight recommendations for the clinical application and more suggestions for the supervision and future directions, thereby promoting the benign development of cognitive digital therapeutics.

A scoping review of recent advancements in intervention and outcome measures for post-stroke cognitive impairments

Cognitive deficit is one of the common impairments that occur post stroke and have a major effect on the quality of life of stroke survivors. However, the intervention and outcome measures used to remediate post-stroke cognitive impairments are diverse and highly heterogeneous. Therefore, a review of intervention and outcome measures for post-stroke cognitive impairments was carried out. To review all available information on the recent advancements in intervention and outcome measures for post-stroke cognitive impairments. An electronic database search was conducted in PubMed, Medline, Google Scholar, and the Cochrane Library with key search terms between 2001 and 2021. The search results were systematically screened, and data was independently extracted by three reviewers. The data was thematically analyzed and narratively synthesized. The search retrieved 2018 records, and we included 12 studies that met the inclusion criteria. Most of the studies targeted global cognitive deficits in ischemic stroke patients in the chronic phase. We categorized data based on the type of cognitive impairment, cognitive- domain targeted, intervention, and available outcome measures for post-stroke cognitive rehabilitation. Attention, memory, executive function, and global cognition were the common cognitive components targeted, managed, and assessed using an outcome measure. We found that technology is replacing conventional approaches to improve cognitive impairment. Regardless of many new developments in post-stroke cognitive rehabilitation interventions driven by technology, there is limited data available on actual implementation as a scalable solution. There is an extensive need for future research for evidence-based assessment and management of cognitive impairments in post-stroke rehabilitation.

Importance of Identifying Cognitive Impairment in Multiple Sclerosis.

This article aims to highlight the impact of cognitive impairment on outcomes and quality of life for people with multiple sclerosis (MS) and to review current evidence for the efficacy of disease-modifying therapies (DMTs) and other interventions. In addition, we provide clinical practice insights regarding screening and management of cognitive impairment in people with MS. Evidence suggests that cognitive deterioration often accompanies magnetic resonance imaging changes. Neocortical volume and deep grey matter atrophy correlate with cognitive impairment. Similarly, cognitive decline is predictive of a higher lesion burden. Cognitive impairment is an important clinical measure of disability and negatively impacts quality of life. Phase 3 studies suggest that DMTs such as natalizumab, ozanimod and fingolimod may provide long-lasting, clinically meaningful effects on cognition in people with MS. Further data are needed to support the use of adjunct cognitive behavioural and exercise interventions for people with MS who have cognitive impairment. More data are needed to define appropriate management strategies for cognitive impairment in people with MS. Baseline and periodic screening for cognitive impairment and inclusion of cognitive impairment as a clinical trial endpoint will help to inform efforts to manage this important aspect of MS.

Protecting cognitive function and delaying dementia: preliminary evidence from Lebanon

AbstractBackgroundIn Lebanon, it is projected that dementia will become a health crisis within the next 20 years. Therefore, the protection and management of cognitive impairment in older adults are of great significance for the aging population. We will present findings from research examining the role cognitive reserve factors and vitamin D play in cognitive impairment among older adults.MethodsIn the first study, we investigated the cognitive function and cognitive reserve factors of 508 community‐based Lebanese older adults aged 65 years using secondary data analysis. In a second cross‐sectional study, we explored the cognitive performance and serum vitamin D levels in 254 older (&gt;60 years) as well as younger (30‐60 years) adults.ResultsStudy 1. Older adults with dementia had lower education levels and attained lower occupational complexity. High education, complex occupation attainment, and leisure activity significantly predicted better global cognitive function. An older adult who gained high education levels or high complexity level occupation was 7.1 or 4.6 times more likely to have better global cognitive function than another who attained lower education or complexity level occupation, respectively. Study 2. Pearson’s correlation and stepwise linear regression analyses showed that a low serum 25 dihydroxy vitamin D (&lt;30ng/ml) level was associated with a higher risk of cognitive impairment in older as well as younger adults (30 years).ConclusionThese results suggest that cognitive reserve factors should be taken into consideration clinically during dementia diagnosis and when initiating community‐based preventive strategies in Arab populations. These findings also suggest that vitamin D correction needs to be explored as an intervention to prevent cognitive impairment. Other evidence supporting lifestyle changes and cognitive rehabilitation for the prevention and treatment of cognitive impairment should also be considered. Such interventions may reduce the risk of cognitive impairment and Alzheimer’s disease in older adults.

Utility of Chinese Versions of Addenbrooke's Cognitive Examination: A Narrative Review.

Addenbrooke’s cognitive examination (ACE) is a cognitive screening tool that has developed through three stages: ACE, ACE-Revised (ACE-R), and ACE-Ⅲ. In addition, mini-Addenbrooke’s Cognitive Examination (M-ACE) and ACE mobile are the additional versions that is derived from ACE-III. ACE and its related versions show better performance than Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) in detecting mild cognitive impairment in different neurological disorders. It has been translated into numerous languages, including Chinese. Through reviewing the history, validity, and comparison with other cognitive tests of Chinese versions of ACE, it aims to facilitate the clinical and scientific use, further development, improvement, and validation of Chinese versions of ACE in various neurological disorders and ultimately promote early identification and management of cognitive impairment in China.

A Critical Review of Role of Medhya Dravyas (Nootropic Drugs) in Brain Fog with special reference to Covid- 19

Cognitive dysfunction after COVID-19 are hypoxia, microvascular injury, immunological dysregulation, chronic inflammation, patients with mild infections also report cognitive symptoms. A recognized symptom of long COVID is “Brain Fog”, characterized by fatigue, lack of ability to concentrate and can severely affect memory and cognition. Long-term side effects of COVID-19 is Brain fog which occurs irrespective of the severity of the infection. The Medhya Dravyas (Nootropic drugs) are beneficial to improve the power of retention, grasping, discrimination and recollection thus improving the Medha (Cognition). Present clinical study is an attempt to evaluate the nootropic effect of certain drugs in Brain Fog with special reference to Covid 19. Aim: To review medicinal plants showing Medhya Karma (Nootropic activity) on signs and symptoms correlated with brain fog in Covid 19 with Ayurveda as a natural and safe remedy. Material and Methods: Materials related to Covid 19, Brain fog, Neurological symptoms cognitive impairment, Medhya Dravyas (Nootropic drugs) have been collected from different journals, Ayurveda and Modern text, Authentic websites (PubMed, Google scholar, Scopus, etc.), Observation and Results: Plants reviewed showed nootropic action by Antioxidant, Acetylcholine esterase inhibition, NMDA antagonism, Dopaminergic, Anti-amyloidogenic, Inhibition of Tau aggregation and Neuroprotection. These properties helps in the management of cognitive impairment. Conclusion-Medhya Dravyas possess nootropic and rejuvenative properties. Plants shown maximum inhibitory activities against the factors causing brain Fog by Neuroprotection and memory enhancement. It reveals the strength of the Ayurveda system as well as potential in developing new drug for memory enhancement