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BackgroundTraumatic brain injury (TBI) incapacitates nearly 3.5 million Indians and can result in a host of physical, cognitive, social, emotional and behavioural problems. Neuropsychological rehabilitation (NR) aids in amelioration of these deficits. As people with low literacy levels represent a significant proportion of the world, specific cognitive rehabilitation modules for such populations are indispensable. A standardised, economical NR intervention may assist in faster recovery.MethodsThe study was initiated after obtaining institute ethics approval and the Clinical Trials Registry – India clearance. A 6-week indigenised literacy-free NR intervention Rehabilitation of Eclectic Cognitive Functioning post Traumatic Brain Injury to Retrain and Restore Attention, Concentration, Memory and Executive Functions (RETRACE) was developed. This intervention targeted areas of memory, attention and concentration, executive functioning, and response inhibition. It was standardised on 50 healthy controls and 18 patients. Prior to recruitment, a written informed consent was obtained from each patient, their primary caregiver and the healthy controls.ResultsIndividuals were divided into four groups based on their education levels: illiterates; 1–9 years, 10–14 years; and >15 years. All the outcomes for each of the four cognitive domains in the intervention did not have any significant difference for errors committed among the healthy controls with respect to different levels of education. The performance of patients with the healthy controls on all the four cognitive domains revealed a significant difference in each.ConclusionsRETRACE covers major areas of cognitive impairment that affects an individual’s social, vocational and personal quality of life after brain injury. This intervention is feasible to administer and may help alleviating cognitive complaints after brain injury in low literate or mixed cultural populations. RETRACE is simple to score and can be done easily at the patient’s home under the supervision of the patient’s caregiver. Further study of its efficacy in a randomised trial is already underway.

Background/Aims: In a linguistically diverse country such as India, challenges remain with regard to diagnosis of early cognitive decline among the elderly, with no prior attempts made to simultaneously validate a comprehensive battery of tests across domains in multiple languages. This study aimed to determine the utility of the Indian Council of Medical Research-Neurocognitive Tool Box (ICMR-NCTB) in the diagnosis of mild cognitive impairment (MCI) and its vascular subtype (VaMCI) in 5 Indian languages. Methods: Literate subjects from 5 centers across the country were recruited using a uniform process, and all subjects were classified based on clinical evaluations and a gold standard test protocol into normal cognition, MCI, and VaMCI. Following adaptation and harmonization of the ICMR-NCTB across 5 different Indian languages into a composite Z score, its test performance against standards, including sensitivity and specificity of the instrument as well as of its subcomponents in diagnosis of MCI, was evaluated in age and education unmatched and matched groups. Results: Variability in sensitivity-specificity estimates was noted between languages when a total of 991 controls and 205 patients with MCI (157 MCI and 48 VaMCI) were compared due to a significant impact of age, education, and language. Data from a total of 506 controls, 144 patients with MCI, and 46 patients with VaMCI who were age- and education-matched were compared. Post hoc analysis after correction for multiple comparisons revealed better performance in controls relative to all-cause MCI. An optimum composite Z-score of −0.541 achieved a sensitivity of 81.1% and a specificity of 88.8% for diagnosis of all-cause MCI, with a high specificity for diagnosis of VaMCI. Using combinations of multiple-domain 2 test subcomponents retained a sensitivity and specificity of >80% for diagnosis of MCI. Conclusions: The ICMR-NCTB is a “first of its kind” approach at harmonizing neuropsychological tests across 5 Indian languages for the diagnosis of MCI due to vascular and other etiologies. Utilizing multiple-domain subcomponents also retains the validity of this instrument, making it a valuable tool in MCI research in multilingual settings.

Epilepsy is one of the most prevalent neurological disorders, accounting for over 13 million disability-adjusted life years (DALYs). Nearly 80% of people with epilepsy live in low- and middle-income countries (WHO, 2019). Rehabilitation of cognitive impairments through compensatory training in such patients encompasses a wide range of techniques. However, interventional studies exploring their efficacy remain scarce despite being recommended in various reviews. Further, cultural contexts and other related factors have often been overlooked. We aimed to appraise the existing evidence on internal and external compensatory strategies in patients with epilepsy and identify the gaps and pitfalls in the existing literature for applicability to low resource and literacy settings from a neuropsychological perspective.

Persons with drug refractory TLE have the option of being managed by surgery. They may develop memory impairment with specific etiology of mesial temporal sclerosis and anterior temporal lobe resection (ATLR). The study evaluated the semantic verbal memory outcomes in pre- and post-surgery temporal lobe epilepsy (TLE) patients using functional MRI and voxel morphometric methods. Twenty consecutive persons with drug-resistant epilepsy (DRE) and 20 healthy controls were recruited after obtaining the institute ethics approval. The fMRI scans were performed on a 1.5 T MR Scanner using standardized semantic verbal memory tasks using a native Hindi paradigm, before and after an anterior temporal lobectomy (in cases). A task-based functional connectivity (FC) was estimated using a conn toolbox. Data analysis was carried out using the statistical parametric imaging (SPM12) and CAT12 toolbox. Post-surgery TLE group showed increased robust FC in the right middle and posterior temporal regions as compared to pre-surgery session. A significant reduction in grey matter volume was observed in the left temporal lobe post-operatively as compared to presurgery and healthy control groups. In the post-surgery TLE group, neuropsychological scores were reduced in specific PGI domains such as visuospatial, working memory, and executive functioning. Our results may help in understanding of memory reorganization in TLE post-operatively.

Many neurological conditions may result in long-term disability. The measures of prevalence and mortality vastly understate the disability they cause. In the Persons with Disabilities Act 1995 (equal opportunities, protection of rights, and full participation), neurological conditions are ignored. Although Indian Disability Evaluation and Asessment Scale (IDEAS), which assesses psychiatric conditions, does include dementia as one of the neurodegenerative conditions. Additionally, according to the global burden of disease report, 33% of years lived with neurological disability and 13% of disability-adjusted life years (DALYs) are due to neurological and psychiatric disorders. In 2001, the World Health Organization (WHO) established a new definition of disability, declaring it an umbrella term with the following three major components; 1) impairments: problems in body function or structure, 2) activity limitations: difficulties encountered by a person in executing a task or action, and 3) participation restrictions: problems of involvement in life situations experienced by a person. Hence, an attempt was made to rectify the above concerns. To address the above mentioned concerns, we think that there is a need of a comprehensive format for neurological disabilities assessment which would also include objective neuropsychological assessments. As future directions, national level meetings are required to formulate 'Indian Standard Track for Assessing Neurological Disability' (I-STAND) and uniform guidelines for disability assessment in 'chronic neurological conditions' with a special focus on "neuropsychological disability".

Background and aims: Memory impairment in epilepsy is a critical determinant of Quality of Life (QoL). Subjective complaints may reflect depression. 6-week home based Neuropsychological Rehabilitation (NR) program was developed for patients with Drug Refractory Epilepsy (DRE) [Post-Operative (PO) & Not Cleared for Surgery (NCS)]. This includes psychoeducation, compensatory training and cognitive retraining aimed at improving memory. Neuropsychological outcomes were studied. Methods: 27 adults with DRE were recruited in a single blind RCT (CTRI/2019/10/021777) with 14 patients in the Intervention (IG) (PO = 13, NCS = 1), and 13 in the Treatment As Usual (TAU) (PO = 11, NCS = 2) groups. They were aged 18–45 years with minimum primary level of education, IQ > 80 and available primary caregiver. Pre-post neuropsychological assessment included Auditory Verbal Learning Test, Everyday Memory Questionnaire (EMQ), Hamilton Depression Inventory and Quality of Life in Epilepsy-31. Due to COVID-19, a booster session (focused on internal & external aids) was given at 3 months and all follow-ups were done through tele-assessment at 6 months. Results: At baseline, there was no significant difference between the groups on objective and subjective measures. Linear regression analysis post adjustment for depression at follow-up revealed a significant difference between the groups on objective cognitive measures of learning (p = 0.019), delayed recall (p = 0.003), retention (p = 0.045) with IG showing higher performance. Similar results were noted for subjective measures of EMQ (p = 0.001) and cognitive (p = 0.001), seizure freedom (p = 0.030), overall QoL (p = 0.046) subdomains of QoL with its total score (p < 0.001). Conclusions: Despite depression, IG reported higher performance on objective tests, lower subjective complaints and better QoL at long term follow-up.

Background: Metabolic patterns on brain F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) can predict the decline in amnestic mild cognitive impairment (aMCI) to Alzheimer's disease dementia (AD) or other dementias. Objective: This study was undertaken to evaluate the diagnostic accuracy of baseline F-18 FDG-PET in aMCI for predicting conversion to AD or other dementias on follow-up. Patients and Methods: A total of 87 patients with aMCI were enrolled in the study. Each patient underwent a detailed clinical and neuropsychological examination and FDG-PET at baseline. Each PET scan was visually classified based on predefined dementia patterns. Automated analysis of FDG PET was performed using Cortex ID (GE Healthcare). The mean follow-up duration was 30.4 ± 9.3 months (range: 18–48 months). Diagnosis of dementia at follow-up (obtained using clinical diagnostic criteria) constituted the reference standard, and all the included aMCI patients were divided into two groups: the aMCI converters (MCI-C) and MCI nonconverters (MCI-NC). Diagnostic accuracy of FDG PET was calculated using this reference standard. Results: There were 23 MCI-C and 64 MCI-NC. Of the 23 MCI-C, 19 were diagnosed as probable AD, 1 as frontotemporal demetia (FTD), and 3 as vascular dementia (VD). Of the 64 MCI-NC, 9 had subjective improvement in cognition, and 55 remained stable. The conversion rate for all types of dementia in our series was 26.4% (23/87) and for Alzheimer's type dementia was 21.8% (19/87). The of PET-based visual interpretation was 91.9%. Sensitivity, specificity, positive predictive value, and negative predictive value for FDG-PET-based prediction of dementia conversion were 86.9% [confidence interval (CI) 66.4%–97.2%)], 93.7% (CI 84.7%–98.2%), 83.3% (CI 65.6%–92.9%), and 95.2% (CI 87.4%–98.9%), respectively. Kappa for agreement between visual and Cortex ID was 0.94 indicating excellent agreement. In the three aMCI patients progressing to VD, no specific abnormality in metabolic pattern was noted; however, there was marked cortical atrophy on computed tomography. Conclusion: FDG-PET-based visual and cortex ID classification has a good accuracy in predicting progression to dementia including AD in the prodromal aMCI phase. Absence of typical metabolic patterns on FDG-PET can play an important exclusionary role for progression to dementia. Vascular cognitive impairment with cerebral atrophy needs further studies to confirm and uncover potential mechanisms.

Background: Due to the paucity of quick, cognitive screening tools available in India that are independent of cultural and educational influences, a 6-item paper and pencil test, covering areas of memory, executive functioning, attention, and visuospatial ability domains – the Neuropsychological Evaluation Screening Tool (NEST) was developed. Aim and Method: NEST was administered to 84 healthy controls to analyze, revise, and review items. In the second phase, 408 patients, above 16 years of age, with their educational level ranging from being illiterate to having greater than 25 years of education, with various neurological and psychiatric conditions were independently administered NEST, Hindi Mental State Examination (HMSE), and a detailed cognitive evaluation using PGI Memory Scale (PGIMS). Results: Using receiver operating characteristics analysis for 341 patients, ≥3 was identified as the optimum cut-off for NEST. NEST could correctly classify 87.9% of the patients with an impaired vs. an intact cognition. The diagnostic characteristics of NEST with PGIMS were sensitivity (95% CI): 94.78% (91.1, 97.3); specificity (95% CI): 60.31% (51.3, 68.7); positive predictive value (95% CI): 80.74% (78.1, 93.0); and negative predictive value (95% CI): 86.81% (75.6, 85.3). NEST had an 82.5% agreement (95% CI: 78.1, 86.2) with PGIMS. On the other hand, the diagnostic characteristics of HMSE with PGIMS were sensitivity (95% CI): 73.79% (67.5, 79.3); specificity (95% CI): 82.44% (74.8, 88.5); positive predictive value (95% CI): 88.02% (82.5, 92.2); and negative predictive value (95% CI): 64.3% (56.5, 71.5). HMSE had a 76.95% (95% CI: 72.2, 81.1) agreement with PGIMS. Conclusions: NEST has better sensitivity compared to HMSE for detecting cognitive impairment when compared to a detailed evaluation at all educational levels.

Introduction: Traumatic brain injury (TBI) is a leading cause of death and disability all over the world. It is associated with diversities of outcomes including cognitive deficits. The worse cognitive outcome is often associated with more severe degree of TBI as measured by initial Glasgow Coma Scale (GCS) score. Materials and Methods: Present study compared the cognitive function of TBI patients having initial GCS score 9-10 with those having the initial GCS score 11-12. The assessment on Postgraduate Institute battery of brain dysfunction was conducted when the patients came for their follow-up visit at a tertiary health care facility between 6 months and 12 months of sustaining TBI. Results: There was moderate degree of cognitive dysfunction in the group with initial GCS score of 9-10 and no dysfunction in the group with initial GCS score of 11-12. Conclusion: The initial GCS score of 10 may be critical to predict cognitive deficits among TBI patients during 6-12 months of recovery period.

Flynn Effect (FE) deals with the issue of how the general scores of a population change over time. The existing cognitive test was developed in 1976 and since then there have been a lot of modernization and technological changes in the country. Hence, the objective was to study the possible FE with respect to cognition in the country. A sample of 142 people was assessed in 1976 to make norms on Post Graduate Institute- Memory Scale (PGI-MS). To compare these results the present study included 140 consenting subjects in 2013 almost in the forth decade after the first study. PGIMS is an original and one of the most popular tests of cognition in India, developed by Dwarka Pershad & N.N.Wig. It measures the cognitive ability, even with the illiterate population. Comparison of the age related norms (1976 and 2013) after 37 years shows that there was FE seen in the age group 20–29 years in the domains of attention and concentration (p=0.04), delayed recall (p=0.001) and recognition (p=0.05). 30–39 years age group also shows the evidence of FE in retention for dissimilar pairs i.e. ability for new learning ability (p=0.001). Finally, in the age group of 40–49 years there was FE seen in immediate recall (p=0.0007) and retention for similar pairs i.e. ability for simple memory (p=0.01). Whereas there was no FE seen in ages between 50–69 years i.e. amongst the senior citizens. Results show there is a shift in the cognition to a higher continuum. The conclusions made on the cognitive abilities for persons between 20 to 49 years, on the bases of age old norms, is an underestimate of their present abilities. On the basis of this study it can be inferred that, there is a change in cognitive abilities over generations, as Flynn (2012) stated, human beings are not getting smarter they are just being more modern. Hence, there is a need to revise the available norms of the test, across all the ages and education level, for assessing the cognitive functioning to make them more valid and reliable for clinical and research purposes.

Summary Background Brain and CNS cancers (collectively referred to as CNS cancers) are a source of mortality and morbidity for which diagnosis and treatment require extensive resource allocation and sophisticated diagnostic and therapeutic technology. Previous epidemiological studies are limited to specific geographical regions or time periods, making them difficult to compare on a global scale. In this analysis, we aimed to provide a comparable and comprehensive estimation of the global burden of brain cancer between 1990 and 2016. Methods We report means and 95% uncertainty intervals (UIs) for incidence, mortality, and disability-adjusted life-years (DALYs) estimates for CNS cancers (according to the International Classification of Diseases tenth revision: malignant neoplasm of meninges, malignant neoplasm of brain, and malignant neoplasm of spinal cord, cranial nerves, and other parts of CNS) from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016. Data sources include vital registration and cancer registry data. Mortality was modelled using an ensemble model approach. Incidence was estimated by dividing the final mortality estimates by mortality to incidence ratios. DALYs were estimated by summing years of life lost and years lived with disability. Locations were grouped into quintiles based on the Socio-demographic Index (SDI), a summary indicator of income per capita, years of schooling, and total fertility rate. Findings In 2016, there were 330 000 (95% UI 299 000 to 349 000) incident cases of CNS cancer and 227 000 (205 000 to 241 000) deaths globally, and age-standardised incidence rates of CNS cancer increased globally by 17·3% (95% UI 11·4 to 26·9) between 1990 and 2016 (2016 age-standardised incidence rate 4·63 per 100 000 person-years [4·17 to 4·90]). The highest age-standardised incidence rate was in the highest quintile of SDI (6·91 [5·71 to 7·53]). Age-standardised incidence rates increased with each SDI quintile. East Asia was the region with the most incident cases of CNS cancer for both sexes in 2016 (108 000 [95% UI 98 000 to 122 000]), followed by western Europe (49 000 [37 000 to 54 000]), and south Asia (31 000 [29 000 to 37 000]). The top three countries with the highest number of incident cases were China, the USA, and India. CNS cancer was responsible for 7·7 million (95% UI 6·9 to 8·3) DALYs globally, a non-significant change in age-standardised DALY rate of −10·0% (−16·4 to 2·6) between 1990 and 2016. The age-standardised DALY rate decreased in the high SDI quintile (−10·0% [–27·1 to −0·1]) and high-middle SDI quintile (−10·5% [–18·4 to −1·4]) over time but increased in the low SDI quintile (22·5% [11·2 to 50·5]). Interpretation CNS cancer is responsible for substantial morbidity and mortality worldwide, and incidence increased between 1990 and 2016. Significant geographical and regional variation in the incidence of CNS cancer might be reflective of differences in diagnoses and reporting practices or unknown environmental and genetic risk factors. Future efforts are needed to analyse CNS cancer burden by subtype. Funding Bill & Melinda Gates Foundation.

Epilepsy is a chronic noncommunicable disorder of the brain that affects people of all ages. Around 50 million people worldwide have epilepsy (WHO, 2012). 45,000 children under the age of 15, develop epilepsy each year (Epilepsy Foundation, 2010). Lower income was, however, associated with a higher incidence of epilepsy in all ethnic groups (Benn, et al., 2008). Neuropsychological impairment is an important co-morbidity of chronic epilepsy (Elger et al., 2004). Recent investigations have focused on the cumulative neurobiological burden associated with epilepsy and the risk of progressive cognitive impairment, but none have studied the effect of epilepsy on cognition on the developing brain, from India so far. Hence, the aim of the study was to study the effect of the temporal and extra temporal epilepsy on the cognitive functioning of children aged 7-12 years. Methodology: a cross-sectional study was carried out with a sample of 52 consenting children with an history of seizure (the 1st seizure occurred at least three months back i.e. the problem of seizure disorder was at least three months old) of neuropsychological assessment of epilepsy were administered with standardized neuropsychological tests, namely (Gesell’s Drawing Test- by Verma et al., 1972, PGI-Memory Scale for children- by Kohli et al., 1998) Results indicated significant findings in nine areas of neuropsychological functioning, namely immediate recall (p=0.001), followed by delayed recall (p=0.001), attention and concentration (p=0.001), recent memory (p=0.001), remote memory (p=0.001), visual retention (p=0.001), retention for similar pairs (p=0.001), mental balance (p=0.001), recognition (p=0.001) as compared to controls. Conclusion: results show that epilepsy does have a significant effect on cognition of children. However, a larger cohort study needs to be carried out to make substantiate claims. Normal 0 false false false EN-US X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Normalni tabulka"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;}

The services of clinical psychology (neuro) were established in 1969 under the tutelage of Dr. Surya Gupta. The unit has now established itself as a core group in the Neurosciences Centre, providing services to various other departments. The research and clinical services in Clinical Neuropsychology have substantially expanded since 2005. Research initiatives are underway toward better and more sophisticated systems of assessment and neuropsychological rehabilitation, aimed at facilitating patient care and in providing value-added services for the patients and their families.

India has a rather unenviable distinction of having the highest rate of head injury in the world. In India, more than 100,000 lives are lost every year with over 1 million suffering from serious head injuries. Traumatic brain injury is a complex injury with a broad spectrum of symptoms and disabilities. The impact on a person and his or her family can be devastating. Cognitive difficulties are very common in people with traumatic brain injury. Studies have shown that cognitive retraining plays a crucial role in improving the cognitive and basic functioning in these patients. We report three confirmed cases of effective cognitive retraining in moderate and severe traumatic brain injury.

Patients with Temporal lobe epilepsy (TLE) frequently display cognitive comorbidity and can have widespread network abnormalities, which might affect a variety of cognitive and intellectual functions. As a result, refractory TLE seems to be associated with slow but ongoing cognitive deterioration. The case is of a 32 year old, right handed male, engineering graduate, diagnosed with TLE- right mesial, 12 years ago. A number of head injuries were caused due to the seizure present, which includes a fall from height of 12 feet in childhood. The neuropsychological tests administered were Gesell’s Drawing Test, Mini Mental State Examination, PGI Memory Scale, Battery of Performance Tests of Intelligence, Verbal Adult Intelligence Scale, Hamilton Rating Scale for Depression, Bender Visual Motor Gestalt Test and Dysfunction Analysis Questionnaire. No impairment found on orientation; average cognitive functioning; above average attention and concentration, verbal working memory, visual and verbal memory; average practical ability, abstract ability, average verbal intellectual ability; superior ability on comprehension and average performance ability. Mild to moderate impairment on perceptuo-motor functioning and an evidence of depression were present. Patient showed high dysfunction in personal, social, vocational and cognitive areas. The study highlights that even despite chronic epilepsy, with a series of head injuries due to the seizures; an individual can still have average neuropsychological abilities. Holistic neuropsychological rehabilitation along with Vocational Retraining would go a long way in the functional independence of the patient. Neuropsychologists have a significant role in the assessment, treatment, and rehabilitation of people with epilepsy.

Neuropsychological rehabilitation is based on the nature and scope of neuropsychological symptoms identified through structured interviews and standardized tests. Here, the focus is to understand brain injury recovery phases and effectively deal with post injury grief-bereavement process. We wanted to test the effect of neuropsychological functioning of a bullet shot/penetrating injury case with cognitive/lobular impairment, social-emotional losses and severe grief-bereavement process. Holistic neuropsychological approach consisting of MMSE and other Indian standardized neuropsychological test battery (VAIS, BSS, Mukundan’s battery, WHOQOL-BREF), cognitive retraining (basic and functional), extensive- flexible Grief-Bereavement Therapy, Supportive Psychotherapy, Family Counseling, Cognitive Behavior Therapy and Person Centered Therapy. Evidence of marked improvement in orientation, comprehension, working memory, verbal and performance ability, fronto-temporal functions and quality of life (physical, psychological, environmental and social) domains in comparison to his pre-therapy. Holistic neuropsychological rehabilitative approach improved both patient’s cognitive functioning and his quality of life. However, for such generalization, extensive studies are required.

It was a pleasure reading your paper entitled “Prevalence and Cognitive Bases of Subjective Memory Complaints in Older Adults: Evidence from a Community Sample,” which was published on 27 April 2014. It was a very detailed paper about the incidence of subjective memory complaints (SMCs) in older adults and how importantly SMCs could have a prognostic value in predicting objective memory decline and dementia [1, 2]. It was very interesting to note the process of making subjects as a part of the study, who are drawn from memory clinics, biased in finding a higher prevalence of SMC as subjects are more likely to have memory impairments, whereas, on the other hand, how population based studies may be biased in finding a lower prevalence of SMC's as the subjects are more willing to participate in research and are also healthier than the patient groups (subjects drawn from memory clinics). However, in the methodology, the clear inclusion and exclusion criteria were not mentioned for the subjects who were made a part of the study. There was no mention about any comorbid conditions or disorders as well, which the participants who were included in the study had, as this information can be important for further having any correlations between the existing comorbid conditions/disorders and SMCs. Also, the subjects were divided into two groups, younger adults and older adults, but there was no mention on what criteria this was based. According to the World Health Organization, any person who is 60 years old and above can be called an elderly or an older population [3], so we would like to know why subjects who were 60 years old and above were not included and why 65 years old and above subjects were enrolled. Moreover, in the methods, there were 3 hypotheses of the study, but there was no mention about them being accepted or rejected. The third objective which stated that gender and objective memory would be associated with a greater risk for SMCs in women than in men was rejected after obtaining the results. The same could have been stated in the results and conclusions. The paper was also very comprehensive about the data and results, but nothing was mentioned about the subjects who actually performed low in the objective neuropsychological evaluation, who turned out to have dementia, whether they referred to a neurology clinic after that for any treatment/intervention or not. The future directions and implications of the study could have been highlighted and how the study can be benefitted to the general population to make substantial generalizations would further strengthen the research. Overall, it was a very interesting study, and we hope that these can be done in India as well, soon.