Displaying publications 1 - 20 of 488 in total

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  1. Choo BKM, Kundap UP, Kumari Y, Hue SM, Othman I, Shaikh MF
    Front Pharmacol, 2018;9:139.
    PMID: 29527169 DOI: 10.3389/fphar.2018.00139
    Epileptic seizures result from abnormal brain activity and can affect motor, autonomic and sensory function; as well as, memory, cognition, behavior, or emotional state. Effective anti-epileptic drugs (AEDs) are available but have tolerability issues due to their side effects. The Malaysian herbOrthosiphon stamineus, is a traditional epilepsy remedy and possesses anti-inflammatory, anti-oxidant and free-radical scavenging abilities, all of which are known to protect against seizures. This experiment thus aimed to explore if an ethanolic leaf extract ofO. stamineushas the potential to be a novel symptomatic treatment for epileptic seizures in a zebrafish model; and the effects of the extract on the expression levels of several genes in the zebrafish brain which are associated with seizures. The results of this study indicate thatO. stamineushas the potential to be a novel symptomatic treatment for epileptic seizures as it is pharmacologically active against seizures in a zebrafish model. The anti-convulsive effect of this extract is also comparable to that of diazepam at higher doses and can surpass diazepam in certain cases. Treatment with the extract also counteracts the upregulation of NF-κB, NPY and TNF-α as a result of a Pentylenetetrazol (PTZ) treated seizure. The anti-convulsive action for this extract could be at least partially due to its downregulation of TNF-α. Future work could include the discovery of the active anti-convulsive compound, as well as determine if the extract does not cause cognitive impairment in zebrafish.
    Matched MeSH terms: Cognition
  2. Pavlov YG, Adamian N, Appelhoff S, Arvaneh M, Benwell CSY, Beste C, et al.
    Cortex, 2021 11;144:213-229.
    PMID: 33965167 DOI: 10.1016/j.cortex.2021.03.013
    There is growing awareness across the neuroscience community that the replicability of findings about the relationship between brain activity and cognitive phenomena can be improved by conducting studies with high statistical power that adhere to well-defined and standardised analysis pipelines. Inspired by recent efforts from the psychological sciences, and with the desire to examine some of the foundational findings using electroencephalography (EEG), we have launched #EEGManyLabs, a large-scale international collaborative replication effort. Since its discovery in the early 20th century, EEG has had a profound influence on our understanding of human cognition, but there is limited evidence on the replicability of some of the most highly cited discoveries. After a systematic search and selection process, we have identified 27 of the most influential and continually cited studies in the field. We plan to directly test the replicability of key findings from 20 of these studies in teams of at least three independent laboratories. The design and protocol of each replication effort will be submitted as a Registered Report and peer-reviewed prior to data collection. Prediction markets, open to all EEG researchers, will be used as a forecasting tool to examine which findings the community expects to replicate. This project will update our confidence in some of the most influential EEG findings and generate a large open access database that can be used to inform future research practices. Finally, through this international effort, we hope to create a cultural shift towards inclusive, high-powered multi-laboratory collaborations.
    Matched MeSH terms: Cognition
  3. Ibrahim A, Singh DKA, Shahar S
    PLoS One, 2017;12(10):e0185641.
    PMID: 28972994 DOI: 10.1371/journal.pone.0185641
    AIMS: The aim of this study was to establish 'Timed up and Go' test (TUG) normative data among community dwelling older adults stratified based on cognitive status, gender and age groups.

    METHODS: A total of 2084 community dwelling older adults from wave I and II were recruited through a multistage random sampling method. TUG was performed using the standard protocol and scores were then stratified based on with and without mild cognitive impairment (MCI), gender and in a 5-year age groups ranging from ages of 60's to 80's.

    RESULTS: 529(16%) participants were identified to have MCI. Past history of falls and medical history of hypertension, heart disease, joint pain, hearing and vision problem, and urinary incontinence were found to have influenced TUG performance. Cognitive status as a mediator, predicted TUG performance even when both gender and age were controlled for (B 0.24, 95% CI (0.02-0.47), β 0.03, t 2.10, p = 0.36). Further descriptive analysis showed, participants with MCI, women and older in age took a longer time to complete TUG, as compared to men with MCI across all age groups with exceptions for some age groups.

    CONCLUSION: These results suggested that MCI needs to be taken into consideration when testing older adults using TUG, besides age and gender factors. Data using fast speed TUG may be required among older adults with and without MCI for further understanding.

    Matched MeSH terms: Cognition*
  4. Tan M.J., Omar, A.H., Dayang Tiawa Awang Hamid
    MyJurnal
    Currently, great emphasis is placed on the development and intervention of psychology in sports in order to address the problem of athletes’ failure to achieve peak performance in actual competitions. This problem is primarily due to internal factors, such as anxieties, as well as external factors, such as the high pressure of the competitive environments athletes encounter. In this study, the cognitive anxiety, somatic anxiety and self confidence levels amongst elite and sub-elite Malaysian volleyball players are defined (male sample n = 50; female sample n = 35; age range between 17 to 25 years). These parameters were measured using the Competitive State Anxiety Inventory (CSAI-2), in which the questionnaires were completed by all respondents 30 minutes prior to the start of a competition. The findings indicated that there was a significant difference (p < 0.005) in cognitive anxiety, somatic anxiety and self-confidence among elite and sub-elite Malaysian (male and female) volleyball athletes. According to the findings, the competitive anxiety levels of the sub-elite athletes were higher than the elite, mainly due to the inability of the sub-elite athletes to control their emotions using psychological skills. In order to minimize this problem, a novel approach that involves using virtual reality to reduce the athletes’ competitive anxiety was proposed. This approach utilizes a 3D immersive environment that was developed based on the challenging real-world situations encountered during a volleyball match. The design and development of this approach is predicted to enhance athletes’ psychological skills, and in turn ensure that they can achieve peak performance under high pressure conditions.
    Matched MeSH terms: Cognition
  5. Ng CG, Abousheishaa AA, Low SY, Zainal NZ, Thong KS, Awaluddin AB, et al.
    Asian Pac J Cancer Prev, 2023 Aug 01;24(8):2583-2591.
    PMID: 37642043 DOI: 10.31557/APJCP.2023.24.8.2583
    OBJECTIVE: Vortioxetine is a monoaminergic drug with a novel multimodal mechanism of action. We investigated its efficacy on depressive symptoms, cognitive function, and quality of life among cancer patients.

    METHODS: In this multicenter, open-label, single-arm, observational study, patients received flexible doses of Vortioxetine for a period of six months. All participants were assessed at baseline and scheduled for monitoring at weeks 2, 4, 8, 12, 16, 20, and 24. Depression severity was assessed using Montgomery-Asberg Depression Rating Scale (MADRS) and the Clinical Global Impression (CGI) scale. The Perceived Deficiency Questionnaire (PDQ-5) assessed the perceived cognitive difficulties in concentration, executive functioning, and memory. The European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC) was used to assess the patients' quality of life. Side effects of vortioxetine were monitored using the Antidepressant Side-Effect Checklist (ASEC).

    RESULTS: Patients experienced a reduction in MADRS scores from 29.89 ± 5.997 at baseline to 11.59 ± 4.629 by Week 24. The PDQ-5 scores showed significant change from Week-4, whereas the EORTC role, emotional, and cognitive functioning scores showed a significant change from Week 2 onwards. CGI-Severity scores decreased from a baseline of 4.39 ± 0.746 to 2.41 ± 1.085 by Week 24. During the 24-Weeks of therapy, around three-quarters of the patients (73.3%) had one or more adverse events reported on the ASEC. The most frequently reported TEAEs were dry mouth, insomnia, somnolence, and headache, with more than a 30% incidence rate.

    CONCLUSION: Vortioxetine seems promising in the management of depression and enhancement of cognitive function and quality of life of cancer patients with Major Depressive Disorder.
    .

    Matched MeSH terms: Cognition
  6. Sahathevan R, Mohd Ali K, Ellery F, Mohamad NF, Hamdan N, Mohd Ibrahim N, et al.
    Int Psychogeriatr, 2014 May;26(5):781-6.
    PMID: 24472343 DOI: 10.1017/S1041610213002615
    Many stroke research trials do not include assessment of cognitive function. A Very Early Rehabilitation Trial (AVERT) is an international multicenter study that includes the Montreal Cognitive Assessment (MoCA) as an outcome. At the Malaysian AVERT site, completion of the MoCA has been limited by low English proficiency in some participants. We aimed to develop a Bahasa Malaysia (BM) version of the MoCA and to validate it in a stroke population.
    Matched MeSH terms: Cognition/physiology
  7. Syed Alwi SM, Mazlan M, Mohd Taib NA, Che Din N, Narayanan V
    PLoS One, 2022;17(11):e0277056.
    PMID: 36395277 DOI: 10.1371/journal.pone.0277056
    OBJECTIVE: Chemotherapy-related cognitive impairment (CRCI) is a well-known phenomenon among breast cancer survivors. Cognitive impairment among breast cancer survivors can significantly affect their quality of life and ability to function independently. However, there is a lack of specific and focused cognitive intervention to improve their cognitive performances. This study aimed to develop a tailored cognitive intervention framework module by adapting the attention and memory interventions from the Cognitive Rehabilitation Manual of the Brain Injury Interdisciplinary Special Interest Group (BI-SIG) of the American Congress of Rehabilitation Medicine (ACRM) and incorporating them with the relevant exercises for cognitive rehabilitation for Malaysian breast cancer survivors with CRCI based on the consensus agreement of the expert panel.

    METHODS AND ANALYSIS: The Delphi consensus technique was conducted online to review and evaluate the framework module. A panel of experts, including rehabilitation medicine physicians, occupational therapists, and clinical psychologists in Malaysia, was invited to participate in this study. For each round, the expert consensus was defined as more than 90% of the expert panel agreeing or strongly agreeing with the proposed items.

    RESULTS: A total of 33 practitioners completed the three Delphi rounds. 72.7% of the expert panel have been practising in their relevant clinical fields for more than six years (M = 10.67, SD = 5.68). In Round 1, 23% of the experts suggested that the framework module for attention training required further improvements, specifically in the language (M = 1.97, SD = 0.75) and instructions (M = 2.03, SD = 0.71) provided. In Round 2, 15% of the experts recommended additional changes in the instruction (M = 2.15, SD = 0.67) for attention training. Amendments made to the framework module in line with the recommendations provided by the experts resulted in a higher level of consensus, as 94% to 100% of the experts in Round 3 concluded the framework module was suitable and comprehensive for our breast cancer survivors. Following the key results, the objectives were practical, and the proposed approaches, strategies, and techniques for attention and memory training were feasible. The clarity of the instructions, procedures, verbatim transcripts, and timeframe further enhanced the efficacy and utility of the framework module.

    CONCLUSIONS: This study found out that the cognitive intervention framework module for breast cancer survivors with cognitive impairment following chemotherapy can be successfully developed and feasible to be implemented using Delphi technique.

    Matched MeSH terms: Cognition
  8. Murukesu RR, Singh DKA, Shahar S, Subramaniam P
    Front Public Health, 2020;8:471.
    PMID: 33014971 DOI: 10.3389/fpubh.2020.00471
    Following the rapid increase of the aging population, health promotion and prevention of physical disability and dementia in older persons are essential for healthy aging. For example, there may be a potential to prevent or reverse cognitive frailty, the co-existence of both physical frailty and cognitive impairment in older persons. However, evidence-based interventions targeting the prevention or potential reversibility of cognitive frailty among community dwelling older adults are scarce. In this paper, we described the rationale, development and delivery of a multi-domain intervention comprising multi-component physical exercise prescription, cognitive training, dietary counseling and promotion of psychosocial support, called the WE-RISE trial. The aim of WE-RISE intervention is to potentially reverse cognitive frailty. This is a two-armed, single blinded, randomized controlled trial conducted over a duration of 6 months, at senior citizen activity centers within the Klang Valley, Malaysia. Ambulating, community dwelling older adults aged 60 years and above with cognitive frailty are randomized into two groups; (1) intervention group: which receives an instructor based "WE-RISE" intervention for the first 3 months, and then a home-based "WE-RISE at Home" intervention for the following 3 months; (2) control group: usual care with no modifications to their daily routine. Primary outcome is cognitive frailty status and secondary outcome include physical function, cognitive performance, nutritional status, psychosocial status and quality of life which are obtained during baseline screening and subsequent follow ups at 3rd and 6th month. Description of the intervention is done using the template for intervention description and replication (TIDieR) checklist. This trial protocol has received approval from Research Ethics Committee of Universiti Kebangsaan Malaysia (UKM PPI/111/8/JEP-2018-558) and the Department of Social Welfare Malaysia (MyResearch Reference: JKMM 100/12/5/2: 2018/405). Trial registration number: ACTRN12619001055190.
    Matched MeSH terms: Cognition
  9. Lim SY, Tan AH, Ahmad-Annuar A, Schneider SA, Bee PC, Lim JL, et al.
    J Mov Disord, 2018 May;11(2):89-92.
    PMID: 29860786 DOI: 10.14802/jmd.17082
    We present a case of beta-propeller protein-associated neurodegeneration, a form of neurodegeneration with brain iron accumulation. The patient harbored a novel mutation in the WDR45 gene. A detailed video and description of her clinical condition are provided. Her movement disorder phenomenology was characterized primarily by limb stereotypies and gait dyspraxia. The patient's disability was advanced by the time iron-chelating therapy with deferiprone was initiated, and no clinical response in terms of cognitive function, behavior, speech, or movements were observed after one year of treatment.
    Matched MeSH terms: Cognition
  10. Mohd Zulkifly MF, Ghazali SE, Che Din N, Singh DK, Subramaniam P
    ScientificWorldJournal, 2016;2016:3456943.
    PMID: 27340686 DOI: 10.1155/2016/3456943
    In this review, we aimed to identify the risk factors that may influence cognitive impairment among stroke survivors, namely, demographic, clinical, psychological, and physical determinants. A search from Medline, Scopus, and ISI Web of Science databases was conducted for papers published from year 2004 to 2015 related to risk factors of cognitive impairment among adult stroke survivors. A total of 1931 articles were retrieved, but only 27 articles met the criteria and were reviewed. In more than half of the articles it was found that demographical variables that include age, education level, and history of stroke were significant risk factors of cognitive impairment among stroke survivors. The review also indicated that diabetes mellitus, hypertension, types of stroke and affected region of brain, and stroke characteristics (e.g., size and location of infarctions) were clinical determinants that affected cognitive status. In addition, the presence of emotional disturbances mainly depressive symptoms showed significant effects on cognition. Independent relationships between cognition and functional impairment were also identified as determinants in a few studies. This review provided information on the possible risk factors of cognitive impairment in stroke survivors. This information may be beneficial in the prevention and management strategy of cognitive impairments among stroke survivors.
    Matched MeSH terms: Cognition Disorders/etiology*
  11. Mohamad NV, Ima-Nirwana S, Chin KY
    Curr Drug Targets, 2018;19(8):898-906.
    PMID: 28914204 DOI: 10.2174/1389450118666170913162739
    Cognitive function and testosterone level of men decline concurrently with age. Low testosterone levels are associated with higher risk of Alzheimer's disease and mild cognitive impairment in men. There are continuous debates on whether this relationship is casual. This paper aims to summarize the current evidence on the association between testosterone level and cognitive function in elderly men. The presence of testosterone, androgen receptor and its responsive genes indicates that testosterone has biological functions in the central nervous system. The ability of the body to convert testosterone into estrogen suggests that part of the actions of testosterone could be mediated by estrogen. Observational studies generally showed that low endogenous testosterone levels were associated with poor cognitive performance in healthy elderly men. Testosterone substitution exerted positive effects on certain cognitive domains in normal and hypogonadal elderly men. In conclusion, testosterone may influence cognitive function in elderly men and its substitution may be considered in men with cognitive impairment and testosterone deficiency.
    Matched MeSH terms: Cognition/drug effects
  12. Chin KY, Tay SS
    Nutrients, 2018 Jul 09;10(7).
    PMID: 29987193 DOI: 10.3390/nu10070881
    Alzheimer’s disease (AD) is plaguing the aging population worldwide due to its tremendous health care and socioeconomic burden. Current treatment of AD only offers symptomatic relief to patients. Development of agents targeting specific pathologies of AD is very slow. Tocotrienol, a member of the vitamin E family, can tackle many aspects of AD, such as oxidative stress, mitochondrial dysfunction and abnormal cholesterol synthesis. This review summarizes the current evidence on the role of tocotrienol as a neuroprotective agent. Preclinical studies showed that tocotrienol could reduce oxidative stress by acting as a free-radical scavenger and promoter of mitochondrial function and cellular repair. It also prevented glutamate-induced neurotoxicity in the cells. Human epidemiological studies showed a significant inverse relationship between tocotrienol levels and the occurrence of AD. However, there is no clinical trial to support the claim that tocotrienol can delay or prevent the onset of AD. As a conclusion, tocotrienol has the potential to be developed as an AD-preventing agent but further studies are required to validate its efficacy in humans.
    Matched MeSH terms: Cognition/drug effects*
  13. Shrestha R, Weikum D, Copenhaver M, Altice FL
    Int J Ment Health Addict, 2017 Aug;15(4):812-825.
    PMID: 29051714 DOI: 10.1007/s11469-017-9752-0
    While neurocognitive impairment (NCI) among people living with HIV (PLWH) who use drugs and its impact on HIV treatment outcomes continue to be widely investigated, there remains a critical gap in NCI assessment among HIV-infected people who use drugs (PWUD) in Malaysian context. The present study, therefore, sought to improve the utility of the existing Neuropsychological Impairment Scale (NIS) as a screening tool for assessing NCI by establishing its psychometric properties in the Malaysian context. The NIS is a brief, self-report measure originally designed to assess NCI by having individuals rate a range of items that may influence cognitive functioning. HIV-infected male prisoners (N=301) administered the full 95-item NIS. An exploratory factor analysis (EFA) was conducted using principal axis factoring and orthogonal varimax rotation. Reliability was measured using Cronbach's alpha. The EFA resulted in an abbreviated, psychometrically sound, eight-factor structure (54-item) revised NIS - now referred to as the Brief Inventory of Neuro-cognitive Impairment-Malaysia (BINI-M). It is better designed to detect NCI in PLWH, ranging from generalized neurocognitive symptoms to more specific forms of impairment with excellent to average reliability. The BINI-M may serve as a useful tool for clinicians and researchers to assess NCI in PLWH and can inform enhanced treatment strategies in the Malaysian context.
    Matched MeSH terms: Cognition
  14. Lua Pei Lin, Nor Khaira Wahida Khairuzzaman
    MyJurnal
    Objective: This paper intended to review and analyse relevant published articles which have studied or applied multimedia as the educational medium for patients or their caregivers. The benefits were also recorded.

    Method: The search was performed across the databases EBSCO Host, Springer Link, Science Direct and PubMed for relevant studies. Only full-text articles using English as a language of publication were included. Eligible articles included any usage of multimedia intervention as health information delivery for patients or caregivers. No restriction for publication date was set to permit a wider capture.

    Result: Twenty articles met the inclusion criteria involving a total of 1,797 respondents. The studies have been conducted in various countries mostly in North American region followed by Europe. The focused disease for each study varied from asthma to cognitive impairment but most were on cancer. Problems in caregiving and depression were also reported. The overall data suggested that the multimedia-based education had generated modest improvement in self-efficacy, patient satisfaction, coping skills, and perceptions of social support. Cost benefits were also recorded. Additionally, patients’ behavioural changes were well maintained in parallel with the intervention programme.

    Conclusion: The evolution of multimedia as an educational medium is growing and its incorporation has benefited health education management especially in improving patients’ and their family’s psychosocial outcomes. However, due to still limited scientific evidence to support its value, further multimedia-based interventions should be developed out of the need to share information and knowledge among patients as well as caregivers.
    Matched MeSH terms: Cognition Disorders
  15. ABM Tofazzal Hossain, Shaila Kabir, Constance Liew Sat Lin, Fairrul Kadir, M Tanvir Hossain Parash, Sadia Choudhury Shimmi, et al.
    MyJurnal
    Introduction: Role of nurses is very important in raising awareness, motivation level and increasing rate of organ donation subsequently. There are many studies on critical care nurses’ roles and education affect organ donation. Methods: A narrative literature review article of published research. Twelve published articles from ten different countries were found using different renowned online search engines. Results: Knowledge about organ donation among nursing students almost all over the world is inadequate than expectation and requirement in respective country. Marlene R et al showed that scores on the knowledge, attitudes, and beliefs subscales were positively cor- related with the number of requests for tissue and organs and consents obtained (0.76); and consents obtained for tissues and consents obtained for organs (0.72). Professional education was indicated in 43% of nurses surpassing family beliefs, religion and mass media. The cognitive part (knowledge) is directly depends on non-cognitive (Aware- ness and Attitude). Findings from almost all articles suggest the need of adding organ donation topic in the nursing and medical curriculum to prepare competent nurses and health care providers for future. Conclusion: This study suggests that there is a need to integrate organ donation aspects into the educational program to prepare nurses for their roles in organ and tissue procurement as well as awareness among policy makers in this regard for the well-be- ing of our patients.
    Matched MeSH terms: Cognition
  16. Samuel G, Ng YS
    Med J Malaysia, 2013 Aug;68(4):376-8.
    PMID: 24145276
    Traumatic Brain injury (TBI) is one of the most common causes of death and disability worldwide, with recent interest in the use of cholinomimetics in the treatment of TBI patients for cognitive impairments. Our patient who suffered TBI was started on a trial of an acetylcholinesterase inhibitor (Donepezil) for five weeks. Cognitive and memory testing with the Mini-Mental State Examination (MMSE) and Functional Independence Measurement (FIM) showed some degree of improvement: The three item recall component of MMSE improved and the FIM Memory score increased from 1 (Complete dependence) to 6 (Functional independence). Subjective assessment of his behaviour in the ward also showed improvement. This suggests that donepezil may help improve memory and behaviour of moderately severe traumatic brain injury patients, although more research in this direction should be undertaken.
    Matched MeSH terms: Cognition Disorders
  17. Mah, S.L., George, P.
    Malaysian Family Physician, 2018;13(2):26-28.
    MyJurnal
    Dementia is typically characterized by the deterioration of cognitive abilities and is a common disorder
    among the elderly in Malaysia. However, behavioral and psychological symptoms are also present
    in approximately 90% of dementia patients.1 We report the manifestation of these symptoms in an
    elderly woman with dementia and the treatment thereof.
    Matched MeSH terms: Cognition
  18. Mah SL, George P
    Malays Fam Physician, 2018;13(2):26-28.
    PMID: 30302180
    Dementia is typically characterized by the deterioration of cognitive abilities and is a common disorder among the elderly in Malaysia. However, behavioral and psychological symptoms are also present in approximately 90% of dementia patients.1 We report the manifestation of these symptoms in an elderly woman with dementia and the treatment thereof.
    Matched MeSH terms: Cognition
  19. Cacha LA, Parida S, Dehuri S, Cho SB, Poznanski RR
    J Integr Neurosci, 2016 Dec;15(4):593-606.
    PMID: 28093025 DOI: 10.1142/S0219635216500345
    The huge number of voxels in fMRI over time poses a major challenge to for effective analysis. Fast, accurate, and reliable classifiers are required for estimating the decoding accuracy of brain activities. Although machine-learning classifiers seem promising, individual classifiers have their own limitations. To address this limitation, the present paper proposes a method based on the ensemble of neural networks to analyze fMRI data for cognitive state classification for application across multiple subjects. Similarly, the fuzzy integral (FI) approach has been employed as an efficient tool for combining different classifiers. The FI approach led to the development of a classifiers ensemble technique that performs better than any of the single classifier by reducing the misclassification, the bias, and the variance. The proposed method successfully classified the different cognitive states for multiple subjects with high accuracy of classification. Comparison of the performance improvement, while applying ensemble neural networks method, vs. that of the individual neural network strongly points toward the usefulness of the proposed method.
    Matched MeSH terms: Cognition/physiology*
  20. Shapi'i A, Mat Zin NA, Elaklouk AM
    Biomed Res Int, 2015;2015:493562.
    PMID: 25815320 DOI: 10.1155/2015/493562
    Brain injury such as traumatic brain injury (TBI) and stroke is the major cause of long-term disabilities in many countries. The increasing rate of brain damaged victims and the heterogeneity of impairments decrease rehabilitation effectiveness and competence resulting in higher cost of rehabilitation treatment. On the other hand, traditional rehabilitation exercises are boring, thus leading patients to neglect the prescribed exercises required for recovery. Therefore, we propose game-based approach to address these problems. This paper presents a rehabilitation gaming system (RGS) for cognitive rehabilitation. The RGS is developed based on a proposed conceptual framework which has also been presented in this paper.
    Matched MeSH terms: Cognition Disorders/pathology; Cognition Disorders/rehabilitation*
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