Aldithya Fakhri

Aphasia diagnosis in Indonesia remains challenging due to limited culturally and linguistically appropriate instruments. Widely used tools such as the Boston Diagnostic Aphasia Examination (BDAE) and Western Aphasia Battery (WAB) are not adapted to the Indonesian context, while Tes Afasia untuk Diagnosis, Informasi, dan Rehabilitasi (TADIR) provides screening but lacks diagnostic accuracy. To address this gap, we developed the Instrumen Diagnosis dan Evaluasi Afasia (IDEA) for native Indonesian speakers and evaluated its validity, reliability, and normative cutoff values in cognitively healthy Indonesian adults. Eighty-three cognitively normal adults (screened using MoCA-Ina) with no history of neurological disease were assessed using IDEA, which evaluates six language domains. Items were adapted from existing tools and reviewed by experts. Content validity, internal consistency (Cronbach’s alpha), and construct validity (Exploratory Factor Analysis) were analyzed using SPSS v25. A total of 83 participants were included (median age = 55.81 years, 54% secondary education). IDEA demonstrated good feasibility, with an average completion time of 45-60 minutes depending on participant engagement. Content validity was established by unanimous expert consensus. Construct validity showed meritorious sampling adequacy (KMO = .872) and significant sphericity (Bartlett’s test χ ² (15) = 278.523, p<.001), supporting factor analysis. Internal consistency showed good reliability across six domains (Cronbach’s α = 0.896). IDEA is a valid and reliable tool for assessing aphasia in Indonesian natives. It is a culturally appropriate assessment tool which offers structured, domain-based evaluation and supports differential diagnosis of both classical and progressive aphasia syndromes. Highlight: Aphasia diagnosis in Indonesia remains challenging due to limited accurate tools. Our instrument evaluates language domains to assess aphasia and its mimics. Validation in 83 cognitively healthy participants showed good validity and reliability.

Background: Meningioma is the most common primary intracranial tumor in adults, and survival outcomes are influenced by histopathological grade, tumor characteristics, and treatment strategies. This study aimed to evaluate overall survival (OS) and identify prognostic factors in patients with meningioma treated at a national referral cancer center in Indonesia. Methods: A retrospective cohort study was conducted at Dharmais National Cancer Center Hospital, including adult patients with histopathologically confirmed intracranial meningioma who underwent surgical resection between January 2019 and 17 August 2025. Overall survival was calculated from the date of histopathological diagnosis to death or last follow-up and analyzed using Kaplan–Meier methods and Cox proportional hazards regression. Results: A total of 114 patients were included (mean age 48.1 ± 10.5 years; 86.8% female), with most tumors classified as WHO Grade I (64.0%) and located at the skull base (57.0%). Subtotal resection was more common (67.5%), and 71.9% did not receive adjuvant radiotherapy. During follow-up, 14.0% of patients died, with cumulative overall survival rates of 95.6% at 6 months and 86.0% at 96 months. On multivariate analysis, only WHO tumor grade remained an independent prognostic factor (HR 2.199; 95% CI 1.161–4.167; p = 0.016), with higher grades associated with worse survival. Extent of resection and adjuvant radiotherapy were not significantly associated with overall survival after adjustment. Conclusions: In this Indonesian tertiary referral cohort, WHO tumor grade emerged as the only independent predictor of overall survival, underscoring its important prognostic role in meningioma; however, these findings should be interpreted with caution due to incomplete clinical data and relatively short follow-up duration. The high proportion of complex cases, including skull base tumors, reflects referral patterns and may also influence treatment outcomes.

Background/Objectives: Alzheimer’s disease (AD) is a leading cause of dementia globally, yet standard diagnostic markers like cerebrospinal fluid (CSF) analysis and molecular imaging are invasive and resource-intensive. While artificial intelligence (AI)-based volumetric magnetic resonance imaging (MRI) offers a scalable and non-invasive alternative, data correlating these structural metrics with fluid biomarkers and cognitive status in Southeast Asian populations are scarce. This study addresses this critical gap by examining the within-cohort relationship between CSF biomarkers and regional brain volumes derived from AI-assisted MRI in Indonesian patients with clinically diagnosed AD, providing novel data for an underrepresented population. Methods: Twenty-one AD patients from three national referral hospitals in Indonesia underwent lumbar puncture for CSF biomarker analysis and 3 Tesla structural brain MRI. Brain volumes were analyzed using United Imaging Intelligence software, focusing on AD-relevant regions (hippocampus, entorhinal cortex, parahippocampus, precuneus, and posterior cingulate cortex [PCC]). Results: Spearman’s correlation revealed significant positive associations between CSF Aβ42 levels and several brain regions. Strong correlations were found with the right entorhinal volume indexed to intracranial volume (VICV) (r = 0.601, p = 0.004), right PCC VICV (r = 0.603, p = 0.004), right entorhinal volume (r = 0.533, p = 0.013), and right hippocampus VICV (r = 0.503, p = 0.020). Furthermore, MoCA-InA scores demonstrated highly significant positive correlations with CSF Aβ42 concentrations (r = 0.720, p < 0.001), right Hippocampus VICV (r = 0.703, p < 0.001), and right PCC VICV (r = 0.695, p < 0.001). No significant correlations were found between CSF pTau or the pTau/Aβ42 ratio and regional volumes. Conclusions: These results highlight the entorhinal cortex and PCC as early affected regions where CSF Aβ42 correlates with preserved volume, supporting their role as structural markers in early AD. The absence of pTau associations may reflect early-stage pathology or limitations of cross-sectional volumetry. In resource-limited settings, AI-assisted volumetric MRI demonstrates potential utility as a non-invasive tool for stratifying amyloid-associated brain atrophy and staging disease severity.

Introduction: Microplastics (MPs) are widespread environmental pollutants with possible neurotoxic effects. Exploring links between plastic use, MP awareness, and cognition is key for assessing public health risks. Objective: To examine correlations between plastic consumption, MP awareness and attitudes, and neurocognitive function among Greater Jakarta residents. Methods: A cross-sectional survey of 562 adults used a validated e-questionnaire covering plastic usage, MP knowledge, attitudes, risk perception, and cognition via the Ascertain Dementia 8 (AD-8). Analyses included chi-square, t-tests, and logistic regression. Results: Suspected cognitive impairment (AD-8 ≥ 2) was observed in 44.5% of respondents. High single-use plastic consumption correlated with worse cognition (p = 0.032), while reusable plastic use showed no association (p = 0.605). Awareness of MPs was relatively low, with 19.4% of respondents having never heard of them. Awareness and knowledge also varied significantly by age (p = 0.007), gender (p = 0.004), and education level (p = 0.027). Positive attitudes and higher risk perception aligned with greater awareness (p < 0.001) but not cognitive scores. Risk perception influenced bottled water use (p = 0.009), with low-risk groups consuming more. Conclusions: Frequent single-use plastic consumption is linked to poorer cognition, while MP awareness and risk perception do not directly affect cognitive outcomes. Educational strategies may enhance awareness and reduce exposure.

Introduction Microplastics (MPs) have emerged as pervasive environmental contaminants, with growing concerns about their potential health impacts, including neurocognitive effects. In Indonesia, where plastic pollution is severe, no validated tool exists to assess public plastic use patterns and MP awareness in relation to cognitive health. Objective This study aimed to develop and validate a comprehensive questionnaire evaluating plastic consumption behaviors, MP knowledge, attitudes, and their association with cognitive function in Indonesian adults. Material and methods A cross-sectional pilot study was conducted with 30 participants (80% female, mean age 37.4±13.7 years). The questionnaire was developed through literature review, expert consultation, and focus group discussions, covering six domains: demographics, health history, MP knowledge, plastic use behaviors, environmental attitudes, and cognitive screening (AD-8). Validity was assessed using Pearson’s correlation, and reliability was measured via Cronbach’s alpha. Result The questionnaire demonstrated strong validity for knowledge (r=0.379, p=0.039), behavior (r=0.726, pDiscussion The tool effectively identified MP knowledge gaps and behavioral risks while suggesting a plausible link between plastic exposure and cognitive impairment. The AD-8’s sensitivity and specificity supported its utility for screening, though the modest sample size limited statistical power for correlation analyses. Conclusion This validated questionnaire provides a critical foundation for assessing MP-related cognitive risks in Indonesia. Future studies should expand validation in larger cohorts and investigate causal mechanisms. The findings underscore the need for public education and policy interventions to reduce plastic exposure.

HIGHLIGHTS ABSTRACT Objective: In vitro fertilization is the most common form of assisted reproductive and fertility technology. However, it is important to note the success rates of IVF generally decrease as a person gets older. Identifying modifiable factors affecting human fertility, including diet, is significant for clinical and community wellness. This systematic review investigates the role of micronutrients supplementation in fertility and its potential impact on in vitro fertilization (IVF) outcomes. Materials and Methods: A systematic search in multiple databases using specific keywords related to in vitro fertilization, micronutrient supplementation, and outcome measures. Results: Out of 1462 retrieved studies, 8 were included in the systematic review. These studies covered a range of micronutrients and their effects on different IVF outcomes. Findings indicated potential benefits of vitamin D3 supplementation. Vitamin D3 supplementation was associated with a significant improvement in implantation rates (p < 0.05) in two studies, while no significant effect was observed in clinical pregnancy rates in other micronutrients. The systematic review highlights the diverse effects of various micronutrient supplements on IVF outcomes. While some supplements showed potential benefits, others did not significantly improve pregnancy rates. Further research with larger cohorts is necessary to establish conclusive evidence. Keywords: micronutrient supplements, IVF outcomes, pregnancy rates. Conclusion: This systematic review sheds light on the impact of micronutrients on IVF outcomes. Some studies suggested potential benefits of vitamin D3 supplementation >20 ng/ml, further research is needed to provide more definitive conclusions. Understanding the function of micronutrients in fertility could have significant implications for IVF treatment and female infertility management.