Higashi et al. [14] documented global cognitive improvement, particularly in orientation and attention; Watari et al. [15] reported additional MMSE gains when Kihito was added to a stable cholinesterase inhibitor regimen; Kim et al. [13] observed no cognitive advantage in moderate AD but noted better responsiveness at the earlier amnestic mild cognitive impairment (aMCI) stage; and Nogami et al. [16] reported marked reductions in agitation, anxiety, and related behavioral symptoms while cognition remained stable. Here, BCHE is linked to Alzheimer disease.