Hindi Mental State Examination Research Articles

Prevalence and patterns of vitamin D deficiency and its role in cognitive functioning in a cohort from South India.

Vitamin D (VitD) is a naturally occurring, fat-soluble vitamin which regulates calcium and phosphate homeostasis in the human body and is also known to have a neuroprotective role. VitD deficiency has often been associated with impaired cognition and a higher risk of dementia. In this study, we aimed to explore the relationship between levels of VitD and cognitive functioning in adult individuals. 982 cognitively healthy adults (≥ 45years) were recruited as part of the CBR-Tata Longitudinal Study for Aging (TLSA). Addenbrooke's cognitive examination-III (ACE-III) and Hindi mental status examination (HMSE) were used to measure cognitive functioning. 25-hydroxyvitamin D [25(OH)D] levels were measured from the collected serum sample and classified into three groups- deficient (< 20ng/ml), insufficient (20-29ng/ml) and normal (≥ 30ng/ml). Statistical analysis was done using IBM SPSS software, version 28.0.1.1(15). The mean age of the participants was 61.24 ± 9years. Among 982 participants, 572 (58%) were deficient, 224 (23%) insufficient and only 186 (19%) had normal levels of VitD. Kruskal-Wallis H test revealed a significant difference in age (p = 0.015) and education (p = 0.021) across VitD levels and the Chi-square test revealed a significant association between gender (p = 0.001) and dyslipidemia status (p = 0.045) with VitD levels. After adjusting for age, education, gender and dyslipidemia status, GLM revealed that individuals with deficient (p = 0.038) levels of VitD had lower scores in ACE-III verbal fluency as compared to normal. Additionally, we also found that 91.2% individuals who had VitD deficiency were also having dyslipidemia. It is concerning that VitD deficiency impacts lipid metabolism. Lower levels of VitD also negatively impacts verbal fluency in adult individuals. Verbal fluency involves higher order cognitive functions and this result provides us with a scope to further investigate the different domains of cognition in relation to VitD deficiency and other associated disorders.

Music and the aging brain - Exploring the role of long-term Carnatic music training on cognition and gray matter volumes.

Aging is a natural process and is often associated with an increased incidence of cognitive impairment. Physical exercise, diet, and leisure activities (music, dance, and art) are some of the lifestyle factors that contribute to healthy aging. The present study aims to explore the differences in cognitive functioning between aging individuals involved in musical activity throughout their lifetime and the ones who were not. Fifty-one healthy elderly individuals (50-80 years of age) residing in an urban locality were selected for the study from the Tata Longitudinal Study of Aging cohort. Participants were divided into two groups: Active musicians trained in Carnatic music for more than five years (n = 18) and age-matched non-musicians (n = 33). Addenbrooke cognitive examination-III, Hindi mental status examination, and trail-making test-B (TMT-B) were used to assess cognitive functioning. A Generalized Linear Regression Model was performed including covariates such as gender, age, and years of education. We also looked at the available brain magnetic resonance imaging data of a subset of our study population to inspect the volumetric differences between musicians and non-musicians. Our results showed that musicians had significantly better visuospatial abilities as compared to non-musicians (P = 0.043). Musicians (130.89 ± 45.16 s) also took less time to complete the TMT-B task than non-musicians (148.73 ± 39.65 s), although it was not a statistically significant difference (P =0.150). In addition, brain imaging data suggested that musicians had increased gray matter volumes in the right precuneus, right post-central gyrus, right medial and superior frontal gyrus, right orbital gyrus, left middle temporal gyrus, left cuneus, left fusiform gyrus, and bilateral cingulate gyrus. Our findings are indicative of music being an important attribute in improving cognitive reserve and predicting cognitive resilience. These findings pave the way to explore the utility of non-pharmacological interventions, such as Music Therapy (especially Carnatic music in the Indian context), as a potential factor for improving cognitive reserve in elderly individuals.

Assessment of Behavioral and Psychological Symptoms in Dementia, Associated Risk Factors and Clinical Correlates

Background: The presence of behavioral and psychological symptoms in dementia (BPSD) are associated with hospitalization, rapid cognitive decline, poor quality of life and higher caregiver burden. Thus, we aim to characterize the BPSD symptoms, its relationship to dementia-related risk factors and their predictive value, if any.Methodology: In 48 adults (mean age: 70.27 ± 10.08) with major neurocognitive disorder (MNCD) as per diagnostic and statistical manual of mental disorders, 5th edition and with Hindi mental status examination scores less than or equal to 23 were recruited. Patients were assessed for cognition by hindi Montreal cognitive assessment (HMOCA) and the clinical dementia rating scale (CDR). BPSD and caregiver burden were assessed using the neuropsychiatric inventory (NPI) and burden assessment schedule (BAS). The correlation of NPI scores with socio-demographic variables and clinical variables was assessed. A forward stepwise linear regression (using p-value &lt; .05) was used to identify possible predictors of the NPI scores.Results: The majority of participants were predominantly males, 25 (52.1%), from urban regions, belonged to middle-class socio-economic status and had severe grading (HMOCA (&lt; 10) of MNCD (25 (52.2%) but had moderate caregiver burden (25 (52.2%)). The most common MNCD type was due to Alzheimer’s disease (22 (45.8%)). Cortical atrophy and ischemic infarcts were the most common neuroimaging abnormalities reported (7 (14.9%)). Mean HMOCA, clinical dementia rating scale (CDR), NPI and BAS scores were 9.13 ± 6.96, 1.50 ± 1.05, 41.79 ± 27.06 and 68.65 ± 22.84, respectively. The most common BPSD domains were sleep disturbance (60.4%) and hallucinations (56.25%). Among the established risk factors, hypertension was present in the highest proportion (21 (43.8%)). As per the stepwise logistic regression model CDR scores, smoking status and HTN were predicted risk factors (R²: 0.452; p = 0.045).Conclusion: Irritability/agitation is most prevalent BPSD. The severity of MNCD, smoking and hypertension may help in the prediction of BPSD and their role may have to be explored in further studies.

Cognitive Functioning Among Community-dwelling Older Adults in Rural Population of Lucknow and Its Association with Comorbidities

Background: The transitional state between normal aging and dementia is known as Cognitive impairment (CI) where a person has memory complaints and objective evidence of CI but no evidence of dementia. With the globe undergoing a “demographic transition,” the magnitude of neurodegenerative disorders is rising. In India, 27.3% of older persons with comorbidities had CI. Early identification of CI will likely help initiate proper remedial intervention, leading to better overall outcomes. In order to determine the prevalence of CI in older persons and whether it is associated with co-morbid conditions, this study was designed. Methods: A descriptive cross-sectional study was conducted among 350 older adults aged ≥60 residing in rural areas of Lucknow, selected using multistage cluster sampling. The Hindi Mental State Examination (HMSE) scale was used to assess cognitive function. A pretested semi-structured questionnaire was used to collect information on sociodemographic characteristics and comorbidity status. Results: Among 350 participants, with mean ± SD age 70.66 ± 9.53 years, the prevalence of CI as per HMSE (&lt;23) was 24.9%. Overall, the mean HMSE score was less in individuals with (25.2) than without (27.19) comorbidities. Those with comorbidities had significantly lower mean scores in all individual domains of HMSE. Conclusion: CI affects one-fourth of the older adult population. Risk increases with the presence of comorbidities. Hence, screening, and early treatment are recommended.

Potentially inappropriate medications, their adverse events, and impact on geriatric vulnerabilities, frailty, and survival in older Indian patients with cancer: A retrospective observational study

Background: Older adults often have chronic diseases for which they receive multiple drugs, which may be potentially inappropriate. Objectives: We aimed to describe the potentially inappropriate medications (PIMs) leading to adverse drug events (ADEs) in older patients with cancer. Our secondary objectives were to evaluate the association of nutrition, cognition, and frailty with PIM-related ADEs and to assess the impact of PIM-related ADEs on overall survival (OS). We also investigated the cut-off for defining polypharmacy as related to ADEs. Materials and Methods: This was a retrospective observational study on patients with cancer aged 60 years and over who were assessed in the geriatric oncology clinic at the Tata Memorial Hospital (Mumbai, India) from June 2018 to August 2022. Medications, PIM assessment, nutrition (assessed by Mini Nutritional Assessment [MNA]), cognition (assessed by Mini Mental State Examination [MMSE] and Hindi Mental State Examination), and frailty (assessed by the Clinical Frailty Scale [CFS]) were extracted from the geriatric oncology clinic database. PIMs were identified using the Beers criteria, European Union-7 (EU[7])-PIM, Screening Tool of Older person’s Prescriptions/Screening tool to Alert to Right Treatment (STOPP/START), Fit fOR The Aged (FORTA), and PRISCUS list. Results: In total, 1472 patients were assessed in the geriatric oncology clinic, of which 823 (55.9%) were enrolled in the study. There were 1287 PIMs detected in 823 patients, of which 431 (33.5%) led to ADEs and 856 (66.5%) did not. Proton pump inhibitors and tramadol were the most common PIMs identified. ADEs were noted in 54 (14.7%) patients on proton pump inhibitors and in 145 (61.1%) patients on tramadol. ADEs were significantly associated with malnutrition, lower cognition, and frailty. The median MNA score in patients without and with ADEs was 20.5 (interquartile range [IQR], 17.5-24.0) and 19.5 (IQR, 15.5–23.5), respectively; P, 0.001. The median MMSE score for the patients without and with ADEs was 28 (IQR, 26-29) and 27 (IQR: 25-29), respectively; P, 0.001. The median CFS scores for the patients without and with ADEs were 3 (IQR, 2-4) and 4 (IQR, 3-5), respectively; P &lt; 0.001. The median OS in patients without and with ADEs was 13.1 months (95% confidence interval [CI], 10.64-17.87) and 10.2 months (95% CI, 8.80-12.85), respectively; P, 0.002. The optimal cut-off for polypharmacy leading to ADEs was 4.5 medications. Conclusions: There is a dire need to recognize and appropriately manage PIMs in older patients with cancer as PIM-related toxicities may negatively impact survival. Monitoring PIMs and following the recommendations to optimize the dose, avoid the drug, and find alternatives may improve the oncologic outcomes. Future studies should focus on adding a control group of patients not on PIMs, following up on PIM after recommendations, and investigating the impact of these recommendations on oncologic outcomes (Clinical Trials Registry-India: CTRI/2020/04/024675).

Association between monolinguals, multilinguals and cognition

AbstractBackgroundRecent research suggests that multilingualism may play an important role in enhancing cognitive health. The process of language acquisition constitutes a form of natural brain training, which in turn is thought to increase the neuroplasticity. The aim of this study is to examine the association between multilingualism and cognitive performance.MethodThis study utilized cross‐sectional (baseline) data from the Srinivasapura Aging Neuro Senescence and COGnition study (SANSCOG), which is an ongoing community‐based, longitudinal aging cohort study conducted in a rural setting in Southern India. Study participants were dementia‐free, aging adults (45 years and above) from the villages of Srinivaspura. This study site is located in the state of Karnataka, close to the border of an adjoining state, Andhra Pradesh. The subjects are separated into two groups, namely monolinguals, participants knowing one language and multilinguals, participants knowing more than one language, to assess if language has any role in cognitive performance. The cognitive performance of the participants was assessed using Hindi Mental State Examination (HMSE) and Clinical Dementia Rating (CDR). A total of 3283 subjects for HMSE, and 3634 for CDR, including both normal and cognitively impaired subjects were considered for the study. Dementia free patients with HMSE scores below 24 and CDR scores of 0.5 are considered as the inclusion criteria. The data analysis was performed using chi‐square test.ResultThe study showed a statistical significance for the association between number of languages spoken and cognition. Multilinguals achieved better cognitive scores, which shows their greater flexibility in cognition. The p value and chi‐square (p value:&lt; 0.001; chi‐square: 59.448) of monolinguals and HMSE scores shows that the analysed data is significant. The odds ratio is 2.562 and it indicates that monolinguals have higher odds of developing cognitive decline than multilinguals. The analysis indicates that exposure to multiple languages has the upper hand, as it is thought to enhance the brain function.ConclusionThis study highlights that learning multiple languages might have a profound impact on cognitive health, thereby reducing the likelihood of developing cognitive impairment.

Apolipoprotein (APOE4) allele as a predictor for Amygdala structure and Anxiety in normal aging‐ Results from the Triple‐A (Amygdala, Anxiety, and Ageing) study

AbstractBackgroundApolipoprotein E4 (APOE4) gene is an important risk factor based on available literature for late onset Alzheimer’s dementia and its effect on normal brain aging in Low and Middle‐income countries has been less studied. The evolutionary benefit that APOE4 confers against various infections during the younger age versus the vulnerability it offers that predisposes to the development of late‐onset cognitive decline is quite exciting but very less studied. We attempt to look into the effects of APOE4 carrier status and its influence on Amygdala structure and as an independent predictor for the development of late‐life anxiety symptoms.MethodThe subjects were recruited from the Tata Longitudinal Study of Ageing (TLSA) cohort, which is an Urban cohort wherein cognitively healthy participants ≥45 years, evaluated for baseline clinical cognitive, genetic, and imaging studies and followed up annually. About 102 participants whose APOE4 genotyping were done were included in this study and compared with their imaging characteristics especially looking into the amygdaloid volumes. Data was analyzed using SPSS v.24ResultMore than half of the participants were females (52%). The APOE4 carrier status (homozygous or heterozygous to APOE4 allele) was present in 51% of the individuals, and only 2.2% of the subjects had overt anxiety symptoms. The mean age of females were 63.89土9.6 and Males 64.82 土 9.3 years, respectively. With normalized imaging data, it was found that males had significantly higher left and right amygdaloid volumes than females(P&lt;0.001) irrespective of the carrier status, and when the Hindi Mental Status Examination (HMSE) scores were considered as an outcome measure, there was a significant reduction in the Right amygdala volumes in the carriers versus non carriers.ConclusionAmygdala is an integral part of the limbic system mediating emotions tagged to cognition, and its structure is likely modulated by the APOE4 carrier status. It could likely impact global cognition even when there is no significant difference in neuropsychological test scores between the carriers and non‐carriers in a cohort of cognitively normal individuals. However, ApoE4 carrier status does not seem to predict anxiety or depression early in cognitively healthy individuals, especially among the Indian population.

Gene‐Based Analysis with Functional Annotation in 2680 South Asians from the LASI‐DAD Study

AbstractBackgroundThe prevalence of dementia among South Asians across India is as high as 10% in those 55 years and older, yet little is known about the risk dementia factors in this population. To date, most known genetic risk loci of Alzheimer’s disease (AD) were identified from studies conducted in European Ancestry (EA) participants. The full mutational spectrum and the functional relevance of those loci in South Asians remains unknown. Analyzing DNA sequence data poses challenges due to the large number of rare variants tested, with most variants likely not associated with dementia. These challenges can be addressed with an annotation‐informed gene‐based analysis.MethodUsing whole‐genome sequence data from 2680 participants from the Diagnostic Assessment of Dementia for the Longitudinal Aging Study of India (LASI‐DAD), we performed a gene‐based analysis of 84 genes known to be associated with AD in EA. We investigated associations with the Hindi Mental State Examination (HMSE) score, general cognitive function, and five cognitive domains. For each gene, we examined missense/loss‐of‐function (LoF) variants and brain‐specific promoter/enhancer variants, separately, both with and without incorporating additional annotation weights (e.g., deleteriousness, conservation scores) using the variant‐Set Test for Association using Annotation infoRmation (STAAR).ResultIn the missense/LoF analysis, when controlling for age, sex, state/territory, and the first 10 principal components, 16 genes were nominally associated with at least one cognitive outcome (p&lt;0.05). Three genes (APOE, PICALM, TSPOAP1) were significant after multiple testing correction (FDR q&lt;0.1). In the brain‐specific promoter/enhancer analysis, 21 genes were nominally significant, but none were significant at FDR q&lt;0.1. Results remained similar after adding annotation weights. The most strongly associated variants in each gene were rs429358 (APOE), rs779406084 (PICALM), and rs9913145 (TSPOAP1). rs779406084 is a missense mutation that is more prevalent in this Indian sample (MAF = 0.075%) compared to EA (MAF = 0.0015%).ConclusionSome genes associated with AD in EA are also associated with cognitive outcomes in South Asians in India. Analyzing sequence data in South Asians provides opportunities to identify potential novel causal variants that are enriched in this population.

A study of sleep quality, cognitive impairment and functional abilities in patients with dementia

AbstractBackgroundSleep quality is affected with cognitive impairment and functional ability in patients with dementia.MethodThirty patients with dementia and thirty normal controls were studied. Subjects were evaluated for global cognitive impairment using Hindi Mental State Examination (HMSE) and activities of daily living using Everyday Ability scale for India (EASI). Dementia severity was assessed using Clinical Dementia Rating scale (CDR). A comprehensive sleep‐wake profile was obtained using a set of questionnaires Semi‐Structured Sleep Performa and Pittsburgh Sleep Quality Index (PSQI).ResultPatients were matched for age and gender. The severity of cognitive impairment (r value‐0.62, p&lt;0.01) and functional ability (r value 0.59, p&lt;0.01) was proportional to the poor sleep quality index.ConclusionSleep‐wake profile was altered in patients with dementia. This study helps to provide insights into sleep disturbances association with degree of cognitive impairment and degree of functional ability.

Effect of APOE ε4 and its modification by sociodemographic characteristics on cognitive measures in South Asians from LASI‐DAD

AbstractBackgroundThe ε4 allele of the apolipoprotein E (APOE) gene is the most significant genetic risk factor for dementia in nearly all human populations. However, the effects of APOE ε4 on late‐life cognitive function and its potential modification by sociodemographic factors have not been extensively studied in South Asians. We investigated the effects of APOE ε4 and its interaction with sociodemographic characteristics on cognitive measures in 2,607 South Asians from the Diagnostic Assessment of Dementia for the Longitudinal Aging Study of India (LASI‐DAD).MethodWe determined APOE ε4 carrier status from rs429358 and rs7412 genotypes in whole genome sequencing data. We first examined the main effects of APOE ε4 on seven cognitive measures, including five broad cognitive domain scores, a general cognitive function summary score, and the Hindi Mental State Examination (HMSE) score using linear regression models. Model 1 adjusted for age, sex, state of residence, and the first 10 genetic principal components (PCs). Model 2 additionally adjusted for education level, literacy, and urban/rural residence. We then tested for interaction between APOE ε4 and sociodemographic factors (age, sex, and education) through cross‐product terms, and further evaluated significant interactions (p&lt;0.05) using stratified analysis.ResultAPOE ε4 was inversely associated with all cognitive measures except visuospatial function in the full sample in Model 1 after Bonferroni correction (p&lt;0.007), all of which remained nominally significant in Model 2 (p&lt;0.05). For example, APOE ε4 carrier status was associated with a decrease in the HMSE score of 0.77 points (p = 1.6×10−4) and a decrease in general cognitive function score of 0.09 standard deviations (p = 0.001) in Model 2. Furthermore, interaction tests showed that the effect of APOE ε4 was stronger in females than males for memory (ßAPOE ε4_male = ‐0.121, βAPOE ε4_female = ‐0.177) and language/fluency (βAPOE ε4_male = 0.075, βAPOE ε4_female = ‐0.125), and stratified analysis indicated that the APOE ε4 effects were significant only in females (p&lt;0.05).ConclusionAPOE ε4 is associated with lower cognitive function in older South Asians from India. For memory and language/fluency, this association is stronger in females than males.

Serum sodium improvement: change in Comprehensive Geriatric Assessment parameters in geriatric patients with hyponatremia

BackgroundHyponatremia presents with symptoms considered age-associated in the elderly. We assess the change in Comprehensive Geriatric Assessment (CGA) parameters after hyponatremia improvement in hospitalized geriatric patients.MethodsWe took 100 hyponatremic and same number of eunatremic geriatric patients (> 60 years) who were comorbidity, presenting-complaints, and age-matched. Four CGA parameters were utilized, the new Hindi Mental State Examination (HMSE), Barthel’s index of activities of daily living (ADL), Timed up and go Test (TUG), and handgrip strength by hand dynamometer (HG). We analyzed these at admission and discharge, and their relationship with change in sodium levels.ResultsAverage age was 68.1 ± 5.8 years, with males constituting 75%. The CGA parameters demonstrated worse values amongst the hyponatremia than the normonatremia group. Severe hyponatremia group showed worse CGA scores in comparison with moderate and mild. With improvement in sodium level, the improvements in ADL, TUG, and HMSE scores were greater in the hyponatremia group (8.8 ± 10.1, 2.2 ± 2.5, and 1.7 ± 2.3 respectively) in comparison to the normonatremia reference group (4.7 ± 9.0, 1 ± 2.0, and 0.7 ± 1.3 respectively, P < 0.05).ConclusionOur study is the first utilizing HMSE to assess change in cognitive ability with improvement in serum sodium levels in the Indian elderly. Hyponatremic patients show worse baseline CGA parameters, and hyponatremia severity correlates with worse motor and cognitive function. Improvement in the serum sodium level improves the CGA parameters. Correction of hyponatremia in the geriatric age group significantly impacts life quality.

Impact of APOE ε4 allele on familial aggregation and cerebrovascular disease in Alzheimer’s Dementia: A cross‐sectional pilot study from India

AbstractBackgroundThe ε4 variant of the apolipoprotein E gene (APOE4) is associated with the risk of Alzheimer’s dementia (AD). Previous studies have reported APOE4 status association with familial loading and vascular changes in AD. With a diverse ethnic population, and high rates of metabolic syndromes, the consequences of being a carrier of the APOE4 polymorphism needs further exploration in Indian context.MethodPatients (N = 452) diagnosed to have AD, including 75 with a family history of AD in first‐degree relatives [‘familial’ AD (FAD)] and others without a significant family history [‘sporadic’ AD (SAD)], under evaluation at a tertiary hospital in India are described. All patients were assessed using Clinical Dementia Rating scale (CDR), Hindi Mental Status Examination (HMSE), Everyday Abilities Scale for India (EASI), Neuropsychiatric Inventory (NPI), and the Hachinski Ischemic Scale (HIS), along with detailed clinical evaluation. Blood samples were collected from AD patients, and 456 matched healthy controls for APOE genotyping using Polymerase Chain Reaction restriction fragment length polymorphism.ResultsThe ε4 allele frequency was 22.57% and 9.65% among AD patients and healthy controls. APOE4 carrier status was noted in 52% of FAD, 38.46% of SAD patients, and was a significant risk factor for FAD with an odd’s ratio (OR) of 1.73 (95% confidence interval (CI):1.04‐2.9, p = 0.03). The presence of APOE4 did not have a significant association with metabolic comorbidities (p = 0.54). Furthermore, APOE4 status was a negative predictor for cerebrovascular disease among all AD patients (OR: 0.32, 95% CI: 0.12‐0.71, p = 0.008).ConclusionAPOE4 allele has a positive association with familial aggregation and a negative association with cerebrovascular adversities in AD. The effect of APOE4 polymorphism on the clinical manifestation of AD in Indian population is unclear and needs further evaluation.

Postoperative delayed neurocognitive recovery: Evaluation of its incidence and correlation with intraoperative cerebral desaturation − A prospective observational study

Delayed neurocognitive recovery (DNR) is commonly seen in patients in the postoperative period. Literature has shown that monitoring cerebral desaturation intraoperatively can predict the development of DNR in elderly patients undergoing surgery in prone position. This prospective observational study was conducted in patients of all ages, with the primary objective to determine the incidence of DNR and its correlation with cerebral oximetry. The secondary objectives were to determine if intraoperative cerebral desaturation influenced the neuropsychometric variables from preoperative to postoperative period. This study included 61 patients, aged >18 years undergoing spinal surgery in prone position. An evening before surgery and at 48h postoperatively, patients were subjected to neuropsychological examination; Hindi Mental State Examination, Colour Trail Test 1 (CTT 1), CTT 2, Auditory Verbal Learning (AVLT) tests conducted by principal investigator (PI). DNR was defined as a 20% change in any of the test scores from the baseline. rSO2 was recorded bilaterally every 10min throughout surgery by an independent person. Cerebral desaturation was defined as a 20% drop in rSO2 from the control value. The incidence of DNR was 24.6%. The duration of anesthesia and cerebral desaturation were found to be independently predictive of DNR, with each hour of anesthesia causing a two-fold increase in the chances of development DNR (P=0.019) and presence of cerebral desaturation causing a 6-fold increase (P=0.039). CTT 1 and CTT 2 tests had significantly larger increase in test scores in the postoperative period, in patients with cerebral desaturation. Duration of anesthesia and cerebral desaturation were factors predictive of the development of DNR in patients undergoing spine surgery in prone position.

Clinical Practice Guidelines for the Use of Electroconvulsive Therapy.

Clinical Practice Guidelines for the Use of Electroconvulsive Therapy.

Psychosocial Correlates and Perceived Needs of Family Caregivers of Persons Living with Dementia in India.

AbstractBackgroundIn India, caregivers of persons living with dementia (CGPwD) often have limited access to dementia care resources. The aim of the study is to understand and deliver psychosocial interventions based on the perceived needs of the CGPwD in accordance with their socio‐cultural background and clinical characteristics of the persons with Dementia (PwD).MethodA sample of 32 CGPwDs attending a Dementia clinic at the NIMHANS, India, between July 2021 – October 2021 was chosen purposively. Cross‐sectional in‐depth interviews were carried out along with Zarit Burden Interview, (Zarit et al., 1980) and Hindi Mental Status Examination (Ganguli et al., 1995).ResultThe mean age of the CGPwD was 42.5 ± 8.5 years with MMSE score 9±7 indicating moderate to severe dementia. Those caregivers who spent more than 6 hours per day towards day‐to‐day caregiving brought out need for information about the illness seeking clarity about mental health care, support in Activities of daily living (ADLs), managing behavioural and psychological symptoms of Dementia (BPSD) and sharing of caregiver responsibilities, whilst those caregivers who took health related decisions for the PwD where concerned about problems associated with instrumental activities of daily living (iADLs), availability and affordability of caregiving resources such as day care, assisted living options, welfare services. Further results will be presented.Conclusion: The perceived needs of CGPwD vary based on severity of illness, socio‐economic status of the CGPwD, age of onset of illness, social support network, relationship between the caregiver and person living with Dementia, spiritual values, readiness to participate in support programs, and much more. Though mental health professionals can develop broader themes for intervention, individualised interventions may warrant poor rates of attrition.

Effect of priming on adjunctive repetitive transcranial magnetic stimulation in treatment of late life depression: Protocol of a prospective randomized sham-controlled study.

AbstractObjectivePriming stimulation, which involves high-frequency repetitive transcranial magnetic stimulation (rTMS) followed by low-frequency, has been shown to enhance neural response and is one of the novel paradigms found beneficial in adult patients with depression and has not been studied in late-life depression (LLD). This study aims to compare the effect of adjunctive priming vis-a-vis no priming rTMS over right dorso-lateral prefrontal cortex (DLPFC), on treatment of LLD.MethodsThis trial is registered in Clinical Trial Registry-India (CTRI) on www.ctri.nic.in. CTRI registration number: CTRI/2020/08/027230. Forty patients of LLD who are symptomatic after an adequate antidepressant trial will be randomized into 2 groups (active priming and sham priming rTMS); each receiving 10 sessions of rTMS over 2 weeks. Patients will remain blind to treatment allocation. Assessments will be done using Hamilton rating scale for depression, Geriatric Depression Scale, Hamilton rating scale for Anxiety, Somatic Symptom Severity Scale 8, Hindi Mental Status Examination, and Clinical Global Impression scale at baseline, week 1, 2, and 4. Side effect checklist will be applied after each session in both groups and at the end of 4 weeks.ResultData will be analyzed using statistical software Statistical Package for Social Sciences. Both the groups (active and sham groups) will be compared at the four given timepoints. Also, the baseline characteristics will be compared with the 3 follow-up points for any change.ConclusionThe findings of the study will give an insight to the possible role of priming to augment the effect of low-frequency rTMS in LLD.

A Real-world Pilot Observational Study of Neuropathic Pain Medications in Older Adult Patients in North India

Aims:This pilot study aimed to make head-to-head comparisons of multiple classes of drugs used in the management of neuropathic pain in North Indian older adult patients presenting to the geriatric clinic of a tertiary medical institutionBackground:Chronic neuropathic pain is a condition affecting nearly one third of older adults. There is paucity of data on head-to-head comparisons of drugs used in neuropathic pain in older adults. Real world studies may be a useful tool to study diverse neuropathic pain medications in this population.Objectives:The study objective was to measure NPRS (numeric pain rating scale), GDS (geriatric depression scale), IADL (instrumental activities of daily living), HMSE (Hindi mental state examination) scores at baseline, and 4- and 12-week follow-ups in all older adults patients receiving neuropathic pain medications.Methods:A prospective observational study was conducted involving older adult patients ≥ 50 years of age with painful peripheral neuropathy of any etiology (n=60; mean age 63±8.4 years). The patients received either gabapentin, pregabalin, duloxetine, amitriptyline, or methyl-cobalamin complex. NPRS, GDS, IADL, and HMSE scores were measured at baseline and post-therapy.Results:All groups except amitriptyline showed statistically significant improvement in NPRS at 4 weeks and 12 weeks compared to baseline. 30% response rate at 4 weeks was maximum for pregabalin (72%) and 50% response rate at 12 weeks was maximum for gabapentin (58%). Numerically maximum improvement in depression was seen with duloxetine. There was no statistically significant difference in the measured parameters between the drug groups across time. Mean daily dose was 172 mg (gabapentin group), 75 mg (pregabalin group) and 20 mg (duloxetine group). The adverse drug reaction rate was 10.5%.Conclusion:All drug groups showed beneficial effects on neuropathic pain at much lower doses than those described in the literature. The effectiveness at these low doses and the lower rates of adverse effects sets the foundation for larger studies in the future in diverse ethnic and aged populations.

Performance of the Informant Questionnaire on Cognitive Decline for the Elderly (IQCODE) in a nationally representative study in India: the LASI-DAD study.

Low and middle-income countries like India anticipate rapid population aging and increases in dementia burden. In India, dementia screening scales originally developed in other contexts need to be assessed for feasibility and validity, given the number of different languages and varying levels of literacy and education. Using data from the Longitudinal Aging Study in India-Diagnostic Assessment of Dementia (N = 4,028), we characterize the performance of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). We described patterns and correlates of missingness, evaluated the psychometric properties of the scale, and assessed criterion validity against the Hindi Mental State Examination (HMSE) using linear regression. Several IQCODE items had high levels of missingness, which was associated with urbanicity, respondent's gender, and informant's generation (same vs. younger generation). Full IQCODE scores showed strong criterion validity against the HMSE; each 1-point increase in IQCODE score was associated with a 3.03-point lower score on the HMSE, controlling for age, gender, and urbanicity. The statistically significant association between IQCODE and HMSE was stronger in urban than rural settings (p-value for interaction = 0.04). Associations between IQCODE and HMSE remained unchanged after removing the three items with the highest levels of differential missingness (remembering addresses and telephone numbers, ability to work with familiar machines, ability to learn to use new gadget or machine). Findings raise questions about the value of including items with high proportions of missingness, which may signal cultural irrelevance, while removing them did not affect criterion validity.

Efficacy and safety of maintenance electroconvulsive therapy (M-ECT) in treatment-resistant schizophrenia: A case series.

Treatment-resistant schizophrenia (TRS) is a substantial burden to patients, caregivers, and the treating team. There is a lack of robust evidence to support the efficacy of various pharmacological and non-pharmacological measures to augment clozapine in this population. When used in conjunction with clozapine or other combination antipsychotic regimens, maintenance electroconvulsive therapy (M-ECT) can be a potential therapeutic option in preventing symptom exacerbation in TRS. However, there is limited evidence supporting the role of M-ECT in TRS. To evaluate the efficacy and safety of maintenance electroconvulsive therapy in patients with TRS. Sociodemographic details, illness characteristics, details of M-ECT procedure, adverse events, and course of the illness were evaluated using a retrospective chart review at a tertiary care psychiatry centre in south India. Scores on Clinical Global Impression-Severity (CGI-S), Social and Occupational Functioning Assessment Scale (SOFAS), and Hindi Mental Status Examination were compared before and after the course of M-ECT. Seven male and three female patients received M-ECT in the last eight years (range of 22-172sessions). There was a reduction in hospitalizations for acute exacerbation and significant improvement in the patient's overall functioning without significant adverse effects. Maintenance ECT can be a safe and effective treatment option for achieving symptom control in the long-term management of refractory schizophrenia. Controlled trials are needed in this area for further evidence.

Reasons for Relapse After In-Patient De-Addiction Treatment for Alcohol Dependence – a Qualitative Analysis From India

AimsTo explore the reasons for relapse after receiving in-patient detoxification and de-addiction treatment for alcohol dependence syndrome, through in-depth interviews and thematic analysis.MethodsThis study was conducted in a tertiary care teaching hospital in South India. After obtaining Institutional ethics committee approval, patients of 18 years and above, who were admitted for the management of alcohol withdrawal syndrome, were approached and informed consent was obtained. Patients were screened with Clinical Institutes Withdrawal Assessment-Alcohol Revised (CIWA-Ar) and 15 patients who scored less than 7, who did not have any severe medical or psychiatric illness, whose cognition was intact according to Hindi Mental Status Examination (HMSE) and those who had two de-addiction treatments in the past were recruited. In-depth interviews were conducted in Tamil, audio-recorded, and transcribed. A semi-structured guided interview format was used to gather their narratives. The transcripts were translated to English on the same day and a step-by-step thematic analysis recommended by Braun et al was followed. The interviews were conducted in a soundproof room ensuring privacy and confidentiality. The recorded audios and the transcripts were firewall protected. The transcripts were read multiple times to familiarize the investigators. By using a general inductive method the data were retrieved, coded, and systematically organized according to patterns and themes. Two investigators coded the transcripts separately and any conflict was resolved by discussion. Thematic saturation was attained with the 14th transcript but the coding was completed for all 15 manuscripts. The mean age of the participants was 26.4 years.ResultsThe analysis resulted in the identification of reasons attributed by the patients for resuming drinking after receiving in-patient detoxification and de-addiction treatment for 21 days. This 21 days deaddiction program comprises of detoxification, motivation enhancement therapy, group therapy, and family interventions. The reasons for relapse included peer pressure, confidence that they will not become dependent again, craving, stressors, and health issues such as pain and insomnia and to test whether the treatment works or not. Reasons for the delay in help-seeking were lack of motivation, poor social support, financial constraints, lack of hope in medical treatment, did not feel the necessity to take treatment, fear of whether the doctors would be upset for relapsing again and, the guilt of letting down the treatment team. The reasons why they finally came for treatment were having severe withdrawal symptoms, pressure from a family member or employee, guilt and a desire to change, and fear of dying.ConclusionThis research provides avenues to understand patients’ perspectives on relapse of alcohol dependence. Understanding these would be beneficial in psychotherapy while managing relapses. It also helps us to reflect on our practice and to address these issues before discharging the patients to minimize the relapses.