Hindi Mental State Examination Research Articles

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.

Priming 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. This 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 2weeks. 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 4weeks. Data 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. The findings of the study will give an insight to the possible role of priming to augment the effect of low-frequency rTMS in LLD.

Association between Hearing Loss and Dementia in Elderly

Background: Long standing hearing-loss often leads to the setting in of dementia as hearing-loss. In this study, elderly population were screened for hearing-loss and dementia using Hindi-Mental State Examination. Aims: To know the association between the dementia and Hearing loss Method 206 participants in the age group of 60-80 years (110 were females and 96 were males) were subjected to audiological evaluation and dementia screening using HMSE dementia scoring scale and it was compared with hearing level. Results: Out of 206 subjects, 110 were females and 96 were males. Right ear hearing-loss was seen in 147 cases and left ear in 130 cases. 48 individuals had no hearing-loss, 39 participants had unilateral hearing-loss and 119 participants had bilateral hearing-loss. Most common type of hearing-loss observed was mild hearing-loss 124 participants had no dementia, 82 had dementia. 60 had mild cognitive impairment and 22 had severe cognitive impairment. 49 out of 82 participants with dementia had bilateral hearing-loss. As the hearing handicap percentage increases from 1-100, dementia score decreases. But it was not statistically significant. More number of men were affected with hearing-loss but more number of female participants had dementia. Conclusion: Hearing-loss is more common in men in elderly population but dementia is more commonly seen in females.

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.

Discrepancy in Fluid and Crystallized Intelligence: An Early Cognitive Marker of Dementia from the LASI-DAD Cohort

Background: Cognitive aging is a complex phenomenon, which comprises various cognitive skills, broadly categorized into fluid and crystallized intelligence. Crystallized intelligence (gc) tends to be maintained, as opposed to fluid intelligence (gf), which tends to decline rapidly with age. The association of the two with cognitive decline remains a matter of conjecture requiring further research. Aim: The aim of the study was to identify the variables of gc and gf from a population data of Longitudinal Aging Study in India-Diagnostic Assessment of Dementia (LASI-DAD) study and investigate its relationship with the onset of cognitive impairment using discrepancy analysis against neuropsychological tests. Methods: This analysis of data from LASI-DAD study was carried out on a sample of 3,223 participants. They were assessed on extensive thirteen cognitive tests and one subjective test of cognition. Standardized score was used for discrepancy analysis. Fluid ability minus crystallized ability was used to assess the cognitive impairment. Any statistical significance with the score difference >0.99 SD was defined as a presence of cognitive decline. Hindi Mental Status Examination (HMSE) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) were used as gold standard. Results: With increased discrepancy score, each cognitive parameter score declined which was found to be statistically significant. In HMSE (Normal = 25.81 ± 3.39; Impaired = 23.17 ± 3.54; p = <0.001), there was a drop of 2 point scores in identifying cognitive impairment in the population sample as per the gold standard. A similar trend was evident in other neurocognitive domains as well. Conclusion: Crystallized-fluid intelligence discrepancy analysis has a strong potential in predicting the onset of cognitive decline ahead of time, facilitating early intervention.

The Assessment of Baseline Comprehensive Geriatric Assessment Parameters in Geriatric Patients With Varying Severity of Hyponatremia at a Tertiary Care Center.

Background and objectiveThe prevalence of hyponatremia is estimated to be significantly higher in the geriatric age group compared to non-geriatric patients. The clinical symptoms of hyponatremia are often subtle and interpreted as age-related in geriatric patients. In this study, we aimed to perform the baseline comprehensive geriatric assessment (CGA) among a group of geriatric population with hyponatremia.MethodsWe utilized four simple CGA parameters: the Hindi Mental State Examination (HMSE) to assess the cognition, the Barthel Index for Activities of Daily Living (ADL) for assessing the level of independence, the Timed Up and Go (TUG) test for risk of fall evaluation, and handgrip (HG) strength by hand dynamometer for frailty. All CGA parameters were analyzed at admission among 100 geriatric patients (>60 years old), and an assessment of their relationship with the severity of hyponatremia was done. An equal number of age-, comorbidity-, and reason for acute presentation-matched hyponatremic patients were enrolled as controls. The student’s t-test and analysis of variance (ANOVA) were used for evaluation. Ethical clearance was obtained from the Institutional Ethics Committee, All India Institute of Medical Sciences, Rishikesh, and informed consent from patients or next of kin was taken before enrollment.ResultsThe mean age of the study population was 68.1 ± 5.8 years, with a male-to-female ratio of 3:1. All CGA parameters tested showed lower values among hyponatremic patients compared to normonatremic patients, although only ADL (71.6 ± 12.3 vs. 76.7 ± 11.5, p=0.001) and HMSE (23.4 ± 3.1 vs. 24.4 ± 2.4, p=0.01) were statistically significant. All parameters were found to be worse in the severe group compared to moderate and mild groups, but significance was found only for TUG (17.9 ± 3.4 vs. 16.4 ± 4.2 vs. 14.6 ± 3.5, p=0.003, with higher values indicating worse status) and HMSE (21.1 ± 4.0 vs. 22.6 ± 2.8 vs. 24.1 ± 2.5, p=0.0007).ConclusionBased on our findings, hyponatremic patients have poor baseline CGA parameter values, and the severity of hyponatremia correlates with poor motor and cognitive functions. Hence, the prompt recognition and correction of hyponatremia should be prioritized in the elderly as both these parameters significantly impact the quality of life in this population. As the severity of hyponatremia increases, the elderly tend to have a higher incidence of the two main geriatric giants: impaired cognition and falls.

Impact of cognitive impairment on activities of daily living among older adults of North India.

Older persons are at risk of developing cognitive impairment, often considered a precursor to more severe conditions, such as dementia or Alzheimer's disease. Cognitive impairment among older adults is one of the most rapidly growing burdens, especially in developing countries. To assess the impact of cognitive impairment on activities of daily living (ADL) among older adults. A cross-sectional descriptive study was conducted among 135 older adults visiting a selected tertiary care centre in Uttarakhand (India) during December 2020, recruited using total enumerative sampling. Data were collected using standardized and validated tools that consisted of socio-demographic information, Hindi Mental Status Examination, and Everyday Abilities Scale for India. Data were analyzed using SPSS version 23, including descriptive (frequency, percentage, mean, and median) and inferential statistics (Chi-square test, binary logistic regression). The results with pooled analysis have shown that 30% of the older adults had mild cognitive impairment, 9% had moderate cognitive impairment, and 61% had normal cognition. About 16% of the older adults' ADL were affected. The statistically significant predictors for cognitive impairment were age group 80 years [odds ratio (OR) = 36.21; 95% confidence interval (CI) = 6.23-210.59], Muslim religion (OR = 6.26; 95% CI = 1.12-34.93), and middle-class families (OR = 11.95; 95% CI = 1.84-77.78). A considerably large proportion of the older adults had cognitive impairment, which further impacted activities of daily living. There is an urgent need to develop geriatric mental health services across all hospitals in the region.

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BACKGROUND :Diabetes Mellitus (DM) and depression share a bidirectional association- both influencing each other in multiple ways with depression increasing the risk of incidence of diabetes and diabetes increasing the risk of subsequent depression. Both diabetes and depression are associated with increased risk of cognitive decline. Less attention has been given to the effect of diabetes on cognitive function which is not a well-recognized complication of diabetes.AIMS:1.To assess the cognitive function in persons with Type 2 Diabetes Mellitus with depressive disorder and without Depressive Disorder.2.To assess the cognitive performance in a healthy control group and compare with the subjects with Type 2 Diabetes Mellitus with depressive disorder and without Depressive Disorder.METHODS:The present study is a cross-sectional observational study ,consisted of 3 study groups,patients with diabetes mellitus and depression (n = 35),only diabetes mellitus (n = 35) and healthy controls(n=35).Participants were assessed clinically and cognitively using the Mini International Neuropsychiatric Interview (6.0), Hamilton Depression Rating Scale(HAM-D) ,Global Assessment of Functioning Scale (GAF), Hindi Mental Status Examination (HMSE) , NIMHANS Neuropsychology Battery- 2004 and a questionnaire about sociodemographic data and were analysed across cognitivedomains of attention, speed, executive functioning, comprehension, visuospatial orientation, learning and memory.RESULTS :The study participants were of age between 18 to 60 years comprising of both male and female. The study showed that patients with both DM and depression had more cognitive dysfunction compared with the group who only had DM. The study also showed significant difference in the cognitive domains when compared between the control group and the DM with depression group. Also significant difference was found when compared between the control group and the DM only group.CONCLUSION :Multipronged interaction between depression and diabetes makes the management of these more challenging. Despite the close relationship between DM,depression and their synergistic effect on cognitive decline, the awareness amongst the medical professionals as well as the public seems to be minimal. Alleviating depressive symptoms in these patients has a positive impact on improving their cognitive, mental as well as physical functioning. Increased awareness about this and timely psychiatrist consultation would help in better care in these group of patients.

Naturalistic study of “Adherence to Follow-Up” in the initial 1st year cohort of patients utilizing a tertiary hospital-based geriatric mental health-care service using the “Service Evaluation Framework”

Background: There are very few specialised hospital with quality assurance services catering to the needs of the elderly with mental illness. The concept of 'Appointment adherence' has received little attention in the field of geriatric mental health from India. There is a need to study the pattern of 'drop-out' amongst geriatric patients. Method: An initial cohort of first 105 cases presenting to the clinic were followed up to explore their socio-demographic and clinical variables, overall functioning and satisfaction with the services. Adopting a 'naturalistic approach,' and using the 'service evaluation framework', at the assessment period of about 36 months, tools like socio-clinical profile, Hindi Mental State Examination (HMSE), Everyday Abilities Scale for India (EASI), Global Assessment of Function (GAF) scale, WHOQOL-BREF-Hindi version, Patient Satisfaction Scale (PAT-SAT) and 'Service Evaluation (SSS-16 and SSS-10 Practitioner Versions)' were administered. Result: 68 cases were available for assessment of functional outcome and satisfaction parameters were assessed for 78 of the cases. 75% had functional disorders and medical morbidity was present in more than 50% of cases. The mean score for WHOQOL-BREF and GAF were 44.4 (poor quality of life) and 72.91 (slight impairment in socio-occupational functioning) respectively. PAT-SAT score in all the sub-categories were above average. 'Organic' diagnosis patients had lower QoL on certain domains compared to 'functional' patients. Only 30.47% patients were coming for follow-up with 25.71% having died. Of the 32/68 (34.29%) cases who had dropped out, 50% were adherent to treatment in different ways. Additionally, GAF scores were lower in 'drop-out' group. Conclusions: There is a relatively high rate of 'drop-out' over a 3-year period. However, if patients keep coming for follow-up (i.e. do not 'drop-out'), they are more likely to show improvement in their level of social and occupational functioning.

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Depression has been linked to poor quality of life, pain and sleep parameters in several studies. Treatment of depression in patients with Chronic Kidney Disease is likely to improve depression and enhance quality of life, as also increasing length of life. Majority of psychotropic medications can be safely used in Chronic Kidney Disease population. Most of these drugs are fat soluble, cross blood brain barrier, non-dialyzable, metabolized in the liver and excreted through bile. Psychopharmacological trials with Escitalopram in patients with depressive disorder undergoing hemodialysis are in the form of case reports and case series. ESRD has minimal impact on clearance of Escitalopram.This study intended to study the efficacy and tolerability of Escitalopram in patients of CKD undergoing hemodialysis with Depressive disorder.The study included Chronic Kidney Disease patients with Major Depressive disorders undergoing Hemodialysis in Department of Nephrology, SDM College of Medical Sciences and Hospital, Dharwad.Patient with CKD having depressive disorder who are advised Escitalopram were evaluated for improvement in the symptoms and development of side effects, after the treatment course with Escitalopram in a dose ranging from 5-20 mg/day were studied on 4, 8, 12 weeks during their follow up administering Hindi Mental Status Examination (HMSE), Hamilton Depression Rating Scale (HAM-D), Global Assessment of Functioning Scale, Systematic Assessment for Treatment Emergent Events (SAFTEE SCALE), Epworth Sleepiness Scale, Pittsburgh Sleep Quality IndexThis resulted in significant reduction in symptomatology of depression with minimum tolerability issues

An exploratory study of caregiver burden amongst urban upper class adults in India during COVID‐19

BackgroundThe COVID pandemic has impacted caregivers of older adults globally and families have been wary of approaching hospitals due to increased risk of exposure. We explored reasons for help seeking and caregiver burden amongst a sample of consecutive urban upper class adults who approached a non‐hospital based organization providing elderly support in Delhi, India.MethodsA detailed assessment was carried out by trained care specialists using a clinical interview, Hindi Mental Status examination, evaluation of independence in activities of daily living and caregiver burden using the Zarit Burden Interview (ZBI). The assessment was conducted online or in person depending on comfort of the family. Descriptive analysis was carried out to understand the caregiver profile and reasons for seeking help.ResultsOf the 39 adults assessed, majority had a primary diagnosis of dementia (80%). 10% had other psychiatric illness and 10% other neurological illness. 87% families preferred an in person assessment, stating that an online assessment would not be possible with their family member. Primary caregivers were mostly female (80%) and older adults (46%). The main reason for seeking help was inability to manage challenging behaviors at home (97%), followed by concerns about increased cognitive impairments during COIVD (80%), mood related disturbances (41%) and difficulties with activities of daily living (41%). Assessment using ZBI revealed 82% primary caregivers experienced mild to moderate caregiver burden, however, they felt that they were doing their duty and none spontaneously reported a need to seek any form of support for themselves.ConclusionCurrently India does not have a public health system that supports dementia care and public awareness about management is limited. Our findings highlight that caregivers experience significant stress particularly managing challenging behaviors. Most caregivers are female older adults in whom caregiver burden may be more due to factors like role‐strain and limited independence. In absence of a supportive public health system, our findings also highlight the important role that non‐hospital based organizations play in bridging a gap for dementia care delivery, particularly during these COIVD times.

Role of transcranial direct current stimulation (TDCS) intervention on resting state functional connectivity in early Alzheimer’s disease

AbstractBackgroundWorking memory and executive function deficits are the characteristic features of Mild Cognitive Impairment and mild Alzheimer’s Disease (mild AD). Studies exploring the alterations in working memory and executive functions show disrupted functional connectivity in Dorsolateral Pre Frontal Cortices (DLPFC) and Angular Gyrus (AG). Transcranial direct current stimulation (tDCS), by stimulating these brain regions, can alter resting‐state functional connectivity (rs‐FC) and has emerged as a safe and non‐invasive technique that has the potential to enhance neuroplasticity and cognitive improvement.MethodWe investigated the effect of anodal stimulation at the left DLPFC and cathode placed at the right supra‐orbital area to observe the rsFC changes in patients with MCI and mild AD (n=12; Age=67.58 ± 8.59 years, Gender ratio 1:1, formal years of education= 14.58±3.55 years, Hindi mental Status examination=26.91±3.1), who attended the outpatient services of Geriatric Clinic and Services, after due approval from institute ethics committee NIMHANS. The resting‐state functional magnetic resonance imaging (rsfMRI) acquisitions were performed before and after the ten sessions of tDCS, each session lasting 20 minutes. Investigations were performed on subregions of DLPFC (left Superior Frontal Gyrus (LSFG), Right SFG, left Middle Frontal Gyrus (LMFG) and Right MFG) and Angular Gyrus (Right Angular Gyrus (RAG) and Left AG), chosen a priori as seeds for the seed based FC (sbFC) analysis after correcting for the influences of age and gender using CONN 18b toolbox. Spherical masks of size 5 mm diameter were also created for the above‐mentioned seeds.ResultThe pre‐post tDCS comparisons of sbFC showed significant (FDR; p&lt;0.05) reduction of rsFC in patients with MCI and mild AD at right supramarginal gyrus, right angular gyrus, right frontal pole (for Seed‐RAG, Voxel‐ whole brain), supramarginal gyrus (for Seed‐RAG, Voxel‐ RAG), and Middle Temporal gyrus, left Temporo‐Occipital part (for Seed‐ RSFG, Voxel‐ whole brain) as shown in Figure 1 a, b, and c respectively (Refer Table 1).ConclusionThe results support that anodal stimulation using tDCS at left DLPFC may lead to the reduction of aberrantly increased functional connectivity between brain regions involved in working memory and executive functions in MCI and mild AD.

Exploring the Serum Level of RE1 Silencing Transcription Factor in Alzheimer's Disease

Objectives The aim of this study was to evaluate the serum RE1 silencing transcription factor (REST) level in Alzheimer's disease (AD), mild cognitive impairment (MCI), and elderly controls by using surface plasmon resonance (SPR) technology. Materials and Methods In this case–control study of 133 subjects, 49 patients with AD, 49 patients with MCI, and 35 elderly controls were recruited. The REST protein concentrations were evaluated by SPR. The resonance unit for each sample was recorded and the concentration of serum REST of study group was derived from the standard curve. All the experiments were done in triplicates. Statistical analysis was done and p-value of &lt; 0.05 was considered as statistically significant. Results A significant difference was observed in the Montreal Cognitive Assessment score, Hindi Mental State Examination scale (HMSE) score education, disease duration, and gender among the groups. A significant (p&gt;0.0001) difference in the duration of disease between AD and MCI was observed. It was observed that the mean concentration of serum REST was not significantly (p = 0.266) different among the groups. Conclusion This study first time evaluated the serum levels of REST in AD, MCI and age-matched elderly controls. The rest levels were similar in all groups; however, it can provide a new direction to future blood-based biomarker studies of REST.

Cost of Illness of Major Neurocognitive Disorders in India.

Major neurocognitive disorders (major NCD) predominantly affect the elderly. Major NCD results in significant morbidity and socioeconomic burden. To estimate the individual cost of care of a person with major NCD according to disease severity and component costs. Fifty patients of major NCD with primary caregivers attending memory clinic of tertiary care center were included. A detailed questionnaire administered after inclusion provided demographic and clinical information. Caregivers were interviewed about details of care provided. Cognitive function was assessed by Hindi mental state examination (HMSE), and major NCD severity was determined by clinical dementia rating scale (CDR). The annual cost of care per patient with mild to moderate and severe major MCD was INR 78288 and INR 167808, respectively. Costs increased with increasing severity of the disease. Direct nonmedical costs were significantly higher than direct medical costs in severe major NCD group and vice versa was found in mild to moderate major NCD group. Increasing population of elderly and prevalence of major NCD suggest an economic burden on caring families and hence the government. Comprehensive health policy toward providing affordable care to people with major NCD is the need of the hour.

Comparison Between Inflammatory Biomarkers (High-Sensitivity C-Reactive Protein and Neutrophil-Lymphocyte Ratio) and Psychological Morbidity in Suicide Attempt Survivors Brought to Medicine Emergency.

Objectives: This study aimed to compare inflammatory biomarkers (high-sensitivity {hs} C-reactive protein, neutrophil-lymphocyte ratio) and psychological morbidity in suicide attempt survivors.Methods: One hundred ninety-eight poisoning cases screened, 40 age-matched suicide attempt survivors (SAS), 40 healthy controls (HC) between the age of 18 years and 60 years were included. Complete hemogram, neutrophil-lymphocyte ratio (NLR), hsCRP values obtained, compared with Hospital Anxiety and Depression Scale (HADS), suicide intent scale, presumptive stressful life events scale (PSLES), general health questionnaire 12-item (GHQ-12) (Hindi version), and Hindi Mental State Examination (HMSE).Results: A statistically significant difference was observed in hsCRP (p=0.016) and NLR (p=0.029) of depressed-suicidal participants vs healthy controls. hsCRP values of anxious-suicidal subjects vs healthy controls showed a statistically significant difference (p=0.001). There was a statistically significant difference between patients, healthy controls in HADS anxiety and HADS depression mean scores (p<0.001). The PSLES items were ranked according to the mean stress scores of all the items (mean±SD), highest four were excessive alcohol use by the family member 47.50 (±27.03), conflicts with in-laws 50 (±27.73), family conflict 50 (±29.42), marital conflict 50.63 (±32.76). There was a statistically significant difference in hemoglobin (p<0.001), red blood cells count (p<0.001), hematocrit (p<0.001) between suicide attempt survivors and healthy controls.Conclusion: Both hsCRP and NLR have emerged as potential inflammatory biomarkers for depressive patients with suicidal attempts. Additionally, there may be a link between anemia and suicide risk in patients with depression.

IS THYROID ASSOCIATED WITH DEMENTIA? A CASE CONTROL STUDY

Objectives: The present study was undertaken with an objective to explore if thyroid is related to dementia among participants aged 45 years and above. Design: Participants aged more than 45 years of age, giving written informed consent and meeting the selection criteria were enrolled in the study. The participants were administered with a series of paper pencil tests. The data was further analyzed for any association using the Statistical Package for Social Sciences, version 22 (SPSS 22). Setting: Participants attending the Outpatient Department (OPD) at Institute of Human Behaviour and Allied sciences (IHBAS), a tertiary care neuropsychiatric hospital and normal elderly controls from local community. Participants: A sample size of at least 40 cases of Dementia of Alzheimer type and at least 40 cases of vascular/ mixed dementia and 60 normal controls were recruited. Measurements: Semi-structured Performa for demographic and clinical variables; Hindi mental status examination (HMSE) for cognitive functions was applied as screening tools for both case and control groups;Tools for patients with dementia: NINCDS-ADRDA criteria for Probable Alzheimer's disease (McKhann et al), NINDS /AIREN criteria for diagnosis of probable vascular dementia (VaD), NINDS-AIREN diagnostic criteria for “Alzheimer's disease with Cerebro-Vascular Disease” (mixed dementia), Clinical Dementia Rating Scale (Morris et al 1997), and 5 ml blood sample collection and analysis through vein puncture. Results: The results of the study indicate that subclinical hypothyroidism is associated with dementia of Alzheimer type. Conclusion: When considered in light with varied ndings of prior studies, it may be implied that subclinical thyroid dysfunction not especially hypo or hyperthyroidism is a risk for DAT.

Cognitive Impairment Among Older Adults With Diabetes Mellitus in Puducherry: A Community-Based Cross-Sectional Study.

BackgroundCognitive impairment is a global public health problem in the elderly population. There is increasing evidence that diabetes mellitus predisposes to cognitive impairment. Early diagnosis and management of cognitive impairment can delay the onset of dementia, thereby improving self-care and quality of life of diabetic patients. This study intends to assess cognitive impairment, and the factors influencing cognitive impairment among older adults with diabetes mellitus in Puducherry.MethodsA community-based cross-sectional study was conducted in field practice areas of a Government Medical College in Puducherry between April and June 2019. After obtaining ethical approval, 240 registered diabetic patients aged 55 years and above were randomly selected. Data on demographic profile and clinical variables were collected using a semi-structured questionnaire. Cognitive function was assessed using the Hindi Mental State Examination (HMSE) tool, and participants who scored below 26 were considered to have cognitive impairment.ResultsAmong 240 participants, 67.9% were aged 60 years and above, 62.5% were females, and 83.8% were unemployed. The proportion of cognitive impairment among older adults with diabetes was 30.0% (95% confidence interval (CI): 24.5-36.03). The mean ± standard deviation of the HMSE Score was 26.13 ± 3.8, and the median score was 27. Female gender (P= 0.02, adjusted prevalence ratio (aPR) = 5.31, 95% CI: 1.34-21), widowhood status (P= 0.005, aPR= 2.71, 95% CI: 1.34-5.46), illiteracy (P<0.001, aPR= 3.55, 95% CI: 1.78-7.07), and presence of probable symptomatic hypoglycemia (P=0.02, aPR= 2.18, 95% CI: 1.13-4.20) were significant predictors of cognitive impairment in the study population by multivariate analysis.ConclusionAlmost one-third of older adults with diabetes were found to be at risk of cognitive impairment. Older diabetic patients with identified risk factors may be prioritized for a screening of cognitive impairment at the primary care level.