Hindi Mental State Examination Research Articles

Prevalence of Cognitive impairment among community dwelling rural elderly of Bangalore, India

Background India is a greying population as the mortality and fertility rates are on a decline. Elderly proportion in India according to 2011 census is 8.1 and is expected to rise to 17 by the year 2025.The special features of Indian elderly population which is a challenge are a majority 80 of them being in the rural areas large percentage 30 being in below poverty line feminization of the elderly population and increase in the number of the oldest age group ge 80 years. Increasing age is associated with increasing disability and functional impairments such as cognitive impairment.Objectives The study was conducted in rural areas and aimed to assess the prevalence of cognitive impairment in the elderly.Methodology A cross sectional study among 222 elderly of 2 villages was done by House to House survey. Elderly identified were administered a questionnaire for assessment of demographic details health and function related information. Cognitive impairment was assessed using Hindi Mental Status Examination questionnaire. Information was entered into MS Excel and analysed using Epi info.Results 12.2 of the population was elderly persons in these two villages. Of the elderly 51 were females and 49 were males. Most of the elderly 16574.3 were illiterate. 40.5 of the elderly were dependent on others completely or partially financially. Significantly higher number of the elderly males 83.7 were married and living with their spouse compared to that of elderly females 35.5. 95.5 of the elderly did not have any cognitive impairment and 4.5 of the elderly had cognitive impairment on assessment using Hindi Mental Status Examination HMSE.Conclusions Cognitive impairment among Indian rural elderly is low compared to that of western countries.

Effect of anaesthetic agents on olfactory threshold and identification - A single blinded randomised controlled study.

Background and Aims:Anaesthetics are implicated in cognitive dysfunction, taste and odour deficits in the postoperative period. We aimed to assess the effect of isoflurane, sevoflurane, propofol and regional anaesthesia on the olfactory threshold, olfactory identification and endocrine regulation of associative memory in the postoperative period.Methods:In this observer-blinded randomised controlled study, 164 patients (>50 years) with the American Society of Anesthesiologists I and II status were randomised into one of four groups to receive regional anaesthesia, general anaesthesia with sevoflurane, general anaesthesia with isoflurane and total intravenous anaesthesia with propofol. Hindi Mental State Examination, olfactory threshold and olfactory identification were tested at 12 h preoperatively (T0), at 3 h postoperatively (T1) and at the time of discharge or postoperative day 3 (T2). In addition, serum melatonin levels were estimated at T0 and T1. The olfactory threshold was tested with n-butyl alcohol and olfactory identification with the University of Pennsylvania Smell Identification Test (UPSIT). Data were analysed using the one-way analysis of variance, Kruskal-Wallis or Mann-whitney tests.Results:The olfactory identification scores were lower with patients receiving sevoflurane-based anaesthesia at 3 h postoperatively (T1) when compared to preoperative (T0) (median 19.5 vs. 22; P = 0.01). This was accompanied by a significant postoperative reduction of plasma melatonin levels in sevoflurane group when compared to other groups (17.34 ± 4.8 pg/ml vs 23.2 ± 3.5 pg/ml; P < 0.001).Conclusion:Sevoflurane was associated with short-term olfactory identification impairment with a concomitant reduction in melatonin levels illustrating a possible humoral mechanism.

Profiling the initial 1st Year cohort of patients utilizing a tertiary hospital-based geriatric mental health-care service using the “Service Evaluation Framework”

Background: Increase in life expectancy of Indians will require revamping the health-care infrastructure for the elderly. In India, either there are not too many specialized geriatric mental health services available across the country or those that are available have problems of resources and quality. With this perspective, the Department of Psychiatry, Government Medical College and Hospital, Chandigarh, developed the Geriatric Mental Health Clinic (GMHC) for the elderly residing in and around Chandigarh. The aim of the study was to study the initial 1-year cohort and assess their satisfaction levels as well as to see whether their functioning improves with the intervention so provided. Materials and Methods: Using the “service evaluation framework,” the patients and caregivers who attended the GMHC over a period of 1 year were evaluated using tools such as Hindi Mental State Examination (HMSE), Everyday Abilities Scale for India (EASI), Global Assessment of Function (GAF) scale, World Health Organization quality of life-BREF (WHO-QoL-BREF)-Hindi version, and Patient Satisfaction Scale (PAT-SAT). In addition, sociodemographic and clinical profile data of the service users were compiled. Results: A total of 105 cases formed the cohort under study, wherein 70% had functional psychiatric illness and almost more than half of the cases had comorbid physical illness, hypertension being the most common. GAF score of 45.42 and WHO-QoL-BREF score of 78.7 at the time of follow-up suggested that there was “slight impairment in socio-occupational functioning” and “poor QoL,” respectively. However, GAF and HMSE scores were significantly decreased in those with organicity. Overall service users reported good service-cum-clinician satisfaction scores on PAT-SAT; there was also significant reduction of EASI score from that of baseline, suggesting improvement in functioning. Conclusions: Findings show that the newly started GMHC, even though in its incipient stage, is attracting patients of all diagnostic categories, from expected catchment areas, is being able to deliver interventions which are bringing about clinical and functional improvement, and service users are not reporting dissatisfaction.

Validity and reliability of Montreal Cognitive Assessment and Its Comparison with the translated Hindi Mental Status Examination in a South Indian Geriatric Population

Introduction: Ever since the MMSE has been brought under exclusive copyright, there has been a search for an alternative test for routine bedside cognition testing. The Montreal Cognitive Assessment scale has been validated in several previous studies

Resolution of Cognitive Adverse Effects of Electroconvulsive Therapy in Persons with Schizophrenia: A Prospective Study.

Background:Cognitive impairments are among the most important adverse effects of electroconvulsive therapy (ECT). Although much is known about them in patients with depression, there is very little information about these in persons with schizophrenia.Methods:In this study, we examined the persistence of cognitive impairments in a subsample of patients (n = 49) with schizophrenia who had earlier participated in a clinical trial comparing the therapeutic and cognitive efficacy of bifrontal ECT (BFECT; n = 23) and bitemporal ECT (BTECT; n = 29) electrode placements. Total scores on Hindi Mental State Examination, processing speed, working memory, and verbal fluency were assessed in these patients at two points: first, at the end of their respective ECT course and at the follow-up (mean [standard deviation] = 98.7 [38.3] days). The course of cognitive impairments was assessed in all patients (n = 49) as a single group. Further, BFECT and BTECT patients were also compared with one another.Results:ECT-induced acute cognitive impairments in patients with schizophrenia had normalized by the end of 3 months’ follow-up post-ECT. All the tested parameters in the realm of Hindi Mental Status Examination, speed of processing, sequencing, spatial and working memory and verbal fluency showed recovery. Further, across all tests, BFECT and BTECT ultimately had similar scores at the follow-up though BFECT performed relatively better with regards to the acute effects. In fact, worst performing BTECT group caught up to recover to comparable levels of performance by the end of follow-up.Conclusions:In patients with schizophrenia, most of acute ECT-induced cognitive impairments recover by the end of 3 months’ post-ECT. Further, different electrode placements do not seem to make any difference regarding ultimate recovery of cognitive deficits. Future prospective studies are needed that could address the limitations of this study.

A STUDY OF GAIT AND FALLS IN OLDER INDIANS

Gait and balance changes with ageing and these changes predispose to falls. In this ongoing cross sectional study we are looking at the Gait and balance parameters in older adults and their association with falls. Gait parameters of ambulatory older patients (> 60 years) were assessed at their usual pace, using Biodex gait trainer-3, a validated electronic walkway.The patients also underwent comprehensive geriatric assessment and were further assessed for fall risk using the Tinetti POMA Scale .28 Subjects (22 males and 6 females) were included in this preliminary analysis. Mean age was 74.53(± 10.05) years. Mean (±SD) values of gait speed was 0.48metre/second (±0.17), Step Cycle time0.83 cycle/second,(±0.16), Stride Length (Right) 64.64 centimeter (±29.20),Stride Length (Left) 59.85 centimeter (+ 29.57).Around 1/5th of the patients had one or more indoor fall in past year and less than half(42.86%) also had Polypharmacy.The mean TUG score was 15.63 seconds (+ 5.08) and mean Performance Oriented Mobility Assessment score was 20.71(± 3.78). 20 subjects were having difficulty in balance and at risk of fall. The Hindi Mental State Examination score was 26.89 (±3.74) and 18 were Frail.This study group was having slow gait speed, low TUG score and polypharmacy which increases the risk of having a fall.

Use of Jonkman et al. Score for Visual Quantification of Electroencephalography as a Tool to Assess Disease Severity in Cortical Dementias.

Objectives:To study electroencephalography (EEG) changes in patients with cortical dementias (Alzheimer's disease [AD] and frontotemporal dementia (FTD). (1) To correlate EEG changes with clinical severity of dementia as assessed by rating scales. (2) To correlate global gray matter volume (GGMV) with EEG scores and clinical severity rating scales.Patients and Methods:This is a prospective cross-sectional study involving patients fulfilling the criteria for Probable AD and FTD. A total of thirty patients (20 = FTD, 10 = AD) underwent detailed neuropsychological evaluation, dementia rating scales, EEG, and magnetic resonance imaging. Five EEG parameters were acquired and each parameter is scaled and the total score was compared with neuropsychological parameters and GGMV.Results:For FTD, the mean age of patients was 58.85 ± 6.87, mean mini-mental state examination score was 13.30 ± 6.33, Hindi mental state examination: 14.35 ± 6.28, mean grant total EEG score (GTES): 7.80 ± 5.39, and mean GGMV: 464580.76 ± 52127 mm3 and for AD, the same were 69.50 ± 8.59, 12.90 ± 5.56, 14.20 ± 5.31, 9.80 ± 5.29, and 483208 ± 47371.5 mm3, respectively. GTES for mild, moderate, and severe FTD are 2.33 ± 1.528, 6.00 ± 3.162, and 10.70 ± 5.677 and for AD it is 4, 7.50 ± 4.041, 15 ± 1.414, respectively. The GGMV for mild, moderate, and severe FTD was 511836 ± 45005, 492693.1 ± 50624, and 430725 ± 30744 and for AD it is 527217.3 ± 36171, 503598 ± 3006, and 440812 ± 33911.Discussion:The most common EEG abnormalities in cortical dementias are reduced frequency of rhythmic background activity. There is a significant correlation between GTES and dementia severity and global gray matter volume but the proportional correlation with GTES and volumetric scores is not significant.Conclusion:EEG is a cheap and sensitive and easily available tool to assess disease severity in patients with cortical dementias and thus helps in planning the type of rehabilitatory interventions and prognostication.

Personality Traits in the Siblings and Children of Patients with Frontotemporal Dementia: A Questionnaire-based Study.

Introduction:Frontotemporal dementias (FLD) form a group of relatively young onset, male dominant dementias with significant behavioral abnormalities early in the course of the disease. Routine assessment suggested preexisting traits such as lack of empathy, self-directedness, and persistence in most of these persons even before the onset of disease. Hence, we decided the study, the siblings and children of patients for any specific traits and correlation with hexanucleotide expansion repeats if any traits were identified.Patients and Methods:A total of 35 age- and gender-matched cases and controls were included for the study as per criteria. They were screened for mental illness and cognitive dysfunction using Hindi Mental State Examination and Mini-mental State Examination. Eligible persons were given temperament and character inventory (TCI) scores for the recommended parameters. Hexanucleotide expansion was also studied in the patients, cases and controls.Results:No specific personality trait was found to have an increased correlation with siblings and children of patients with FLD in this small group using TCI scores.Conclusions:7% of cases showed Hexanucleotide expansion suggesting a possible risk. The role of self reporting bias resulting in normal personality trait needs to be addressed in future studies.

Assessment of Cognition and Quality of Life in Non-Hodgkin’s Lymphoma Patients One Year Post-Treatment

Objectives: An increasing number of patients with cancer are offered chemotherapy given either alone or in combination with radiotherapy, surgery, or both as neo-adjuvant, concomitant, or adjuvant treatment. Cognitive dysfunction is a prevalent side effect of cancer treatments that may persist for years following treatment and has negative impact on quality of life. Thus, the present study was planned to investigate the prevalence of cognitive impairment, assess the quality of life (QOL) and determine the socioeconomic status in NHL patients one year post chemotherapy treatment. Methods: This was an observational study. All the prospective participants were screened on the basis of inclusion and exclusion criteria and the participants who met all the study inclusion criteria and had none of the exclusion criteria were enrolled in the study. Cognitive function was evaluated using Mini Mental State Examination (MMSE) or Hindi Mental State Examination (HMSE), socioeconomic status was determined by Kuppuswamy scale and quality of life (QoL) was assessed by EORTC QLQ. Results: A total of 90 subjects (45 cases and 45 controls) were enrolled in the study. The control group scored more on MMSE/HMSE scale than the Non-Hodgkin’s Lymphoma (NHL) patient group, suggesting difference in cognitive functioning between the groups (26.6 ± 2.4 vs. 27.8 ± 2.1, p=0.019), respectively. Socio-economic status did not have any impact on the prevalence of cognitive impairment in NHL patients; however, NHL was found to be more prevalent in upper-middle class. No significant difference was found between case and control for QoL. Conclusion: Cognitive dysfunction is a prevalent side effect of cancer treatment that may persist for a year following treatment. Further studies are needed to clarify the effect on quality of life.

Association of Cognitive and Noncognitive Symptoms of Delirium: A Study from Consultation-liaison Psychiatry Set-up

Aims:This study aims to evaluate the cognitive functions of patients with delirium using Hindi Mental Status Examination (HMSE), to study the correlation of cognitive functions assessed by HMSE with noncognitive symptoms as assessed using Delirium Rating Scale-Revised 1998 (DRS-R-98) and to study the association of cognitive functions assessed using HMSE and DRS-R98.Methods:A total of 76 consecutive patients fulfilling the diagnosis of delirium were evaluated on DRS-R-98, HMSE, and Short Informant Questionnaire on Cognitive Decline in the Elderly (retrospective IQCODE).Results:The mean DRS-R-98 score 33.9 (standard deviation [SD] - 7.2) and the mean DRS-R-98 severity score was 25.9 (SD - 7.2). The mean score on HMSE was 19.3 (7.98). There were significant correlations of all the domains of HMSE with DRS-R-98 total score, DRS-R-98 severity score, DRS-R-98 cognitive subscale score, DRS-R-98 noncognitive domain subscale score, and DRS severity score without attention score. When the association of each item of DRS-R-98 and HMSE was evaluated, except for the items of delusions, lability of affect and motor retardation, there were significant negative association between all the items of DRS-R-98 and HMSE, indicating that higher severity of cognitive symptoms as assessed on HMSE is associated with higher severity of all the cognitive symptoms and most of the noncognitive symptoms as assessed by DRS-R-98.Conclusion:The present study suggests that attention deficits in patients with delirium influence the severity of cognitive and noncognitive symptoms of delirium. Further, the present study suggests an increase in the severity of cognitive symptoms in other domains is also associated with an increase in the severity of noncognitive symptoms of delirium.

Vertex-wise shape analysis of subcortical structures in Alzheimerʼs disease

Background: Most MRI studies in Alzheimer’s disease (AD) have focused on cortical and hippocampal atrophy. This study, however, examines regional volumetric and shape abnormalities of subcortical and limbic structures in AD. Methods: Thirty-six patients with AD and 36 matched controls were included in the study. All subjects were right-handed, evaluated using standard clinical assessment scales and genotyped at ApoE locus. Structural T1- weighted images were acquired using 3 Tesla MRI. Vertex-wise shape analysis was performed, with age, gender and total brain volume used as covariates of no interest. Data on the volumes of the hippocampus, amygdala, caudate, putamen and thalamus were statistically analyzed. Results: The bilateral hippocampus, amygdala, caudate, putamen and thalamus of AD patients were significantly lower in volume than controls. With respect to ApoE4 carrier status, there were no within-group volumetric differences in either AD or controls. Vertex-wise shape analysis of AD patients revealed significant surface reductions at the bilateral hippocampus, amygdala, caudate and putamen. No shape-wise difference was observed between ApoE4 carrier and non-carrier subjects in either group. Correlation analysis revealed a significant negative correlation between the Hindi mental status examination score, and shape analysis of atrophy of the hippocampus, caudate and putamen. Conclusions: Significant volume reductions and shape differences were observed in subcortical and limbic structures in AD patients. The observed atrophy of neocortical and deep grey matter structures in AD patients indicates ongoing degenerative processes in the amygdala, caudate and putamen – similar to the hippocampus – which may contribute to cognitive and/or other clinical features in AD.

Prevalence of dementia and other psychiatric morbidities among geriatric population of Salagame primary health centre in Hassan district, Karnataka, India

Background: Depression and dementia are mental health problems that are encountered in elderly in india. it is imperative for us to recognize these symptoms in elderly and treat them appropriately. Thus we intended to study the prevalence and risk factors of depression and dementia in geriatric population in selected field practice area of Hassan Medical College. Methods: A community based descriptive study was conducted among 231 individuals in geriatric age group aged 60 and above, over a period of 2 months. The sample size was estimated based on the prevalence of depression as 31% stated in one of the large community based study using similar scale. Geriatric Depression Scale-15 (GDS-15) was used to screen for depressive disorders and Barthel Index to grade their physical activity. Dementia among elderly was screened with a vernacular adaptation of the Hindi Mental State Examination tool (HMSE). Results: Among 231 individuals, 150 (64.93%) were females and 81 (35.06%) were males. 45.88% of them had no formal education. Among 231 elderly individuals, 13 cases of dementia were identified with a prevalence rate of 5.6%. Total prevalence of depression was found to be 60.17%. Higher prevalence of dementia was found in females (6.6%), age above 80 years (18.7%), unemployed and labourers (7.4%), illiterates (7.4%), low SES (6.5%) and dependents (7.5%). Conclusions: Depression and dementia are important health problems of the elderly population. Simple tools used in this study can be used at primary health care settings for early identification of dementia and depression in the elderly population.

Vitamin B12 deficiency: an important reversible co-morbidity in neuropsychiatric manifestations.

Background:Vitamin B12 deficiency is a common condition causing neurologic, cognitive, psychiatric, and mood symptoms. With varied religious, ethnic, and socioeconomic heterogeneity among the people in India greatly influencing their dietary habits and with the high prevalence of Helicobacter pylori infection, Vitamin B12 deficiency is not uncommon, but is often under recognized due to the lack of classical symptomatic presentation.Materials and Methods:Retrospective study on Vitamin B12 deficiency with neuropsychiatric symptoms in patients who attended neurology, psychiatry, and geriatric OPDs for a period of 1 year in a specialized neuropsychiatric institute in South India.Results:Out of 259 patients who had Vitamin B12 deficiency (<220 pmol/L), 60 had neuropsychiatric symptoms. Among them the Vitamin B12 levels were <150 (severe), 150-200 (moderate), and 201-220 pmol/L (mild) in 19, 24, 17 patients, respectively. Twenty one were diagnosed with Posterior dementias, 20 with frontotemporal dementia, 7 with Schizophrenia, 4 each with Parkinson's disease and alcohol-dependent syndromes (ADS), 3 with bipolar affective disorder, and 1 with Creutzfeldt-Jakob disease. Eight patients also had hypothyroidism. First symptom of presentation was behavioral disturbances in 30 (50%), memory loss in 20 (33.9%), and sensorimotor and movement disorders in 9 (15.3%), and 56.7% were vegetarians while 43.3% were nonvegetarians. In our study, Vitamin B12 deficiency was more prevalent in elderly males (56.67%) and was associated with increased severity of behavioral disturbances (P = 0.043) which was the most common presentation. Memory loss was present in 16 (84.2%) patients of severe Vitamin B12 deficiency. Hindi mental status examination (HMSE) score was graded as <20, 20-24, 24-31 in 37 (61.7%), 10 (16.7%), and 13 (21.7%) patients, respectively. Cognitive decline in Vitamin B12 deficiency was significantly associated with increased serum cholesterol (P = 0.019) and was significantly prevalent in neurological disorders when compared with primary psychiatric illnesses (P = 0.001). Mean folate and mean homocysteine in our study was 11.7 ± 6.44 ng/ml and 17.77 ± 5.45 μmol/L, respectively. Eighty percent of the population had normal folate levels whereas mean homocysteine values were much higher than that of the western population (10-12 μmol/L).Conclusion:Vitamin B12 deficiency though common in India is often overlooked. It increases the load of cognitive decline and accentuates vascular risk factors in neuropsychiatric illnesses. Vitamin B12 deficiency also increases homocysteine levels contributing to the vascular comorbidity in cerebro and cardiovascular illnesses. So prevention, early detection, and management of this reversible Vitamin B12 deficiency state is of profound importance.

Errors in conducting screening for mild cognitive impairment with Hindi mental state examination.

Errors in conducting screening for mild cognitive impairment with Hindi mental state examination.

Volumetric analysis of hippocampal sub-regions in late onset depression: A 3 tesla magnetic resonance imaging study

BackgroundWhile many studies have reported reduced volume of hippocampus in late onset depression (LOD), the status of hippocampus sub-regions (anterior/posterior) is yet to be explored. Evaluating hippocampal sub-regions might facilitate better elucidation of the neurobiological basis of LOD. MethodsTwenty five elderly subjects with LOD (mean age=65.28yr, SD=5.73, 15 females) and 20 healthy controls (mean age=65.35yr, SD=5.67, 7 females) were examined using 3-tesla magnetic resonance imaging (MRI). They were also evaluated with Montgomery Asberg Depression Rating Scale (MADRS) and Hindi Mental State Examination (HMSE). We examined the difference in volume of Hippocampal sub-regions between the LOD group and control group controlling for the age, sex and intracranial volume. ResultsLeft posterior hippocampus volume was significantly smaller in LOD group than the control group (1.01±0.19ml vs 1.16±0.25ml, F=7.50, p=0.009). There was a similar trend for the right posterior hippocampus (1.08±0.19ml vs 1.18±0.27ml, F=3.18, p=0.082). Depression severity (mean MADRS score=20.64±8.99) had a significant negative correlation with volumes of right posterior hippocampus (r=−0.37, p=0.012) and left posterior hippocampus (r=−0.46, p=0.001) in the LOD group. ConclusionsSpecific reduction of posterior hippocampus volume and its relationship with depression severity indicates sub region specific hippocampal volumetric abnormalities in LOD. Future studies need to evaluate sub region specific hippocampal volume in LOD longitudinally for better understanding of the pathogenesis of LOD in view of the functional differences between anterior and posterior hippocampus.

COMPARISON OF PERFORMANCE IN MINI-MENTAL STATE EXAMINATION (MMSE) AND MONTREAL COGNITIVE ASSESSMENT SCALE (MOCA) OF ELDERLY ENGAGED IN TAI CHI VERSUS AEROBIC PHYSICAL EXERCISE

Background: Persons with Dementia (PwD) in India are largely cared for at home by their families. Several studies from the west have established that in many respects the Quality of Life (QoL) of the caregiver is core of successful care giving. Since the perception of QoL varies across cultures, we aimed to study what aspects of caregiver and patient characteristics predicted QoL of caregivers India. Methods: 192 consecutive PwD and their primary caregivers were recruited. Socio demographic variables and QoL was assessed for caregivers of PwD, using WHO QOL (BREF version). The PwD were assessed using Hindi Mental Status Examination (HMSE), Everyday Ability Scale for India (EASI), Neuro Psychiatric Inventory (NPI), after confirming the diagnosis of Dementia (fulfilling ICD 10 diagnostic criteria), from the treating clinician at the Geriatric Clinic and Services, NIMHANS, and seeking informed consent. Appropriate statistical measures were used for analysis. Results: 122 (63%) of the caregivers were male, and 86 (45%) were spouses, the mean age and education of the caregiver was 48.2 616.2 years and 10.965.6 years respectively. There were no gender differences in the overall QoL. Spouses experienced poorer QoL (mean 78.16 14.5, f1⁄44.57**) than other relatives. Caregiver education was highly positively correlated with the overall QoL (r1⁄4.475**). The illness characteristics of patient (HMSE, EASI and NPI) were significantly highly correlated with overall QoL of the caregiver (r1⁄4 -.205**, -.237**, -.204** respectively)[note: **p<0.001]Conclusions: The results of the present study show that caregivers experienced poor QoL, especially the spouse and those caring severely ill patients. This poses a challenge to the health care professional of not only treating the illness but also providing adequate support to the caregiver. Currently in India, formal care services in public sector for Dementia care is scarce. Policy makers therefore, considering these implications should find strategies for scaling up more home based and community based supportive services for PwD and thus providing better QoL to the caregiver in sustaining long term care.

Age, education and gender effects on neuropsychological functions in healthy Indian older adults.

It is essential to use culturally appropriate, sensitive and specific tests that reflect true cognitive performance. However, several factors including age, education and gender can influence neuropsychological test performance.ObjectiveTo examine the effects of age, education and gender on neuropsychological function in older adults using measures of global cognitive screening, attention, working memory, executive functions, memory, construction, language and parietal focal signs.MethodsThis is a cross sectional normative study of 180 community-dwelling normal older adults. All participants were screened with the Hindi Mental Status Examination (HMSE), Everyday Activities Scale for India (EASI), Edinburgh handedness inventory (EDI) and MINI Screen, and followed by a detailed neuropsychological assessment.ResultsStepwise regression analysis revealed that education was associated with better performance on all the neuropsychological tests. Females performed significantly better on measures of memory. Further, most of the illiterate subjects, including low educated participants, refused to cooperate on measures of executive functioning.ConclusionEducation was found to be the strongest determinant of neuropsychological test performance followed by age and gender. Our study demonstrates that Indian healthy normal older adults with low education perform poorly on measures of planning and working memory. Traditional measures of planning and working memory should be avoided or used cautiously in the presence of low education. There is an urgent need to develop tasks for measuring executive functions, especially in low educated Indian older adults.

A Retrospective Study on Relation between Cognitive Performance and Lobar Perfusions of Brain in Alzheimer’s Dementia using Single Photon Emission Computer Tomography

Background and objectives: Alzheimer’s disease (AD) is a chronic neurodegenerative condition that progressively affects all cognitive domains. Patients with AD have been documented to have perfusion deficits. We aim to study the perfusion of lobes and its role in cognition among patients with AD. Methodology: Clinical data including cognitive scores on Hindi Mental Status Examination (HMSE) of 16 right handed patients with AD visiting geriatric clinic were recorded. Single Photon Emission Computer Tomography (SPECT) was acquired with standard protocol. Region of interest was applied at each of the frontal, temporal, parietal, occipital, cerebellar lobes to measure the regional perfusion. Results: Patients with AD aged 73.5 ± 8.5 years (6 males) with mean HMSE scores 11.69 ± 5.4 formed the study group. Left temporal lobe perfusion scores emerged as significant (p=0.04) predictor of cognitive scores in patients with AD. We observed a significant difference in perfusion between individual lobes within right hemisphere (p=0.003) and left hemisphere (p=0.009). Conclusion: In this sample of patients with AD we were able to demonstrate the differential pattern of brain perfusion within the intra-hemispheric lobes, possibly due to differential rate of degeneration. We were able to demonstrate a possible association between the left temporal lobe perfusion and cognitive scores in patients with AD.

Relationship of clinical and cognitive variables with brain morphometric abnormalities in Alzheimer's disease: a voxel based morphometric study using 3-tesla MRI.

Alzheimer's disease (AD) is associated with widespread structural and functional brain alterations. The current study examined the gray matter (GM) voxel based morphometric (VBM) correlates of cognitive and clinical severity scores in patients with AD. The study included 34 patients with AD according to NINCDS/ADRDA AD criteria and 28 matched elderly controls. All subjects were clinically evaluated using Hindi Mental Status Examination (HMSE), Everyday Abilities Scale for India (EASI) and the Clinical Dementia Rating (CDR) scale. The structural Magnetic Resonance Imaging (MRI) data were acquired using a 3 Tesla MRI scanner and VBM analysis was performed using VBM5.1 toolbox. The patients with AD had significantly lower GM volume, white matter volume and total brain volume as compared to controls. The HMSE scores were positively correlated (p=0.009) and EASI (p=0.04) & CDR (p=0.0004) were negatively correlated with the total GM volumes in patients with AD. The VBM analysis revealed diffuse GM atrophy in patients with AD. Frontal& temporal GM volumes were positively correlated with the HMSE scores. Thus the results of the study replicate the previous observations of generalized GM atrophy, in an Indian sample with AD. The cognitive decline, clinical dementia severity and impairment in activities of daily living were correlated whole brain GM and WM volumes as well as with specific brain regional atrophy in AD. However further studies with larger samples & with more detailed cognitive evaluation are required for confirmation & validation of the relationship between regional morphometric abnormalities and cognitive deficits in AD.

Prevalence and correlates of cognitive impairment in a north Indian elderly population.

Cognitive impairment, an age-related condition, is often considered a precursor to more serious diseases such as depression/dementia/Alzheimer's disease. Alzheimer's disease, which is characterized by cognitive impairment, could have a devastating impact on low- and middle-income countries whose populations are ageing rapidly. The disease has, so far, largely remained neglected by researchers and national health services in India. In view of the growing elderly population and diverse sociocultural and geographical milieu of India, epidemiological data for the condition are desirable for different populations. Moreover, there is a dearth of population-based epidemiological studies on cognitive impairment in the Punjab state of India. Three thousand and thirty-eight consenting elderly adults aged over 60 years, of both sexes, residing in Ludhiana, Punjab state, India were examined for cognitive functioning, using a modified Hindi Mental State Examination, and a score of ≤25 was considered to be indicative of cognitive impairment. Data analysis included calculations of proportions; odds ratio and their 95% confidence intervals (CIs) were also calculated. The chi-square test and multiple logistic regression model were used to determine the association of cognitive impairment with various sociodemographic parameters. The prevalence of cognitive impairment in the study population was 8.8% (95% CI = 8.06 to 9.54). Increasing age, unmarried/widowed status, illiteracy, unemployment and poverty were found to be independently associated with cognitive impairment. The prevalence of cognitive impairment in this north Indian population of elderly individuals is higher than that found in northern India. With emerging focus on geriatric health services, cognitive impairment, which is a precursor of Alzheimer's disease/dementias, needs to be included in priority care within the national primary health-care framework.