Context: Elderly have increased risk for cognitive impairment and dementia. Yoga therapy may be helpful in elderly to improve cognitive function.
Aims: We examined the benefits of yoga-based ...intervention compared with waitlist control group on cognitive function in the residents of elderly homes.
Settings and Design: Single blind controlled study with block randomization of elderly homes.
Materials and Methods: Study sample included yoga group (n=62) and waitlist group (n=58). A total of 87 subjects (yoga=44, waitlist=43) completed the study period of 6 months. Yoga group received daily yoga sessions for 1 month, weekly until 3 rd month and encouraged to continue unsupervised until 6 months. They were assessed on Rey′s Auditory Verbal Learning Test (RAVLT), Rey′s complex figure test (CFT), Wechsler′s Memory Scale (WMS)-digit and spatial span, Controlled Oral Word Association (COWA) test, Stroop Color Word Interference Test and Trail Making Test A and B at baseline and at the end of 6 th month.
Statistical Analysis: Paired t-test and analysis of covariance (ANCOVA) to compare the difference in neuropsychological test scores.
Results: Yoga group showed significant improvement in immediate and delayed recall of verbal (RAVLT) and visual memory (CFT), attention and working memory (WMS-spatial span), verbal fluency (COWA), executive function (Stroop interference) and processing speed (Trail Making Test-A) than waitlist group at the end of 6 months after correcting for corresponding baseline score and education.
Conclusion: Yoga based-intervention appears beneficial to improve several domains of cognitive function in elderly living in residential care homes. Study findings need to be interpreted after considering methodological limitations like lack of active comparison group.
Context: Yoga as a life-style practice has demonstrated beneficial effects. The role of yoga in the elderly for such benefits merits investigation.
Aims: The aim of this study is to examine the ...effects of yoga intervention on quality-of-life (QOL) and sleep quality in the elderly living in old age homes.
Settings and Design: Single blind controlled study with block randomization of elderly homes.
Materials and Methods: A total of 120 subjects from nine elderly homes were randomized in to yoga group (n=62) and waitlist group (n=58). Subjects in the yoga group were given yoga intervention daily for 1 month and weekly until 3 months and were encouraged to practice yoga without supervision until for 6 months. Subjects in waitlist group received no intervention during this period. Subjects were evaluated with World Health Organization Quality of Life (WHOQOL)-BREF for measuring QOL and Pittsburgh Sleep Quality Index for sleep quality in the baseline and after 6 months.
Statistical Analysis: Independent t-test and repeated measures analysis of covariance respectively was used to measure the difference in outcome measures between the two groups at baseline and after the study period.
Results: Subjects in the yoga group had significantly higher number of years of formal education. Subjects in the yoga group had significant improvement in all the domains of QOL and total sleep quality after controlling for the effect of baseline difference in education between the two groups.
Conclusion: Yoga intervention appears to improve the QOL and sleep quality of elderly living in old age homes. There is a need for further studies overcoming the limitations in this study to confirm the benefits of yoga for elderly in QOL and sleep quality.
Though "Reversible" causes are less frequent, they carry good prognosis with prompt treatment of the underlying condition. ...the evaluation for all potentially reversible conditions which cause ...dementia syndrome is the first most important step in the assessment of dementia syndrome and this is essential in all cases presenting with features of dmentia. Specification of features for possible subtypes. Because of the possibility that subtypes exist, it is recommended that the following characteristics be ascertained as a basis for a further classification: age at onset; rate of progression; the configuration of the clinical features, particularly the relative prominence (or lack) of temporal, parietal or frontal lobe signs; any neuropathological or neurochemical abnormalities, and their pattern. Unequal distribution of deficits in higher cognitive functions, with some affected and others relatively spared. ...memory may be quite markedly affected while thinking, reasoning and information processing may show only mild decline. ...there has been very active global effort to develop effective disease modifying drug for Alzheimer's disease in the past decade.
There are more than 5 million people with dementia in India. Multicentre studies looking at details of treatment for people with dementia In India are lacking. Clinical audit is a quality improvement ...process which aims to systematically assess, evaluate, and improve patient care. Evaluating current practice is the key to a clinical audit cycle.
This study aimed to assess the diagnostic patterns and prescribing practices of psychiatrists for patients with dementia in India.
A retrospective case file study was conducted across several centers in India.
Information from the case records of 586 patients with dementia was obtained. Mean age of the patients was 71.14 years (standard deviation = 9.42). Three hundred twenty one (54.8%) were men. Alzheimer's disease (349; 59.6%) was the most frequent diagnosis followed by vascular dementia (117; 20%). Three hundred fifty five (60.6%) patients had medical disorders and 47.4% patients were taking medications for their medical conditions. Eighty one (69.2%) patients with vascular dementia had cardiovascular problems. Majority of the patients (524; 89.4%) were on medications for dementia. Most frequently prescribed treatment was Donepezil (230; 39.2%) followed by Donepezil-Memantine combination (225; 38.4%). Overall, 380 (64.8%) patients were on antipsychotics. Quetiapine (213, 36.3%) was the most frequently used antipsychotic. Overall, 113 (19.3%) patients were on antidepressants, 80 (13.7%) patients were on sedatives/hypnotics, and 16 (2.7%) patients were on mood stabilizers. Three hundred nineteen (55.4%) patients and caregivers of 374 (65%) patients were receiving psychosocial interventions.
Diagnostic and prescription patterns in dementia which emerged from this study are comparable to other studies both nationally and internationally. Comparing current practices at individual and national levels against accepted guidelines, obtaining feedback, identifying gaps and instituting remedial measures help to improve the standard of care provided.
Background
In 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).
Method
A 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).
Result
The 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.
References
Zarit, S. H., Bach‐Peterson, J., & Reever, K. E. (1980). Burden interview. The gerontologist.
Ganguli, M., Ratcliff, G., Chandra, V., Sharma, S., Gilby, J., Pandav, R., … & Dekosky, S. (1995). A Hindi version of the MMSE: the development of a cognitive screening instrument for a largely illiterate rural elderly population in India. International Journal of Geriatric Psychiatry, 10(5), 367‐377.
Abstract
Background
Stroke and cognitive impairment often co‐exist in older adults. Every one minute three people get stroke in India, who are potentially at risk for cognitive impairment. However ...the literature on this area is limited from India.The objective is study the cognitive impairment in older adults with arterial stroke. To study the relation between the cognitive impairment and disability.
Method
Sample includes patients above the age of 45 years with arterial stroke seeking treatment from NIMHANS outpatient departments. Ethical clearance was obtained. Patient underwent neurological examination. Standard instruments applied were Modified Rankin scale (MRS), Barthel index (BI), Stroke specific quality of life (SS‐QOL) and Addenbrooke’s cognitive examination (ACE‐III).
Results
100 stroke patients were recruited as per the inclusion criteria. The sample included 75% males (M:F‐ 3:1), with mean age of 63.98 (SD‐8.45) years. Among them majority were living with spouse (87%), from urban background (75%) and 52% had education of high school and above. Median duration of stroke at assessment was 5 months. The mean score on MRS, BI and SS‐QOL were 2.12 (SD‐1.13), 82.0 (18.64) and 180 (SD‐35.175)respectively. Among our patients 10% meets criteria for vascular dementia and 20% for mild cognitive impairment.On ACE‐III the mean score was 65.50 (SD‐17.72) with score on Attention‐13.21 (SD‐4.54), Memory‐15.11 (SD‐7.07), Fluency‐5.63 (SD‐3.174), Language‐19.92 (SD‐5.59),Visuo‐spatial‐9.69 (SD‐4.51). There was positive correlation between ACE‐ III scores and Barthel index (r= 0.526; p<0.001)and SS‐QOL (r=0.716; P<0.001).There was negative correlation between ACE‐III score and MRS (r= ‐ 0.599; p<0.001).
Conclusion
In our study, one‐third of sample had cognitive impairment, at 5 months (median) after stroke.The prevalence of post stroke cognitive impairment is on the lower side as compared to recent meta‐analysis (Barbay et al., 2018; Merriman et al., 2019) which could be due to inclusion of outpatient sample and time of assessment. Cognitive impairment has negative impact of functioning and quality of life in stroke patients which is in agreement with previous studies.
Background
Stroke and cognitive impairment often co‐exist in older adults. Every one minute three people get stroke in India, who are potentially at risk for cognitive impairment. However the ...literature on this area is limited from India.The objective is study the cognitive impairment in older adults with arterial stroke. To study the relation between the cognitive impairment and disability.
Method
Sample includes patients above the age of 45 years with arterial stroke seeking treatment from NIMHANS outpatient departments. Ethical clearance was obtained. Patient underwent neurological examination. Standard instruments applied were Modified Rankin scale (MRS), Barthel index (BI), Stroke specific quality of life (SS‐QOL) and Addenbrooke’s cognitive examination (ACE‐III).
Results
100 stroke patients were recruited as per the inclusion criteria. The sample included 75% males (M:F‐ 3:1), with mean age of 63.98 (SD‐8.45) years. Among them majority were living with spouse (87%), from urban background (75%) and 52% had education of high school and above. Median duration of stroke at assessment was 5 months. The mean score on MRS, BI and SS‐QOL were 2.12 (SD‐1.13), 82.0 (18.64) and 180 (SD‐35.175)respectively. Among our patients 10% meets criteria for vascular dementia and 20% for mild cognitive impairment.On ACE‐III the mean score was 65.50 (SD‐17.72) with score on Attention‐13.21 (SD‐4.54), Memory‐15.11 (SD‐7.07), Fluency‐5.63 (SD‐3.174), Language‐19.92 (SD‐5.59),Visuo‐spatial‐9.69 (SD‐4.51). There was positive correlation between ACE‐ III scores and Barthel index (r= 0.526; p<0.001)and SS‐QOL (r=0.716; P<0.001).There was negative correlation between ACE‐III score and MRS (r= ‐ 0.599; p<0.001).
Conclusion
In our study, one‐third of sample had cognitive impairment, at 5 months (median) after stroke.The prevalence of post stroke cognitive impairment is on the lower side as compared to recent meta‐analysis (Barbay et al., 2018; Merriman et al., 2019) which could be due to inclusion of outpatient sample and time of assessment. Cognitive impairment has negative impact of functioning and quality of life in stroke patients which is in agreement with previous studies.
Background
Transcranial direct current stimulation (tDCS) is a safe non‐invasive brain stimulation (NIBS) procedure which helps to stimulate a particular region of interest by modulating the neuronal ...firing rate, thereby modulating the cognitive functioning. The tDCS intervention is known to show improvement on memory recall and recognition in patients with mild cognitive impairment (MCI) and mild Alzheimer’s Disease (mild AD)
Method
We investigated the effect of anodal stimulation at the left dorsolateral prefrontal cortex (DLPFC) and cathodal stimulation at the right supra‐orbital area in patients with MCI (n = 18) and mild AD (n = 20) (Refer Table 1), after due approval from Institute Ethics Committee NIMHANS. Both baseline and post‐intervention assessments for a single patient were administered by the different assessors allocated randomly using NIMHANS neuropsychological battery for elderly (NNB‐E). Two resting state functional magnetic resonance imaging (rsfMRI) acquisitions, before and after the ten sessions of tDCS, each session lasting 20 minutes. A spherical mask of 5 mm diameter was chosen a priori on the left middle frontal gyrus (LMFG) as a seed for performing seed based functional connectivity (sbFC) analysis using default preprocessing pipeline and pre‐post analysis setup in CONN 18b toolbox.
Result
The combined sample of patients with MCI and mild AD showed significant improvement in word list learning trial 3 (pre tDCS 5.85 (1.59); post tDCS 6.63 (1.67); Z = 3.586, p<0.0001) and delayed recall (pre tDCS 1.50 (1.88); post tDCS 2.45 (2.33); Z = 3.656, p<0.0001) scores using NNB‐E. The sbFC analysis showed significantly reduced functional connectivity between left MFG (the region of anodal stimulation) and posterior cingulate cortex (PCC) as well as precuneus cortex (cluster‐level extent threshold p‐FDR <0.05) after tDCS. Post‐hoc tests showed that these reductions after tDCS intervention were also found to be significantly associated with attention and auditory verbal learning memory scores (Refer Figure 1 and Table 2).
Conclusion
The tDCS intervention helped reducing the functional connectivity at rest, which was responsible for compensatory neuronal processes found in early AD. These findings unravel the therapeutic role of tDCS by enhancing auditory verbal memory performance and altering the functional connectivity at PCC and precuneus cortex in earlier stages of AD.
Background
Vascular dementia (VaD) is the second most common dementia in elderly and the major contributor being Cerebral Small Vessel Disease (SVD) which has radiological manifestations of White ...Matter Hyperintensities(WMH), Cerebral Microbleeds and Lacunar infarcts. This study looks into the role of clinico‐demographic profile, genetic factors in terms of Apo E4 status and neuropsychological characteristics in predicting the course and outcome in patients with Subcortical VaD.
Method
A prospective cohort study involving 202 patients who were followed up at baseline and subsequently after 1 and 2 years’ time intervals following informed consent and IEC approval with attempt to understand the role of APOE4 positive status as a predictor for cognitive decline. Comparison of Neuropsychological test performance with ANOVA, regression analysis and survival analysis by plotting Kaplan Meier’s curve was done using SPSS v.21.
Result
The major risk factor identified was Hypertension in 92% followed by smoking in 76% and low socioeconomic status in 56% patients. 35.7% of the population had an APO E4 allele positivity. Regression analysis done showed APO E4 positive status as a significant independent predictor of poorer performance in neuropsychological test scores across time periods. However, survival analysis utilizing Kaplan Meir’s plot showed that unlike smoking and WMH (Odds ratio : 2.62) which increased mortality rates more than twofold, APO E4 did not contribute to increased mortality.
Conclusion
This study comprehensively looks into the role of APO E4 in VaD and identifies need for prevention of modifiable risk factors like smoking, hypertension, low SES, poor cognitive reserves and WMH which predicts cognitive decline in subcortical VaD and lead to early mortality in patients with VaD. Positive APO E4 allele status significantly affects performance in cognitive assessments but does not appear to predict mortality and hence risk modification needs to be tailored in patients with VaD.
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