This open access book takes a multidisciplinary approach to provide a holistic understanding of late old age, and situates the aged person within the context of family, caregivers, clinical and other ...institutions. All through the book, the author discusses preparedness for an aging individual as well as the society in the Indian context. The book highlights inevitable but mostly neglected health issues like depression, dementia, fall, and frailty and provides detailed analyses of solutions that are practicable in low resource settings. It also brings up intergenerational differences and harmony in the context of holistic care of older Indians. Alongside clinical perspectives, the book uses narratives of elderly patients to dwell on the myriad of problems and issues that constitute old age healthcare. Demonstrating cases that range from the most influential to the most underprivileged elderly in India, the book enlightens multiple caregivers—doctors, nurses, and professional caregivers as well as family members—about the dynamic approach required in dealing with complex issues related to late old age. The narratives make the book relatable and interesting to non-academic readers, with important lessons for gerontological and geriatric caregiving. It is also of use to older adults in preparing for active aging.
Alzheimer’s disease (AD) is an accelerating neurodegenerative disorder. Dysfunction of mitochondria and oxidative stress contributes to the pathogenesis of AD. Sirtuins play a role in this pathway ...and can be a potential marker to study neurodegenerative changes. This study evaluated serum levels of all seven sirtuin (SIRT1–SIRT7) proteins in three study groups: AD, mild cognitive impairment (MCI) and geriatric control (GC) by surface plasmon resonance (SPR) technique. Further, it was validated by the Western blot experiment. ROC analysis was performed to differentiate the study group based on the concentration of serum SIRT proteins. Out of seven sirtuins, serum SIRT1, SIRT3 and SIRT6 levels (mean ± SD) were significantly decreased in AD (1.65 ± 0.56, 3.15 ± 0.28, 3.36 ± 0.32 ng/µl), compared to MCI (2.17 ± 0.39, 3.60 ± 0.51, 3.73 ± 0.48 ng/µl) and GC (2.84 ± 0.47, 4.55 ± 0.48, 4.65 ± 0.55 ng/µl). ROC analysis showed the cut-off value with high sensitivity and specificity for cognitive impairment (AD and MCI). The concentration declined significantly with the disease progression. No specific difference was observed in the case of other SIRTs between the study groups. This study reveals an inverse relation of serum SIRT1, SIRT3 and SIRT6 concentration with AD. ROC analysis showed that these serum proteins have greater accuracy in diagnosing of AD. This is the first report of estimation of all seven serum sirtuins and the clinical relevance of SIRT3 and SIRT6 as serum protein markers for AD.
Introduction This study was aimed to investigate the effect of multimodal intervention on the cognitive functions of older adults with subjective cognitive impairment (SCI). Materials and methods ...Sixty subjects were randomized 1:1:1:1 to receive either computer based cognitive therapy (CBCT) or CBCT+Mediterranean equivalent diet (MED) or CBCT+MED+ Exercise regime and the control group. The intervention group received supervised CBCT twice a week to have 40 sessions, each of 40 minutes duration, and/ or supervised aerobic and resistive exercise twice a week for 24 weeks and or MED at home under the supervision of a dietician. The control group was provided with health awareness instructions for brain stimulating activities such as sudoku, mental maths, and learning music and new skills. Results Cognitive functions which was the primary outcome measure were assessed using the Post Graduate Institute Memory Scale (PGI-MS), and Stroop Colour and Word Test at baseline and after 6 months intervention period. As assessed by the PGI-MS, there was significant improvement in domains such as mental balance, attention and concentration, delayed recall, immediate recall, verbal retention of dissimilar pairs, Visual retention, and total score both in the unimodal and multimodal intervention groups. However, the improvement was observed to be the highest in the multimodal intervention group as compared to unimodal group. All the participants completed the trial. Conclusion This pilot randomized control trial indicated that multimodal intervention could be an effective non-pharmacological intervention in individuals with SCI for improving their cognitive functions.
Water is the preferred cooling media in numerous industrial applications. Recirculating cooling water system with cooling tower is a common setup in thermal power plants, iron & steel plant, ...petroleum refinery and other industries. Cooling Tower working in the principle of evaporative cooling allows a small fraction of circulating water to pass into the vapour phase dissipating the thermal load from water as latent heat. As water molecule evaporates, concentration of dissolved species in circulating water build-up with consequence of deposition of scales like CaCO
3
, CaSO
4
inside heat-exchanging equipment. Scaling is the biggest danger for heat transfer process. The preventive mechanism is to discharge a portion of cooling water termed as “blow-down” along with dosing of scale inhibiting chemical in the circulating water. The blow-down constitutes a major portion of the total makeup water demand of the cooling water circuit. The current article demonstrates an innovative scheme of ion-exchange based side-stream softening treatment (3ST) for a small fraction (~ 1%) of circulating water is capable of reducing blow-down quantity significantly with simultaneous reduction of scale-formation possibility. While reduction in blow-down helps conservation of water, additional benefits are lower scale problems and better equipment (Heat exchangers, pipes) health, and a possible reduction in dosing of scale inhibiting chemical. From theoretical viewpoint with 3ST technique, a close approach to “zero blow-down” is possible with negligible quantity of forced blow-down in the form of drift loss.
Introduction
This study was aimed to investigate the effect of multimodal intervention on the cognitive functions of older adults with subjective cognitive impairment (SCI).
Materials and methods
...Sixty subjects were randomized 1:1:1:1 to receive either computer based cognitive therapy (CBCT) or CBCT+Mediterranean equivalent diet (MED) or CBCT+MED+ Exercise regime and the control group. The intervention group received supervised CBCT twice a week to have 40 sessions, each of 40 minutes duration, and/ or supervised aerobic and resistive exercise twice a week for 24 weeks and or MED at home under the supervision of a dietician. The control group was provided with health awareness instructions for brain stimulating activities such as sudoku, mental maths, and learning music and new skills.
Results
Cognitive functions which was the primary outcome measure were assessed using the Post Graduate Institute Memory Scale (PGI-MS), and Stroop Colour and Word Test at baseline and after 6 months intervention period. As assessed by the PGI-MS, there was significant improvement in domains such as mental balance, attention and concentration, delayed recall, immediate recall, verbal retention of dissimilar pairs, Visual retention, and total score both in the unimodal and multimodal intervention groups. However, the improvement was observed to be the highest in the multimodal intervention group as compared to unimodal group. All the participants completed the trial.
Conclusion
This pilot randomized control trial indicated that multimodal intervention could be an effective non-pharmacological intervention in individuals with SCI for improving their cognitive functions.
Metal oxide nanoparticles such as oxides of Fe(III), Zr(IV), Ti(IV), and Al(III) are environmentally benign and exhibit amphoteric sorption behaviors. Depending upon the pH, they can act like Lewis ...acids (electron acceptors) or bases (electron donors). Thus, they are capable of binding transition metal cations such as Cu2+, Pb2+, Zn2+ and Ni2+, and anionic ligands such as arsenate and phosphate. Because sorption sites reside predominantly on the surface, the metal oxides offer very high specific sorption capacity at nanoscale sizes due to their high surface area-to-volume ratio. However, poor hydraulic and mechanical properties of these nanoparticles make them unsuitable for practical application in fixed-bed columnar configuration or in any flow-through system like reactive permeable barriers. Dispersal of the nanoparticles inside a functionalized polymer like ion exchange resins renders favorable hydraulic property. It also opens up a new possibility of controlling the behavior of the hybrid nanocomposite by synergistically enhancing or altering the adsorption capabilities for different toxic metal cations and anionic ligands. The Donnan membrane effect which arises out of non-diffusibility of the fixed functional groups covalently attached to the matrix of the ion exchanger can be intelligently used to design hybrid ion exchangers dispersed with metal oxide nanoparticles to suit different environmental applications. Encapsulation of the metal oxide nanoparticles also makes the nanocomposite regenerable. Apart from their application in sorption processes for removal of environmental contaminants, the hybrid nanocomposite also helps to avoid interference of phosphate and natural organic matter (NOM), in a process that, in conjunction with another hybrid material, enables for cost-effective real-time sensing of trace toxic metals in natural waters using pH as a surrogate parameter.
Mild Behavioural Impairment (MBI), an "at risk" state for incident cognitive declin, is characterized by late onset, sustained neuropsychiatric symptoms of any severity which cannot be accounted for ...by other formal medical and psychiatric nosology. There is no study related to MBI from India.
In this cross-sectional observational study 124 subjects 60 years and above were recruited between March 2017 to October 2018, from memory clinic of department of Geriatric medicine with memory or behavioural complains. Subjects with major neurocognitive impairment (CDR score of 1 or more), major depressive disorder, generalized anxiety disorder and impaired activities of daily living (ADL) were excluded. Subjects with Mild Cognitive impairment (MCI) (CDR- 0.5), and Subjective cognitive impairment (SCI) (CDR- 0) were included. Neuropsychiatric Inventory Questionnaire (NPI-Q) was used to identify the presence of NPS. The ISTAART-MBI (International Society of Advance Alzheimer's Research and Treatment-Alzheimer's Association) diagnostic criteria was used to diagnose MBI. All the participants underwent a geriatric assessment using standardised screening. The objectives of this study was to determine the frequency of mild behavioural impairment (MBI), and its domains, in MCI or SCI and its association with comorbidities and geriatric syndromes. The mean age of the participants was 69.21, 71.77% (89) were male and 28.23% (35) were female. 41.13% (51) of these individuals were diagnosed with MBI. The MBI and non MBI group differed significantly in marital status, cognitive status and MCI subtype. The proportion of domains involved are as follows: decreased motivation 60.78%(31), emotional dysregulation 54.90% (28), impulse dyscontrol 68.63% (35), social inappropriateness 21.57%(11), abnormal perception 2 (3.93%). Presence of multi-morbidity, and diabetes, were statistically significant between the groups.
This study presents the first clinic-based prevalence estimates of MBI from Asia. Findings indicate a relatively high prevalence of MBI in predementia clinical states, impulse dyscontrol was the most commonly involved MBI domain. Multimorbidity, diabetes, urinary incontinence were other determinants of MBI.
Background Alzheimer's disease (AD) is a neurodegenerative disease characterized by Abeta plaques and neurofibrillary tangles. Chronic inflammation and synaptic dysfunction lead to disease ...progression and cognitive decline. Small extracellular vesicles (sEVs) are implicated in AD progression by facilitating the spread of pathological proteins and inflammatory cytokines. This study investigates synaptic dysfunction and neuroinflammation protein markers in plasma-derived sEVs (PsEVs), their association with Amyloid-beta and tau pathologies, and their correlation with AD progression. Methods A total of 90 AD = 35, mild cognitive impairment (MCI) = 25, and healthy age-matched controls (AMC) = 30 participants were recruited. PsEVs were isolated using a chemical precipitation method, and their morphology was characterized by transmission electron microscopy. Using nanoparticle tracking analysis, the size and concentration of PsEVs were determined. Antibody-based validation of PsEVs was done using CD63, CD81, TSG101, and L1CAM antibodies. Synaptic dysfunction and neuroinflammation were evaluated with synaptophysin, TNF-alpha, IL-1beta, and GFAP antibodies. AD-specific markers, amyloid-beta (1-42), and p-Tau were examined within PsEVs using Western blot and ELISA. Results Our findings reveal higher concentrations of PsEVs in AD and MCI compared to AMC (p < 0.0001). Amyloid-beta (1-42) expression within PsEVs is significantly elevated in MCI and AD compared to AMC. We could also differentiate between the amyloid-beta (1-42) expression in AD and MCI. Similarly, PsEVs-derived p-Tau exhibited elevated expression in MCI compared with AMC, which is further increased in AD. Synaptophysin exhibited downregulated expression in PsEVs from MCI to AD (p = 0.047) compared to AMC, whereas IL-1beta, TNF-alpha, and GFAP showed increased expression in MCI and AD compared to AMC. The correlation between the neuropsychological tests and PsEVs-derived proteins (which included markers for synaptic integrity, neuroinflammation, and disease pathology) was also performed in our study. The increased number of PsEVs correlates with disease pathological markers, synaptic dysfunction, and neuroinflammation. Conclusions Elevated PsEVs, upregulated amyloid-beta (1-42), and p-Tau expression show high diagnostic accuracy in AD. The downregulated synaptophysin expression and upregulated neuroinflammatory markers in AD and MCI patients suggest potential synaptic degeneration and neuroinflammation. These findings support the potential of PsEV-associated biomarkers for AD diagnosis and highlight synaptic dysfunction and neuroinflammation in disease progression. Keywords: Alzheimer's disease, Mild cognitive impairment, Small extracellular vesicles, Synaptic dysfunction, Neuroinflammation
Limb‐girdle muscular dystrophy is a genetic disorder usually presenting in younger age patients. This case report presents a case of late‐onset limb‐girdle muscular dystrophy type R1 (Calpainopathy) ...in a 65 year old patient.
ObjectivesSince the onset of the COVID-19 pandemic, behavioural interventions to reduce disease transmission have been central to public health policy worldwide. Sustaining individual protective ...behaviour is especially important in low-income and middle-income settings, where health systems have fewer resources and access to vaccination is limited. This study seeks to assess time trends in COVID-19 protective behaviour in India.DesignNationally representative, panel-based, longitudinal study.SettingWe conducted a panel survey of Indian households to understand how the adoption of COVID-19 protective behaviours has changed over time. Our data span peaks and valleys of disease transmission over May–December 2020.ParticipantsRespondents included 3719 adults from 1766 Indian households enrolled in the Harmonised Diagnostic Assessment of Dementia for the Longitudinal Ageing Study in India.AnalysisWe used ordinary least squares regression analysis to quantify time trends in protective behaviours.ResultsWe find a 30.6 percentage point (95% CI (26.7 to 34.5); p<0.01) decline in protective behaviours related to social distancing over the observation period. Mask wearing and handwashing, in contrast, decreased by only 4.3 percentage points (95% CI (0.97 to 7.6); p<0.05) from a high base. Our conclusions are unchanged after adjusting for recorded COVID-19 caseload and nationwide COVID-19 containment policy; we also observe significant declines across socioeconomic strata spanning age, gender, education and urbanicity.ConclusionWe argue that these changes reflect, at least in part, ‘COVID-19 fatigue,’ where adherence to social distancing becomes more difficult over time irrespective of the surrounding disease environment.
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