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Kalaria R, Maestre G, Mahinrad S, Acosta DM, Akinyemi RO, Alladi S, Allegri RF, Arshad F, Babalola DO, Baiyewu O, Bak TH, Bellaj T, Brodie‐Mends DK, Carrillo MC, Celestin K, Damasceno A, de Silva RK, de Silva R, Djibuti M, Dreyer AJ, Ellajosyula R, Farombi TH, Friedland RP, Garza N, Gbessemehlan A, Georgiou EE, Govia I, Grinberg LT, Guerchet M, Gugssa SA, Gumikiriza‐Onoria JL, Hogervorst E, Hornberger M, Ibanez A, Ihara M, Issac TG, Jönsson L, Karanja WM, Lee JH, Leroi I, Livingston G, Manes FF, Mbakile‐Mahlanza L, Miller BL, Musyimi CW, Mutiso VN, Nakasujja N, Ndetei DM, Nightingale S, Novotni G, Nyamayaro P, Nyame S, Ogeng'o JA, Ogunniyi A, de Oliveira MO, Okubadejo NU, Orrell M, Paddick S, Pericak‐Vance MA, Pirtosek Z, Potocnik FCV, Raman R, Rizig M, Rosselli M, Salokhiddinov M, Satizabal CL, Sepulveda‐Falla D, Seshadri S, Sexton CE, Skoog I, George‐Hyslop PHS, Suemoto CK, Thapa P, Udeh‐Momoh CT, Valcour V, Vance JM, Varghese M, Vera JH, Walker RW, Zetterberg H, Zewde YZ, Ismail O. The 2022 symposium on dementia and brain aging in low- and middle-income countries: Highlights on research, diagnosis, care, and impact. Alzheimers Dement 2024; 20:4290-4314. [PMID: 38696263 PMCID: PMC11180946 DOI: 10.1002/alz.13836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 05/04/2024]
Abstract
Two of every three persons living with dementia reside in low- and middle-income countries (LMICs). The projected increase in global dementia rates is expected to affect LMICs disproportionately. However, the majority of global dementia care costs occur in high-income countries (HICs), with dementia research predominantly focusing on HICs. This imbalance necessitates LMIC-focused research to ensure that characterization of dementia accurately reflects the involvement and specificities of diverse populations. Development of effective preventive, diagnostic, and therapeutic approaches for dementia in LMICs requires targeted, personalized, and harmonized efforts. Our article represents timely discussions at the 2022 Symposium on Dementia and Brain Aging in LMICs that identified the foremost opportunities to advance dementia research, differential diagnosis, use of neuropsychometric tools, awareness, and treatment options. We highlight key topics discussed at the meeting and provide future recommendations to foster a more equitable landscape for dementia prevention, diagnosis, care, policy, and management in LMICs. HIGHLIGHTS: Two-thirds of persons with dementia live in LMICs, yet research and costs are skewed toward HICs. LMICs expect dementia prevalence to more than double, accompanied by socioeconomic disparities. The 2022 Symposium on Dementia in LMICs addressed advances in research, diagnosis, prevention, and policy. The Nairobi Declaration urges global action to enhance dementia outcomes in LMICs.
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Grants
- P30AG066506 National Institute of Aging (NIA)
- P01 HD035897 NICHD NIH HHS
- R13 AG066391 NIA NIH HHS
- International Society for Neurochemistry
- National Council for Scientific and Technological Development
- R01 AG075775 NIA NIH HHS
- Bluefield Project, the Olav Thon Foundation, the Erling-Persson Family Foundation, Stiftelsen för Gamla Tjänarinnor, Hjärnfonden, Sweden
- U19 AG074865 NIA NIH HHS
- UH3 NS100605 NINDS NIH HHS
- R01AG072547 Multi partner Consortium for Dementia Research in Latino America-Dominican Republic (LATAM-FINGERS)
- ASP/06/RE/2012/18 University of Sri Jayewardenepura, Sri Lanka
- D43 TW011532 FIC NIH HHS
- UF1 NS125513 NINDS NIH HHS
- 2019-02397 Swedish Research Council
- FLR/R1/191813 UK Royal Society/African Academy of Sciences
- R01 AG054076 NIA NIH HHS
- GOK: Government of Karnataka
- R56 AG074467 NIA NIH HHS
- R21 AG069252 NIA NIH HHS
- RF1 AG059421 NIA NIH HHS
- R56 AG061837 NIA NIH HHS
- Global Brain Health Institute (GBHI)
- 1R01AG068472-01 National Institute of Aging (NIA)
- FCG/R1/201034 UK Royal Society/African Academy of Sciences
- Appel à Projet des Equipes Émergentes et Labellisées scheme (APREL)
- Alzheimer's Drug Discovery Foundation (ADDF)
- R01 AG062588 NIA NIH HHS
- 1R01AG070883 University of Wisconsin, Madison
- U01 HG010273 NHGRI NIH HHS
- R25 TW011214 FIC NIH HHS
- ASP/06/RE/2013/28 University of Sri Jayewardenepura, Sri Lanka
- R01 AG052496 NIA NIH HHS
- R01 AG080468 NIA NIH HHS
- RBM: Rotary Bangalore Midtown
- U19 AG068054 NIA NIH HHS
- ADSF-21-831376-C Alzheimer Drug Discovery Foundation
- ADSF-21-831377-C Alzheimer Drug Discovery Foundation
- Canadian Institute of Health Research
- U19 AG078558 NIA NIH HHS
- 1P30AG066546-01A1 National Institutes of Health (NIH)
- RF1 AG059018 NIA NIH HHS
- National Research Foundation (NRF)
- P30 AG062422 NIA NIH HHS
- LSIPL: M/s Lowes Services India Private Limited
- UKDRI-1003 UK Dementia Research Institute at UCL
- U19AG074865 Multi partner Consortium for Dementia Research in Latino America-Dominican Republic (LATAM-FINGERS)
- P01 AG019724 NIA NIH HHS
- National Institute for Health and Care Research, United Kingdom
- R01 AG066524 NIA NIH HHS
- RF1 AG063507 NIA NIH HHS
- WCUP/Ph.D./19B 2013 University of Sri Jayewardenepura (USJ), Sri Lanka
- WCUP/Ph.D./19/2013 University of Sri Jayewardenepura (USJ), Sri Lanka
- GBHI ALZ UK-21-724359 Pilot Award for Global Brain Health Leaders
- R01AG080468-01 National Institute of Aging (NIA)
- U01 AG058589 NIA NIH HHS
- R01 AG057234 NIA NIH HHS
- SP/CIN/2016/02) Ministry of Primary Industries, Sri Lanka
- R01 AG072547 NIA NIH HHS
- U01 AG051412 NIA NIH HHS
- P30 AG059305 NIA NIH HHS
- Alzheimer's Association, USA
- R35 AG072362 NIA NIH HHS
- R01 NS050915 NINDS NIH HHS
- P30 AG066546 NIA NIH HHS
- 2022-01018 Swedish Research Council
- U19 AG063893 NIA NIH HHS
- ALFGBG-71320 Swedish State Support for Clinical Research
- U01 AG052409 NIA NIH HHS
- 1R13AG066391-01 National Institutes of Health (NIH)
- R01 AG21051 NIH and the Fogarty International Center [FIC]
- DP1AG069870 National Institutes of Health (NIH)
- Marie Skłodowska-Curie
- U19 AG078109 NIA NIH HHS
- Chinese Neuroscience Society, China
- RF1 AG061872 NIA NIH HHS
- DP1 AG069870 NIA NIH HHS
- P30 AG066506 NIA NIH HHS
- Wellcome Trust
- U01HG010273 Multi partner Consortium for Dementia Research in Latino America-Dominican Republic (LATAM-FINGERS)
- JPND2021-00694 European Union Joint Programme - Neurodegenerative Disease Research
- ASP/06/RE/2010/07 University of Sri Jayewardenepura, Sri Lanka
- Rainwater Charitable Foundation - The Bluefield project to cure FTD, and Global Brain Health Institute
- 101053962 European Union's Horizon Europe
- R01 AG058464 NIA NIH HHS
- R01 AG068472 NIA NIH HHS
- Michael J. Fox Foundation for Parkinson's Research, USA
- UL1 TR001873 NCATS NIH HHS
- SG-21-814756 National Institutes of Health (NIH)
- 201809-2016862 Alzheimer Drug Discovery Foundation
- UK National Health Service, Newcastle University,
- R01 AG058918 NIA NIH HHS
- National Institute for Health and Care Research University College London Hospitals Biomedical Research Centre
- Wellcome Trust, UK
- ADSF-21-831381-C Alzheimer Drug Discovery Foundation
- Health Professionals Education Partnership Initiative Ethiopia
- ANR-09-MNPS-009-01 French National Research Agency
- R01 AG062562 NIA NIH HHS
- AXA Research Fund
- ICMR: Indian Council for Medical Research
- R01 AG070883 NIA NIH HHS
- International Society for Neurochemistry
- French National Research Agency
- AXA Research Fund
- National Center for Advancing Translational Sciences
- National Council for Scientific and Technological Development
- Swedish Research Council
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Affiliation(s)
- Raj Kalaria
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Gladys Maestre
- Departments of Neuroscience and Human GeneticsUniversity of Texas Rio Grande ValleyOne W. University BlvdBrownsvilleTexasUSA
| | - Simin Mahinrad
- Division of Medical and Scientific RelationsAlzheimer's AssociationChicagoIllinoisUSA
| | - Daisy M. Acosta
- Universidad Nacional Pedro Henriquez Urena (UNPHU)Santo DomingoDominican Republic
| | - Rufus Olusola Akinyemi
- Neuroscience and Ageing Research UnitInstitute for Advanced Medical Research and TrainingCollege of MedicineUniversity of IbadanIbadanOyoNigeria
| | - Suvarna Alladi
- Department of NeurologyNational Institute of Mental Health and NeurosciencesBengaluruKarnatakaIndia
| | - Ricardo F. Allegri
- Fleni Neurological InstituteBuenos AiresArgentina
- Department of NeurosciencesUniversidad de la Costa (CUC)BarranquillaColombia
| | - Faheem Arshad
- Department of NeurologyNational Institute of Mental Health and NeurosciencesBengaluruKarnatakaIndia
| | | | | | | | | | | | - Maria C. Carrillo
- Division of Medical and Scientific RelationsAlzheimer's AssociationChicagoIllinoisUSA
| | - Kaputu‐Kalala‐Malu Celestin
- Department of NeurologyCentre Neuropsychopathologique (CNPP)Kinshasa University Teaching HospitalUniversity of KinshasaKinshasaRepublic Democratic of the Congo
| | | | - Ranil Karunamuni de Silva
- Interdisciplinary Centre for Innovation in Biotechnology and NeuroscienceFaculty of Medical SciencesUniversity of Sri JayewardenepuraNugegodaSri Lanka
- Institute for Combinatorial Advanced Research and Education (KDU‐CARE)General Sir John Kotelawala Defence UniversityRatmalanaSri Lanka
| | - Rohan de Silva
- Reta Lila Weston Institute and Department of ClinicalMovement NeuroscienceUCL Queen Square Institute of NeurologyLondonUK
| | - Mamuka Djibuti
- Partnership for Research and Action for Health (PRAH)TbilisiGeorgia
| | | | - Ratnavalli Ellajosyula
- Cognitive Neurology ClinicManipal Hospitaland Annasawmy Mudaliar HospitalBengaluruKarnatakaIndia
- Manipal Academy of Higher Education (MAHE)ManipalKarnatakaIndia
| | | | | | - Noe Garza
- Department of Neuroscience and Human GeneticsUniversity of Texas Rio Grande ValleyHarlingenTexasUSA
| | - Antoine Gbessemehlan
- Inserm U1094, IRD U270University of LimogesCHU Limoges, EpiMaCT ‐ Epidemiology of Chronic Diseases in Tropical ZoneInstitute of Epidemiology and Tropical NeurologyOmegaHealthLimogesFrance
- Inserm, Bordeaux Population Health Research CenterUniversity of BordeauxBordeauxFrance
| | - Eliza Eleni‐Zacharoula Georgiou
- Department of PsychiatryPatras University General HospitalFaculty of Medicine, School of Health SciencesUniversity of PatrasPatrasGreece
| | - Ishtar Govia
- Caribbean Institute for Health ResearchThe University of the West Indies, JamaicaWest IndiesJamaica
- Institute for Global HealthUniversity College LondonLondonUK
| | - Lea T. Grinberg
- Department of Neurology and PathologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Department of PathologyUniversity of Sao PauloR. da Reitoria, R. Cidade UniversitáriaSão PauloSao PauloBrazil
| | - Maëlenn Guerchet
- Inserm U1094, IRD U270University of LimogesCHU Limoges, EpiMaCT ‐ Epidemiology of Chronic Diseases in Tropical ZoneInstitute of Epidemiology and Tropical NeurologyOmegaHealthLimogesFrance
| | - Seid Ali Gugssa
- Department of NeurologySchool of MedicineAddis Ababa UniversityAddis AbabaEthiopia
| | | | - Eef Hogervorst
- Loughborough UniversityLoughboroughUK
- Respati UniversityYogyakartaIndonesia
| | | | - Agustin Ibanez
- Latin American Institute for Brain Health (BrainLat)Universidad Adolfo IbanezPeñalolénSantiagoChile
- Global Brain Health Institute (GBHI)University California San Francisco (UCSF)San FranciscoCaliforniaUSA
- Global Brain Health Institute (GBHI)Trinity College DublinLloyd Building Trinity College DublinDublinIreland
- Cognitive Neuroscience Center (CNC)Universidad de San Andrés, and National Scientific and Technical Research Council (CONICET)VictoriaProvincia de Buenos AiresArgentina
| | - Masafumi Ihara
- Department of NeurologyNational Cerebral and Cardiovascular CenterSuitaOsakaJapan
| | - Thomas Gregor Issac
- Centre for Brain ResearchIndian Institute of Science (IISc)BengaluruKarnatakaIndia
| | - Linus Jönsson
- Department of NeurobiologyCare Science and Society, section for NeurogeriatricsKarolinska Institute, SolnavägenSolnaSweden
| | - Wambui M. Karanja
- Global Brain Health Institute (GBHI)Trinity College DublinLloyd Building Trinity College DublinDublinIreland
- Brain and Mind InstituteAga Khan UniversityNairobiKenya
| | - Joseph H. Lee
- Sergievsky CenterTaub Institute for Research on Alzheimer's Disease and the Aging BrainDepartments of Neurology and EpidemiologyColumbia UniversityNew YorkNew YorkUSA
| | - Iracema Leroi
- Global Brain Health Institute (GBHI)Trinity College DublinLloyd Building Trinity College DublinDublinIreland
| | | | - Facundo Francisco Manes
- Institute of Cognitive and Translational Neuroscience (INCYT)INECO FoundationFavaloro UniversityBuenos AiresArgentina
| | - Lingani Mbakile‐Mahlanza
- Global Brain Health Institute (GBHI)University California San Francisco (UCSF)San FranciscoCaliforniaUSA
- University of BotswanaGaboroneBotswana
| | - Bruce L. Miller
- Department of NeurologyMemory and Aging CenterUniversity of California San Francisco Weill Institute for NeurosciencesSan FranciscoCaliforniaUSA
| | | | - Victoria N. Mutiso
- Africa Mental Health Research and Training FoundationNairobiKenya
- Department of PsychiatryUniversity of NairobiNairobiKenya
- World Psychiatric Association Collaborating Centre for Research and TrainingNairobiKenya
| | | | - David M. Ndetei
- Africa Mental Health Research and Training FoundationNairobiKenya
- Department of PsychiatryUniversity of NairobiNairobiKenya
- World Psychiatric Association Collaborating Centre for Research and TrainingNairobiKenya
| | - Sam Nightingale
- Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
| | - Gabriela Novotni
- University Clinic of NeurologyMedical Faculty University Ss Cyril and Methodius Institute for Alzheimer's Disease and NeuroscienceSkopjeNorth Macedonia
| | - Primrose Nyamayaro
- Global Brain Health Institute (GBHI)Trinity College DublinLloyd Building Trinity College DublinDublinIreland
- Faculty of Medicine and Health SciencesUniversity of ZimbabweHarareZimbabwe
| | - Solomon Nyame
- Kintampo Health Research CentreGhana Health ServiceHospital RoadNear Kintampo‐north Municipal HospitalKintampoGhana
| | | | | | - Maira Okada de Oliveira
- Global Brain Health Institute (GBHI)University California San Francisco (UCSF)San FranciscoCaliforniaUSA
- Global Brain Health Institute (GBHI)Trinity College DublinLloyd Building Trinity College DublinDublinIreland
- Department of Psychiatry at Massachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
- Cognitive Neurology and Behavioral Unit (GNCC)University of Sao PauloR. da Reitoria, R. Cidade UniversitáriaSão PauloSao PauloBrazil
| | - Njideka U. Okubadejo
- Neurology UnitDepartment of MedicineFaculty of Clinical SciencesCollege of MedicineUniversity of LagosYabaLagosNigeria
| | - Martin Orrell
- Institute of Mental HealthUniversity of NottinghamNottinghamUK
| | - Stella‐Maria Paddick
- Newcastle UniversityNewcastle upon TyneUK
- Gateshead Health NHS Foundation TrustSheriff HillTyne and WearUK
| | - Margaret A. Pericak‐Vance
- John P Hussman Institute for Human GenomicsMiller School of MedicineUniversity of MiamiCoral GablesFloridaUSA
- Dr. John T Macdonald Foundation Department of Human GeneticsUniversity of Miami Miller School of MedicineCoral GablesFloridaUSA
| | - Zvezdan Pirtosek
- Faculty of MedicineUniversity Medical Centre LjubljanaLjubljanaSlovenia
| | - Felix Claude Victor Potocnik
- Old Age Psychiatry Unit, Depth PsychiatryStellenbosch UniversityWestern Cape, Stellenbosch CentralStellenboschSouth Africa
| | - Rema Raman
- Alzheimer's Therapeutic Research InstituteUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Mie Rizig
- Department of Neuromuscular DiseasesUCL Queen Square Institute of NeurologyQueen SquareLondonUK
| | - Mónica Rosselli
- Department of PsychologyCharles E. Schmidt College of ScienceFlorida Atlantic UniversityBoca RatonFloridaUSA
- Florida Alzheimer's Disease Research CenterGainesvilleFloridaUSA
| | | | - Claudia L. Satizabal
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative DiseasesUniversity of Texas Health Sciences CenterSan AntonioTexasUSA
- Department of NeurologyBoston University School of MedicineBostonMassachusettsUSA
- The Framingham Heart StudyFraminghamMassachusettsUSA
| | - Diego Sepulveda‐Falla
- Molecular Neuropathology of Alzheimer's DiseaseInstitute of NeuropathologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases and South Texas ADRCUT Health San AntonioSan AntonioTexasUSA
- University of Texas Health Sciences CenterSan AntonioTexasUSA
| | - Claire E. Sexton
- Division of Medical and Scientific RelationsAlzheimer's AssociationChicagoIllinoisUSA
| | - Ingmar Skoog
- Institute of Neuroscience and FysiologySahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Peter H. St George‐Hyslop
- Taub Institute for Research on Alzheimer's Disease and the Aging BrainDepartment of NeurologyColumbia University Irving Medical CenterNew YorkNew YorkUSA
- Cambridge Institute for Medical Research and Department of Clinical NeurosciencesSchool of Clinical MedicineUniversity of CambridgeAddenbrookes Biomedical CampusTrumpingtonCambridgeUK
- Department of Medicine (Neurology)Temerty Faculty of MedicineUniversity of Torontoand University Health Network27 King's College CirTorontoOntarioCanada
| | - Claudia Kimie Suemoto
- Division of GeriatricsUniversity of Sao Paulo Medical SchoolR. da Reitoria, R. Cidade UniversitáriaSão PauloSao PauloBrazil
| | - Prekshy Thapa
- Global Brain Health Institute (GBHI)Trinity College DublinLloyd Building Trinity College DublinDublinIreland
| | - Chinedu Theresa Udeh‐Momoh
- Global Brain Health Institute (GBHI)University California San Francisco (UCSF)San FranciscoCaliforniaUSA
- FINGERS Brain Health Institutec/o Stockholms SjukhemStockholmSweden
- Department of Epidemiology and PreventionWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
- Department of NeurobiologyCare Sciences and Society (NVS)Division of Clinical GeriatricsKarolinska Institute, SolnavägenSolnaSweden
- Imarisha Centre for Brain health and AgingBrain and Mind InstituteAga Khan UniversityNairobiKenya
| | - Victor Valcour
- Memory and Aging CenterDepartment of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Jeffery M. Vance
- John P Hussman Institute for Human GenomicsMiller School of MedicineUniversity of MiamiCoral GablesFloridaUSA
| | - Mathew Varghese
- St. John's Medical CollegeSarjapur ‐ Marathahalli Rd, beside Bank Of Baroda, John Nagar, KoramangalaBengaluruKarnatakaIndia
| | - Jaime H. Vera
- Department of Global Health and InfectionBrighton and Sussex Medical SchoolBrightonUK
| | - Richard W. Walker
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Henrik Zetterberg
- Department of Psychiatry and NeurochemistryInstitute of Neuroscience and Physiologythe Sahlgrenska Academy at the University of GothenburgGöteborgSweden
- Clinical Neurochemistry LaboratorySahlgrenska University HospitalMölndalSweden
- Department of Neurodegenerative DiseaseUCL Institute of NeurologyQueen Square, Queen SquareLondonUK
- UK Dementia Research Institute at UCLUniversity College LondonLondonUK
- Hong Kong Center for Neurodegenerative DiseasesClear Water BayHong KongChina
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Yared Z. Zewde
- Department of NeurologySchool of MedicineAddis Ababa UniversityAddis AbabaEthiopia
| | - Ozama Ismail
- Division of Medical and Scientific RelationsAlzheimer's AssociationChicagoIllinoisUSA
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Bhat A, Biswas A. Cognitive Profile of Large-Vessel Vascular Dementia—An Observational Study from a Tertiary Care Center in Kolkata. J Neurosci Rural Pract 2022; 13:411-416. [PMID: 35946021 PMCID: PMC9357488 DOI: 10.1055/s-0042-1744467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Vascular dementia is the second leading cause of dementia worldwide. Its heterogenous presentation along with potential for reversibility at earlier stages makes it unique among all dementias.
Objectives
We aimed to study the cognitive dysfunction in large-vessel vascular dementia. Second, we tried to study the cognitive dysfunction in large-vessel vascular dementia as per the arterial territory involvement. Additionally, we also tried to study the contribution of hemispheric involvement to the dementia severity as evidenced by clinical dementia rating (CDR) scale.
Materials and Methods
We recruited 28 patients of large-vessel vascular dementia and categorized them on the basis of the arterial territories and hemisphere involved. The groups were later studied for the type of cognitive and behavioral dysfunctions as well as the dementia severity.
Results
Among 28 patients of large-vessel vascular dementia, attention (100%), executive function (100%), and behavior (100%) were more impaired in anterior cerebral artery territory infarcts (
p
< 0.05). Language (53.8%) and memory (53.8%) were more impaired in middle cerebral artery territory infarcts, while visuoperceptual (33.3%) domains were more impaired in posterior cerebral artery territory infarcts (
p
> 0.05). The mean CDR was lower in patients of right-sided lesions (1.292) than in those with left-sided (1.750) or bilateral lesions (2.000).
Conclusion
Different arterial territory lesions have different patterns of cognitive impairment in large-vessel vascular dementia. The dementia severity is less in right-sided lesions when compared with left-sided or bilateral lesions.
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Affiliation(s)
- Ashwani Bhat
- Department of Neurology, Bangur Institute of Neurosciences and IPGME&R, Kolkata, West Bengal, India
- Department of Neurology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Atanu Biswas
- Department of Neurology, Bangur Institute of Neurosciences and IPGME&R, Kolkata, West Bengal, India
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Arshad F, MM S, Paplikar A, Rajendran S, Kalkonde Y, Alladi S. Vascular cognitive impairment in India: Challenges and opportunities for prevention and treatment. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2021; 3:100034. [PMID: 36324418 PMCID: PMC9616277 DOI: 10.1016/j.cccb.2021.100034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/22/2021] [Accepted: 11/23/2021] [Indexed: 06/16/2023]
Abstract
The burden of vascular contribution to cognitive impairment and dementia is substantially high in India. There are approximately 5.3 million dementia patients in India and nearly 40% are estimated to be due to vascular dementia. Several factors pose unique challenges to reducing the burden of vascular dementia and vascular cognitive impairment (VCI) in India. Wide heterogeneity in vascular risk factor profile, diversity in socioeconomic, ethnic and dietary factors, as well as regional and rural-urban differences impact uniform implementation of preventive and therapeutic strategies. There is limited evidence on the natural history of vascular disease from longitudinal cohorts in India. Additionally, the lack of advanced brain imaging and genetic information pose challenges to understanding pathophysiology and treatment response to VCI in India. Efforts are now being made to implement programmes to reduce cardiovascular risk and VCI at the population level. Cognitive and functional measures appropriate to the diverse linguistic and educational context have been developed to diagnose VCI across India. Multicentric clinical and research cohorts of stroke are also being established. Filling research gaps and developing intervention strategies for the Indian context are crucial to address the growing burden of VCI.
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Affiliation(s)
- Faheem Arshad
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Samim MM
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Avanthi Paplikar
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Srijithesh Rajendran
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
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Menon RN, Varghese F, Paplikar A, Mekala S, Alladi S, Sharma M, Aralikatte Onkarappa S, Gollahalli D, Dutt A, Ghosh A, Dhaliwal RS, Hooda R, Iyer GK, Justus S, Kandukuri R, Kaul S, Banu Khan A, Nandi R, Narayanan J, Nehra A, Vasantha PM, Pauranik A, Mathew R, Ramakrishnan S, Sarath L, Shah U, Tripathi M, Padmavathy Narayana S, Varma RP, Verma M, Vishwanath Y. Validation of Indian Council of Medical Research Neurocognitive Tool Box in Diagnosis of Mild Cognitive Impairment in India: Lessons from a Harmonization Process in a Linguistically Diverse Society. Dement Geriatr Cogn Disord 2021; 49:355-364. [PMID: 33412549 DOI: 10.1159/000512393] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/16/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS In a linguistically diverse country such as India, challenges remain with regard to diagnosis of early cognitive decline among the elderly, with no prior attempts made to simultaneously validate a comprehensive battery of tests across domains in multiple languages. This study aimed to determine the utility of the Indian Council of Medical Research-Neurocognitive Tool Box (ICMR-NCTB) in the diagnosis of mild cognitive impairment (MCI) and its vascular subtype (VaMCI) in 5 Indian languages. METHODS Literate subjects from 5 centers across the country were recruited using a uniform process, and all subjects were classified based on clinical evaluations and a gold standard test protocol into normal cognition, MCI, and VaMCI. Following adaptation and harmonization of the ICMR-NCTB across 5 different Indian languages into a composite Z score, its test performance against standards, including sensitivity and specificity of the instrument as well as of its subcomponents in diagnosis of MCI, was evaluated in age and education unmatched and matched groups. RESULTS Variability in sensitivity-specificity estimates was noted between languages when a total of 991 controls and 205 patients with MCI (157 MCI and 48 VaMCI) were compared due to a significant impact of age, education, and language. Data from a total of 506 controls, 144 patients with MCI, and 46 patients with VaMCI who were age- and education-matched were compared. Post hoc analysis after correction for multiple comparisons revealed better performance in controls relative to all-cause MCI. An optimum composite Z-score of -0.541 achieved a sensitivity of 81.1% and a specificity of 88.8% for diagnosis of all-cause MCI, with a high specificity for diagnosis of VaMCI. Using combinations of multiple-domain 2 test subcomponents retained a sensitivity and specificity of >80% for diagnosis of MCI. CONCLUSIONS The ICMR-NCTB is a "first of its kind" approach at harmonizing neuropsychological tests across 5 Indian languages for the diagnosis of MCI due to vascular and other etiologies. Utilizing multiple-domain subcomponents also retains the validity of this instrument, making it a valuable tool in MCI research in multilingual settings.
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Affiliation(s)
- Ramshekhar N Menon
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India,
| | - Feba Varghese
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Avanthi Paplikar
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Shailaja Mekala
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.,Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India.,Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | | | | | - Divyaraj Gollahalli
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Aparna Dutt
- Apollo Gleneagles Hospital, Cognitive Neurology Unit, Kolkata, India.,Duttanagar Mental Health Centre, Neuropsychology & Clinical Psychology Unit, Duttanagar, Kolkata, India
| | - Amitabha Ghosh
- Apollo Gleneagles Hospital, Cognitive Neurology Unit, Kolkata, India
| | | | - Roopa Hooda
- Departments of Neurology and Neuropsychology, All India Institute of Medical Sciences, Delhi, India
| | - Gowri K Iyer
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India.,Indian Institute of Public Health, Hyderabad, India
| | - Sunitha Justus
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Rajmohan Kandukuri
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Subhash Kaul
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India.,Department of Neurology, Krishna Institute of Medical Sciences, Hyderabad, India
| | - Arfa Banu Khan
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, India
| | - Ranita Nandi
- Apollo Gleneagles Hospital, Cognitive Neurology Unit, Kolkata, India
| | | | - Ashima Nehra
- Departments of Neurology and Neuropsychology, All India Institute of Medical Sciences, Delhi, India
| | - Padma M Vasantha
- Departments of Neurology and Neuropsychology, All India Institute of Medical Sciences, Delhi, India
| | | | - Robert Mathew
- Department of Neurology, Sree Mookambika Institute of Medical Sciences, Tamil Nadu, India
| | - Subasree Ramakrishnan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Lekha Sarath
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | - Manjari Tripathi
- Departments of Neurology and Neuropsychology, All India Institute of Medical Sciences, Delhi, India
| | - Sylaja Padmavathy Narayana
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Ravi Prasad Varma
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Mansi Verma
- Departments of Neurology and Neuropsychology, All India Institute of Medical Sciences, Delhi, India
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Feter N, Leite JS, Cardoso RK, Rombaldi AJ. Economic burden of physical inactivity in hospitalizations due to dementia: a Brazilian nationwide study. CAD SAUDE PUBLICA 2021; 37:e00046520. [PMID: 33566988 DOI: 10.1590/0102-311x00046520] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/24/2020] [Indexed: 11/21/2022] Open
Abstract
Our study aimed at determining the economic burden of leisure-time physical inactivity in hospitalizations due to dementia in Brazil. In this national-wide descriptive study, we used secondary data from the Brazilian Health Informatics Department and from the latest Brazilian National Health Survey (2013). Rate of hospitalization and economic cost were extracted from 2013. Leisure-time physical inactivity prevalence was used to estimate its population attributable fraction for dementia. Outcomes were stratified into sex (man/woman), age groups (< 50, 50-59, 60-69, 70-79, 80+), ethnicity (white, black, mixed race, other), and region (South, Southeast, North, Northeast, and Central). In 2013, 3,724 people were hospitalized due to dementia in Brazil resulting in a total cost of BRL 17,971,833.85 (USD 7,673,973.05). More than half of cost among men was spent with individuals younger than 59 years, white and mixed-race, and from Southeast region. Proportion of cost was higher in women older than 60 years and white. In 2013, 37% of all hospitalization from dementia in Brazil were attributable to physical inactivity, with values reaching 42.9% and 43.8% for men and women aged 80 or older, respectively. Physical inactivity cost BRL 6,994,254.75 (USD 2,986,546.78) in 2013 on hospitalizations due to dementia in Brazil. Higher attributable-cost was found for patients younger than 50 years and women older than 80. Strategies to preserve the quality of life of these patients are needed to reduce the burden for the patients, their family, and on the healthcare system.
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Affiliation(s)
- Natan Feter
- Universidade Federal de Pelotas, Pelotas, Brasil.,The University of Queensland, St. Lucia, Australia
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6
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Singh V, Dhamoon MS, Alladi S. Stroke Risk and Vascular Dementia in South Asians. Curr Atheroscler Rep 2018; 20:43. [DOI: 10.1007/s11883-018-0745-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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7
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Divya KP, Menon RN, Varma RP, Sylaja PN, Thomas B, Kesavadas C, Sunitha J, Lekha VS, Deepak S. Post-stroke cognitive impairment - A cross-sectional comparison study between mild cognitive impairment of vascular and non-vascular etiology. J Neurol Sci 2017; 372:356-362. [DOI: 10.1016/j.jns.2016.10.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 09/19/2016] [Accepted: 10/19/2016] [Indexed: 11/27/2022]
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8
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Seetlani NK, Kumar N, Imran K, Ali A, Shams N, Sheikh T. Alzheimer and vascular dementia in the elderly patients. Pak J Med Sci 2016; 32:1286-1290. [PMID: 27882038 PMCID: PMC5103150 DOI: 10.12669/pjms.325.10792] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To find out the frequency of Alzheimer's and Vascular dementia in the elderly patients. METHODS This cross sectional descriptive study was conducted in Department of Medicine, Ziauddin Hospital Karachi from 1st October 2013 to 31st March 2014. Patients with symptoms of dementia for more than 6 months duration, and Mini Mental State Examination score <24 were included in this study. Patients who fell in category of dementia were assessed for duration of symptoms. Patients underwent CT scan of brain. Patients with generalized atrophy of brain on CT scanning of brain were labeled as Alzheimer's dementia, while patients with ischemic or hemorrhagic stroke on CT scan of brain were labeled as vascular dementia. RESULTS Four hundred twenty two patients were included in this study. There were 232 (54.98 %) male and 190 (45.02 %) were female. The mean age ± SD of the patients was 72.58±5.34 years (95% CI: 72.07 to 73.09), similarly average duration of symptoms was 10.14±2.85 months. About 18.96% of patients were illiterate, 32.23% were matric, 28.44% were intermediate and 20.33% were graduate and post graduate. Hypertension and diabetes were the commonest co-morbid i.e. 81.3% and 73.7%, hyperlipedimia and smoking were 38.2% and 45% respectively. Frequency of Alzheimer's disease and vascular dementia in the elderly was observed in 3.79% (16/422) and 2.61% (11/422) cases. CONCLUSION A good number of patients, 27 out of 422, in this hospital based study were suffering from Alzheimer's disease and vascular dementia. Early detection and prompt treatment can reduce the burden of the disease in our population.
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Affiliation(s)
- Naresh Kumar Seetlani
- Naresh Kumar Seetlani, MBBS, FCPS. Assistant Professor, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Narindar Kumar
- Narindar Kumar, MBBS, FCPS. Resident, Ziauddin Medical University, Karachi, Pakistan
| | - Khalid Imran
- Khalid Imran, MBBS, FCPS. Professor of Medicine, Dow International Medical College, Karachi, Pakistan
| | - Asif Ali
- Asif Ali, MBBS, FCPS. Registrar, Civil Hospital Karachi, Pakistan
| | - Nadia Shams
- Nadia Shams, MBBS, FCPS. Assistant Professor of Medicine, RIHS Islamabad, Pakistan
| | - Taha Sheikh
- Taha Sheikh, MBBS. Final year Medical Student, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
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9
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Ying H, Jianping C, Jianqing Y, Shanquan Z. Cognitive variations among vascular dementia subtypes caused by small-, large-, or mixed-vessel disease. Arch Med Sci 2016; 12:747-53. [PMID: 27478455 PMCID: PMC4947622 DOI: 10.5114/aoms.2016.60962] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 10/20/2014] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Vascular dementia (VaD) is a heterogeneous disease that can vary in clinical presentation and cognitive profile. The cognitive profiles of different VaD subtypes depend on the anatomical distribution of the vascular insults that have been documented. MATERIAL AND METHODS We reviewed demographic, cognitive, and imaging data in 402 patients who were clinically diagnosed with VaD between January 2002 and June 2012 at the First Affiliated Hospital of Gan Nan Medical College in Ganzhou, China. RESULTS Based on magnetic resonance imaging (MRI) results, patients were classified as having large- (24.1%), small- (70.4%), or mixed-vessel VaD (5.5%). Hypertension was the most prevalent risk factor (81%), followed by smoking (37%), hyperlipidemia (35%), and diabetes (27%). Hyperlipidemia, cardiac risk factors (history of cardiovascular disease, heart valve disorder) and carotid stenosis were more frequent in patients with large-vessel disease compared to those with small-vessel or mixed-vessel disease (p < 0.001). A median of 4 (maximum 11) cognitive domains were impaired in each VaD patient. After memory dysfunction, executive defects were the most prevalent (68.9%), and neurobehavioral dysfunction was the most rare (13.2%). Patients with small-vessel VaD showed more executive dysfunction than patients with large-vessel and mixed-vessel VaD (p < 0.05), whereas patients with large-vessel VaD had a higher prevalence of visuospatial or language dysfunction (p < 0.05). CONCLUSIONS The results indicate that specific subtypes and underlying vascular mechanisms will help predict clinical courses and produce more focused treatment and prevention of VaD.
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Affiliation(s)
- Huang Ying
- Department of Neurology, the First Affiliated Hospital, Gan Nan Medical College, Jiangxi, China
| | - Chen Jianping
- Department of Neurology, the First Affiliated Hospital, Gan Nan Medical College, Jiangxi, China
| | - Yuan Jianqing
- Department of Neurology, the First Affiliated Hospital, Gan Nan Medical College, Jiangxi, China
| | - Zhong Shanquan
- Department of Neurology, the First Affiliated Hospital, Gan Nan Medical College, Jiangxi, China
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10
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Alladi S, Bak TH, Mekala S, Rajan A, Chaudhuri JR, Mioshi E, Krovvidi R, Surampudi B, Duggirala V, Kaul S. Impact of Bilingualism on Cognitive Outcome After Stroke. Stroke 2015; 47:258-61. [PMID: 26585392 DOI: 10.1161/strokeaha.115.010418] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 09/24/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Bilingualism has been associated with slower cognitive aging and a later onset of dementia. In this study, we aimed to determine whether bilingualism also influences cognitive outcome after stroke. METHODS We examined 608 patients with ischemic stroke from a large stroke registry and studied the role of bilingualism in predicting poststroke cognitive impairment in the absence of dementia. RESULTS A larger proportion of bilinguals had normal cognition compared with monolinguals (40.5% versus 19.6%; P<0.0001), whereas the reverse was noted in patients with cognitive impairment, including vascular dementia and vascular mild cognitive impairment (monolinguals 77.7% versus bilinguals 49.0%; P<0.0009). There were no differences in the frequency of aphasia (monolinguals 11.8% versus bilinguals 10.5%; P=0.354). Bilingualism was found to be an independent predictor of poststroke cognitive impairment. CONCLUSIONS Our results suggest that bilingualism leads to a better cognitive outcome after stroke, possibly by enhancing cognitive reserve.
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Affiliation(s)
- Suvarna Alladi
- From the Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India (S.A., S.M., A.R., R.K., S.K.); Department of Psychology, Centre for Clinical Brain Sciences and Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom (T.H.B.); Department of Neurology, Yashoda Hospitals, Hyderabad, India (J.R.C.); Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (E.M.); Cognitive Science Laboratory, IIIT, Hyderabad, India (B.S.); and Department of Linguistics, Osmania University, Hyderabad, India (V.D.).
| | - Thomas H Bak
- From the Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India (S.A., S.M., A.R., R.K., S.K.); Department of Psychology, Centre for Clinical Brain Sciences and Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom (T.H.B.); Department of Neurology, Yashoda Hospitals, Hyderabad, India (J.R.C.); Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (E.M.); Cognitive Science Laboratory, IIIT, Hyderabad, India (B.S.); and Department of Linguistics, Osmania University, Hyderabad, India (V.D.)
| | - Shailaja Mekala
- From the Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India (S.A., S.M., A.R., R.K., S.K.); Department of Psychology, Centre for Clinical Brain Sciences and Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom (T.H.B.); Department of Neurology, Yashoda Hospitals, Hyderabad, India (J.R.C.); Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (E.M.); Cognitive Science Laboratory, IIIT, Hyderabad, India (B.S.); and Department of Linguistics, Osmania University, Hyderabad, India (V.D.)
| | - Amulya Rajan
- From the Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India (S.A., S.M., A.R., R.K., S.K.); Department of Psychology, Centre for Clinical Brain Sciences and Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom (T.H.B.); Department of Neurology, Yashoda Hospitals, Hyderabad, India (J.R.C.); Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (E.M.); Cognitive Science Laboratory, IIIT, Hyderabad, India (B.S.); and Department of Linguistics, Osmania University, Hyderabad, India (V.D.)
| | - Jaydip Ray Chaudhuri
- From the Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India (S.A., S.M., A.R., R.K., S.K.); Department of Psychology, Centre for Clinical Brain Sciences and Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom (T.H.B.); Department of Neurology, Yashoda Hospitals, Hyderabad, India (J.R.C.); Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (E.M.); Cognitive Science Laboratory, IIIT, Hyderabad, India (B.S.); and Department of Linguistics, Osmania University, Hyderabad, India (V.D.)
| | - Eneida Mioshi
- From the Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India (S.A., S.M., A.R., R.K., S.K.); Department of Psychology, Centre for Clinical Brain Sciences and Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom (T.H.B.); Department of Neurology, Yashoda Hospitals, Hyderabad, India (J.R.C.); Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (E.M.); Cognitive Science Laboratory, IIIT, Hyderabad, India (B.S.); and Department of Linguistics, Osmania University, Hyderabad, India (V.D.)
| | - Rajesh Krovvidi
- From the Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India (S.A., S.M., A.R., R.K., S.K.); Department of Psychology, Centre for Clinical Brain Sciences and Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom (T.H.B.); Department of Neurology, Yashoda Hospitals, Hyderabad, India (J.R.C.); Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (E.M.); Cognitive Science Laboratory, IIIT, Hyderabad, India (B.S.); and Department of Linguistics, Osmania University, Hyderabad, India (V.D.)
| | - Bapiraju Surampudi
- From the Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India (S.A., S.M., A.R., R.K., S.K.); Department of Psychology, Centre for Clinical Brain Sciences and Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom (T.H.B.); Department of Neurology, Yashoda Hospitals, Hyderabad, India (J.R.C.); Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (E.M.); Cognitive Science Laboratory, IIIT, Hyderabad, India (B.S.); and Department of Linguistics, Osmania University, Hyderabad, India (V.D.)
| | - Vasanta Duggirala
- From the Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India (S.A., S.M., A.R., R.K., S.K.); Department of Psychology, Centre for Clinical Brain Sciences and Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom (T.H.B.); Department of Neurology, Yashoda Hospitals, Hyderabad, India (J.R.C.); Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (E.M.); Cognitive Science Laboratory, IIIT, Hyderabad, India (B.S.); and Department of Linguistics, Osmania University, Hyderabad, India (V.D.)
| | - Subhash Kaul
- From the Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India (S.A., S.M., A.R., R.K., S.K.); Department of Psychology, Centre for Clinical Brain Sciences and Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom (T.H.B.); Department of Neurology, Yashoda Hospitals, Hyderabad, India (J.R.C.); Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom (E.M.); Cognitive Science Laboratory, IIIT, Hyderabad, India (B.S.); and Department of Linguistics, Osmania University, Hyderabad, India (V.D.)
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11
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Chaudhari TS, Verma R, Garg RK, Singh MK, Malhotra HS, Sharma PK. Clinico-radiological predictors of vascular cognitive impairment (VCI) in patients with stroke: a prospective observational study. J Neurol Sci 2014; 340:150-8. [PMID: 24680559 DOI: 10.1016/j.jns.2014.03.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 02/17/2014] [Accepted: 03/10/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Cognitive dysfunction occurs commonly following stroke and varies in severity. This study was aimed to determine the clinical, neuro-imaging, laboratory predictors of post stroke cognitive impairment and factors related to poor functional outcome in patients with post-stroke vascular cognitive impairment (VCI). MATERIAL AND METHODS We prospectively evaluated 102 of 240 consecutive stroke patients for 6 months after incident stroke for development of VCI. Patients with VCI comprised of those with VCI-no dementia (VCIND) and vascular dementia (VaD). Functional outcome was assessed by modified Barthel index (MBI). RESULTS Frequency of post-stroke VCI was 45.1% (46/102): 26.5% (27/102) having VCI-ND and 18.6% (19/102) having VaD. Patients with VCI were more likely to have lower educational and socioeconomic status, diabetes, hypertension, prior stroke, multiple risk factors, urinary incontinence, gait abnormality, peripheral signs of atherosclerosis, higher blood sugar level on admission and LDL levels, strategic site lesion, higher ARWMC (age related white matter changes) score, worse stroke severity (NIHSS) and functional outcome scores. On logistic regression analysis, lower educational status, strategic site lesion, higher ARWMC score and baseline stroke severity score were found to independently predict the risk of developing VCI. Worse stroke severity (NIHSS) scores and functional status scores at baseline predicted poor outcome in patients with VCI. CONCLUSION Post-stroke cognitive impairment is frequent and is associated with poor functional outcome. Predictors like lower educational status, strategic site lesion, greater severity of age related white matter changes and baseline stroke severity independently contributed to the risk of developing VCI in stroke patients.
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Affiliation(s)
| | - Rajesh Verma
- Department of Neurology, King George's Medical University, Lucknow, UP, India.
| | - Ravindra Kumar Garg
- Department of Neurology, King George's Medical University, Lucknow, UP, India
| | - Manish Kumar Singh
- Department of Neurology, King George's Medical University, Lucknow, UP, India
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Alladi S, Mekala S, Chadalawada SK, Jala S, Mridula R, Kaul S. Subtypes of dementia: a study from a memory clinic in India. Dement Geriatr Cogn Disord 2012; 32:32-8. [PMID: 21832829 DOI: 10.1159/000329862] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The clinical syndrome of dementia consists of several subtypes that are distinct in their etiology, clinical profile, management, and outcome. Limited specialized services are available for dementia patients in India. We report the profile of dementia subtypes from a clinic-based dementia registry in India. METHODS Consecutive dementia patients were investigated with clinical evaluation, neuropsychological tests modified for local use, and brain imaging. RESULTS In 347 consecutive dementia patients, Alzheimer's disease was the most common subtype of dementia (38.3%), followed by a high proportion of vascular dementia (25.4%). Frontotemporal dementia syndromes were not uncommon (18.7%). Dementia with Lewy bodies was encountered in 8.9% of the patients, and mixed dementia was found in 8.6%. The mean age of the group at presentation was 66.3 years, nearly a decade younger than in developed countries. The proportion of patients with early-onset dementia was high (49.9%). CONCLUSIONS Our results demonstrate that the clinical profiles of dementia subtypes in a clinic population are influenced by the population's demographic profile, cardiovascular risk factor burden, sociocultural attitudes about cognitive impairment, and possibly genetic factors.
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Affiliation(s)
- Suvarna Alladi
- Department of Neurology, Nizam’s Institute of Medical Sciences, Punjagutta, Hyderabad 500082, India.
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13
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Neurologic signs in relation to cognitive function in subcortical ischemic vascular dementia: a CREDOS (Clinical Research Center for Dementia of South Korea) study. Neurol Sci 2011; 33:839-46. [PMID: 22068220 DOI: 10.1007/s10072-011-0845-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2010] [Accepted: 10/28/2011] [Indexed: 10/15/2022]
Abstract
The objective of this study was to investigate the relationship between neurologic signs and cognitive dysfunction in subcortical ischemic vascular dementia (SIVD). 121 patients with SIVD were recruited from multiple nationwide hospitals. The patients' neurologic signs were evaluated using the Focal Neurologic Sign Score (FNSS). The FNSS scores did not correlate with the composite neuropsychology scores and Korean Mini-Mental State Examination scores. The FNSS scores correlated with the letter fluency and Rey-Osterrieth Complex Figure (ROCF) copy scores. Using a multivariate regression analysis controlled for age, sex, and educational level, the FNSS scores had a significant relationship with the letter fluency test scores (R (2) = 0.08, β = -2.28, p = 0.02) and ROCF copy scores (R (2) = 0.08, β = -0.42, p = 0.03). These findings suggest that the neurologic signs in patients with SIVD do not correlate with global cognitive functions; however, these signs do correlate with executive dysfunction in these patients.
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14
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Debate:. DEMENTIA 2010. [DOI: 10.1017/cbo9780511780615.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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15
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De Silva DA, Ancalan M, Doshi K, Chang HM, Wong MC, Chen C. Intracranial large artery disease in Alzheimer’s disease and vascular dementia among ethnic Asians. Eur J Neurol 2009; 16:643-5. [DOI: 10.1111/j.1468-1331.2009.02551.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Kalaria RN, Maestre GE, Arizaga R, Friedland RP, Galasko D, Hall K, Luchsinger JA, Ogunniyi A, Perry EK, Potocnik F, Prince M, Stewart R, Wimo A, Zhang ZX, Antuono P. Alzheimer's disease and vascular dementia in developing countries: prevalence, management, and risk factors. Lancet Neurol 2008; 7:812-26. [PMID: 18667359 DOI: 10.1016/s1474-4422(08)70169-8] [Citation(s) in RCA: 702] [Impact Index Per Article: 43.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Despite mortality due to communicable diseases, poverty, and human conflicts, dementia incidence is destined to increase in the developing world in tandem with the ageing population. Current data from developing countries suggest that age-adjusted dementia prevalence estimates in 65 year olds are high (>or=5%) in certain Asian and Latin American countries, but consistently low (1-3%) in India and sub-Saharan Africa; Alzheimer's disease accounts for 60% whereas vascular dementia accounts for approximately 30% of the prevalence. Early-onset familial forms of dementia with single-gene defects occur in Latin America, Asia, and Africa. Illiteracy remains a risk factor for dementia. The APOE epsilon4 allele does not influence dementia progression in sub-Saharan Africans. Vascular factors, such as hypertension and type 2 diabetes, are likely to increase the burden of dementia. Use of traditional diets and medicinal plant extracts might aid prevention and treatment. Dementia costs in developing countries are estimated to be US$73 billion yearly, but care demands social protection, which seems scarce in these regions.
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Affiliation(s)
- Raj N Kalaria
- Institute for Ageing and Health, Newcastle General Hospital, Newcastle upon Tyne, UK.
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