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Bhattacharyya B, Paplikar A, Varghese F, Das G, Shukla V, Arshad F, Gupta A, Mekala S, Mukherjee A, Mukherjee R, Venugopal A, Tripathi M, Ghosh A, Biswas A, Alladi S. Illiterate Addenbrooke's Cognitive Examination-III in Three Indian Languages: An Adaptation and Validation Study. Arch Clin Neuropsychol 2024:acad106. [PMID: 38273465 DOI: 10.1093/arclin/acad106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/15/2023] [Accepted: 12/15/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Literacy is an important factor that predicts cognitive performance. Existing cognitive screening tools are validated only in educated populations and are not appropriate for older adults with little or no education leading to poor performance on these tests and eventually leading to misdiagnosis. This challenge for clinicians necessitates a screening tool suitable for illiterate or low-literate older individuals. OBJECTIVES The objective was to adapt and validate Addenbrooke's Cognitive Examination-III (ACE-III) for screening general cognitive functions in illiterate and low-literate older populations in the Indian context in three languages. METHOD The Indian illiterate ACE-III was systematically adapted by modifying the original items of the Indian literate ACE-III to assess the cognitive functions of illiterates and low-literates with the consensus of an expert panel of professionals working in the area of dementia and related disorders. A total of 180 illiterate or low-literate participants (84 healthy-controls, 50 with dementia, and 46 with mild cognitive impairment [MCI]) were recruited from three different centers speaking Bengali, Hindi, and Kannada to validate the adapted version. RESULTS The optimal cut-off score for illiterate ACE-III to distinguish controls from dementia in all 3 languages was 75. The optimal cut-off scores in distinguishing between controls and MCI ranged from 79 to 82, with a sensitivity ranging from 93% to 99% and a specificity ranging from 72% to 99%. CONCLUSION The test is found to have good psychometric properties and is a reliable cognitive screening tool for identifying dementia and MCI in older adults with low educational backgrounds in the Indian context.
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Affiliation(s)
- Bidisha Bhattacharyya
- Department of Neurology, Bangur Institute of Neurosciences and Institute of Post Graduate Medical Education & Research, Kolkata, India
| | - Avanthi Paplikar
- Department of Speech and Language Studies, Dr. S. R. Chandrasekhar Institute of Speech and Hearing, Bengaluru, India
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Feba Varghese
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Gautam Das
- Department of Neurology, Bangur Institute of Neurosciences and Institute of Post Graduate Medical Education & Research, Kolkata, India
| | - Vasundhara Shukla
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Faheem Arshad
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Aakansha Gupta
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Shailaja Mekala
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Adreesh Mukherjee
- Department of Neurology, Bangur Institute of Neurosciences and Institute of Post Graduate Medical Education & Research, Kolkata, India
| | - Ruchira Mukherjee
- Department of Neurology, Bangur Institute of Neurosciences and Institute of Post Graduate Medical Education & Research, Kolkata, India
| | - Aparna Venugopal
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
- Department of Speech Language Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Amitabha Ghosh
- Department of Neurology, Apollo Multispecialty Hospital, Kolkata, India
| | - Atanu Biswas
- Department of Neurology, Bangur Institute of Neurosciences and Institute of Post Graduate Medical Education & Research, Kolkata, India
| | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
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Paplikar A, Venugopal A, Ballal D, Varghese F, Ramappa R, Shekar R, Manae T, Hoskeri R, Thanissery N, Arshad F, Banavaram A, Rao G, Arora N, Alladi S. Impact of bilingualism on prevalence of dementia and MCI: A community study from India. Alzheimers Dement 2022. [DOI: 10.1002/alz.065972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Avanthi Paplikar
- National Institute of Mental Health and Neurosciences Bengaluru India
- Dr. S. R. Chandrasekhar Institute of Speech and Hearing Bengaluru India
| | - Aparna Venugopal
- National Institute of Mental Health and Neurosciences Bengaluru India
| | - Divya Ballal
- National Institute of Mental Health and Neurosciences Bengaluru India
| | - Feba Varghese
- National Institute of Mental Health and Neurosciences Bengaluru India
| | - Renuka Ramappa
- National Institute of Mental Health and Neurosciences Bengaluru India
| | - Revathy Shekar
- National Institute of Mental Health and Neurosciences Bengaluru India
| | - Tejaswini Manae
- National Institute of Mental Health and Neurosciences Bengaluru India
| | - Rakshith Hoskeri
- National Institute of Mental Health and Neurosciences Bengaluru India
| | - Nithin Thanissery
- National Institute of Mental Health and Neurosciences Bengaluru India
| | - Faheem Arshad
- National Institute of Mental Health and Neurosciences Bengaluru India
| | - Aravind Banavaram
- National Institute of Mental Health and Neurosciences Bengaluru India
| | - Girish Rao
- National Institute of Mental Health and Neurosciences Bengaluru India
| | | | - Survana Alladi
- National Institute of Mental Health and Neurosciences Bengaluru India
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Kaul S, Goyal S, Paplikar A, Varghese F, Alladi S, Menon R, Sharma M, Dhaliwal RS, Ghosh A, Narayanan J, Nehra A, Tripathi M. Evaluation of Vascular Cognitive Impairment Using the ICMR-Neuro Cognitive Tool Box (ICMR-NCTB) in a Stroke Cohort from India. Ann Indian Acad Neurol 2022; 25:1130-1137. [PMID: 36911460 PMCID: PMC9996510 DOI: 10.4103/aian.aian_755_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 09/14/2022] [Accepted: 10/10/2022] [Indexed: 03/14/2023] Open
Abstract
Background and Purpose Vascular cognitive impairment (VCI) presents with a spectrum of cognitive impairment due to stroke and poses a huge socioeconomic burden especially in low middle-income countries. There is a critical need for early recognition and identification of VCI patients. Therefore, we developed and validated culturally appropriate neuropsychological instruments, the ICMR-Neuro Cognitive Tool-Box (ICMR-NCTB) and Montreal Cognitive Assessment (MoCA) to diagnose vascular MCI and dementia in the Indian context. Methods A total of 181 participants: 59 normal cognition, 25 stroke with normal cognition, 46 vascular MCI (VaMCI) and 51 vascular dementia (VaD) were recruited for the study. The ICMR-NCTB and MoCA were administered to patients with VCI and major cognitive domains were evaluated. Results The ICMR-NCTB was found to have good internal reliability in VaMCI and VaD. The sensitivity of the ICMR-NCTB to detect VaMCI and VaD ranged from 70.8% to 72.9% and 75.9% to 79.7%, respectively, and the specificity for VaMCI and VaD ranged from 84.8% to 86.1% and 82.5% to 85.2%, respectively. The MoCA had excellent sensitivity and specificity to detect VaMCI and VaD at ideal cut-off scores. Conclusion The ICMR-NCTB is a valid neuropsychological toolbox that can be used for comprehensive cognitive assessment and diagnosis of VCI in India. In addition, the Indian version of MoCA is more adept as a screening instrument to detect VCI due to its high sensitivity. The ICMR-NCTB will aid in early detection and management of many patients, thereby reducing the burden of vascular MCI and dementia in India.
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Affiliation(s)
- Subhash Kaul
- Department of Neurology, Krishna Institute of Medical Sciences, Hyderabad, Telangana, India
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Sheetal Goyal
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Avanthi Paplikar
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
- Department of Speech and Language Studies, Dr. S. R. Chandrasekhar Institute of Speech and Hearing, Bengaluru, Karnataka, India
| | - Feba Varghese
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ramshekhar Menon
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | | | - RS Dhaliwal
- Indian Council of Medical Research, New Delhi, India
| | - Amitabha Ghosh
- Cognitive Neurology Unit, Apollo Gleneagles Hospital, Kolkata, West Bengal, India
| | - Jwala Narayanan
- Department of Neurology, Manipal Hospitals, Bengaluru, Karnataka, India
| | - Ashima Nehra
- Neuropsychology, Neuroscience Center, All India Institute of Medical Sciences, Delhi, India
| | - Manjari Tripathi
- Department of Neurology All India Institute of Medical Sciences, Delhi, India
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Kaul S, Paplikar A, Varghese F, Alladi S, Sharma M, Dhaliwal RS, Goyal S, Saroja AO, Arshad F, Divyaraj G, Ghosh A, Iyer GK, J S, Khan AB, Kandukuri R, Mathew R, Mekala S, Menon R, Pauranik A, Nandi R, Narayanan J, Nehra A, Padma MV, Ramakrishnan S, Sarath L, Shah U, Tripathi M, Sylaja PN, Varma RP, Verma M, Vishwanath Y, Consortium ICMRNCTB. MoCA in five Indian languages: A brief screening tool to diagnose dementia and MCI in a linguistically diverse setting. Int J Geriatr Psychiatry 2022; 37. [PMID: 36069187 DOI: 10.1002/gps.5808] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/20/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION AND OBJECTIVES Early dementia diagnosis in low and middle-income countries (LMIC) is challenging due to limited availability of brief, culturally appropriate, and psychometrically validated tests. Montreal Cognitive Assessment (MoCA) is one of the most widely used cognitive screening tests in primary and secondary care globally. In the current study, we adapted and validated MoCA in five Indian languages (Hindi, Bengali, Telugu, Kannada, and Malayalam) and determined the optimal cut-off points that correspond to screening for clinical diagnosis of dementia and MCI. METHODS A systematic process of adaptation and modifications of MoCA was fulfilled. A total of 446 participants: 214 controls, 102 dementia, and 130 MCI were recruited across six centers. RESULTS Across five languages, the area under the curve for diagnosis of dementia varied from 0.89 to 0.98 and MCI varied from 0.73 to 0.96. The sensitivity, specificity and optimum cut-off scores were established separately for five Indian languages. CONCLUSIONS The Indian adapted MoCA is standardized and validated in five Indian languages for early diagnosis of dementia and MCI in a linguistically and culturally diverse population.
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Affiliation(s)
- Subhash Kaul
- Krishna Institute of Medical Sciences, Hyderabad, India
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Avanthi Paplikar
- Department of Speech and Language Studies, Dr. S. R. Chandrasekhar Institute of Speech and Hearing, Bengaluru, India
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Feba Varghese
- 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
| | | | - R S Dhaliwal
- Indian Council of Medical Research, New Delhi, India
| | - Sheetal Goyal
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | | - Faheem Arshad
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Gollahalli Divyaraj
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
- Pause for Perspective, Hyderabad, India
| | - Amitabha Ghosh
- Apollo Gleneagles Hospital, Cognitive Neurology Unit, Kolkata, India
| | - Gowri K Iyer
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
- Indian Institute of Public Health, Hyderabad, India
| | - Sunitha J
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Arfa Banu Khan
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, India
| | - Rajmohan Kandukuri
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | | | - Shailaja Mekala
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Ramshekhar Menon
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | - Ranita Nandi
- All India Institute of Medical Sciences, Delhi, India
| | | | - Ashima Nehra
- All India Institute of Medical Sciences, Delhi, India
| | - M V Padma
- All India Institute of Medical Sciences, Delhi, India
| | - Subasree Ramakrishnan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Lekha Sarath
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | - P N Sylaja
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Ravi Prasad Varma
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Mansi Verma
- All India Institute of Medical Sciences, Delhi, India
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Paplikar A, Varghese F, Alladi S, Vandana VP, Darshini KJ, Iyer GK, Kandukuri R, Divyaraj G, Sharma M, Dhaliwal RS, Kaul S, Saroja AO, Ghosh A, Sunitha J, Khan AB, Mathew R, Mekala S, Menon R, Nandi R, Narayanan J, Nehra A, Padma MV, Pauranik A, Ramakrishnan S, Sarath L, Shah U, Tripathi M, Sylaja PN, Varma RP, Verma M, Vishwanath Y. Picture-naming test for a linguistically diverse population with cognitive impairment and dementia. Int J Lang Commun Disord 2022; 57:881-894. [PMID: 35522006 DOI: 10.1111/1460-6984.12728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 03/25/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Picture-naming tests (PNTs) evaluate linguistic impairment in dementia due to semantic memory impairment, impaired lexical retrieval or perceptual deficits. They also assess the decline in naming impairment at various stages of dementia and mild cognitive impairment (MCI) that occurs due to progressive cognitive impairment. With the increasing numbers of people with dementia globally, it is necessary to have validated naming tests and norms that are culturally and linguistically appropriate. AIMS In this cross-sectional study we harmonized a set of 30 images applicable to the Indian context across five languages and investigated the picture-naming performance in patients with MCI and dementia. METHODS & PROCEDURES A multidisciplinary expert group formed by the Indian Council of Medical Research (ICMR) collaborated towards developing and adapting a picture naming test (PNT) known as the ICMR-PNT in five Indian languages: Hindi, Bengali, Telugu, Kannada and Malayalam. Based on cross-cultural adaptation guidelines and item-wise factor analysis and correlations established separately across five languages, the final version of the ICMR-PNT test was developed. A total of 368 controls, 123 dementia and 128 MCI patients were recruited for the study. Psychometric properties of the adapted version of the ICMR-PNT were examined, and sensitivity and specificity were examined. OUTCOMES & RESULTS The ICMR-PNT scores in all languages combined were higher in controls compared with patients with dementia and MCI (F2, 615 = 139.85; p < 0.001). Furthermore, PNT scores for MCI was higher in comparison with patients with dementia in all languages combined (p < 0.001). The area under the curve across the five languages ranged from 0.81 to 1.00 for detecting dementia. There was a negative correlation between Clinical Dementia Rating (CDR) and ICMR-PNT scores and a positive correlation between Addenbrooke's Cognitive Examination-III (ACE-III) and ICMR-PNT scores in control and patient groups. CONCLUSIONS & IMPLICATIONS The ICMR-PNT was developed by following cross-cultural adaptation guidelines and establishing correlations using item-wise factor analysis across five languages. This adapted PNT was found to be a reliable tool when assessing naming abilities effectively in mild to moderate dementia in a linguistically diverse context. WHAT THIS PAPER ADDS What is already known on this subject Picture-naming evaluates language impairment linked to naming difficulties due to semantic memory, lexical retrieval or perceptual disturbances. As a result, picture naming tests (PNTs) play an important role in the diagnosis of dementia. In a heterogeneous population such as India, there is a need for a common PNT that can be used across the wide range of languages. What this study adds to existing knowledge PNTs such as the Boston Naming Test (BNT) were developed for the educated, mostly English-speaking, Western populations and are not appropriate for use in an Indian context. To overcome this challenge, a PNT was harmonized in five Indian languages (Hindi, Bengali, Telugu, Kannada and Malayalam) and we report the patterns of naming difficulty in patients with MCI and dementia. The ICMR-PNT demonstrated good diagnostic accuracy when distinguishing patients with mild to moderate dementia from cognitively normal individuals. What are the potential or actual clinical implications of this work? With the growing number of persons suffering from Alzheimer's disease and other forms of dementia around the world, its critical to have culturally and linguistically relevant naming tests and diagnosis. This validated ICMR-PNT can be used widely as a clinical tool to diagnose dementia and harmonize research efforts across diverse populations.
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Affiliation(s)
- Avanthi Paplikar
- Department of Speech and Language Studies, Dr. S. R. Chandrasekhar Institute of Speech and Hearing, Bengaluru, India
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Feba Varghese
- 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
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - V P Vandana
- Department of Speech-Language-Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - K J Darshini
- Department of Speech-Language-Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Gowri K Iyer
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
- Indian Institute of Public Health, Hyderabad, India
| | - Rajmohan Kandukuri
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Gollahalli Divyaraj
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
- Pause for Perspective Uma Nagar, Hyderabad, India
| | | | - R S Dhaliwal
- Indian Council of Medical Research (ICMR), Delhi, India
| | - Subhash Kaul
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
- Krishna Institute of Medical Sciences, Hyderabad, India
| | - Aralikatte Onkarappa Saroja
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research Center Belagavi, Karnataka, India
| | - Amitabha Ghosh
- Apollo Gleneagles Hospital, Cognitive Neurology Unit, Kolkata, India
| | - J Sunitha
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Arfa Banu Khan
- Department of Psychiatry, KAHER's Jawaharlal Nehru Medical College and Research Center Belagavi, Karnataka, India
| | | | - Shailaja Mekala
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Ramshekhar Menon
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Ranita Nandi
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research Center Belagavi, Karnataka, India
| | | | - Ashima Nehra
- Clinical Neuropsychology, Neurosciences Centre, All India Institute of Medical Sciences, Delhi, India
| | - M V Padma
- Department of Neurology, All India Institute of Medical Sciences, Delhi, India
| | | | - Subasree Ramakrishnan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Lekha Sarath
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, Delhi, India
| | - P N Sylaja
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Ravi Prasad Varma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Mansi Verma
- Department of Neurology, All India Institute of Medical Sciences, Delhi, India
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Rajagopalan J, Arshad F, Thomas PT, Varghese F, Hurzuk S, Hoskeri RM, Ramappa RB, Nair VS, Paplikar A, Mekala S, Manae TS, Ramanna DBP, Rakesh G, Ganeshbhai PV, Dhiren SR, Komaravolu S, Kammammettu C, Rao GN, Alladi S. Cognition, Behavior, and Caregiver Stress in Dementia during the COVID-19 Pandemic: An Indian Perspective. Dement Geriatr Cogn Disord 2022; 51:90-100. [PMID: 35184061 PMCID: PMC9059024 DOI: 10.1159/000519616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 09/10/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Little is known regarding the cognitive and behavioral status of patients with dementia and their caregivers in lower middle-income countries during the COVID-19 pandemic. This study aimed to understand the impact of the pandemic on persons with dementia and their caregivers in India. METHODS This was an observational study. A cohort of 66 persons with dementia and their caregivers were evaluated during the COVID-19 pandemic in 2 specialist hospitals in South India. Caregivers were interviewed at 2 distinct time points of the pandemic: during the national lockdown and 5 months after during later periods of the "cluster of cases" transmission phase. Participants were assessed via telephone utilizing validated instruments (Neuropsychiatric Inventory [NPI], Clinical Dementia Rating [CDR] Scale, and Depression, Anxiety and Stress Scale [DASS-21]) and a semi-structured questionnaire. The questionnaire documented sociodemographic information, clinical history, infection measures adopted, changes in caregiving routines, involvement in functional rehabilitation activities, and access to medical and long-term care support services. RESULTS The 2-phase follow-up study found a significant worsening of behavior in dementia patients, demonstrated by a difference in the NPI sub-domain scores for anxiety (mean difference [standard deviation, SD] = -0.552 [1.993], t58 = -2.109, p = 0.039) and eating disturbances (mean difference [SD] = -1.121 [2.493], t59 = -3.424, p = 0.001). A relatively high proportion of patients developed anxiety (cumulative incidence = 24.53%) and eating disturbances (cumulative incidence = 26.92%), without having these symptoms at baseline. There was a trend toward an increase in proportion of persons with severe dementia (19.7% vs. 39.4%) on follow-up. Caregiver distress reported was significantly associated with neuropsychiatric symptoms (r = 0.712, p < 0.001) and dementia severity (ρ = 0.365, p = 0.004). In addition, difficulties in accessing medical care persisted between the 2 assessments, and there were statistically significant differences between functional rehabilitation activities such as indoor activities (p < 0.001), outdoor activities (p = 0.013), and physical exercises (p = 0.003) between baseline and follow-up. CONCLUSION Findings suggest interruption of functional rehabilitation activities and disruption in medical care services are likely to have had an adverse impact on patients with dementia and contributed toward caregiver distress.
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Affiliation(s)
- Jayeeta Rajagopalan
- Strengthening Responses to Dementia in Developing Countries (STRiDE) India, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Faheem Arshad
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India,*Faheem Arshad,
| | - Priya Treesa Thomas
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Feba Varghese
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Saadiya Hurzuk
- Strengthening Responses to Dementia in Developing Countries (STRiDE) India, Alzheimer's and Related Disorders Society of India, Hyderabad, India
| | | | - Renuka Bavikatti Ramappa
- Dementia Science Programme, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Vasundharaa S. Nair
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Avanthi Paplikar
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Shailaja Mekala
- Department of Neurology, Nizam's Institute of Medical Sciences India, Hyderabad, India
| | - Tejaswini S. Manae
- Dementia Science Programme, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Gurrapu Rakesh
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Patel Vishal Ganeshbhai
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Shah Rutul Dhiren
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Shashidhar Komaravolu
- Alzheimer's and Related Disorders Society of India Hyderabad Deccan Chapter, Hyderabad, India
| | | | - Girish N. Rao
- Department of Epidemiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
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Arshad F, Varghese F, Paplikar A, Gangadhar Y, Ramakrishnan S, Chaudhuri JR, Mahadevan A, Alladi S. Role of Autoantibodies in Neurodegenerative Dementia: An Emerging Association. Dement Geriatr Cogn Disord 2021; 50:153-160. [PMID: 34237731 DOI: 10.1159/000517238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/12/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE In the background of an emerging role for immune dysregulation in neurodegenerative dementias, this study aimed to investigate the relationship between systemic autoimmunity and dementia. The objective was to study the frequency and profile of disease-specific autoantibodies in Alzheimer's dementia (AD), frontotemporal dementia (FTD), and dementia with Lewy bodies (DLB). METHODS Immunological testing was performed in a large cohort of neurodegenerative dementia diagnosed based on standard clinical and imaging criteria. Patients were evaluated for the presence of autoantibodies specific for systemic autoimmune diseases that included anti-extractable nuclear antibody profile, rheumatoid factor antibody (RA), perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA), and cytoplasmic anti-neutrophil cytoplasmic antibody (c-ANCA) in serum. RESULTS Of 174 patients with degenerative dementia (FTD = 114, AD = 53, and DLB = 7) evaluated with immunological testing, 18.9% (n = 33) were seropositive for autoantibodies. The common antibodies detected were anti-Scl-70 (25%), anti-Ro-52 (18.7%), anti-nRNP-Sm (12.5%), and anti-CENP-B (9.3%). There were no significant systemic complaints in the majority of patients. A wider range of antibodies were positive in FTD compared to AD and DLB. While no difference was observed in the mean age, sex, or duration of illness between seropositive and negative patients, family history of dementia was more frequent among seronegative patients. CONCLUSION Our findings indicate an emerging role for immune dysregulation in patients with classical neurodegenerative dementias, especially those with FTD. These autoantibodies could play a role in immune degradation of protein aggregates that characterize neurodegeneration. Study findings emphasize the need to explore the complex relationship between systemic autoimmunity and neurodegenerative dementia.
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Affiliation(s)
- Faheem Arshad
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Feba Varghese
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Avanthi Paplikar
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Yashwanth Gangadhar
- Autoimmune Laboratory, Department of Neuropathology, NIMHANS, Bengaluru, India
| | - Subasree Ramakrishnan
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | | | - Anita Mahadevan
- Autoimmune Laboratory, Department of Neuropathology, NIMHANS, Bengaluru, India.,Department of Neuropathology, NIMHANS, Bengaluru, India
| | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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8
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Verma M, Tripathi M, Nehra A, Paplikar A, Varghese F, Alladi S, Narayanan J, Dhaliwal RS, Sharma M, Saroja AO, Arshad F, Divyaraj G, Ghosh A, Manae TS, Mekala S, Menon RN, Hooda R, Iyer GK, Sunitha J, Kandukuri R, Kaul S, Khan AB, Mathew R, Nandi R, Padma MV, Pauranik A, Ramakrishnan S, Sarath L, Shah U, Sylaja PN, Varma RP, Vishwanath Y. Validation of ICMR Neurocognitive Toolbox for Dementia in the Linguistically Diverse Context of India. Front Neurol 2021; 12:661269. [PMID: 34733226 PMCID: PMC8558406 DOI: 10.3389/fneur.2021.661269] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 09/16/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: The growing prevalence of dementia, especially in low- and middle-income countries (LMICs), has raised the need for a unified cognitive screening tool that can aid its early detection. The linguistically and educationally diverse population in India contributes to challenges in diagnosis. The present study aimed to assess the validity and diagnostic accuracy of the Indian Council of Medical Research-Neurocognitive Toolbox (ICMR-NCTB), a comprehensive neuropsychological test battery adapted in five languages, for the diagnosis of dementia. Methods: A multidisciplinary group of experts developed the ICMR-NCTB based on reviewing the existing tools and incorporation of culturally appropriate modifications. The finalized tests of the major cognitive domains of attention, executive functions, memory, language, and visuospatial skills were then adapted and translated into five Indian languages: Hindi, Bengali, Telugu, Kannada, and Malayalam. Three hundred fifty-four participants were recruited, including 222 controls and 132 dementia patients. The sensitivity and specificity of the adapted tests were established for the diagnosis of dementia. Results: A significant difference in the mean (median) performance scores between healthy controls and patients with dementia was observed on all tests of ICMR-NCTB. The area under the curve for majority of the tests included in the ICMR-NCTB ranged from 0.73 to 1.00, and the sensitivity and specificity of the ICMR-NCTB tests ranged from 70 to 100% and 70.7 to 100%, respectively, to identify dementia across all five languages. Conclusions: The ICMR-NCTB is a valid instrument to diagnose dementia across five Indian languages, with good diagnostic accuracy. The toolbox was effective in overcoming the challenge of linguistic diversity. The study has wide implications to address the problem of a high disease burden and low diagnostic rate of dementia in LMICs like India.
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Affiliation(s)
- Mansi Verma
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashima Nehra
- Clinical Neuropsychology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Avanthi Paplikar
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Feba Varghese
- 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.,Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Jwala Narayanan
- Department of Neurology, Manipal Hospitals, Bengaluru, India
| | - R S Dhaliwal
- Indian Council of Medical Research, New Delhi, India
| | | | - Aralikatte Onkarappa Saroja
- Department of Neurology, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, India
| | - Faheem Arshad
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Gollahalli Divyaraj
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Amitabha Ghosh
- Cognitive Neurology Unit, Apollo Gleneagles Hospital, Kolkata, India
| | - Tejaswini S Manae
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Shailaja Mekala
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Ramshekhar N Menon
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Roopa Hooda
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Gowri K Iyer
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - J Sunitha
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, 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
| | - Arfa Banu Khan
- Department of Psychiatry, KAHER's Jawaharlal Nehru Medical College and Research Center, Belagavi, India
| | - Robert Mathew
- Department of Neurology, Government Medical College, Alappuzha, India
| | - Ranita Nandi
- Cognitive Neurology Unit, Apollo Gleneagles Hospital, Kolkata, India
| | - M V Padma
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Apoorva Pauranik
- Department of Neurology Mahatma Gandhi Mission Medical College, Indore, 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
| | - Urvashi Shah
- Department of Neurology, King Edward Memorial Hospital, Mumbai, India
| | - P N Sylaja
- 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
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9
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Rajagopalan J, Arshad F, Hoskeri RM, Nair VS, Hurzuk S, Annam H, Varghese F, Br R, Dhiren SR, Ganeshbhai PV, Kammammettu C, Komaravolu S, Thomas PT, Comas-Herrera A, Alladi S. Experiences of people with dementia and their caregivers during the COVID-19 pandemic in India: A mixed-methods study. Dementia (London) 2021; 21:214-235. [PMID: 34346238 PMCID: PMC8685595 DOI: 10.1177/14713012211035371] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background The COVID-19 pandemic has unprecedented consequences for the management of chronic diseases such as dementia. However, limited evidence exists on the condition of persons with dementia and their caregivers during the pandemic in lower-middle-income countries (LMICs). The study aimed to provide insights into the experiences of persons with dementia and their families during the early phases of the pandemic in India. Methods This study adopted a mixed-method approach. One hundred and four persons with dementia and their caregivers were evaluated via telephone using validated instruments and a semi-structured interview guide. We used the quantitative data collected to establish a baseline, whereas qualitative data were analysed thematically. Results The study revealed that persons with dementia and their caregivers experienced difficulties during the pandemic, which included worsening of behaviour, problems in accessing care, disruptions in functional activities and struggles in enforcing infection prevention contributing to caregiver distress. An important finding that emerged was the unchanging reality of caregiving for families. The relative success of the public health response to the COVID-19 pandemic contrasted with the lack of awareness and formal support for dementia. Conclusions The COVID-19 pandemic has exposed the vulnerabilities of persons with dementia and their caregivers. This calls for a collaborative reframing of medical care and public health policies to address dementia care.
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Affiliation(s)
- Jayeeta Rajagopalan
- Strengthening Responses to Dementia in Developing Countries (STRiDE) India, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Faheem Arshad
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Vasundharaa S Nair
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Saadiya Hurzuk
- Strengthening Responses to Dementia in Developing Countries (STRiDE) India, Alzheimer's and Related Disorders Society of India, Hyderabad, India
| | - Harikrishna Annam
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Feba Varghese
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Renuka Br
- Dementia Science Programme, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Shah R Dhiren
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Patel V Ganeshbhai
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Shashidhar Komaravolu
- Alzheimer's and Related Disorders Society of India Hyderabad Deccan Chapter, Hyderabad, India
| | - Priya T Thomas
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Adelina Comas-Herrera
- Care Policy and Evaluation Centre, 4905London School of Economics and Political Science (LSE), London, UK
| | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
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10
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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11
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Paplikar A, Alladi S, Varghese F, Mekala S, Arshad F, Sharma M, Saroja AO, Divyaraj G, Dutt A, Ellajosyula R, Ghosh A, Iyer GK, Sunitha J, Kandukuri R, Kaul S, Khan AB, Mathew R, Menon R, Nandi R, Narayanan J, Nehra A, Padma MV, Pauranik A, Ramakrishnan S, Sarath L, Shah U, Tripathi M, Sylaja PN, Varma RP, Verma M, Vishwanath Y. Bilingualism and Its Implications for Neuropsychological Evaluation. Arch Clin Neuropsychol 2021:acab012. [PMID: 33772268 DOI: 10.1093/arclin/acab012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE In the background of a large population of bilinguals globally, the study aimed to develop standards of neuropsychological testing in the context of bilingualism. Because bilingualism is known to affect cognitive processes, bilinguals and monolinguals were compared on their performance on cognitive tests, to investigate the possibility of the need for separate normative data for the two groups. METHOD A comprehensive neuropsychological test battery, standardized across five Indian languages: the Indian Council of Medical Research-Neuro Cognitive Tool Box (ICMR-NCTB) was administered to 530 participants (267 monolingual and 263 bilinguals matched for age and education). A systematic method of testing cognition in bilinguals was developed; to identify the appropriate language for testing, ensure language proficiency of examiner, and to interpret the bilingual responses. Additionally, the performance of bilinguals on the ICMR-NCTB was compared with monolinguals. RESULTS Cognitive testing in the bilingual context was performed in the most proficient language of the participants, by examiners well versed with the language. Results from the language-based tests suggested that the frequent occurrence of borrowed- and language-mixed words required consideration while scoring. The reported bilingual effect on cognitive processes did not reflect as differences in the performance between bilinguals and monolinguals. CONCLUSIONS Observations from the study provide robust recommendations for neuropsychological testing in the context of bilingualism. Results indicate that separate normative data may not be required for bilinguals and monolinguals. The study will be relevant and provide a reference framework to address similar issues in the large population of bilinguals in other societies.
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Affiliation(s)
- Avanthi Paplikar
- 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
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Feba Varghese
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Shailaja Mekala
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Faheem Arshad
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | | | | - Gollahalli Divyaraj
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Aparna Dutt
- Neuropsychology and Clinical Psychology Unit, Duttanagar Mental Health Centre, Duttanagar, Kolkata, India
| | | | - Amitabha Ghosh
- Neurology Unit, Apollo Gleneagles Hospital, Kolkata, India
| | - Gowri K Iyer
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
- Indian Institute of Public Health, Hyderabad, India
| | - J Sunitha
- Cognition & Behavioral Neurology, Sree Chitra Tirunal Institute for Medical Science and Technology Thiruvanathapuram, Kerala, 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
- Krishna Institute of Medical Sciences, Hyderabad, India
| | - Arfa Banu Khan
- Department of Psychiatry, KAHER's Jawaharlal Nehru Medical College and Research Center Belagavi, Karnataka India
| | | | | | - Ranita Nandi
- Neuropsychology and Clinical Psychology Unit, Duttanagar Mental Health Centre, Duttanagar, Kolkata, India
| | | | - Ashima Nehra
- Clinical Neuropsychology, Neurosciences Centre, AIIMS, New Delhi, India
| | - M V Padma
- Department of Neurology, All India Institute of Medical Sciences, Delhi, India
| | | | - Subasree Ramakrishnan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Lekha Sarath
- Cognitive Behavioral Neurology Section, Sree Chithra Tirunal Institute of medical science and Technology, Thiruvananthapuram, Kerala, India
| | - Urvashi Shah
- Department of Neurology, King Edward Memorial Hospital, Mumbai, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, Delhi, India
| | - P N Sylaja
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Ravi Prasad Varma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Mansi Verma
- Department of Neurology, All India Institute of Medical Sciences, Delhi, India
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12
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Paplikar A, Iyer GK, Varghese F, Alladi S, Pauranik A, Mekala S, Kaul S, Sharma M, Dhaliwal RS, Saroja AO, Dharamkar S, Dutt A, Divyaraj G, Ghosh A, Kandukuri R, Mathew R, Menon R, Narayanan J, Nehra A, Padma MV, Ramakrishnan S, Ravi SK, Shah U, Tripathi M, Sylaja PN, Varma RP. A Screening Tool to Detect Stroke Aphasia: Adaptation of Frenchay Aphasia Screening Test (FAST) to the Indian Context. Ann Indian Acad Neurol 2020; 23:S143-S148. [PMID: 33343139 PMCID: PMC7731676 DOI: 10.4103/aian.aian_499_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 05/23/2020] [Indexed: 12/01/2022] Open
Abstract
Background: Aphasia is a common consequence of stroke. To optimize recovery, it becomes critical as there are early identification and treatment of language deficits. The rising burden of stroke aphasia and lack of screening tools in the Indian context necessitates the need for a screening tool. Objective: We aimed to adapt and validate the Frenchay Aphasia Screening Test (FAST) to the Indian context in two widely spoken Indian languages, Telugu and Kannada, for the literate and illiterate population. Methods: A systematic process of adaptation and culturally appropriate modifications of the original FAST were done in 116 healthy controls and 115 patients. The validity of the adapted test was established. Results: The optimum cut-off values for detecting aphasia in our sample ranged from 25 to 25.5 (literate) and 13.5 to 15.5 (illiterate) with high sensitivity and specificity. There was also a significant correlation between aphasia scores for adapted FAST and the Western Aphasia Battery (WAB), establishing good convergent validity. Discussion: Results of the adaptation and validation of two Indian versions of FAST, suggest that it is an easy-to-use screening measure for detecting stroke-related language disabilities. The psychometric properties of the Indian version of FAST met the standardised requirements for adaptation and validation. Conclusions: The Indian version of FAST was found to be a reliable and valid bedside screening tool for aphasia in stroke patients. We aim that this study will facilitate the use of the test across other Indian languages and a large clinical population in the future.
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Affiliation(s)
- Avanthi Paplikar
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Gowri K Iyer
- Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.,Indian Institute of Public Health, Hyderabad, Telangana, India
| | - Feba Varghese
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Suvarna Alladi
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.,Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | | | - Shailaja Mekala
- Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Subhash Kaul
- Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.,Krishna Institute of Medical Sciences, Hyderabad, Telangana, India
| | | | - R S Dhaliwal
- Indian Council of Medical Research, New Delhi, India
| | | | | | - Aparna Dutt
- Duttanagar Mental Health Centre, Duttanagar, Kolkata,West Bengal, India
| | | | | | | | | | - Ramshekhar Menon
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | | | - Ashima Nehra
- All India Institute of Medical Sciences, Delhi, India
| | - M V Padma
- All India Institute of Medical Sciences, Delhi, India
| | | | - Sunil Kumar Ravi
- Shravana Institute of Speech and Hearing, Bellary, Karnataka, India
| | | | | | - P N Sylaja
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Ravi Prasad Varma
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Arshad F, Paplikar A, Mekala S, Varghese F, Purushothaman VV, Kumar DJ, Shingavi L, Vengalil S, Ramakrishnan S, Yadav R, Pal PK, Nalini A, Alladi S. Social Cognition Deficits Are Pervasive across Both Classical and Overlap Frontotemporal Dementia Syndromes. Dement Geriatr Cogn Dis Extra 2020; 10:115-126. [PMID: 33442389 PMCID: PMC7772884 DOI: 10.1159/000511329] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 12/12/2022] Open
Abstract
Objectives Frontotemporal dementia (FTD) syndromes are a complex group of disorders characterised by profound changes in behaviour and cognition. Many of the observed behavioural abnormalities are now recognised to be due to impaired social cognition. While deficits in emotion recognition and empathy are well-recognised in behavioural-variant (Bv)FTD, limited information exists about the nature of social cognitive impairment in the language variant primary progressive aphasia (PPA) that includes progressive non-fluent aphasia (PNFA) and semantic dementia (SD), and in the motor variants FTD amyotrophic lateral sclerosis (FTD-ALS) and FTD progressive supranuclear palsy (FTD-PSP). This prospective study sought to explore the nature and profile of social cognition deficits across the spectrum of FTD. Methods Sixty patients on the FTD spectrum, i.e., classical (16 with BvFTD and 20 with PPA) and overlap FTD syndromes (13 with FTD-ALS and 11 with FTD-PSP) were evaluated by means of the social cognition tasks, the Interpersonal Reactivity Index (IRI) for empathy, and pictures of facial affect (POFA) for emotion recognition. General cognition and behaviour were also assessed. Results A significant impairment in emotion recognition and empathy was detected in both the classical and overlap FTD syndromes. The recognition of positive emotions was relatively preserved compared to that of negative emotions. Among the FTD subtypes, maximal impairment of empathy was demonstrated in FTD-PSP. Conclusion Social cognition impairment is pervasive across the spectrum of FTD disorders, and tests of emotion recognition and empathy are clinically useful to identify the nature of behavioural problems in both classical and overlap FTD. Our findings also have implications for understanding the neural basis of social cognition in FTD.
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Affiliation(s)
- Faheem Arshad
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Avanthi Paplikar
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Shailaja Mekala
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Feba Varghese
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Darshini Jeevandra Kumar
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Leena Shingavi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Subasree Ramakrishnan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
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Paplikar A, Ballal D, Varghese F, Sireesha J, Dwivedi R, Rajan A, Mekala S, Arshad F, Kaul S, Alladi S. Assessment of Lifestyle Experiences across Lifespan and Cognitive Ageing in the Indian Context. Psychology and Developing Societies 2020. [DOI: 10.1177/0971333620937512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
With rising numbers of elderly and dementia in developing societies, there is a need to understand factors protective against dementia. Evidence suggests that lifetime cognitive activities including education, occupation, and complex leisure activities contribute to cognitive reserve. However, these factors are understudied in India. This paper describes the validation of the Lifetime of Experiences Questionnaire (LEQ), a comprehensive measure of complex lifetime activities, to the Indian cultural context. It also examines the relationship between lifetime experiences and cognition among 52 healthy elderly and 30 dementia patients. High inter-rater (κ=0.923, p < 0.001), test-retest (ρ: 0.905 to 0.986) reliability, and internal consistency were found for LEQ-total (0.992) and sub-scores. Literate dementia patients (25) scored significantly lower mid-life (27.5 vs. 23.3), late-life (28.5 vs. 22.5) and total LEQ (83.5 vs. 20.9) scores than literate healthy group (37). LEQ scores positively correlated with global cognition, and domains of attention and memory on the Addenbrooke’s Cognitive Examination, in healthy and dementia groups. Moreover, LEQ scores correlated positively with age at onset of dementia and negatively with clinical dementia rating (CDR) scores. Our study demonstrates that lifetime activities, especially mid-life experiences, play a protective role in development of late-life dementia, and need to be advocated to preserve late-life cognition.
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Affiliation(s)
- Avanthi Paplikar
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Divya Ballal
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Feba Varghese
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Jala Sireesha
- Department of Neurology, Nizam’s Institute of Medical Sciences, Hyderabad, India
| | - Ramya Dwivedi
- Department of Neurology, Nizam’s Institute of Medical Sciences, Hyderabad, India
| | - Amulya Rajan
- Department of Neurology, Nizam’s Institute of Medical Sciences, Hyderabad, India
| | - Shailaja Mekala
- Department of Neurology, Nizam’s Institute of Medical Sciences, Hyderabad, India
| | - Faheem Arshad
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Subhash Kaul
- Department of Neurology, Nizam’s Institute of Medical Sciences, Hyderabad, India
| | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Hyland CJ, Varghese F, Yau C, Beckwith H, Khoury K, Varnado W, Hirst G, Chien J, Yee D, Isaacs C, Forero-Torres A, Esserman L, Melisko M. Abstract P5-15-01: The use of 18F-FDG PET/CT as an initial staging procedure for stage II-III breast cancer reduces false positives, costs, and time to treatment: A multicenter value analysis in the I-SPY2 trial. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p5-15-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Diagnostic metastatic staging imaging (SI) for asymptomatic stage I-II patients (pts) is not routinely recommended, but is warranted in stage II-III pts with high risk biological subtypes, where previous trials have shown up to a 15% rate of de novo metastatic disease. NCCN guidelines endorse CT CAP and bone scan (STD) for stage III pts, but not PET/CT, and PET/CT is not covered in most parts of the country. We present data on the performance and value of PET/CT.
Methods: Data were available for 799 high risk clinical stage II-III pts screened for I-SPY2 at UCSF, Uminn, UAB, and Georgetown. Of these, 564 pts ranging in age from 25-81 (median = 48) had complete records that were retrospectively reviewed for SI and potential false positives (FP), defined as incidental findings on SI proven benign by subsequent workup. Economic evaluation was conducted from the payer perspective using the mean national 2018 Medicare Physician Fee Schedule and representative costs from the UCSF billing department. The incremental cost effectiveness ratio (ICER) measured the cost of using PET/CT per percent patient (pt) who avoided a FP.
Results: The rate of de novo metastatic disease was 4.8% (38/799), range 3.6-6.4%. Of the 564 pts with complete records, diagnostic SI varied significantly among the four sites (p < 0.0001). STD was used for most pts at UAB (92.8%, 141/152) and Georgetown (85.7%, 54/63), while PET/CT was used for most pts at UCSF (86.6%, 226/261) and Uminn (63.6%, 56/88). Chest X-ray was used for 29.5% (26/88) at Uminn. There were significantly more pts with FP in the group that received STD (22.1%, 51/231) vs. PET/CT (11.1%, 33/298) (p < 0.05). Mean time between incidental finding on SI to determination of FP was 10.8 days. When controlling for institution, mean time from cancer diagnosis to initiation of neoadjuvant chemotherapy was significantly different between STD (44.3 days) and PET/CT (37.5 days) groups (p < 0.05). When aggregating the four sites using mean costs from the 2018 Medicare Physician Fee Schedule, the mean cost/pt was $1132 for STD vs. $1477 for PET/CT. The mean increase in price from baseline SI costs due to FP workup was $216 (23.6%) for STD vs. $65 (4.6%) for PET/CT. The ICER was $31 per percent pt who avoided a FP. When analyzing UCSF pts alone using representative reimbursements from Medicare, the mean cost/pt was $1236 for STD vs. $1081 for PET/CT; using representative reimbursements from Anthem Blue Cross, the mean cost/pt was $3080 for STD vs. $1662 for PET/CT. The ICERs were -$10 and -$95 per percent pt who avoided a FP, respectively.
Conclusion: As compared to STD metastatic staging workup, PET/CT added value by decreasing FP two-fold. This reduced direct costs of FP workup procedures that took a mean time of 10.8 days to resolve. PET/CT also accelerated treatment start. Reducing the chance of FP workup for metastatic disease is of enormous value to pts. Our data establish the value of PET/CT for staging in our high risk clinical stage II-III trial population and highlight the need for alignment between hospital pricing strategies and payer coverage policies in order to deliver high value care to pts.
Citation Format: Hyland CJ, Varghese F, Yau C, Beckwith H, Khoury K, Varnado W, Hirst G, Chien J, Yee D, Isaacs C, Forero-Torres A, Esserman L, Melisko M, I-SPY2 Consortium. The use of 18F-FDG PET/CT as an initial staging procedure for stage II-III breast cancer reduces false positives, costs, and time to treatment: A multicenter value analysis in the I-SPY2 trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-15-01.
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Affiliation(s)
- CJ Hyland
- University of California, San Francisco, San Francisco, CA; University of Minnesota, Minneapolis, MN; Georgetown University, Washington, DC; University of Alabama at Birmingham, Birmingham, AL; Quantum Leap Healthcare Collaborative, San Francisco, CA
| | - F Varghese
- University of California, San Francisco, San Francisco, CA; University of Minnesota, Minneapolis, MN; Georgetown University, Washington, DC; University of Alabama at Birmingham, Birmingham, AL; Quantum Leap Healthcare Collaborative, San Francisco, CA
| | - C Yau
- University of California, San Francisco, San Francisco, CA; University of Minnesota, Minneapolis, MN; Georgetown University, Washington, DC; University of Alabama at Birmingham, Birmingham, AL; Quantum Leap Healthcare Collaborative, San Francisco, CA
| | - H Beckwith
- University of California, San Francisco, San Francisco, CA; University of Minnesota, Minneapolis, MN; Georgetown University, Washington, DC; University of Alabama at Birmingham, Birmingham, AL; Quantum Leap Healthcare Collaborative, San Francisco, CA
| | - K Khoury
- University of California, San Francisco, San Francisco, CA; University of Minnesota, Minneapolis, MN; Georgetown University, Washington, DC; University of Alabama at Birmingham, Birmingham, AL; Quantum Leap Healthcare Collaborative, San Francisco, CA
| | - W Varnado
- University of California, San Francisco, San Francisco, CA; University of Minnesota, Minneapolis, MN; Georgetown University, Washington, DC; University of Alabama at Birmingham, Birmingham, AL; Quantum Leap Healthcare Collaborative, San Francisco, CA
| | - G Hirst
- University of California, San Francisco, San Francisco, CA; University of Minnesota, Minneapolis, MN; Georgetown University, Washington, DC; University of Alabama at Birmingham, Birmingham, AL; Quantum Leap Healthcare Collaborative, San Francisco, CA
| | - J Chien
- University of California, San Francisco, San Francisco, CA; University of Minnesota, Minneapolis, MN; Georgetown University, Washington, DC; University of Alabama at Birmingham, Birmingham, AL; Quantum Leap Healthcare Collaborative, San Francisco, CA
| | - D Yee
- University of California, San Francisco, San Francisco, CA; University of Minnesota, Minneapolis, MN; Georgetown University, Washington, DC; University of Alabama at Birmingham, Birmingham, AL; Quantum Leap Healthcare Collaborative, San Francisco, CA
| | - C Isaacs
- University of California, San Francisco, San Francisco, CA; University of Minnesota, Minneapolis, MN; Georgetown University, Washington, DC; University of Alabama at Birmingham, Birmingham, AL; Quantum Leap Healthcare Collaborative, San Francisco, CA
| | - A Forero-Torres
- University of California, San Francisco, San Francisco, CA; University of Minnesota, Minneapolis, MN; Georgetown University, Washington, DC; University of Alabama at Birmingham, Birmingham, AL; Quantum Leap Healthcare Collaborative, San Francisco, CA
| | - L Esserman
- University of California, San Francisco, San Francisco, CA; University of Minnesota, Minneapolis, MN; Georgetown University, Washington, DC; University of Alabama at Birmingham, Birmingham, AL; Quantum Leap Healthcare Collaborative, San Francisco, CA
| | - M Melisko
- University of California, San Francisco, San Francisco, CA; University of Minnesota, Minneapolis, MN; Georgetown University, Washington, DC; University of Alabama at Birmingham, Birmingham, AL; Quantum Leap Healthcare Collaborative, San Francisco, CA
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Paplikar A, N S, Wadhwani N, Varghese F, Cherodath S, Joshi H, M M, K R, Alladi S. The neural correlates of attention and executive functions in monolingual and bilingual aphasia: Evidence from Voxel based Lesion Symptom Mapping (VLSM). Front Hum Neurosci 2019. [DOI: 10.3389/conf.fnhum.2019.01.00070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
BACKGROUND There is considerable debate regarding the clinical issues surrounding the wish to hasten death (WTHD) in the terminally ill. The clinical factors contributing to the WTHD need further investigation among the terminally ill in order to enhance understanding of the clinical assessment and treatment needs that underlie this problem. A more detailed understanding may assist with the development of appropriate therapeutic interventions. METHOD A sample of terminally ill cancer patients (N = 256) recruited from an in-patient hospice unit, home palliative care service and a general hospital palliative care consulting service from Brisbane Australia between 1998-2001 completed a questionnaire assessing psychological (depression and anxiety), social (family relationship, social support, level of burden on others) and the impact of physical symptoms. The association between these factors and the WTHD was investigated. RESULTS A high WTHD was reported by 14 % of patients. A discriminant function analysis revealed that the following variables were associated with a high WTHD (P < 0.001): higher levels of depressive symptoms, being admitted to an in-patient hospice setting, a greater perception of being a burden on others, lower family cohesion, lower levels of social support, higher levels of anxiety and greater impact of physical symptoms. CONCLUSIONS Psychological and social factors are related to a WTHD among terminally ill cancer patients. Greater attention needs to be paid to the assessment of psychological and social issues in order to provide appropriate therapeutic interventions for terminally ill patients.
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Affiliation(s)
- B Kelly
- Department of Psychiatry and Office of Public Policy and Ethics, University of Queensland and Centre for Palliative Care, Research and Education, Queensland University of Technology, Brisbane, Australia
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Abstract
This exploratory study investigated factors associated with the wish to hasten death among a sample of terminally ill cancer patients. Semi-structured interviews conducted on a total of 72 hospice and home palliative care patients were subjected to qualitative analysis using QSR-NUDIST. The main themes to emerge suggested that patients with a high wish to hasten death had greater concerns with physical symptoms and psychological suffering, perceived themselves to be more of a burden to others, and experienced higher levels of demoralization, while also reporting less confidence in symptom control, fewer social supports, less satisfaction with life experiences and fewer religious beliefs when compared with patients who had a moderate or no wish to hasten death. The implications of these findings will be discussed.
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Affiliation(s)
- B Kelly
- Department of Psychiatry, University of Queensland, Woolloongabba, Australia.
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Abstract
The authors first review issues related to the life cycle and the significance of time for older adults. They then consider the types of psychopathological problems that can occur in older individuals and discuss the indications for and the goals and effectiveness of psychodynamic psychotherapy in older patients. The next section of the paper addresses technical aspects of psychotherapy with older patients, including transference, countertransference, and process issues. The article concludes with a consideration of practical problems (e.g., vision or hearing deficits) as well as other types of challenges that may need to be dealt with in providing psychotherapy to older patients.
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Affiliation(s)
- R Leigh
- University of Queensland and Princess Alexandra Hospital, Brisbane, Australia
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Hebert JR, Gupta PC, Mehta H, Ebbeling CB, Bhonsle RR, Varghese F. Sources of variability in dietary intake in two distinct regions of rural India: implications for nutrition study design and interpretation. Eur J Clin Nutr 2000; 54:479-86. [PMID: 10878649 DOI: 10.1038/sj.ejcn.1601042] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Limited inter-person variability in nutrient intake hampers epidemiologic studies of diet-disease relationships. Despite conjecture about non-traditional study bases providing large inter-person differences, virtually nothing is known about variations in nutrient intake outside of Europe and North America. The current study was conducted in India to determine sources of variability in the intakes of nutrients thought to be of public health importance. DESIGN Adult subjects in Gujarat (North India; n=60) and in Kerala (South India, n=60) were administered 24 h diet recall interviews six and eight times, respectively, over a 1 y period. To assess subject (inter-person) and residual (intra-person) contributions to variance, regression models were fit to the data. From this, the variance ratio (VR, total within or intra-person: total between or inter-person) was computed. SETTING Rural communities in North and South India. RESULTS In both regions, inter-person variability was larger than that observed in the West. This was most pronounced in Gujarat, for which the VR was <1.0 for seven of the 12 energy-adjusted nutrient intakes in both men and women. In analyses of the combined data, region accounted for >20% of variance for fat, iron, copper, zinc, beta-carotene and riboflavin in both men and women. With the region term removed from this model, virtually all of the variability ascribed to region contributed to inter-person variability. CONCLUSIONS The relatively large inter-person variability observed here could contribute to improved 'resolution' of diet-outcome relationships in epidemiologic studies. While this applies to data from each region, it was especially evident in analyses of the combined data.
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Affiliation(s)
- J R Hebert
- Department of Epidemiology and Biostatistics, University of South Carolina, School of Public Health, Columbia 29208, USA.
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Coroneos E, Petrusevska G, Varghese F, Truong LD. Focal segmental glomerulosclerosis with acute renal failure associated with alpha-interferon therapy. Am J Kidney Dis 1996; 28:888-92. [PMID: 8957041 DOI: 10.1016/s0272-6386(96)90389-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Both alpha- and beta- interferons (IFNs) have been increasingly used for the treatment of many types of malignancy, and recently the use of alpha-IFN in the management of hepatitis C virus (HCV) infection with or without renal involvement has been emphasized. We report a patient who developed nephrotic syndrome and acute renal failure while being treated with alpha-IFN for HCV infection. The renal biopsy showed focal segmental glomerulosclerosis and tubulointerstitial nephritis. Although several renal lesions have been described in association with either alpha-IFN treatment or HCV infection, focal segmental glomerulosclerosis has not been emphasized in either instance. This case also indicates that when renal abnormalities occur during treatment of HCV infection with alpha-IFN, kidney biopsy may define the responsible renal lesions, suggest possible association with other conditions, and serve as a guideline for proper management.
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Affiliation(s)
- E Coroneos
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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Keks N, McGrath J, Lambert T, Catts S, Vaddadi K, Burrows G, Varghese F, George T, Hustig H, Burnett P. The Australian multicentre double-blind comparative study of remoxipride and thioridazine in schizophrenia. Acta Psychiatr Scand 1994; 90:358-65. [PMID: 7872041 DOI: 10.1111/j.1600-0447.1994.tb01607.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A double-blind, randomized study of parallel group design comparing remoxipride and thioridazine (dose range 150-600 mg/day of either drug) was undertaken at 11 Australian centres. A total of 144 patients (remoxipride = 73, thioridazine = 71) with DSM-III-R schizophrenia or schizophreniform disorder commenced the study, and 89 patients (remoxipride = 45, thioridazine = 44) completed the 6 weeks of the trial. The mean daily doses at last rating were 404 mg (remoxipride) and 378 mg (thioridazine). Initial Brief Psychiatric Rating Scale scores decreased by a mean 8.7 points in both remoxipride and thioridazine groups. Equivalent treatment responses were also confirmed by Clinical Global Impression. During the study, sedatives or hypnotics were needed by 68% of the remoxipride patients and 51% of the thioridazine patients. Thioridazine was associated with more postural hypotension, drowsiness, increased sleep, headache, dizziness on rising, dry mouth, sexual dysfunction and weight gain, while remoxipride patients reported more insomnia. There were no differences between remoxipride and thioridazine on dystonia, hypokinesia, dyskinesia, rigidity and akathisia. The results indicate that remoxipride has similar antipsychotic efficacy to thioridazine but causes fewer side effects.
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Affiliation(s)
- N Keks
- Alfred Hospital, Melbourne, Victoria, Australia
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Abstract
The reliability of the diagnoses of axis II of DSM-III was examined by measuring the levels of agreement among three psychiatrists who independently examined the same patients in everyday clinical settings. The kappa coefficient levels were lower than those reported from the field trials.
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