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BACKGROUND: Mercury (Hg) is a toxic heavy metal with multiple uses in various medical devices. Hg is used in dentistry as a restorative material. Such use creates significant exposure to dental practitioners. Hence, it is important to assess the risk created by Hg use in healthcare. OBJECTIVE: To quantify airborne Hg vapour exposure and Hg levels in dental healthcare workers, and determine the association of various symptoms and diseases to Hg exposure. METHODS: Air monitoring of Hg vapours were conducted in dental clinics and amalgam rooms. Urine samples were collected from occupationally exposed dental healthcare workers and urine Hg levels were measured. A cross-sectional health survey was conducted in 23 healthcare units of Delhi to determine an association between Hg exposure and various health effects. RESULTS: Hg vapour concentration ranged from 0.96μg/m3 to 15μg/m3, the highest concentration was recorded in the amalgam room (15μg/m3). Urine Hg levels in healthcare workers (0.51±0.17μg/L) were higher than the control (0.29±0.05μg/L). A cross-sectional health survey revealed a significant prevalence of confusion, forgetfulness, muscle spasm, and tremors by the respondents. CONCLUSION: Hg concentration in dental clinics may hover above the prescribed safe levels posing a definitive health risk to healthcare workers. Urinary Hg measurements did not reveal an excess of body burden except in one case. Since Hg bio accumulates, it is probable as these workers grow older, they may end up with a higher body burden of Hg that may lead to a variety of adverse health outcomes. [ABSTRACT FROM AUTHOR]

Background: The transitional state between normal aging and dementia is known as Cognitive impairment (CI) where a person has memory complaints and objective evidence of CI but no evidence of dementia. With the globe undergoing a "demographic transition," the magnitude of neurodegenerative disorders is rising. In India, 27.3% of older persons with comorbidities had CI. Early identification of CI will likely help initiate proper remedial intervention, leading to better overall outcomes. In order to determine the prevalence of CI in older persons and whether it is associated with co-morbid conditions, this study was designed. Methods: A descriptive cross-sectional study was conducted among 350 older adults aged ≥60 residing in rural areas of Lucknow, selected using multistage cluster sampling. The Hindi Mental State Examination (HMSE) scale was used to assess cognitive function. A pretested semi-structured questionnaire was used to collect information on sociodemographic characteristics and comorbidity status. Results: Among 350 participants, with mean ± SD age 70.66 ± 9.53 years, the prevalence of CI as per HMSE (<23) was 24.9%. Overall, the mean HMSE score was less in individuals with (25.2) than without (27.19) comorbidities. Those with comorbidities had significantly lower mean scores in all individual domains of HMSE. Conclusion: CI affects one-fourth of the older adult population. Risk increases with the presence of comorbidities. Hence, screening, and early treatment are recommended. [ABSTRACT FROM AUTHOR]

Purpose: The potential benefits of vegetarian diets in reducing cognitive impairment have garnered attention due to existing mixed results; hence, our study aims to examine the impact of vegetarianism on cognitive function and neuropsychological status among urban community-dwelling adults from Telangana. Methods: The dietary patterns were self-reported and dietary data collected using a Food Frequency Questionnaire while cognitive function was assessed using Mini-Mental State Examination (MMSE) and depression, anxiety, and stress (DASS-21) questionnaire for psychological measures. Adults (N = 304) aged 40 years and above, who followed either a vegetarian or non-vegetarian diet for at least 6 months prior to data collection, scored MMSE ≥ 19 indicating mild cognitive impairment, and were recruited using convenience sampling. Results: Among the participants, vegetarians (n = 155) exhibited significantly better mood states compared to non-vegetarians (n = 149), as indicated by lower scores on the DASS subscales for depression (10.0 ± 0.06 vs. 17.0 ± 0.07, p = < 0.001), anxiety (4.0 ± 0.05 vs. 6.0 ± 0.07, p = 0.005), and stress (8.0 ± 0.02 vs. 10.0 ± 0.05, p = 0.007). Vegetarians also demonstrated superior cognitive functioning compared to non-vegetarians, as indicated by higher MMSE scores (26.0 ± 0.04 vs. 24.0 ± 0.03, p = < 0.001). MMSE scores were inversely correlated with depression, anxiety, and stress for vegetarians (ρ = − 0.371, p = 0.000; ρ = − 0.027, p = 0.734; and ρ = − 0.105, p = 0.914), respectively. Similar to the vegetarians group, MMSE scores were negatively correlated with depression (ρ = − 0.059), but the correlation is not significant. Conclusion: Vegetarianism exerted a positive influence on the cognitive and neuropsychological status of the investigated population. Nevertheless, additional research is required to comprehend the underlying mechanisms that elucidate the long-term effects of vegetarianism and plant-based nutritional interventions on brain health. [ABSTRACT FROM AUTHOR]

Canine cognitive dysfunction syndrome is a common behavioural disorder of geriatric dogs prevailing in the world including India. The etiology is not confirmed yet, however, the main pathological change is age-related and progressive amyloid protein deposition in the brains of affected dogs. The syndrome usually goes unnoticed due to unawareness among caretakers and non-specific clinical signs such as altered behaviour and cognition. When detected early, environmental enrichment, nutritive diet and supportive therapeutic agents can be beneficial in procrastinating the disorder and improving the quality of life of the animal. [ABSTRACT FROM AUTHOR]

Background: To evaluate the cognitive function, psychoemotional status, treatment adherence, and quality of life in patients with type 2 diabetes mellitus. Materials & Methods: A descriptive cross-sectional study conducted from July 2022 to December 2022 at a tertiary care teaching hospital in India. The study included all the T2DM patients, of both genders, aged 18-75 years, and asked them to complete a proposed set of standard questionnaires. In this study all the patient information was collected using a case report form including their socio-demographic data, and self-reported adherence to diabetic medication, and all the patients were interviewed and asked to complete a set of standardized questionnaires (mini-mental state examination (MMSE), hospital anxiety and depression scale (HADS), and European quality of life questionnaire (EQ-5D-5L)). Results: about 60% of type 2 diabetic patients reported non-adherence to medication. These patients showed low MMSE, EQ-5D-5L scores, and high HADS scores. The MMSE results showed that the majority of the patients with T2DM had mild cognitive impairment and HADS scores reported that the majority of the T2DM patients had mild depression. The quality of life scores were positively correlated with MMSE scores (p < 0.0001) whereas, the quality of life scores negatively correlated with HADS scores (p < 0.0001). The EQ index and VAS scores are affected by the presence of depression, anxiety, and cognitive impairment. Conclusion: The quality of life is decreased with depression, anxiety, and cognitive impairment. There is a complex relationship between the patient's psychoemotional state, mental status, and quality of life of the patient. The cognitive and psychoemotional determinants of the patients should be assessed and treated to increase the quality of life of the patient and to provide effective optimal drug therapy. The role of a clinical pharmacist was understood in promoting adherence to medication by educating and counselling patients. [ABSTRACT FROM AUTHOR]

The present study aimed to understand how informal caregivers and occupational therapists support daily time management (DTM) of older persons with dementia (PwD) and their views regarding assistive products for DTM, i.e., time management products (TMPs). The study involved a qualitative descriptive approach rooted in principles of naturalistic inquiry. Twelve caregivers of PwD and eight occupational therapists were interviewed. Conventional content analysis was performed. Findings are described in three categories. The first category "current strategies to support DTM" described the low-tech strategies used for specific cognitive functions. The second category "factors influencing DTM and TMP" entailed factors related to the PwD (especially premorbid time management), the caregiver (multiple caregivers, attitude towards technology), the occupational therapist (impairment-oriented practice, limited resources and training in DTM) and the context (attitude towards time, poor awareness and knowledge of dementia, an expectation of recovery, negative societal attitudes towards devices, affordability/access). The third category "expectations from TMP" described the participants' expectations regarding device-related features (low-cost, easy to use, portable, low maintenance, customisable and useable across the disease continuum) and support for device use (maintenance, caregiver education). The study provides contextually relevant recommendations and strategies to inform the provision, acceptance and adherence to DTM interventions and guide the development and prescription of indigenous TMP for PwD in India. Adoption of time management products (TMPs) for people with dementia in India requires an understanding of contextual factors, especially culturally influenced attitudes of persons with dementia and their family members towards time, assistive products and elders. Contextually relevant approaches and strategies are suggested to guide the provision of daily time management (DTM) interventions including TMPs for people with dementia and their families in India. It is imperative to assess the relevance, acceptance and feasibility of available TMPs for people with dementia and their families living in India and develop contextually relevant indigenous products. Occupational therapists working with people with dementia and their families would benefit from more opportunities for training and access to resources (including contextually relevant standardized assessments) to implement DTM interventions. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 (COVID-19) virus has caused widespread Acute Respiratory Disease globally since 2020. Patients with evidence of lower respiratory illness either clinically or radiologically had moderate-to-severe illness. COVID respiratory and nonrespiratory symptoms (psychological and cognitive) noticed after 4–8 weeks of primary disease were called long COVID syndrome. Survivors of moderate-to-severe disease had a poor quality of life. The main objective of this retrospective study was to assess the role of outpatient pulmonary rehabilitation (PR) done in moderate-severe COVID-19 survivors who had symptoms after 4–8 weeks at Shaivam Lung Rehabilitation Centre, Ahmedabad. Methods: We analyzed the impact of PR on 30 patients' post-COVID-19 who were willing to participate during the ongoing pandemic. It was an outpatient 6–8 weeks of program designed to target respiratory and general muscle training, relaxation technique, nutritional counseling, occupational and psychological support. Patients were tested with of combination of self-assessment quality of life scale (adapted from short form 36 questionnaire), muscle training, dyspnea scale, and physical assessment. The standard objective assessment included oxygenation index (SpO2/FiO2 ratio), 6 min walk distance (6 MWD), Modified Medical Research Council (MMRC) score, manual muscle testing (MMT) along with pulmonary function testing. All these subjective and objective variables were tested pre- and post-PR program to assess the impact on defined parameters. Results: From December 2020 to March 2022, we studied the impact of PR on 30 out of 55 patients fitting into the inclusion criteria. Significant benefit was noted in subjective Short Form 36 (SF 36) score and objective (6 MWD, MMRC, oxygenation, MMT) quality of life post-PR program (P < 0.001). Improvement in spirometry was not statistically significant, indicating structural chronicity of COVID pulmonary fibrosis. Conclusion: PR is safe, effective, and feasible on an outpatient basis in COVID-19 survivors of illness with poor quality of life. Further research is required to prove its widespread benefit in such patients. [ABSTRACT FROM AUTHOR]

Bell's mania is the co-occurrence of delirium and mania. We present two cases of Bell's mania in a neurosurgical setting. The first case is of a 52-year-old male who presented with holocranial headache, disorientation, and manic symptoms for five months. He was found to have suprasellar craniopharyngioma. He significantly improved with olanzapine, but re-emergence of mood symptoms was noted after surgery. The second case is of a 42-year-old male who presented with a 15-day history of seizures and disorientation. He was found to have a dural arteriovenous fistula. He developed Bell's mania in the post-procedural period, which improved with olanzapine. Compression of the hypothalamo-pituitary stalk in the first case and vascular and inflammatory changes in the second case could have led to Bell's mania. Atypical age of onset and presence of neurological symptoms in patients presenting with psychiatric symptoms should raise the suspicion of an underlying organicity. Atypical anti-psychotics can be a useful management strategy for Bell's mania. [ABSTRACT FROM AUTHOR]

Introduction: The term "Dementia" refers to a significant cognitive decline from previous level of performance which interferes with independence in daily activities. Deficits in cognition function significantly hinder social and occupational functioning. "Non-cognitive" neuropsychiatric symptoms or the behavioural and psychological symptoms of dementia (BPSD) are a major contributor for high level of care giver burden and poor quality of life in patients with dementia. It is important to understand the occurrence of BPSD with severity of cognitive impairment, as this would help caregivers and healthcare professionals to predict likely behavioural and psychological issues. Aims: To describe the patterns of BPSD among dementia patients attended to psychiatry department at RGKar MCH, Kolkata and its association (if any) with the degree of cognitive impairment. Materials and Methods: The present study was a cross-sectional descriptive study. This study was conducted over a period from January 2019 to Decemder 2019 at Department of Psychiatry, R.G. Kar Medical College & Hospital, Kolkata. Total 90 patients were included in this study. An interviewer administered questionnaire, Mini mental state examination and the Neuropsychiatric Inventory (NPI) were used. Result: In our study, 43.3% patients were Females. Mean age was 63.2+/- 6.4 yrs. As per MMSE score, severity of dementia was mild, moderate and severe in 26.7%, 53.3% and 20% patients respectively. Common BPSD were delusion (51.1%), agitations (51.1%), hallucination (41.1%) and depression (35.5%) etc. Hallucinations, disinhibition and aberrant motor behaviour were significantly more prevalent with increase severity of dementia. Depression, anxiety symptoms were mostly seen in mild dementia. Conclusion: Majority of individuals experienced BPSD. Depending on the level of cognitive impairment seen, there was a statistically significant prevalence in certain symptom groups. [ABSTRACT FROM AUTHOR]

Schizophrenia is a chronic, severe mental disorder affecting thoughts, actions, emotions, perception of reality, and relationships. Schizophrenia, affecting around one percent of the adult population, is not as common as other major mental illnesses, but it can be one of the most chronic and disabling conditions. Effective care options include medication, psychoeducation, family interventions, cognitivebehavioural therapy, and psychosocial rehabilitation (e.g., life skills training). This case study highlights the need for facilitating assisted living, supported housing, and employment for individuals with schizophrenia. A recovery-oriented approach, which empowers individuals in treatment decisions, is crucial for patients and their families. [ABSTRACT FROM AUTHOR]

Objectives: Increased depression severity has been linked to cognitive impairment (CI). Importantly, CI is a known risk factor for impaired balance and falls. Therefore, this study aims to explore the relationship between CI and neuromuscular functions and secondarily it aims to find out if CI is a potential predictor for neuromuscular functions deficits in depressed elderly. Methods: Eighty‐four depressed elderly participated in the study. Assessment for CI symptoms were done using Mini Mental Status Examination (MMSE) in subjects having confirmed depression. Neuromuscular functions such as balance confidence, static and dynamic balance, functional mobility, and fall risk were subjectively assessed using Activities‐specific Balance Confidence (ABC) Scale, Berg Balance Scale (BBS), Timed Up and Go (TUG) Test, and Performance Oriented Mobility Assessment (POMA), respectively. Results: Pearson's analysis revealed that there was moderate positive linear‐correlation between MMSE and BBS (R = 0.382, p = <0.001) and between MMSE and ABC (R = 0.229, p = 0.036*). Further, regression analysis (R2) revealed that MMSE significantly predicted the neuromuscular functions using BBS [F(1, 82) = 14.013, p < 0.001, with an R2 of 0.146] and ABC [F(1, 82) = 4.545, p= 0.036*, with an R2 of 0.053]. Conclusion: Results of this study points to an impaired CI as a possible factor in development of neuromuscular function impairment in depressed elderly. [ABSTRACT FROM AUTHOR]

Persons with severe mental illness (PwSMI) are at risk of being victimized due to persistent cognitive, emotional, and behavioral symptoms, which can become potential threats for effective reintegration into the community. A total of 217 PwSMI, receiving outpatient psychiatric treatment from a tertiary hospital, were screened for abuse, and if they were identified as abuse, then information about contextual factors contributing to abuse, sociodemographic, family, and clinical and legal profiles was created. Overall, 150 PwSMI were victimized, of which 56% were females, 50.7% were married, 20.7% were educated up to middle school, and 31.4% were homemaker. The most common form of diagnosis was schizophrenia (43.3%), with a mean duration of illness of 14 years. All the victimized PwSMI were subjected to emotional abuse. PwSMI were more likely to be victimized by multiple family members due to poor knowledge and understanding about illness (24%). The majority of the PwSMI had disclosed abuse (62.7%) to nonformal sources (33.3%) with no documentation in the clinical file (82.7%). PwSMI experience ongoing abuse and are more likely to be re-victimized, which increases the need for regular screening and culturally sensitive and comprehensive community-coordinated care and support. [ABSTRACT FROM AUTHOR]

Objective: To study the prevalence of cognitive impairment in survivors of intracerebral hemorrhage (ICH). Methods: Survivors of spontaneous ICH were followed up in the neurology outpatient department when they reported for follow-up after 6 months. Neuroimaging records at the onset and at follow-up visits are studied for the location of ICH, volume of ICH, intraventricular extension, and hydrocephalus. The volume of ICH is calculated by ABC/2 method on a CT scan. All patients underwent cognitive assessment with Addenbrooke's cognitive examination ACE III and were categorized as patients having cognitive impairment (or) no cognitive impairment. Results: A total of 120 patients were studied, out of which 77 (64%) are males and 43 (36%) are females with age groups ranging from 26 to 75 years. In the study population, the mean age was found to be 62.3 years. Specifically, the mean age for males was 56.9 years, while for females it was 63.4 years. Cognitive impairment was noted in 34 of 120 patients (28%) during 6 to 12 months of examination, of which 11 of 19 were in lobar location, 21 of 94 were in sub-cortical location, and 2 of 7 were in infratentorial location. Conclusion: It was found that 28% of survivors of ICH were cognitively impaired. Hence, it is essential to assess cognition in post-ICH patients during follow-up, so that suitable adjustments can be made in their employment, and also in educating family members in providing a good quality of life. [ABSTRACT FROM AUTHOR]

Background: Schizophrenia may cause significant impairment in social and economic aspects of a patient's life. Current evidence suggests that cognitive deficits may affect the functioning of a person with schizophrenia more than positive or negative symptoms. There is a lack of literature on explanatory models of cognitive deficits in schizophrenia that can influence help-seeking behavior. Objectives: This study aimed to estimate the prevalence of cognitive deficits and assess their relationship with socio-demographic and clinical characteristics among patients with schizophrenia. We also planned to explore the explanatory models of cognitive deficits in these patients. Methods: Consecutive outpatients with schizophrenia who met eligibility criteria were recruited after obtaining informed consent. The Addenbrooke's Cognitive Examination Tamil version (ACE III) and Observable Social Cognition -- A Rating Scale (OSCARS) and Positive and Negative Symptom Scale (PANSS) were used to assess cognitive functioning and symptom profile, respectively. Beliefs about illness were recorded using the modified Short Explanatory Model Interview (SEMI). Socio-demographic and treatment-related details were collected with a structured proforma. Statistical analysis was done using SPSS for Windows (version 16.0.1). Results: One hundred and forty patients participated in the study. The prevalence of cognitive deficits was 75.7% using ACE-III scores, 19.3% on OSCARS, and 40% based on subjective reports. Though the majority (81.4%) of patients reported a medical explanatory model for cognitive impairment, a significant number of them (70.7%) also held non-medical models simultaneously. Conclusion: Cognitive deficits are prevalent in the majority of patients with schizophrenia. Poor test performance on cognitive testing was observed in those with a significant family history. Multiple contradictory explanatory models for the causation of cognitive deficits were reported. [ABSTRACT FROM AUTHOR]

Background: The Unani formulation Majun Brahmi (MB), a combination of herbs, is used in India as a brain tonic and memory enhancer. Aluminium deposition in the brain is associated with the development of neurodegenerative diseases. Aims and Objectives: The present study was designed to observe that the effects of MB have been evaluated on aluminium trichloride or aluminium chloride (AlCl3)-induced cognitive impairment in an experimental rat model. Materials and Methods: Twenty male Wistar albino rats were divided into four groups of five rats each. AlCl3 was administered orally for 30 days to induce cognitive impairment. Group I received saline, Group II-AlCl3 (100 mg/kg b.wt), Group III-MB (1027.77 mg/kg b.wt), and Group IV-AlCl3 + MB (100 mg/kg b.wt+1027.77 mg/kg b. wt). At the end of the experiment, rats were subjected to behavioral and biochemical assessments. Results: Animals treated with AlCl3 showed a significant increase in time to reach the platform in the Morris water maze test (MWM), prolonged transfer latency (TL) in the elevated plus maze, and decreased step-down latency in the passive avoidance test, as compared to controls (P<0.01). Cotreatment with MB resulted in a reduced time to reach the platform in MWM, increased step-down latencies, and decreased TL. AlCl3 induction significantly increased malondialdehyde and decreased superoxide dismutase, glutathione reductase, glutathione, total antioxidant capacity, and catalase levels. Concomitant administration of MB significantly attenuated the effects AlCl3 on lipid peroxidation and restored the reduced antioxidant parameters. Conclusion: The study provides strong evidence for the potential use of MB in the treatment of neurodegenerative disorders like Alzheimer's disease. [ABSTRACT FROM AUTHOR]

Descriptive research design was adopted for the study. The investigator selected 156 samples through non-probability convenient sampling technique . The tool has three parts Section- A consists of Semi structured interview schedule to assess the demographic variables. Section- B was check list to assess Pre Menstrual Syndrome among adolescent girls. Section –C included Rating scale to assess the practice during menstruation among adolescent girls. The results of present study reveals that majority 98(73%) of adolescent girls experience irritability, headache 68(51%), anxiety41(30%), tension 83(62%), depression 51(38%), anger 85(63%), breast tenderness/Pain 49(36%), Impaired work activities 8(51%), and only 35(26%) adolescent girls have confusion as Pre Menstrual Symptoms before their menstruation . 156(100%) of them were having adequate practices during menstruation. There was no significant association found between level of practice during menstruation with their selected demographic variables such as age, and age at menarche, duration of menstruation, menstrual cycle, type of menstrual flow, experience of Pre Menstrual Syndrome, Dysmenorrhoea during menstruation. [ABSTRACT FROM AUTHOR]

Background: Given the unique socioeconomic structures, and the rural/urban differentials in the prevalence of mental illnesses in the country, this study aimed to explore the associations of childhood, adulthood and late-life rural/urban place of residence with mental health outcomes, namely depressive symptoms and cognitive impairment, among older adults in India. The study also examined the relationship between older individuals' life-course rural/urban place of residence and late-life mental and cognitive health. Methods: Utilizing data from the Longitudinal Aging Study in India (n = 28,027 older adults age 60 years and above), the study employed multivariable logistic and linear regression models to examine the association between urban/rural residential status, life-course residence, depressive symptoms and cognitive impairment among older adults. Results: Childhood and adulthood place of residence was not associated with depressive symptoms in older men and women. Current rural place of residence was positively associated with depressive symptoms in older women [adjusted odds ratio (aOR): 1.37, confidence interval (CI): 1.05–1.80] but not men. Childhood [aOR: 1.88, CI: 1.16–3.04], adulthood [aOR: 2.00, CI: 1.26–3.16] and current rural residence [aOR: 1.93, CI: 1.27–2.91] was positively associated with cognitive impairment in men. Only current rural residence [aOR: 1.71, CI: 1.29–2.27] was associated with cognitive impairment in women. There was no significant association between life-course place of residence and depressive symptoms except in case of lifetime rural residence Respondents with urban-urban-urban (childhood-adulthood-current) place of residence were less likely to have depressive symptoms [adjusted coefficient (aCoef.): -0.14, CI: -0.21- -0.07] compared to those with rural-rural-rural place of residence. There were significant associations between life-course residence and cognitive impairment except among rural-urban-rural and urban-rural-rural migrants, showing an urban advantage in cognitive function among older adults. Conclusions: This study showed significant associations between life-course residence and depressive symptoms among permanent rural/urban residents. The study also showed significant associations between life-course residence and cognitive impairment except among rural-urban-rural and urban-rural-rural migrants. Considering the rural disadvantage in mental and cognitive health among older adults, the government should continue to support policies that can improve access to education and healthcare among people residing in rural areas and women, in particular. The findings also urge social scientists and gerontologists in particular, to consider the importance of lifetime historical context while evaluating mental and cognitive health of older persons. [ABSTRACT FROM AUTHOR]

Background and Objective: Nearly 40–65% patients with MS develop cognitive impairment during the disease. There is no treatment clearly effective in improving the cognitive deficits. To evaluate the efficacy and safety of Rivastigmine in cognitively impaired MS patients. Materials and Methods: This was a parallel group randomized open label study with blinded end‑point assessment. The patient allocation to treatment and control arm was done by telephonic contact with an independent statistician who used a computer to generate a random sequence of allocation using permuted block randomization (varying block size of 4 and 6) in 1:1 ratio. The outcome assessor was blinded to this allocation. A total of 60 patients were in included in the study (30 in each arm). Primary outcome was improvement in memory functions (using logical memory subset of Wechsler Memory Scale III, India) assessed after 12 weeks. Secondary outcomes included fatigue, depression, and safety. Results: In modified intention to treat analysis (N = 22), treatment arm showed statistically significant improvement in memory function with mean difference of 7.56 [95% CI (0.67,14.46), p 0.032] as compared to control arm. There was no statistically significant difference in outcomes such as fatigue and depression. Vomiting was the most common side effect. No major adverse events were observed in either group. Conclusion: Rivastigmine is safe and effective in improving memory functions in cognitively impaired MS patients. However, our study has a small sample size and tested only a single domain. Larger studies with a validated single comprehensive neuropsychological test are needed. [ABSTRACT FROM AUTHOR]

Objectives: Cardiovascular risk factors (e.g., diabetes and hypertension) are comorbidities associated with cognitive impairment. The present study was planned to study the relationship between cardiovascular risk factors and cognitive impairment using General Practitioner assessment of Cognition (GPCOG) scale, which is easy to use scale in the primary care. Materials and Methods: A total of 350 older adults (mean age=66.71 ± 6.53 years; M:F = 220:130) among 3000 who reported to the primary care center in West India were screened. Cardiovascular risk factors were assessed based on written medical records. GPCOG was used for cognitive screening of those over the age of 60 with subjective memory complaints. Results: Frequency of cardiovascular (CV) risk factors in those with cognitive impairment was 46.2% (n = 162/350) and 29% (101/350) in those without cognitive impairment. A Chi-square test of proportion showed values to be statistically significantly different (Chi-square value = 22.04; P =< 0.001; 95% confidence interval [CI] = 10.0463-24.1076%). Odds ratio was found to be 1.6 (95% CI =2-2.1; P =< 0.05). Conclusion: A higher CV risk factors were observed among those with cognitive impairment compared to those cognitively normal older adults in the primary care. [ABSTRACT FROM AUTHOR]

Background: Diabetes is no longer the domain of physicians alone. Every specialty needs to know about diabetes management, which, when poorly controlled, affects patient outcomes. Knowledge, attitude, and practice surveys in this group would help design and change the current academic scenario. This study aims to conduct this amongst postgraduate students in surgical branches at a medical college in rural Gujarat. Objective: The aims of this study were (1) to assess the knowledge, attitude, and practices regarding Diabetes management among surgical postgraduate students; (2) to formulate or modify teaching practices based on the knowledge gaps; and (3) to stress the need for more weightage to diabetes in the medical curriculum. Materials and Methods: This cross-sectional study was conducted at a teaching hospital in rural Gujarat and 73 surgical postgraduate students participated. Results: Attitude towards learning was good, with 98.6% keen to learn. 97.3% felt the need for a teaching program. With regards to hurdles faced, 57.5% attributed it to lack of knowledge, 93.2% felt diabetes was not their domain, and 84.9 % regarded confusion regarding insulins. Only 48% were aware of the magnitude of the problem and knowledge regarding the management of diabetes in inpatients was less than expected. Conclusion: Results showed a good attitude, willingness to learn, and awareness about the impact of uncontrolled diabetes. The need for reinforcement of knowledge about diabetes was felt and willingness to manage diabetes if the hurdles were addressed was seen. There is a need to implement changes and give more weightage to diabetes and more hands-on experience to graduates and postgraduate curriculum (surgical branches) in medical colleges. [ABSTRACT FROM AUTHOR]

The goal of this research is to study the prevalence of cognitive impairment in diabetes mellitus (DM) patients and establish the necessity of detecting and treating it early in these patients. A cross-sectional study was conducted at a tertiary care hospital in Mysuru for 4 months examined diabetic patients (test) and nondiabetic subjects (control) for cognitive decline using the Montreal Cognitive Assessment (MoCA) tool. Cognitive functions such as visuospatial/executive function, naming, attention, language, abstraction, delayed recall, and orientation were assessed in both groups. The diabetic group showed a significantly lower total MoCA score than the non-diabetic group (18.99 ± 0.48 and 26.21 ± 0.46, respectively; p < 0.001). Assessment of scores in diabetic patients demonstrated the significant influence of age demographics on cognitive impairment (p-value < 0.001). Furthermore, a higher proportion of diabetic patients displayed cognitive impairment despite a higher score in a single subdomain, making it evident that diabetes is diverse and multifactorial in origin, where oxidative stress and inflammatory responses play a predominant role. This study suggested that the local T2DM population residing in Mysuru (India) has a high prevalence of cognitive impairment, evident from poor performance in almost all cognitive domains assessed by MoCA. Future studies could examine the generalizability of cognitive function findings in diabetic patients across diverse geographic regions and ethnic groups, as well as investigate interventions such as lifestyle modifications and medication to prevent or delay cognitive decline in those with diabetes. [ABSTRACT FROM AUTHOR]

Celastrus paniculatus Wild is an evergreen climbing shrub. The plant is of great significance in the traditional Indian System of Medicine, such as Ayurveda, Unani, and Siddha. The seeds and their oil are extensively used to treat neurological disorders such as cognitive dysfunction, paralysis, epilepsy, insomnia, and other ailments like rheumatism, arthritis, sciatica, and leprosy. This paper aims to highlight the nootropic activity of C. paniculatus and explore its phytochemistry, traditional uses, and other pharmacological activities. All available information concerning C. paniculatus has been searched in the internationally accepted scientific databases, including PubMed, ScienceDirect, Scopus, and Google Scholar. Additional knowledge was gathered from the classical Textbooks and Unani Pharmacopoeia. C. paniculatus is a rich source of several secondary metabolites, such as β-Dihydroagarofuranoids sesquiterpenes, alkaloids (Celastrine, Celapanin, Celapagin, and paniculatin), flavonoids, terpenoid (β-amyrin, Lupeol, Pristimerin), sterols (β-sitosterol, campesterol, stigmasterol, α-tocopherol, γ-Tocopherol), fatty acid (palmitic, stearic, oleic, linoleic, linolenic acids) and non-fatty acids (Benzoic acid, Cinnamic acid). The various study shows that the extracts and active constituent of this plant possess potent nootropic activity. Besides nootropic activity, it has also been reported for anti-Alzheimer, anticonvulsant, antidepressant, antioxidant, analgesic, anti-inflammatory, antiarthritic, gastroprotective, anti-psoriatic, wound healing, antibacterial, antimalarial, and several other properties. Several in vitro and in vivo trials confirm the conventional use of C. paniculatus in cognitive dysfunction. However, the relations between the possible mechanisms of other activities and traditional uses of the C. paniculatus remain indistinct. Still, pharmacological studies also explored the effects of C. paniculatus, which were not recognized in ancient times, such as cytotoxic, ACE inhibitor, and antidiabetic activities. These discoveries are may be beneficial in the development of the new drug to treat various diseases. It is also confirmed that the β-dihydroagarofuranoids exhibit significant AChE inhibitory, cytotoxic, antibacterial, and insecticidal effects. This versatile medicine is truly a life elixir. Considering the therapeutic importance of the C. paniculatus and the absence of any reported clinical studies, extensive clinical trials are needed to explore its memory enhancing and other activities. [ABSTRACT FROM AUTHOR]

Background: Abnormal blood lipid levels in the general population and adverse reproductive events among women have been associated with cognitive impairment (CI). However, their relationship has not been extensively studied in community settings. Hence, this study aims to explore the association of CI with blood lipid levels in both sexes and reproductive events/trajectory among women. Methods: A cross-sectional study was conducted among a North Indian rural population. A total of 808 adults were recruited through door-to-door household survey. Data on socio-demographic variables, reproductive profile of women, and cognitive impairment status were collected. Fasting blood sample was collected to estimate serum lipid profile. Multivariate logistic regression was performed to test for association. Results: The study demonstrated a lack of association between lipid profile and cognitive impairment among males. Surprisingly, low HDL-C among females was found to be protective against moderate/severe cognitive impairment (value of p = 0.049). Further, menopausal women and those having five or higher live births were found to be at higher risk of CI than pre-menopausal women and those with 1--2 live births, respectively. Conclusion: The present study hints toward a gender-specific association of blood lipid levels with CI. Further, higher live births and menopause appear to be important risk factors for CI among women. [ABSTRACT FROM AUTHOR]

The article focuses on clinical practice guidelines for the use of Electroconvulsive Therapy (ECT) as a safe treatment for psychiatric conditions, including depression, mania, and acute exacerbations of psychosis in schizophrenia. It mentions that the guideline document aims to enable consistent, safe, and effective practice of ECT and outlines the indications for ECT and the predictors of response to treatment.

Background: Cognitive impairment (CoI) is a significant risk factor for ill-health status among the older adults and a major burden on public health. This study unearths the degree of socioeconomic inequalities and assesses the determinants of CoI among the older adults in India. Methods: Data on cognitive impairment of older adults aged 60 + years (n = 31,646) gathered in a nationally representative Longitudinal Ageing Study in India (2017–18) was analyzed through STATA with a significance level of 5%. Binary logistic regression, the concentration index, concentration curve, and Shapley decomposition analysis were performed to assess the socioeconomic inequalities and the determinants of CoI. Results: Sixteen percent of the older adults had CoI. Females (OR = 1.88, 95% CI = 1.70–2.09), those aged 80 plus years (OR = 3.98, 95%CI = 3.56–4.44), from ST (OR = 2.65, 95%CI = 2.32–3.02), with perceived poor health (OR = 1.61,95%CI = 1.45–1.79), with depression (OR = 1.32, 95%CI = 1.21–1.43), with no schooling (OR = 16.46, 95%CI = 11.31–23.97) with 1 + ADL (OR = 1.43, 95%CI = 1.31–1.57) and 1 + IADL (OR = 1.30, 95%CI = 1.19–1.41) had higher odds of CoI than their respective counterparts. Older adults from urban areas (OR = 0.63, 95%CI = 0.57–0.70), higher income groups (OR = 0.61, 95%CI = 0.53- 0.70) and higher education level with sources of financial support (OR = 0.68, 95%CI = 0.61- 0.76) less likely to experience CoI. Economic inequalities exist in the distribution of CoI-the poorest being the most disadvantaged (concentration index value = -0.118). Conclusions: There are socioeconomic-related inequalities in CoI among the older adults. The socioeconomically vulnerable older adults, including those illiterates, with poor economic status, women, not-in-union, the older, and those without social support, are more likely to develop CoI. The results suggest awareness generation and more customized policies and programs to reduce the socioeconomic inequalities in CoI among the older adults in India. The improved mental health of the older adults will contribute to achieving Sustainable Development Goals, including Goal 3 on guaranteeing good health and well-being for all. [ABSTRACT FROM AUTHOR]

Repetitive transcranial magnetic stimulation (rTMS) is potentially effective as an augmentation strategy in the treatment of many neuropsychiatric conditions. Several Indian studies have been conducted in this regard. We aimed to quantitatively synthesize evidence from Indian studies assessing efficacy and safety of rTMS across broad range of neuropsychiatric conditions. Fifty two studies- both randomized controlled and non-controlled studies were included for a series of random-effects meta-analyses. Pre-post intervention effects of rTMS efficacy were estimated in "active only" rTMS treatment arms/groups and "active vs sham" (sham-controlled) studies using pooled Standardized Mean Differences (SMDs). The outcomes were 'any depression', depression in unipolar/bipolar depressive disorder, depression in obsessive compulsive disorder (OCD), depression in schizophrenia, schizophrenia symptoms (positive, negative, total psychopathology, auditory hallucinations and cognitive deficits), obsessive compulsive symptoms of OCD, mania, craving/compulsion in substance use disorders (SUDs) and migraine (headache severity and frequency). Frequencies and odds ratios (OR) for adverse events were calculated. Methodological quality of included studies, publication bias and sensitivity assessment for each meta-analyses was conducted. Meta-analyses of "active only" studies suggested a significant effect of rTMS for all outcomes, with moderate to large effect sizes, at both end of treatment as well as at follow-up. However, except for migraine (headache severity and frequency) with large effect sizes at end of treatment only and craving in alcohol dependence where moderate effect size at follow-up only, rTMS was not found to be effective for any outcome in the series of "active vs sham" meta-analyses. Significant heterogeneity was seen. Serious adverse events were rare. Publication bias was common and the sham controlled positive results lost significance in sensitivity analysis. We conclude that rTMS is safe and shows positive results in 'only active' treatment groups for all the studied neuropsychiatric conditions. However, the sham-controlled evidence for efficacy is negative from India. Conclusion: rTMS is safe and shows positive results in "only active" treatment groups for all the studied neuropsychiatric conditions. However, the sham-controlled evidence for efficacy is negative from India. [ABSTRACT FROM AUTHOR]

Anti N-meihyl D-aspartate receptor encephalitis (NMDAR-E) though rare, is currently considered as the commonest antibody mediated encephalitis in the world. No review on perspectives of NMDAR-E from India is available. The aim of the study was to review all the cases of NMDAR-E reported from India until June 2021 in terms of clinical features, diagnosis, and treatment, and perform a comparison of adult and paediatric cases. A literature review of NMDAR-E case reports/case series published from India till June 2021 was done. Demography, clinical profile, triggers, electroencephalography (EEG), neuroimaging, treatment details and outcomes were analysed. Sixteen case series and 35 case reports with a total of 249 cases were analysed. 82% of cases were from paediatric age group. The female to male ratio was 3:1. Psychiatric deficits, movement disorders, seizures, and language abnormalities were the most common clinical features. MRI brain abnormalities were seen in 45% patients. Electroencephalographic abnormalities were seen in 85% of patients. Infective triggers (herpes simplex virus and various other agents) were reported in 11% of the cases. Pediatric patients as compared with adults had more encephalopathy, autonomic dysfunctions, and normal imaging whereas the latter had more cognitive dysfunctions and delta brush pattern in electroencephalography (p<0.005). Therefore, to conclude, this literature review suggests that overall, the clinical spectrum of Indian cases is like cases described from other parts of the world. However, most reported cases from India belonged to paediatric age group who had more encephalopathy, autonomic dysfunctions, and normal brain imaging compared to adults. A few novel infectious agents as triggers were described from India. [ABSTRACT FROM AUTHOR]

Context: Pain-related fear is more disabling than pain itself. Assessment of kinesiophobia should be practiced as a regular basis for any traumatic painful conditions. As upper limb fractures are most prevalent among all the other types of fractures, this study aims to assess the prevalence of kinesiophobia in posttraumatic upper limb conditions and its correlation with cognitive status. Aim: The aim of this study was to determine the prevalence of kinesiophobia in upper limb traumatic fractures and observe its correlation with cognitive status. Settings and Design: This cross-sectional study was conducted at tertiary care hospital, and data were obtained from the orthopedics department of the hospital. Subjects and Methods: Three hundred (n = 300) patients with upper limb fractures were screened for kinesiophobia and cognitive impairment. Kinesiophobia was assessed using Tampa Scale for Kinesiophobia and cognition was assessed using Mini-Mental State Examination Scale. Statistical Analysis: Descriptive statistics were applied and frequency distribution in percentages to see the prevalence of kinesiophobia in upper limb fractures. Karl's Pearson's coefficient correlation test was applied to evaluate the correlation between cognitive status. Results: There is an inverse negative correlation between cognitive status and kinesiophobia (r = 0.06, P = 0.002). There was 58% of overall prevalence in upper limb fractures but the highest was observed in fractures of the shoulder complex which was 32%. Conclusions: The overall prevalence of kinesiophobia in upper limb fractures was high, however, it was highest in fractures of the shoulder complex with compound fractures. This study also concludes that reduced cognitive status leads to increased kinesiophobia. [ABSTRACT FROM AUTHOR]

Cognition capacity is essentially age-dependent and it is associated with the overall well-being of an individual. The public health aspects of cognitive research primarily focus on the possible delaying of cognitive decline among the older adult population. In this context, using the most recent round of the Longitudinal Ageing Study in India, 2017–2018 data, this study examines the cognition capacity among older adults aged 45 and above subject to their nutritional health and health behaviour (tobacco and alcohol consumption). It is observed that almost one in every tenth individual (10%) above 45 years of age in India shows low cognition scores. Low cognition is much more prevalent among 60 + females than males. Around one-fifth of the underweight older adults (18%) demonstrate low cognition capacity among them. Of those older adults who consume only tobacco, 11% of them demonstrate low cognition than the rest. The partial proportional odds model estimation shows that older adults are at higher risk of developing low cognition with increasing age and beyond age 65, the individuals carry a critically higher risk to experience low cognition. The estimation also shows that with increasing age older adults are higher likely to experience poor cognition independent of nutritional status, but underweight older adults are comparatively more likely to experience low cognition followed by normal and overweight older adults. In terms of alcohol-tobacco consumption behaviour, older adults who consume both are more likely to experience low cognition with increasing age followed by 'only alcohol consumers', and 'only tobacco consumers'. [ABSTRACT FROM AUTHOR]

Background: Older persons are at risk of developing cognitive impairment, often considered a precursor to more severe conditions, such as dementia or Alzheimer's disease. Cognitive impairment among older adults is one of the most rapidly growing burdens, especially in developing countries. Aim: To assess the impact of cognitive impairment on activities of daily living (ADL) among older adults. Materials and Methods: A cross-sectional descriptive study was conducted among 135 older adults visiting a selected tertiary care centre in Uttarakhand (India) during December 2020, recruited using total enumerative sampling. Data were collected using standardized and validated tools that consisted of socio-demographic information, Hindi Mental Status Examination, and Everyday Abilities Scale for India. Data were analyzed using SPSS version 23, including descriptive (frequency, percentage, mean, and median) and inferential statistics (Chi-square test, binary logistic regression). Results: The results with pooled analysis have shown that 30% of the older adults had mild cognitive impairment, 9% had moderate cognitive impairment, and 61% had normal cognition. About 16% of the older adults' ADL were affected. The statistically significant predictors for cognitive impairment were age group 80 years [odds ratio (OR) = 36.21; 95% confidence interval (CI) = 6.23–210.59], Muslim religion (OR = 6.26; 95% CI = 1.12–34.93), and middle-class families (OR = 11.95; 95% CI = 1.84-77.78). Conclusion: A considerably large proportion of the older adults had cognitive impairment, which further impacted activities of daily living. There is an urgent need to develop geriatric mental health services across all hospitals in the region. [ABSTRACT FROM AUTHOR]

Background: Older patients with cancer are more vulnerable to the effects of cognitive impairment affecting their functional status, quality of life, compliance to treatment and ultimately survival. Cancer-related cognitive impairment may be due to the cancer itself or due to the treatment of cancer. There are no data regarding the prevalence of cognitive impairment in older persons with cancer and brain metastasis. Methods: This retrospective analysis was conducted on a prospectively collected data set of patients who attended the geriatric oncology clinic at a tertiary care comprehensive cancer centre in India from June 2018 to July 2021. Patients aged 60 years and above with malignancy were included. Cognition was assessed with the mini-mental status examination (MMSE); the Hindi MMSE was used for illiterate patients. A score of <23 on the MMSE was considered abnormal. Correlation between the presence of cognitive impairment and brain metastasis was tested using the chi-square test. Results: A total of 597 patients were included, of which 462 (77.4%) were male. The median age was 69 years (range: 60–100 years). All patients had solid tumours; 244 (40.9%) had lung, 189 (31.7%) had gastrointestinal and 75 (12.6%) had head and neck malignancies. Forty-one (6.9%) patients had brain metastases, of which 10 (24.4%) had solitary, 30 (73.2%) had multiple lesions and 1 (2.4%) had leptomeningeal metastases. Cognitive impairment was noted in 11 (26.8%) of the 41 patients with brain metastases and 91 (16.4%) of the 556 patients without brain metastases. There was no significant correlation between the presence of brain metastases and cognitive impairment, p = 0.086. Conclusion: Older persons with cancer and brain metastases were not found to have a higher occurrence of cognitive impairment than those without brain metastases in this study. The next step is to understand whether older persons with brain metastases are at a higher risk for cognitive decline as a result of therapeutic interventions such as cranial radiotherapy and chemotherapy. [ABSTRACT FROM AUTHOR]

Large population-based studies on the associations of childhood factors with late-life cognition are lacking in many low and middle income countries including India. In this study, we assessed the prevalence of late-life cognitive impairment and examined the associations of childhood socioeconomic status (SES) and health conditions with cognitive impairment among older adults in India. Data for this study were derived from the Longitudinal Ageing Study in India conducted in 2017–18. The effective sample size was 31,464 older adults aged 60 years and above. Cognitive functioning was measured through five global domains (memory, orientation, arithmetic function, executive function, and object naming). The overall score ranged between 0 and 43, and the score was reversed indicating cognitive impairment. Descriptive statistics along with mean scores of cognitive impairment were presented. Additionally, moderated multivariable linear regression models were employed to examine the association between explanatory variables, including childhood SES and health conditions and late-life cognitive impairment. The mean score of cognitive functioning among the study participants was 21.72 (CI 2.64–21.80). About 15% of older adults had poor health conditions, and 44% had lower financial status during their childhood. Older adults who had a fair health during their childhood were more likely to suffer from cognitive impairment in comparison to older adults who had good health during their childhood (Coef: 0.60; CI 0.39, 0.81). In comparison to older adults who had good childhood financial status, those who had poor childhood financial status were more likely to suffer from cognitive impairment (Coef: 0.81; CI 0.56, 1.07). Older adults who had fair childhood health status and poor childhood financial status were more likely to suffer from cognitive impairment in comparison to older adults who had good childhood health and good financial status (Coef: 1.26; CI 0.86, 1.66). Social policies such as improving educational and financial resources in disadvantaged communities and socioeconomically poor children and their families, would help to enhance a better cognitive ageing and a healthy and dignified life in old age. [ABSTRACT FROM AUTHOR]

Due to different nature of social engagements of older adults in South Asian countries specially attributed to the traditional family-based care and support, beneficial effects of religiosity and religious involvement on mental health and cognitive function in older age might be different than those in the Western world. Yet, there is a paucity of research in these countries on the role of religion in moderating the relationship between late life depression and cognition. This study explored the association of depressive symptoms with cognitive impairment and the moderating effects of religiosity and religious participation in those associations among older Indian adults. A cross-sectional study was conducted on data that were drawn from the Longitudinal Ageing Study in India wave-1, collected during 2017–2018. The sample size comprised of 31,464 older adults aged 60 years and above. Shortened 10-item Centre for Epidemiologic Studies Depression Scale was used to measure depressive symptoms. Items from the Mini-Mental State Examination and the cognitive module of the China Health and Retirement Longitudinal Study and the Mexican Health and Aging Study were adapted for measuring cognitive impairment. Moderated multiple linear regression models were used to test the research hypotheses of the study. The proportion of older adults who reported religion as less important to them was 21.24%, whereas, only 19.31% of the respondents participated in religious activities. The mean score of cognitive impairment (on a scale of 0–43) in the current sample was 19.43 [confidence interval (CI): 19.32–19.53] among men and 23.55 [CI: 23.44–23.66] among women. Older adults with depressive symptoms had significantly higher likelihood of cognitive impairment [aCoef: 0.18, CI: 0.16–0.20] in comparison to older adults with no depressive symptoms. Older individuals who were religious were significantly less likely to have cognitive impairment [aCoef: − 0.43, CI: − 0.61 to − 0.25] than their non-religious counterparts. Compared to older adults who did not participate in religious activities, those who participated in religious activities were less likely [aCoef: − 0.52, CI: − 0.69 to − 0.34] to have cognitive impairment. Further, significant moderating effects of religiosity and religious participation in the relationship between depressive symptoms and cognitive impairment were observed. The current study contributes to advancing knowledge about the mental health benefits of religiosity and religious participation by focusing on older adults in India who culturally have limited chances to participate in social activities. The findings suggest that older adults with depressive symptoms may participate in religious activities which may reduce their chances of cognitive impairment. This protective effect of religiosity and religious participation on late life cognitive health has important implications for promoting alternative social support mechanisms for older adults in terms of enhancing their mental wellbeing and contributing to active aging. [ABSTRACT FROM AUTHOR]

Background: Antenatal care (ANC) services are a prime focus of the Government of India's National Health Mission (NHM), of which a key pillar is the promotion of maternal and child health. To ensure uninterrupted service delivery at the last mile, a cadre of Frontline Health Workers (FLHWs) has been appointed and health centres established at the village level. However, the onset of the COVID-19 pandemic and the nationwide lockdown from late March to June 2020 impacted pregnant women's access to institutional antenatal care services. Methods: Using a qualitative research design, data was collected through 12 in-depth interviews (IDIs) with pregnant women and 17 IDIs with frontline health workers in the selected six districts under study. The narratives were analysed using inductive coding in Atlas.ti. Results: During the first wave of the COVID-19 pandemic, pregnant women, most of whom belonged to poor and marginalised groups, were left with limited access to health centres and FLHWs. Respondents from the study areas of rural Jharkhand, Madhya Pradesh and Uttar Pradesh extensively reported concerns stemming from the lockdown that influenced their decision to access ANC services. These included anxieties around meeting their families' daily needs due to a loss of livelihood (in particular, abject food insecurity), inability to access healthcare, and a sense of mistrust in public health systems and functionaries. All of these, coupled with the real threat to health posed by COVID-19, disrupted their plans for pregnancy and delivery, further compunding the risk to their health and wellbeing. Conclusion: This study identified several social, behavioural and structural facets of the communities that contributed to the confusion, anxiety and helplessness experienced during the COVID-19 first wave by both groups, viz. pregnant women and FLHWs. In planning and implementing initiaves to ensure the delivery and uptake of ANC services in this and similar contexts during times of crisis, these facets must be considered. Plain language summary: This article highlights the status of ANC services during the nationwide lockdown imposed in the first wave of the COVID-19 pandemic in the Indian states of Jharkhand, Madhya Pradesh and Uttar Pradesh. Data was collected through 12 in-depth interviews with pregnant women and 17 in-depth interviews with frontline health workers. Findings suggest that pregnant women were aware of the unprecedented threat of COVID-19 and recommended protective measures through trusted sources of information, including their local Accredited Social Health Activist (ASHA). However, both pregnant women and FLHWs believed that the information they received on the health risks of the pandemic and strategies to address these was inadequate. Temporary suspension of health services in the rural countryside meant that pregnant women could not track the foetus's health status, resulting in confusion and distress. Limited or no interaction with FLHWs, coupled with a reported lack of attention to conditions unrelated to COVID-19 and discrimination at healthcare institutions increased the uncertainty around institutional deliveries. This was further heightened by the loss of livelihoods due to the shutdown of businesses during the lockdown, as the respondents could not turn to private hospitals for childbirth. This resulted in the collapse of the trust of pregnant women and their families in the public healthcare system. To bridge this gap and alleviate the sense of mistrust the pandemic has created in its end-users, strategies to improve the utilisation of health services should respond to the barriers identified in this study. [ABSTRACT FROM AUTHOR]

This article aims to identify the factors prevalent among health science librarians toward vaccine hesitancy. With the development of COVID-19 vaccines in 2021, numerous efforts are being taken to vaccinate people to control the spread of coronavirus. Recent research has shown a high level of vaccine hesitancy among various groups in various fields but no study has been conducted to explore the factors responsible for vaccine hesitancy among library professionals. A cross-sectional online survey of Indian health science librarians was conducted. Data was collected through an online questionnaire designed on Google Forms and analyzed using MS-Excel. Descriptive statistics were used in the study. The majority of respondents (77%) showed a high level of vaccine hesitancy due to issues of safety, negative information, and confusion over vaccines. Measures to increase vaccination uptake and authentic sources with respect to COVID-19 vaccines have been discussed. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Introduction: Attention deficit hyperactivity disorder (ADHD) has hyperactivity, impulsivity, and inattentiveness. Brain iron stores influence dopamine synthesis and behavior. Serum ferritin is a marker for iron stores. Few studies are there on serum ferritin levels in ADHD, and the results showed either way as low or equal to controls. Contradictory results were observed in two published Indian studies, hence the need for the study. Aims and Objectives: The objectives of this study were to compare serum ferritin and hematological indexes between children with ADHD and normal controls and also to compare ADHD subscales in two of ADHD groups divided on a cutoff serum value of below 15 ng/ml (World Health Organization criteria). Materials and Methods: Children with ADHD without comorbidities were compared with controls at a child and adolescent psychiatry unit, Hyderabad, India, after ethics committee approval. The assessments included Conners' Parent Rating Scale (CPRS)-Revised (S), serum ferritin, and hematological indexes. Results: Two-three children with ADHD and 38 normal children as controls participated. The mean (standard deviation [SD]) of serum ferritin levels in the ADHD group 28.26 (16.46) and controls 23.06 (18.88) was not statistically significant. Significantly higher mean values (14.60) on cognitive/inattention subscale was noticed In below (15 ng/ml) serum ferritin level group compared to the mean (11.50) in above (15 ng/ml) serum ferritin group. Negative nonsignificant correlation (r = −0.366) between cognitive-inattention subscale of ADHD and serum ferritin levels was noticed. Conclusions: Iron-deficiency state showed higher inattentiveness on CPRS subscale than noniron-deficiency state. There is a weak negative correlation between serum ferritin and inattentiveness. [ABSTRACT FROM AUTHOR]

Background: Elderly population in India is steadily increasing and depression and dementia are the most common neuropsychiatric disorders in the older adult population. Epidemiological studies have reported disparity in the prevalence of mental health morbidity in older Indian adults. The aim of the present study was to assess community-based prevalence of undiagnosed depression and cognitive impairment with possible dementia and its associated factors in elderly persons residing in urban areas. Materials and Methods: The present study was a cross-sectional community-based study conducted in persons above 60 years residing in urban localities of selected four different zones of Greater Hyderabad through multistage sampling. The questionnaire consisted of sociodemographic details, the validated "Mini-Mental State Examination (MMSE)" Questionnaire and Geriatric Depression Scale short-form. Results: The study was completed with a total of 230 individuals. The mean age of participants was 68.02 (±5.71) years. The study group comprised 50.87% males and 49.13% females and 56.08% of participants were self-employed/employed. Of total participants, 37.39% were residing alone of whom 70% were male. More than half (57.83%) of study participants had studied less than 8th grade. Cognitive impairment with possible dementia was present in 51.74% of participants, the prevalence of depression was 22.71% and in 16.09% of participants, both conditions coexisted. Factors found to be significantly associated with depression and cognitive impairment with possible dementia or both conditions were current unemployment [Odds ratio [OR] 5.0 (95% CI (2.44–10.81)], residing alone (OR 2.78 [1.48–5.23]) and education less than high school (OR 24.85 [2.53–9.32]). Conclusions: Depression and cognitive impairment with possible dementia were considerably prevalent in the elderly population of Hyderabad, India. Factors significantly associated with the prevalence of either or both conditions were, residing alone and education less than high school. [ABSTRACT FROM AUTHOR]

To study the correlation between telomere length (TL) and long-acting injectable (LAI) and oral atypical antipsychotic (OAA) efficacy on schizophrenia (SCZ) severity and cognitive impairment. Sixty Schizophrenia patients of 18–50 years and of either sex were included in a 12-week study. Thirty patients were recruited in each group, LAI and OAA. Positive and Negative Syndrome Scale (PANSS) and National Institute of Mental Health and Neuro-Sciences (NIMHANS) neuropsychological battery tests were evaluated at baseline and 12 weeks. TL was estimated at baseline. Both groups showed a significant improvement in PANSS and NIMHANS battery test scores after treatment (p < 0.001) within the group, though not between the groups. Mean TL at baseline was 407.58 ± 143.93 and 443.40 ± 178.46 in LAI and OAA groups respectively. A significant negative correlation (r = −0.28, p = 0.03) of TL was seen with the mean change in negative PANSS score after treatment. LAI antipsychotics are similar to OAA in decreasing the disorder severity and improving the cognitive impairment in schizophrenia. Also, patients who have shorter TL show greater improvement in the negative PANSS score. Hence, TL holds the potential of predicting antipsychotic drug response in schizophrenia patients. Long-acting injectable antipsychotic was comparable to oral atypical antipsychotics in bringing out improvement in disorder severity, cognitive functions over 12 weeks. Shorter telomere length has been found to be associated with a greater response in negative symptoms of schizophrenia. [ABSTRACT FROM AUTHOR]

Aim: To investigate the viability of implementing neurobic exercise interventions among adults diagnosed with Mild Cognitive Impairment (MCI). Materials and Methods: A comprehensive search of electronic databases PubMed, Google Scholar, Medline, was done for relevant studies, including randomised controlled trials, observational studies. Inclusion criteria were both male and female with cognitive impairment, implementation of neurobic programme and their follow ups. A total of four articles were synthesised out of 12, for the review based on the inclusion criteria. Results: All the four studies yielded positive results. Firstly, use of neurobic exercises exhibited a significant decrease in Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) relative change scores, indicating cognitive decline improvement, and significantly higher Catechol-O-methyltransferase (COMT) relative Pooja Purendra Chandrakar, Postgraduate Student, Department of Physiotherapy, School of Allied Health Sciences, MRIIRS, Faridabad, Haryana, India. Sunita Kumari, Assistant Professor, Department of Physiotherapy, School of Allied Health Sciences, MRIIRS, Faridabad, Haryana, India. Exploring the Viability of Neurobic Exercises as an Intervention for Cognitive Impairment: A Literature Review Abstract ID: PG-64 change scores, reflecting enhanced cognitive performance at 3rd and 6th weeks. Secondly, serum Brain-derived Neurotrophic Factor (BDNF) level in the neurobic group was slightly higher than pretest. There was change in Montreal Cognitive Assessment (MoCA) scale in post treatment experimental group as compared to conventional group. Participants expressed high satisfaction with the activities and perceived the intervention as helpful. Conclusion: The implementation of neurobic exercise interventions proved to be both feasible and was well-received by people with cognitive impairment. It also proved to improve quality of life. Neurobic exercises suggest future research avenues demonstrating a forward looking approach to address existing research gaps. [ABSTRACT FROM AUTHOR]

This study has important ethnopharmacological implications since it systematically investigated the therapeutic potential of Bacopa monnieri (L.) Wettst. (Brahmi) in treating neurological disorders characterized by oxidative stress—a growing issue in the aging population. Bacopa monnieri , which is strongly rooted in Ayurveda, has long been recognized for its neuroprotective and cognitive advantages. The study goes beyond conventional wisdom by delving into the molecular complexities of Bacopa monnieri , particularly its active ingredient, Bacoside-A, in countering oxidative stress. The study adds to the ethnopharmacological foundation for using this herbal remedy in the context of neurodegenerative disorders by unravelling the scientific underpinnings of Bacopa monnieri 's effectiveness, particularly at the molecular level, against brain damage and related conditions influenced by oxidative stress. This dual approach, which bridges traditional wisdom and modern investigation, highlights Bacopa monnieri 's potential as a helpful natural remedy for oxidative stress-related neurological diseases. The aim of this study is to investigate the detailed molecular mechanism of action (in vitro, in silico and in vivo) of Bacopa monnieri (L.) Wettst. methanolic extract and its active compound, Bacoside-A, against oxidative stress in neurodegenerative disorders. ROS generation activity, mitochondrial membrane potential, calcium deposition and apoptosis were studied through DCFDA, Rhodamine-123, FURA-2 AM and AO/EtBr staining respectively. In silico study to check the effect of Bacoside-A on the Nrf-2 and Keap1 axis was performed through molecular docking study and validated experimentally through immunofluorescence co-localization study. In vivo antioxidant activity of Bacopa monnieri extract was assessed by screening the oxidative stress markers and stress-inducing hormone levels as well as through histopathological analysis of tissues. The key outcome of this study is that the methanolic extract of Bacopa monnieri (BME) and its active component, Bacoside-A, protect against oxidative stress in neurodegenerative diseases. At 100 and 20 μg/ml, BME and Bacoside-A respectively quenched ROS, preserved mitochondrial membrane potential, decreased calcium deposition, and inhibited HT-22 mouse hippocampus cell death. BME and Bacoside-A regulated the Keap1 and Nrf-2 axis and their downstream antioxidant enzyme-specific genes to modify cellular antioxidant machinery. In vivo experiments utilizing rats subjected to restrained stress indicated that pre-treatment with BME (50 mg/kg) downregulated oxidative stress markers and stress-inducing hormones, and histological staining demonstrated that BME protected the neuronal cells of the Cornu Ammonis (CA1) area in the hippocampus. Overall, the study suggests that Bacopa monnieri (L.) Wettst. has significant potential as a natural remedy for neurodegenerative disorders, and its active compounds could be developed as new drugs for the prevention and treatment of oxidative stress-related diseases. [Display omitted] • Bacoside-A in Bacopa Monnieri modulate the expression of antioxidant genes in response to oxidative stress. • Bacoside-A inhibits the interaction between Nrf-2 and Keap-1. • Bacopa monnieri mitigates oxidative stress induced by restraint stress in Sprague-Dawley rats. [ABSTRACT FROM AUTHOR]

Background: The rapidly aging population is a major concern for countries, especially where cognitive health in older age is poor. The study examined the socioeconomic and health-related factors associated with cognitive impairment among older adults and the contribution of those factors to the concentration of low cognitive functioning among older adults from economically poor households.Methods: Data this study were derived from the "Building Knowledge Base on Population Ageing in India" (BKPAI) survey, which was carried out in seven major states of India. The effective sample size for the analysis was 9176 older adults aged 60 years and above. Results from descriptive and bivariate analysis were reported in the initial stage. Multivariable logistic regression analysis was conducted to explore the associations. Additionally, the concentration index and concentration curve were used to measure socioeconomic inequality in cognitive impairment among older adults. Wagstaff decomposition was employed to explore the key contributors in the concentration index.Results: Nearly 60% of older adults suffered from cognitive impairment in the study. The likelihood of cognitive impairment were higher among older adults with a low level of self-perceived income sufficiency [coefficient: 0.29; confidence interval (CI): 0.07- 0.52] compared to older adults with higher levels of perceived income status. Older adults with more than 10 years of schooling were less likely to be cognitively impaired [coefficient: -1.27; CI: - 1.50- -1.04] in comparison to those with no education. Cognitive impairment was concentrated among older adults from households with the lowest wealth quintile (concentration index (CCI): - 0.10: p < 0.05). Educational status explained 44.6% of socioeconomic inequality, followed by 31.8% by wealth status and 11.5% by psychological health. Apart from these factors, difficulty in instrumental activities of daily living (3.7%), caste (3.7%), and perceived income sufficiency to fulfil basic needs (3.0%) explained socioeconomic inequality in cognitive impairment among older adults.Conclusions: Findings suggest that older adults with lower perceived income, lower levels of education, poor physical and mental health, and poor physical and social resources were more likely to be cognitively impaired. Education, wealth and psychological health are major contributors in socioeconomic inequality in late-life cognitive impairment, which may be target areas in future policy formulation to reduce the inequality in cognitive impairment in older Indian adults. [ABSTRACT FROM AUTHOR]

Introduction: Due to rapid urbanization, Covid-19 pandemic and increasing food prices, a higher rate of food insecurity has been observed in recent years in India. Thus, we aim to study the prevalence of food insecurity among older Indian adults and the association of food insecurity as a modifiable risk factor with late-life cognitive impairment. Method: Data for this study were obtained from the recent release of the Longitudinal Ageing Study in India (2017-18). The total sample size for the study was 31,464 older adults aged 60 years and above. Cognitive functioning was measured through five broad domains (memory, orientation, arithmetic function, executive function, and object naming) adapted from the cognitive module of the US Health and Retirement Study (HRS). Descriptive statistics along with cross-tabulation were presented in the study. Additionally, multivariable logistic regression analysis was used to fulfil the objectives of the study. Results: It was found that 7.7% of older adults in rural areas reduced their size of meals due to unavailability (urban, 3.2%), 41.2% of them did not eat enough food of their choice (urban, 38.3%), 6.9% were hungry but did not eat food (urban, 2.6%), 5.0% did not eat for whole day (urban, 2.2%), and 6.9% lost weight due to lack of food in their household (urban, 2.9%). It was found that older adults who did not have enough food of their choice had significantly higher odds [AOR: 1.24; CI: 1.14, 1.35] of suffering from cognitive impairment in reference to their counterparts. Similarly, the older adults who were hungry but did not eat were 30% [AOR: 1.30; CI: 1.02, 1.73] more likely to suffer from cognitive impairment in reference to their counterparts. Interaction model revealed that older adults who had food insecurity in rural areas had higher odds of cognitive impairment than older adults who had food insecurity in urban areas. Conclusion: The findings of the study highlight that the food security status in older adults may bring about greater challenges due to their limited economic resources. Interventions focusing on food security may have unintended positive impacts on late-life mental wellbeing as the older age is associated with higher cognitive deficits. [ABSTRACT FROM AUTHOR]

Introduction: Mild cognitive impairment (MCI) is a transitional stage in the continuum of cognitive decline. Multiple risk factors may be involved apart from neuropathological states such as Alzheimer's disease, Parkinson's disease, and vascular dementia. There is scant data in the literature pertaining to our study population in Kerala, South India that provide associations between suggested risk factors and MCI. Most of the elderly present to family and primary care physicians with complaints of some form of memory impairment. Objectives: To find out the significant neuropathological comorbid conditions present in elderly patients with MCI. To assess for other risk factors in the same population- including laboratory parameters, comorbidities, and psychosocial parameters. Methods: This retrospective record-based study included a sample of 93 patients with MCI as quantified by the Mini-Mental Status Examination (MMSE). These subjects were compared with controls (n = 97) without MCI, with respect to neuropathological diagnoses, laboratory parameters and psychosocial parameters. Results: The findings of our study were that female gender, higher depression scores, a greater number of medications taken, benzodiazepine use, higher alkaline phosphatase levels, positive fall history, loss of a spouse, and lower levels of education were associated with MCI. MCI is negatively associated with positive alcohol history. The most commonly seen proven neuropathological diagnosis was Parkinson's disease. Conclusion: The risk factors that were found in our study should be highlighted in the elderly and preventive measures should be taken to prevent the downward progression through the cognitive continuum. Prospective studies looking into mild cognitive impairment with better screening tools and proper assessment of neuropathological comorbid conditions can further elucidate the findings related to this study. [ABSTRACT FROM AUTHOR]

Background: The association between cognitive decline and diabetes mellitus has been evidenced throughout recent decades. Objectives: The objective of this study was to determine the prevalence of cognitive decline in diabetics and nondiabetics in association with age, gender, level of education, risk factors, and duration of diabetes mellitus in middle-aged and elderly patients. Materials and Methods: A prospective, case-control study was conducted at a tertiary-care center between May 2014 and December 2015. Patients with diabetes (n = 150) and normal patients (n = 150) were compared. Patients were divided into groups according to age, gender, education, and duration of diabetes mellitus. The Hindi mini-mental state examination (HMMSE) was used to detect cognitive decline. Results: In diabetics with HMMSE score <27, 24 (46.1%) were aged <60 years, whereas 28 (53.9%) were aged =60 years. In diabetics with HMMSE score =27, 52 (53.1%) were aged <60 years, whereas 46 (46.9%) were aged =60 years. This finding was not statistically significant. In nondiabetics with HMMSE score <27, 13 (34.2%) nondiabetics were aged <60 years, whereas 25 (65.8%) were aged =60 years. In nondiabetics with HMMSE score =27, 61 (54.4%) were aged <60 years, whereas 51 (45.6%) were aged =60 years. This finding was statistically significant. Conclusion: Our study findings revealed no statistically significant findings in diabetics. However, specific cognitive domains such as orientation to place, concentration, and drawing displayed statistical significance for cognitive decline. [ABSTRACT FROM AUTHOR]

The magnitude of type 2 diabetes mellitus (T2DM) is ever-increasing in India, and at present, ~77 million people live with diabetes. Studies have established that T2DM increases the risk of neurodegenerative disorders. This study aimed to determine the age-related prevalence of mild cognitive impairment (MCI) in T2DM patients in the Indian population and to identify link between cognitive dysfunction in T2DM patients and serum lipid composition through untargeted and targeted lipidomic studies. Using a cross-sectional study, we evaluated 1278 T2DM patients with Montreal cognitive assessment test (MoCA) and digit symbol substitution test (DSST) for cognitive functions. As per MoCA, the prevalences of MCI in T2DM patients in age groups below 40, 41-50, 51-60, 61-70, 71-80 and 81-90 years were 13.7, 20.5, 33.5, 43.7, 57.1 and 75% with DSST scores of 45.8, 41.7, 34.4, 30.5, 24.2 and 18.8% respectively. Binomial logistic regression analysis revealed serum HbA1c ≥ 7.51, duration of T2DM over 20 years, age above 41 years, and females were independent contributors for cognitive dysfunction in T2DM patients. Preliminary studies with untargeted lipidomics of the serum from 20 T2DM patients, including MCI and normal cognition (NC) group, identified a total of 646 lipids. Among the identified lipids, 33 lipids were significantly different between MCI and NC group, which comprised of triglycerides (TGs, 14), sphingolipids (SL, 11), and phosphatidylcholines (PC, 5). Importantly, 10 TGs and 3 PCs containing long-chain polyunsaturated fatty acids (PUFA) were lower, while 8 sphingolipids were increased in the MCI group. Since brain-derived sphingolipids are known to get enriched in the serum, we further quantified sphingolipids from the same 20 serum samples through targeted lipidomic analysis, which identified a total of 173 lipids. Quantitation revealed elevation of 3 species of ceramides, namely Cer (d18:1_24:1), Hex1Cer (d16:0_22:6), and Hex2Cer (d28:1) in the MCI group compared to the NC group of T2DM patients. Overall, this study demonstrated an age-related prevalence of MCI in T2DM patients and highlighted reduced levels of several species of PUFA containing TGs and PCs and increased levels of specific ceramides in T2DM patients exhibiting MCI. Large-scale lipidomic studies in future could help understand the cognitive dysfunction domain in T2DM patients, while studies with preclinical models are required to understand the functional significance of the identified lipids. [ABSTRACT FROM AUTHOR]

Introduction: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder of motor neurons. Spread of pathology to other brain areas leads to development of non-motor symptoms (NMSs). These usually remain undiagnosed because of overwhelming motor problem and are responsible for significant distress to the patient. Our objective was to explore the burden of various NMSs of patients with ALS, compare between limb-onset and bulbar-onset patients, and to correlate with severity and duration of disease. Methods: Fifty patients with ALS diagnosed according to revised El Escorial Criteria and 50 healthy controls were included in this study. They were assessed with NMS Questionnaire, Beck's Depression Inventory, Center for Neurologic Study-Lability Scale, Drooling Frequency and Severity Scale, Epworth Sleepiness scale, Bengali Mental State Examination, and Frontal Assessment Battery and relevant statistical analyses were carried out. Results: The patients with ALS had significantly increased prevalence of almost all NMSs compared to controls. There was also significant increase in depression, suicidal ideation, pseudobulbar affect, and daytime sleepiness in patients with ALS. The bulbar onset subgroup had significantly increased daytime drooling, dysphagia, nausea and vomiting, whereas the limb onset subgroup reported increased frequency of leg swelling. Executive dysfunction was detected in 24% of patients with ALS and 9.8% had mild cognitive impairment. Weight loss, frequency of falling, insomnia, unpleasant nocturnal leg sensations, difficulty having sex, depression, and cognitive impairment increased significantly with an increase in severity of the disease. Conclusion: NMSs were significantly more prevalent in patients with ALS. Some NMSs worsened with advancement of the disease. [ABSTRACT FROM AUTHOR]

Background: HIV is an infectious disease affecting 36.7 million people worldwide. In recent times, Antiretroviral Therapy (ART) has become accessible to the majority of People Living with HIV (PLHIV) and this has transformed the course of infection to one that is chronic, characterized by fewer diseases pathognomonic of AIDS. In view of this, there is a pressing need for better markers, apart from the routine HIV indicators, to detect comorbidities such as Neurocognitive Impairment (NCI). The aim of this study was to find out the association between Veterans Aging Cohort Study (VACS) index and Neurocognitive function in HIV positive patients. Methods: In our study, we included 97 HIV positive patients and their Neurocognitive function was assessed using a combination of Montreal Cognitive Assessment and Grooved Pegboard Test, while VACS index was calculated using the most recent laboratory values. Binomial Logistics Regression analyses, adjusting for potential confounding variables, was performed to determine the association between VACS score and Neurocognitive Impairment. Results: We found that a higher VACS Index was associated with global and domain-wise Neurocognitive impairment (p < 0.01), specifically in the domains of attention (p < 0.01) and fine motor skills (p = 0.01). Our study also showed that among all the VACS components, older age (p = 0.02) and lower hemoglobin (p < 0.01) values were associated with global NCI. After plotting an ROC curve, a VACS cut-off score of 11.00 was identified as it had good sensitivity (87.0%) and specificity (71.4%) in identifying Global NCI. Conclusion: Our findings extend prior research on the use of VACS Index to predict global and domain-wise NCI in HIV-positive patients. However, further research with more comprehensive neurocognitive testing is required in our setting before VACS Index can be used as a tool to screen for neurocognitive dysfunction among PLHIV. [ABSTRACT FROM AUTHOR]