Mild cognitive decline: Concept, types, presentation, and management

As advancements are being made in the medical field, the average life span is increasing and more complaints related to the elderly are coming into notice. Of these, mild cognitive decline (MCD) or mild cognitive impairment (MCI) is recently becoming an increasingly recognized entity that is often considered a precursor of dementia but is found to have other outcomes as well. It also has variations in presentations; it does not present only as memory complaint but also in the form of other cognitive or behavioral manifestations and has always been a point of controversy regarding the objectivity of the diagnosis. It is considered as the appropriate stage for intervention to prevent its progression to dementia and therefore, requires early identification for which various diagnostic modalities such as neuroimaging, neuropsychological tests, and biological markers are considered. Currently, there are no specific treatment guidelines for MCD. Drugs used in Alzheimer′s disease (AD), lifestyle modifications, and other nonpharmacological approaches have shown some benefit in MCI but the results are variable; hence, the need for further research is warranted for effective preventive therapy. In this article, we will be discussing MCD as a clinical construct, evaluation of a person suspected of having MCD, and management of the same

Study of cognitive profile in the elderly presenting with both depressive and cognitive symptoms

Background: Elderly patients presenting with cognitive and depressive symptoms often create a diagnostic challenge between depression and the dementing process. Various screening and diagnostic instruments have been developed for differentiating the two, one of which is Addenbrooke′s cognitive examination (ACE). However, results have not been consistent across various studies, and not much data is available in the Indian context. Aims and Objectives: To study cognition in elderly patients presenting with both cognitive and depressive symptoms at the baseline and at 3 months follow-up after starting antidepressants, and to compare the two profiles. Materials and Methods: It was a follow-up study with 70 participants who had presented with both depressive and cognitive symptoms. Tablet escitalopram was given and ACE was performed at the baseline and at 3 months after starting antidepressants. Improvement on ACE was present in 37 participants and absent in 33 participants. The cognitive profile of these two groups was subjected to statistical analysis. Wilcoxon signed-rank test was used to study the difference between the full and domain ACE scores between the preintervention phase and postintervention phase within each group. Results: There is a significant difference between preintervention and postintervention full ACE scores and different domain scores in the depression group unlike in the MCI group. Conclusion: Diagnostic tools such as ACE can be utilized for differentiating mood disorder with an actual dementing process. It also reveals the need for periodic assessments of such patients

Does resilience affect illness perception and well-being in the elderly?

Background: Increased life expectancy has increased many chronic illnesses in the elderly population, adding a phase of life affecting resilience, well-being, and perception of illness. Aims and Objectives: To assess resilience, well-being, and illness perception in the elderly and study the relation among them. Materials and Methods: A population of 90 (30 from the psycho-geriatric OPD, 30 from medical geriatric OPD and 30 normal elderly, accompanying patients in psycho geriatric OPD) patients age 60 years or more were taken, at a tertiary care center. Geriatric depression scale was applied and score 7 and fulfilling diagnostic and statistical manual-IV TR criteria were taken in depression group. Semi-structured proforma and scales (Connor Davidson resilience scale, Warwick Edinberg mental well-being scale, and brief illness perception scale) were applied, and statistical analysis was done using Statistical Package for the Social Sciences. Results: Results demonstrated resilience (P < 0.001) significantly differed in the three groups. Resilience was higher in normal (P < 0.001) than rheumatoid arthritis, which is higher (P < 0.02) than depression group. Well-being also significantly differ in all three group (P < 0.001), higher in normal elderly (P < 0.001) than affected elderly. We found strong positive correlation between resilience and well-being. Conclusion: Resilience is higher in those with a higher hardiness, optimism, purpose of life, and resourcefulness. Well-being gets significantly affected with mental and physical illness

Study of internet addiction in children with attention-deficit hyperactivity disorder and normal control

Background: In the current era, the use of electronic media in the form of Internet has increased exponentially, particularly among children, and has led to their excessive involvement in Internet. In this context, attention-deficit hyperactivity disorder (ADHD) children were found to have increased tendency for this addiction. Aims and Objectives: The aim is to study and compare Internet addiction between ADHD and normal children and the relation of demographic profile to Internet addiction. Materials and Methods: This was a cross-sectional study including 100 children (50 ADHD cases and 50 normal children without any psychiatric illness as controls) between the ages of 8 and 16 years. A semi-structured pro forma for demographic profile and Internet usage using Young's Internet Addiction Test (YIAT) was used. Statistical analysis was done using SPSS 20. Results: Internet addiction among ADHD children was 56% (54% having “probable Internet addiction” and 2% having “definite Internet addiction”). This was statistically significant (P < 0.05) in comparison with normal children where only 12% had Internet addiction (all 12% had “probable Internet addiction”). ADHD children were 9.3 times more prone to the development of Internet addiction as compared to normal (odds ratio – 9.3). Significant increase in average duration of Internet usage in ADHD children with increasing score of YIAT (P < 0.05) was seen. The incidence of Internet addiction was more in male ADHD children as compared to normal (P < 0.05). Conclusions: ADHD children are more prone to Internet addiction as compared to normal children and thus require preventive strategies

Perception of old age and self: A comparative study of elderly females living in community and in old age home

Aims and Objectives: To study and compare the perception of old age and self in elderly women living in community and in old age homes. Materials and Methods: By using a cross sectional study design 60 elderly females (30 each from community and old age homes) were assessed using a semi-structured proforma and an interview questionnaire. Data was qualitatively analysed and frequency computation was done. Results: The elderly women living in community had more of an attitude of ′acceptance′ towards old age and ′generativity′ was a part of ageing for them. They were found to be more satisfied with life and had better emotional support, whereas elderly in old age home perceived better instrumental support. Conclusion: Both community living and living in an old age home, have certain positive aspects. From a perspective of future policies and outreach services, it would be interesting to note the same and use best of both the worlds to provide the best for the elder in either setting

Study of loneliness, depression and coping mechanisms in elderly

Aims and Objectives: To study loneliness, depression and coping mechanism and the relationship between these factors in depressed and non-depressed elderly. Materials and Methods: Cross sectional study was done on 46 depressed and 48 non-depressed elderly were assessed clinically and using Geriatric Depression Scale-Short form [GDS-SF], loneliness scale, and brief cope scale. Statistical analysis was done using SPSS 20 software. Result: Mean GDS scores, mean loneliness (emotional and social) scores of depressed patients were higher than that of non- depressed, and this difference was found to be statistically significant [GDS: t = 14.33, p<0.001, loneliness Score: t = 7.23, p<0.001]. Self-distraction (mal-adaptive-passive) was the most commonly used coping mechanism in depressed group, while in the non-depressed group active coping (adaptive) was most common coping mechanism. Loneliness (emotional as well as social subscale) was a significant predictor of depression in both depressed and non-depressed group (Beta = .714, p<0.001) and (Beta = .629, p<0.001) and predicted 51% and 39% variance in depression respectively. Loneliness appeared as a distinct factor which seems to have a temporal and synergistic relationship with depression. Use of more adaptive coping mechanisms is associated with decrease in loneliness and depression while use of maladaptive coping mechanism is associated with decreased depression and loneliness in elderly. Conclusion: Loneliness is an important distinct factor in predicting depression in elderly. Coping mechanisms used, also affects loneliness and depression significantly

Electroconvulsive therapy in the elderly: Retrospective analysis from an urban general hospital psychiatry unit

Introduction: The number of elder patients with severe psychiatric illnesses other than depression is increasing. Electroconvulsive therapy (ECT) has a special role in the treatment of late-life depression and other psychiatric conditions in the elderly. Using ECTs in the elderly could be difficult. In an Indian setting, ECT in the geriatric population is used as last resort of treatment which is in contrast to Western countries. There is dearth of data available for the use of ECT in the elderly in India. Methodology: Retrospective data review was carried out to identify patients 55 years or older who had received ECT from January 2014 to June 2016 in tertiary care teaching hospital in a metropolitan city in India. Results: A total of 304 ECTs were administered to 25 elderly aged> 55 years with average of 12 ECTs per patient. Schizophrenia (56%) was the most common diagnosis among patients who were considered for ECT, and this was followed by major depression without psychotic features (24%) and major depression with psychotic features (8%). The most common indication to start ECT was nonresponsiveness to medications (92%). There was an increase in mean Mini-Mental State Examination (MMSE) scores from baseline (23.42) to the end of the sixth (24.60) and last ECT (24.60). Duration of current used during ECT had positive correlation with MMSE. Patients with comorbid medical illness (20%) received ECT without any complication. Conclusions: This study adds to scarce database on the use of ECT in old-age patients in India and adds to evidence that ECT is safe and effective treatment in old age with no negative impact on cognition

Study of suicidal ideations, hopelessness and impulsivity in elderly

Aims and Objectives: This study aimed to assess the suicidal ideations, hopelessness and impulsivity in depressed and non-depressed elderly and to study the relationship of suicidal ideations with hopelessness and impulsivity in them. Materials and Methods: This cross sectional study was done on 60 elderly patients (30 cases and 30 controls) above the age of 60 years. The scales used were Geriatric Suicide Ideation Scale, Beck Hopelessness Scale, Barrat′s Impulsiveness Scale, Geriatric Depression Scale. Results: Mean Geriatric Suicide Ideations Scale scores, mean Beck Hopelessness Scale scores and mean Barrat′s Impulsiveness Scale and scores of depressed elderly were higher than that of elderly who were not depressed and these differences were statistically significant. Hopelessness was a significant predictor of suicidal ideation in the entire sample as well as in the depressed and non-depressed elderly when the two groups were considered separately. Impulsivity when considered alone was a significant predictor of suicidal ideations in the entire sample. Conclusion: Hopelessness and impulsivity both by themselves are significant predictors for suicidal ideations in the elderly and when both are considered together hopelessness is a better predictor of suicidal ideations than impulsivity