Dementia diagnosis in seven languages: the Addenbrooke’s Cognitive Examination-III in India

OBJECTIVE: With the rising burden of dementia globally, there is a need to harmonize dementia research across diverse populations. The Addenbrooke's Cognitive Examination-III (ACE-III) is a well-established cognitive screening tool to diagnose dementia. But there have been few efforts to standardize the use of ACE-III across cohorts speaking different languages. The present study aimed to standardize and validate ACE-III across seven Indian languages and to assess the diagnostic accuracy of the test to detect dementia and mild cognitive impairment (MCI) in the context of language heterogeneity.  METHODS: The original ACE-III was adapted to Indian languages: Hindi, Telugu, Kannada, Malayalam, Urdu, Tamil, and Indian English by a multidisciplinary expert group. The ACE-III was standardized for use across all seven languages. In total, 757 controls, 242 dementia, and 204 MCI patients were recruited across five cities in India for the validation study. Psychometric properties of adapted versions were examined and their sensitivity and specificity were established.  RESULTS: The sensitivity and specificity of ACE-III in identifying dementia ranged from 0.90 to 1, sensitivity for MCI ranged from 0.86 to 1, and specificity from 0.83 to 0.93. Education but not language was found to have an independent effect on ACE-III scores. Optimum cut-off scores were established separately for low education (≤10 years of education) and high education (>10 years of education) groups.  CONCLUSIONS: The adapted versions of ACE-III have been standardized and validated for use across seven Indian languages, with high diagnostic accuracy in identifying dementia and MCI in a linguistically diverse context

Assessment and comparison of the memory profile in traumatic brain injury and subarachnoid hemorrhage patients

Background: Traumatic brain injury (TBI) and Subarachnoid Hemorrhage (SAH) are the leading cause of death and disability in both developed and developing countries. They have significant cognitive and behavioral consequences, affecting the quality of life of both patients and their families. Aim: To compare the memory functioning of TBI and SAH and study the effect of demographics on the same through a retrospective study. Materials and Methods: A sample of 210 patients clinically diagnosed as TBI (N = 165; M = 145/F = 20) and SAH (N = 45; M = 35/F = 10) were using post graduate institute of memory scale (PGI-MS) which assesses 10 memory domains. Results: Odds Ratio (OR) was calculated by categorizing the scores as average and impaired on PGI-MS, the percentage of impaired cases of SAH were significantly less as compared to TBI (8.9% vs. 22.4%; OR = 0.34) Moreover, only two domains were found to have significant results, i.e. delayed recall and recognition. When the scores were adjusted for age, education and gender, memory impairment was found to be statistically significant in domains of remote memory (OR = O.10) recent memory (OR = 0.32), delayed recall (OR = 0.26), immediate memory (OR = 0.30), new learning ability (OR = 0.38), and recognition (OR = 0.17). Conclusion: A primary prevention (awareness program about risk factors) and tertiary prevention (holistic rehabilitation) would play a crucial role in improving the quality of life of both patients as well as the population at risk

Development and standardization of Indian aphasia battery

Background: Aphasia is a language disorder which may disrupt an individual's functioning. To plan a mode of therapeutic/rehabilitative work, it is important to assess problems from a neuropsychological perspective focused on remediation of the impaired processes or compensation through the intact processes or both. Aim: Due to the paucity of tests available for the assessment of aphasia in the Indian population with specific colloquial expression, the aim of the present study was to develop an aphasia test for Hindi-speaking population and to provide evidence with its reliability and validity. Methods: The conception of the test took place in two phases: Phase 1 was the development of Indian Aphasia Battery (IAB) and Phase 2 was its standardization. IAB was administered along the Hindi adaptation of the Western Aphasia Battery (WAB-H) on participants with aphasia, probable aphasia, and healthy volunteers. Outcomes and Results: Based on the results of this study, IAB has a high concurrent validity and test–retest reliability in comparison to WAB-H. The subtests are sensitive enough to contribute to global aphasia quotient as a functional measure of aphasia in Indian brain-damaged patients. Conclusion: IAB is a quick and easy to administer measure for assessment of aphasia in Hindi-speaking population with high reliability and validity

Translation and adaptation of stroke aphasia depression questionnaire-10 to Hindi

Background: Depression is one of the most researched emotional responses after stroke and shows that the emotional impact of aphasia can have a marked negative impact on recovery, response to rehabilitation, and psychosocial adjustment. There is an evident dearth of validated instruments to assess depression in people with aphasia including Hindi, the national language of the country. Aims: The aim of this study was to translate and adapt the original English version of widely used hospital version of Stroke Aphasia Depression Questionnaire (SADQ-10) to Hindi. Subjects and Methods: English version of SADQ-10 was translated and adapted for the use in Hindi-speaking population in concordance to the WHO guidelines. Statistical Analysis Used: The intraclass correlation coefficient (ICC) analysis of the data was performed using SPSS, version 16, to compute the test–retest reliability. Results: The Hindi version of SADQ-10 yielded an overall high test–retest reliability (ICC = 0.91) as well as internal consistency (α = 0.98), which in turn were comparable to the original instrument in English. Conclusions: SADQ10-Hindi may assist the identification of depressed mood in patients with speech and language impairment in an Indian population as well. It is an easy to administer and quick test which can be used by health-care professionals in a hospital- or community-based settings

Enhancing memory and activities of daily living in patients with early Alzheimer's disease using memory stimulation intervention: A randomized controlled trial

Objective: The objective of this study was to assess the effectiveness of memory stimulation intervention added to donepezil treatment as compared to donepezil alone in patients with early Alzheimer's disease (eAD). Materials and Methods: Patients in the combined treatment group (CTG = 21) received standard dosages of donepezil and weekly memory stimulation activities sessions for 2 months, whereas the treatment as usual group (TAU = 22) received only standard dosages of donepezil. Each session had extensive tasks on memory and its implied practice on instrumental activities of daily living. After 8 sessions, both groups were evaluated for changes in memory and functional outcomes by administering the mini-mental state examination (MMSE), memory (Postgraduate Institute of Memory Scale), and instrumental activities of daily living scale (IADLS). This trial was registered on the Clinical Trials Registry - India (CTRI/2014/04/004550). Results: Statistical analysis was done using independent t-test, which revealed a significant difference between the groups on MMSE, memory, and IADLS post intervention. The MMSE score in the TAU group, while it increased in the CTG group by 4 points. A similar trend was evident in the memory and IADLS scores as well. Effect size in the CTG group was relatively large as compared to the TAU group where the effects were small and negative on some outcomes. Conclusion: The CTG group showed positive treatment effect on cognitive tests suggesting that combined memory stimulation and donepezil treatment has potential to improve the cognitive and functional performance of patients with eAD

Mapping of cognitive functions in chronic intractable epilepsy: Role of fMRI

Background: Functional magnetic resonance imaging (fMRI), a non-invasive technique with high spatial resolution and blood oxygen level dependent (BOLD) contrast, has been applied to localize and map cognitive functions in the clinical condition of chronic intractable epilepsy. Purpose: fMRI was used to map the language and memory network in patients of chronic intractable epilepsy pre- and post-surgery. Materials and Methods: After obtaining approval from the institutional ethics committee, six patients with intractable epilepsy with an equal number of age-matched controls were recruited in the study. A 1.5 T MR scanner with 12-channel head coil, integrated with audio-visual fMRI accessories was used. Echo planar imaging sequence was used for BOLD studies. There were two sessions in TLE (pre- and post-surgery). Results: In TLE patients, BOLD activation increased post-surgery in comparison of pre-surgery in inferior frontal gyrus (IFG), middle frontal gyrus (MFG), and superior temporal gyrus (STG), during semantic lexical, judgment, comprehension, and semantic memory tasks. Conclusion: Functional MRI is useful to study the basic concepts related to language and memory lateralization in TLE and guide surgeons for preservation of important brain areas during ATLR. This will help in understanding future directions for the diagnosis and treatment of such disease

Comparing cognition, coping skills and vedic personality of individuals practicing yoga, physical exercise or sedentary lifestyle: a cross-sectional fMRI study

Background: Nature and intensity of physical activity may influence cognition, coping mechanisms and overall personality of an individual. The objective of this cross-sectional study was to compare cognition, coping styles and vedic personality among individuals practicing different lifestyle. Methods: Thirty-nine healthy young adults of both gender (27.63±4.04 years) were recruited and categorized into three groups; i.e. yoga, physical activity or sedentary lifestyle groups. Participants were assessed on cognition, coping styles and Vedic personality inventory (VPI). Verbal-n-back and Stroop tasks were performed using 3 Tesla MRI scanner. Task Based Connectivity (TBC) analysis was done using CONN toolbox in SPM. Results: There were no significant differences in the cognitive domains across the groups. The planning (p=0.03) and acceptance domain (p=0.03) of the Brief COPE scale showed difference across the groups. Post-hoc analysis revealed that planning and acceptance scores were distinctly higher in the physical activity group, however, there was no difference between physical activity group and yoga practitioners. Similarly, in the VPI, Sattva (p=0.003), Rajas (p=0.05) and Tamas (p=0.01) were different across the groups, and the post hoc analysis showed superiority in Sattva scores in Yoga group, meanwhile, both Rajas and Tamas were higher in the physical activity group. Yoga practitioners preferentially recruited left Superior Frontal Gyrus in relation to the physically active group and precuneus in relation to the sedentary lifestyle group. Conclusion: The study revealed that yoga practitioners had a distinct higher sattva guna and preferentially recruited brain areas associated with self-regulation and inhibitory control