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   Table of Contents - Current issue
July-December 2022
Volume 9 | Issue 2
Page Nos. 63-110

Online since Friday, January 20, 2023

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Disclosing the diagnosis of dementia: Is it something to bother about? p. 63
Sandeep Grover
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Exergaming as a mental health intervention in the elderly: A clinical review p. 66
Ishita Bhattacharya, Divya Ambetkar, Vishakha Patil, Avinash De Sousa, Sagar Karia
Exergames is a new arena of mental health intervention in the elderly. The present article is a clinical review on various areas where exergaming has been used to enhance mental health in the elderly. The review looks at the use of exergames in dementia, geriatric depression, as a tool for movement and to improve memory and cognition. The role of exergames in improving intellectual function, instability and falls in the elderly is also discussed. The role of exergames to improve fragility is mentioned. The review looks at the advantages and disadvantages of exergames in the elderly and the limitations of various studies done so far from a clinical and scientific rigor standpoint. The future research needs are also discussed. Exergames is a mental health intervention area in geriatric mental health that will be used more in the years to come.
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Delirium in elderly: Battling a silent killer in the Indian context p. 75
Sandeep Grover
Delirium is considered a manifestation of acute brain failure that usually has an acute onset, fluctuating course, and is often associated with multitude of negative outcomes. It is usually seen in medical-surgical patients, with very high prevalence rates among those on mechanical ventilation. It is often undiagnosed and undertreated. In developed countries, delirium is usually managed by multidisciplinary teams and the focus is on both prevention and management of delirium. In contrast to the developed countries, in India, physicians–surgeons have a negative attitude toward delirium and due to which not only it is underdiagnosed and undertreated but also mismanaged, and mental health professionals are not consulted. The research on delirium in India is also limited. The psychiatrists when involved in the care of patients with delirium also mainly focus on using pharmacological agents, with relatively lesser emphasis on the use of nonpharmacological measures. Further, in their encounter with specialists from other specialties, psychiatrists pay little attention to discussing the diagnosis of delirium and its management. There is a need to have an attitudinal change both at the level of the physicians–surgeons and psychiatrists in terms of clinical practice and research on delirium in the Indian context.
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A study of handwriting sample in geriatric population with cognitive impairment: A cross-sectional observational study p. 79
V Suresh Heijebu, Bhupendra Singh, Shrikant Srivastava, Shivendra Kumar Singh
Objectives: Cognitive impairment in the geriatric population often remains undiagnosed until progressed enough to cause interruptions in activities of daily living. Routine tests are time taking, requiring a specialist. Handwriting function reflects the brain's cognitive capacity by involving it's both halves. It is easy to collect and does not strain the participant, and can aid in the faster diagnosis of cognitive impairment. Materials and Methods: To study handwriting parameters collected with Livescribe Echo Smart Pen and compare them with cognitive scores of Montreal Cognitive Assessment-Hindi (MOCA-H) and Addenbrooke's Cognitive Examination-Hindi (ACE-H) in a cross-sectional observational study. Handwritten parameters differentiating both cognitive groups were identified and analyzed. Results: The mean age of the study population was 66.4 (5.3) years. The mean MOCA score in the cognitively impaired (CI) and noncognitively (NCI) group was 22.67 and 27.00, respectively. The mean ACE-H score in CI and NCI group was 80.68 and 93.05, respectively. In all handwriting tasks (T1-T3), higher scores were obtained on all parameters in the CI group except text width (TW), stroke frequency (SF), and writing speed (WS). In handwriting task 3 (single letter repetition), WC (word count) was found to be higher in the NCI group. Handwriting parameters of the whole task (TOT, PSPS, TW, TH, NOL, and WS) and text line (MTOL and MTOSS) were found to be helpful in group differentiation in all three tasks. There was a moderate degree of positive correlation with handwriting parameters (PSPS, WS, and WC) and a negative correlation with handwriting parameters (NOPS, TOT, TH, NOL, MHOL, MTOL, and MTOSS) across the tasks with MOCA and ACE scores. Conclusion: Inclusion of quantitative handwriting analysis in neuropsychological assessment can be one step forward towards a simple, reliable, and faster diagnosis of geriatric cognitive impairment.
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Undiagnosed depression and cognitive impairment with possible dementia among elderly population in urban areas of Hyderabad: Prevalence and associated factors p. 87
Saba Syed, Pranati Kilaru
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.
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Relationship between disability, caregiver burden and coping with depression in stroke survivors: A cross-sectional study in South India p. 93
Saraswathi Nagaraju, Aralikatte Onkarappa Saroja, Karkal Ravishankar Naik, Vijaykumar Harbishettar
Background: Post-stroke depression (PSD) is seen in up to 35% of stroke survivors, contributing to morbidity and caregiver burden, that could deter the acute and rehabilitation treatment. Depression in stroke contributes to more disability and caregiver burden. Understanding coping methods of caregivers in PSD results in better caregiving, reduces stress and improves family relationships. There is paucity of studies examining PSD and its determinants in Indian context. Objectives: The objective is to study the association of PSD with disability, with caregiver burden, and coping methods adopted by the caregivers. Methods: Consenting participants (and their caregivers) attending Neurology outpatients with the first episode of Stroke (N=226) in a tertiary care center in a tier 2 city in South India, with 56% participants from rural background, were evaluated between three and six months of stroke. Two groups namely PSD (n = 67) and post-stroke without depression (PSwD, n = 159) based on cutoff score of 9/10 on a valid Hamilton Depression Rating Scale were compared for their demographics, social, physical, and functional factors. Barthel Disability Index (BDI) for disability, Zarit Burden Interview (ZBI) for caregiver burden and coping checklist (CCL) by Rao et al. on caregivers particularly prepared for studying in the Indian context were also administered. Results: The rate of PSD was found to be 29.6%. PSD group were older and had relatively more common in females (p < 0.001). The type of stroke and site of vascular lesion were not associated with PSD (p = 0.68 and p = 0.24). Stroke severity scores were higher in PSD group (p < 0.001). Disability as per BDI scores was greater in PSD group against PSwD group (p < 0.001). ZBI scores show greater caregiver burden in PSD group than PSwD (p < 0.001). Measures were significantly higher in all CCL sub-categories in caregivers of PSD group compared with PSwD. Conclusion: PSD prevalence of close to one third in stroke survivors, with female gender, older age, stroke severity, and functional disability as its key determinants. Furthermore, the PSD was significantly associated with caregiver burden and study also found preferred coping methods were adopted by caregivers of PSD group. Early identification and treatment of PSD is of utmost important to minimize disability, reduce caregiver burden and improvise coping methods.
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Assessment of alexithymia and cognition in elderly patients with depression: A cross-sectional exploratory study p. 100
Abhijeet Faye, Rahul Tadke, Sushil Gawande, Sudhir Bhave, Vivek Kirpekar, Anirban Chatterjee
Objectives: Depression is the most common psychiatric illness in the elderly. Alexithymia and cognitive impairment can be independently associated with depression and old age. This study aims to assess the alexithymia and cognitive dysfunction in geriatric patients with depression. Materials and Methods: A cross-sectional study was conducted on 100 participants of >60 years with depression. Participants were assessed using semi-structured pro forma, Geriatric Depression Scale (GDS), Hamilton Depression Rating Scale (HDRS), Toronto Alexithymia Scale-20 (TAS-20) having 3 subscales – “difficulty describing feeling” (DDF), “difficulty identifying feeling” (DIF), and “externally oriented thinking,” and Montreal Cognitive Assessment (MoCA). Statistical analysis was done using Chi-square/Fisher's exact test, Pearson's correlation, and t-test. Results: The mean age of the participants was 67.35 years with equal gender distribution. Thirty-four percent were >70 years of age and 53% from rural area. The median duration of depression was 30 months with a median duration of untreated illness, 6 months. Anxiety was the most common psychiatric comorbidity (43%). Seventy-one percent had alexithymia whereas 77% had cognitive impairment (MoCA score <26). Scores on GDS, HDRS, TAS-20, DIF, DDF, and MoCA (<26) were significantly higher in elder participants (P < 0.05) and those from rural area (P < 0.05). Higher TAS-20 score correlated with lower MoCA score (P < 0.01). Furthermore, severe depression correlated with higher TAS-20 and lower MoCA score. Conclusion: More than two-third of participants had alexithymia and cognitive dysfunction. Higher alexithymia was associated with poor cognition. Severe depression correlated with higher alexithymia and cognitive impairment. Alexithymia and cognitive dysfunction were higher in the elderly from rural region.
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Understanding geriatric binge-watching from a case-based perspective p. 109
Manoj Kumar Sharma, Senthil Amudhan, Sidharth Arya, Nitin Anand, Anamika Sahu, Rajesh Kumar, Ravikesh Tripathi
Binge-watching is a new phenomenon characterized by watching TV/online series continuously. The relatively sedentary way of life and its associated psychological factors among the elderly may make them vulnerable to technology misuse and potential problematic binge-watching. We describe a case of a 72-year-old male professional who sought help to manage problematic binge-watching of teleseries. The clinical evaluation highlighted the mediating role of motivation factors (need for self-absorbing activities, compensatory motivation to manage low mood and loneliness) in binge-watching. This case study provides insights into the motives of the elderly for binge-watching and highlights the need to promote behavioral strategies for strengthening the healthy use of technology among the elderly, allowing them to age healthily with advancing technologies.
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