Cognition, Behavior, and Caregiver Stress in Dementia during the COVID-19 Pandemic: An Indian Perspective.

OBJECTIVES: Little is known regarding the cognitive and behavioral status of patients with dementia and their caregivers in lower middle-income countries during the COVID-19 pandemic. This study aimed to understand the impact of the pandemic on persons with dementia and their caregivers in India. METHODS: This was an observational study. A cohort of 66 persons with dementia and their caregivers were evaluated during the COVID-19 pandemic in 2 specialist hospitals in South India. Caregivers were interviewed at 2 distinct time points of the pandemic: during the national lockdown and 5 months after during later periods of the "cluster of cases" transmission phase. Participants were assessed via telephone utilizing validated instruments (Neuropsychiatric Inventory [NPI], Clinical Dementia Rating [CDR] Scale, and Depression, Anxiety and Stress Scale [DASS-21]) and a semi-structured questionnaire. The questionnaire documented sociodemographic information, clinical history, infection measures adopted, changes in caregiving routines, involvement in functional rehabilitation activities, and access to medical and long-term care support services. RESULTS: The 2-phase follow-up study found a significant worsening of behavior in dementia patients, demonstrated by a difference in the NPI sub-domain scores for anxiety (mean difference [standard deviation, SD] = -0.552 [1.993], t58 = -2.109, p = 0.039) and eating disturbances (mean difference [SD] = -1.121 [2.493], t59 = -3.424, p = 0.001). A relatively high proportion of patients developed anxiety (cumulative incidence = 24.53%) and eating disturbances (cumulative incidence = 26.92%), without having these symptoms at baseline. There was a trend toward an increase in proportion of persons with severe dementia (19.7% vs. 39.4%) on follow-up. Caregiver distress reported was significantly associated with neuropsychiatric symptoms (r = 0.712, p < 0.001) and dementia severity (ρ = 0.365, p = 0.004). In addition, difficulties in accessing medical care persisted between the 2 assessments, and there were statistically significant differences between functional rehabilitation activities such as indoor activities (p < 0.001), outdoor activities (p = 0.013), and physical exercises (p = 0.003) between baseline and follow-up. CONCLUSION: Findings suggest interruption of functional rehabilitation activities and disruption in medical care services are likely to have had an adverse impact on patients with dementia and contributed toward caregiver distress.

Experiences of people with dementia and their caregivers during the COVID-19 pandemic in India: A mixed-methods study.

BACKGROUND: The COVID-19 pandemic has unprecedented consequences for the management of chronic diseases such as dementia. However, limited evidence exists on the condition of persons with dementia and their caregivers during the pandemic in lower-middle-income countries (LMICs). The study aimed to provide insights into the experiences of persons with dementia and their families during the early phases of the pandemic in India. METHODS: This study adopted a mixed-method approach. One hundred and four persons with dementia and their caregivers were evaluated via telephone using validated instruments and a semi-structured interview guide. We used the quantitative data collected to establish a baseline, whereas qualitative data were analysed thematically. RESULTS: The study revealed that persons with dementia and their caregivers experienced difficulties during the pandemic, which included worsening of behaviour, problems in accessing care, disruptions in functional activities and struggles in enforcing infection prevention contributing to caregiver distress. An important finding that emerged was the unchanging reality of caregiving for families. The relative success of the public health response to the COVID-19 pandemic contrasted with the lack of awareness and formal support for dementia. CONCLUSIONS: The COVID-19 pandemic has exposed the vulnerabilities of persons with dementia and their caregivers. This calls for a collaborative reframing of medical care and public health policies to address dementia care.

Psychosocial Factors in Brain Infections Research in the Last Decade: A Scoping Review.

Background: Brain infections are serious neurological events that require immediate care, with around 171 districts of 19 states in India reporting cases every year. Along with the biomedical factors, psychosocial factors of health (BPS) are influential in the outcomes of brain infections as well. Materials and Methods: A scoping review was conducted to understand the psychosocial factors explored in brain infections in the last decade. Articles focusing on social, psychological, public health factors, sequelae, and rehabilitation of inflammatory conditions, both pathogenic and autoimmune were covered. The search was conducted using keywords related to brain infections in electronic databases: PubMed, EBSCO, ProQuest, Scopus, and Google Scholar. Prisma-ScR guidelines were used to screen articles and the identified factors were categorized under eight psychosocial factors using Arksey and O'Malley's framework of analysis. Results: From a total of 6012 documents retrieved, 11 articles met the criteria. Global burden associated with brain infections, disability and death, the vulnerable population at risk of developing brain infections, gaps in existing literature, pathways to care, mental health, cognitive difficulty associated with infections and their sequelae were the major psychosocial factors identified. Conclusions: The review focussed to understand the multitude of psychosocial factors causing delay and damage in brain infections in LMIC context. Along with biomedical factors, there exist several psychosocial factors that could potentially influence the outcome of treatment in brain infections. However, only few have been explored, suggesting the need for more studies to inform the care and sustainable interventions at the macro level to improve the outcomes and reduce the burden in brain infections.

A Bio-Psychosocial Framework for Chronic Daily Headaches: A Mixed Methods Study.

Chronic daily headaches (CDH) are primarily understood from a psychophysiological formulation. A broad biopsychosocial understanding, where there is equal importance given to biological, psychological and socio-cultural factors, is underexplored in headache. Socio-cultural factors, such as gender, socio-economic factors can perpetuate and worsen the condition. For an effective and sustainable intervention, these factors need to be considered. The current study aims to explore and develop a biopsychosocial framework for headache disorders. A convergent parallel mixed methods design was used and participants were recruited from a tertiary referral care hospital, Bengaluru, India. Headache Assessment Sheet, GAD 7, HDRS, PSS and B COPE were used in the quantitative phase. The data was analysed using r software. Qualitative phase of the study, in depth interview guide was used and data analysed thematically. Quantitative phase, 38 participants were recruited. The average age, was 38.02 (±10.17), majority of the participants being females 31 (81.58%). The mean duration of illness was 8.63 (±4.73) years. The anxiety scores positively correlated with pain intensity (r = 0.50 at P ≤ .001) and the median anxiety scores varied with photophobia (P ≤ .03). The anxiety scores correlated with PSS (r = 0.428 at P ≤ .007) and HDRS (r = 0.428 at P ≤ .007) scores. Gender variations in coping were seen, avoidant coping having higher median scores in women. (P ≤ .08). In qualitative phase of the study, six participants were recruited. Three main themes emerged from the qualitative phase of the study: headache - an illness, headache factors and the impact. Chronic daily headaches are influenced by biological, psychological, environmental and socio-cultural factors. A bio-psychosocial framework will help to understand and develop targeted interventions.

"Crisis Within the Walls": Rise of Intimate Partner Violence During the Pandemic, Indian Perspectives.

The ongoing coronavirus disease 2019 pandemic has been a social "un-equalizer," besides being a global health threat. Gender inequality has been globally prominent during the outbreak and the consequent lockdown. Although domestic abuse and intimate partner violence have increased due to chronic entrapment, overcrowding in families, enhanced substance use, distorted relationship dynamics, travel restrictions, and reduced healthcare access, coercive sexual practices have also been on the rise. In low- and middle-income countries, the lack of awareness, societal pressure, administrative apathy, fear of legal hassles, and inadequate knowledge-attitude-practice related to help-seeking lead to underreporting and mismanagement of domestic abuse, which can perpetuate its vicious cycle during the ongoing crisis. India, with its socio-culturally diverse population, has been one of the nations worst hit by the pandemic. With the rise in reports of gender-based violence on the premise of preexisting gender inequality and minority stress, concerns behind "closed doors" are as threatening as the infection itself. With this background, the authors highlight the backdrop of domestic violence as a "hidden pandemic" during the coronavirus disease 2019 crisis, drawing on perspectives from India and briefly reviewing the data from other nations. The role of mental health education and digital literacy as mitigating strategies is subsequently discussed.