Feasibility and acceptability study of risk reduction approach for stroke prevention in primary care in Western India.

Objectives: Stroke is among the leading cause of morbidity and mortality and prevention is the need of the hour. Risk assessment of stroke could be done at primary care. A study was hence planned to assess if an information, education, and communication (IEC) intervention module could be used to address risk factors of stroke among attendees of primary care in Western India. Materials and Methods: Patients (>30 years) attending primary care center were enrolled (n = 215). Knowledge, attitude, and practice (KAP) questionnaire was administered at baseline and end line, and detailed diagnosis (hypertension and/diabetes, stroke, coronary artery disease, etc.) was noted from written records. A predesigned IEC module was administered about stroke, risk factors, and their prevention. Body mass index (BMI) and waist-to-hip ratio were taken before and after 16 weeks. Results: A total of 215 participants (M: F = 85:130; mean age = 51.66 ± 13.32 years) had risk factors such as hypertension (26.7%), diabetes (32.5%), history of stroke (n = 3; = 1.39%), and 7.4% (16/215) had coronary artery disease. Before and after comparison of KAP scores indicated significant difference (62.23 ± 19.73 vs. 75.32 ± 13.03); P ≤ 0.0001). Change of waist-to-hip ratio occurred from baseline 0.91-0.9 (P ≤ 0.001). Comparison of the proportion of patients taking antihypertensives before and after IEC intervention was statistically significant (P < 0.05), indicating improvement in drug compliance. BMI comparison changed marginally (26.5 ± 4.7 vs. 26.2 ± 4.5) before and after but was not significant (P ≥ 0.05). The intervention was found to be feasible and acceptable. Conclusion: IEC intervention appears to be a low-cost, feasible, and acceptable implementation model for addressing risk factors for stroke in primary care.

Hippocampal Volume in Children with Attention Deficit Hyperactivity Disorder and Speech and Language Delay.

Introduction: Hippocampus is a complex brain structure located deep in the temporal lobes of the brain. The structure has been implicated in several disorders related to cognition. Reports are emerging of its involvement in attention deficit hyperactivity disorder (ADHD). The current study was planned to assess the volume of the hippocampus in children with ADHD and speech and language delay with normal birth history using magnetic resonance imaging (MRI) of the brain. Material and Methods: MRI brain of 12 children (age range = 3-6 years) and 22 controls with clinical diagnosis of ADHD as per Diagnostic and Statistical Manual-5 were obtained in oblique coronal sequence (T1 weighted). The entire hippocampus formation was outlined manually using Image-J software available freely from www.freesurfer.com. Results were expressed as volume cubic millimeters ± SD. Results: Volumes of the hippocampi of children with ADHD were 2450.2 ± 667 mm3 (R) and 2505.8 ± 878.5 mm3 (L), respectively. The mean volume (bilateral) of the cases was 2478 ± 772.75 mm3. The right hippocampal volume of the controls was 3255.8 ± 1374.3 mm3 (R) and that of the left side was 3159.3 ± 1451 (L) mm3, respectively. Conclusion: Current study reported a substantial shrinkage (23%) of the left and right hippocampus in children with ADHD compared to controls.

Cognition and cardiovascular comorbidities among older adults in primary care in West India.

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.

Protocol of systematic reviews on implementation research on cardiovascular diseases, diabetes mellitus and mental ailments in India.

Introduction: The burden of non-communicable diseases (NCDs) is a major public health concern across the world. Various initiatives have tried to address these with varying degrees of success. Objective: The objective is to assess and collate existing evidence in implementation research done in India on three broad domains of NCDs namely, cardiovascular diseases (CVD), diabetes mellitus (DM), and mental health (MH) in India. Materials and methods: Three systematic review protocols have been drafted to explore and collate extant evidence of implementation research on cardiovascular diseases, diabetes mellitus, and mental health in India, in accordance with the PRISMA-P statement. Academic databases including PubMed, Embase and Science Direct will be searched. Search strategies will be formulated in iterative processes and in accordance with the formats that are specific to the databases that will be searched. In addition, grey literature and non-academic databases will also be explored. Data extracted from the selected studies will be analysed and a narrative summary of the selected articles, using the SWiM (Synthesis without meta-analysis) guidelines will be produced. Intended Outcomes: The outputs of these systematic reviews could help in a better understanding of implementation research gaps and also how to address them. Apart from giving insights into how healthcare initiatives for CVDs, diabetes and mental health could be implemented in a better way, the study could also advocate the need to build and consolidate capacity for implementation research in the country.

Community Screening of Probable Dementia at Primary Care Center in Western India: A Pilot Project.

Introduction Timely detecting dementia is an important goal of clinicians and public health professionals alike for better management and prevention of complications. Community screening of dementia could be a powerful strategy. Facilities for dementia screening at primary care level are virtually nonexistent and are a prominent implementation gap. Hence, a study was done to assess the feasibility of dementia screening at primary care using General Practitioner Assessment of Cognition (GPCoG) scale among older adults with subjective memory complaints. It was further aimed to assess the frequency of cardiovascular risk factors in those who met screening criteria for cognitive impairment. Materials and Methods Older adults coming to three urban primary care centers in western India for screening of noncommunicable diseases such as diabetes and hypertension (opportunistic screening) with subjective memory complaints were enrolled and screened for dementia using GPCoG. A Mini-Mental State Examination (MMSE) was done in patients who came alone for referral purpose in case the score levels in GPCoG examination met cutoff limits for informant interview. Written medical records were examined to assess status of comorbid vascular risk factors such as diabetes, hypertension, coronary artery disease, and cerebrovascular accidents. Results A total of 350 older adults (M:F = 276: 74; mean age ± 68 ± 6.7 years) were screened out of 3,000 older adults who reported during the study period. There were 161 older adults with GPCoG score less than or equal to 5 (56.14%) and 149 subjects with MMSE less than or equal to 24 indicating significant cognitive impairment (42.5%). There were very few ( n = 11, 3.14%) out of 350 people who came with caregivers; hence, MMSE was done along with for referral to healthcare providers. A total of 142 had comorbid diabetes/and or hypertension (40.5%). A total of 86 had diabetes alone (24.5%) and a total of 128 had hypertension (36.5%). Conclusion Current study results indicate that using a simple screening tool such as GPCoG, community screening of probable dementia, is feasible in primary care settings, as is indicated by significant yield of probable dementia cases (42.5%). These cases can be referred to appropriate centers for further workup, confirmation of diagnosis, and treatment. Also, detection of comorbid cardiovascular conditions, for example, diabetes and hypertension, that can be managed along with cognitive impairment/dementia for potential prevention/further deterioration, which can strengthen noncommunicable disease screening.

SARS-CoV-2 seroprevalence among the general population and healthcare workers in India, December 2020-January 2021.

BACKGROUND: Earlier serosurveys in India revealed seroprevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) of 0.73% in May-June 2020 and 7.1% in August-September 2020. A third serosurvey was conducted between December 2020 and January 2021 to estimate the seroprevalence of SARS-CoV-2 infection among the general population and healthcare workers (HCWs) in India. METHODS: The third serosurvey was conducted in the same 70 districts as the first and second serosurveys. For each district, at least 400 individuals aged ≥10 years from the general population and 100 HCWs from subdistrict-level health facilities were enrolled. Serum samples from the general population were tested for the presence of immunoglobulin G (IgG) antibodies against the nucleocapsid (N) and spike (S1-RBD) proteins of SARS-CoV-2, whereas serum samples from HCWs were tested for anti-S1-RBD. Weighted seroprevalence adjusted for assay characteristics was estimated. RESULTS: Of the 28,598 serum samples from the general population, 4585 (16%) had IgG antibodies against the N protein, 6647 (23.2%) had IgG antibodies against the S1-RBD protein, and 7436 (26%) had IgG antibodies against either the N protein or the S1-RBD protein. Weighted and assay-characteristic-adjusted seroprevalence against either of the antibodies was 24.1% [95% confidence interval (CI) 23.0-25.3%]. Among 7385 HCWs, the seroprevalence of anti-S1-RBD IgG antibodies was 25.6% (95% CI 23.5-27.8%). CONCLUSIONS: Nearly one in four individuals aged ≥10 years from the general population as well as HCWs in India had been exposed to SARS-CoV-2 by December 2020.

Correlation between hippocampal volumes and medial temporal lobe atrophy in patients with Alzheimer's disease.

INTRODUCTION: Hippocampus undergoes atrophy in patients with Alzheimer's disease (AD). Calculation of hippocampal volumes can be done by a variety of methods using T1-weighted images of magnetic resonance imaging (MRI) of the brain. Medial temporal lobes atrophy (MTL) can be rated visually using T1-weighted MRI brain images. The present study was done to see if any correlation existed between hippocampal volumes and visual rating scores of the MTL using Scheltens Visual Rating Method. MATERIALS AND METHODS: We screened 84 subjects presented to the Department of Neurology of a Tertiary Care Hospital and enrolled forty subjects meeting the National Institute of Neurological and Communicative Disorders and Stroke, AD related Disease Association criteria. Selected patients underwent MRI brain and T1-weighted images in a plane perpendicular to long axis of hippocampus were obtained. Hippocampal volumes were calculated manually using a standard protocol. The calculated hippocampal volumes were correlated with Scheltens Visual Rating Method for Rating MTL. A total of 32 cognitively normal age-matched subjects were selected to see the same correlation in the healthy subjects as well. Sensitivity and specificity of both methods was calculated and compared. RESULTS: There was an insignificant correlation between the hippocampal volumes and MTL rating scores in cognitively normal elderly (n = 32; Pearson Correlation coefficient = 0.16, P > 0.05). In the AD Group, there was a moderately strong correlation between measured hippocampal volumes and MTL Rating (Pearson's correlation coefficient = -0.54; P < 0.05. There was a moderately strong correlation between hippocampal volume and Mini-Mental Status Examination in the AD group. Manual delineation was superior compared to the visual method (P < 0.05). CONCLUSIONS: Good correlation was present between manual hippocampal volume measurements and MTL scores. Sensitivity and specificity of manual measurement of hippocampus was higher compared to visual rating scores for MTL in patients with AD.

An unusual case of reversible mild cognitive impairment.

Mild cognitive impairment (MCI) is cognitive dysfunction greater than expected for age and education in either a single cognitive domain or in multiple domains without impairment of activities of daily living. The present case report describes the case of an elderly male patient of 71 years who presented with MCI and was Venereal Disease Research Laboratory test reactive in serum. This was confirmed by Treponema pallidum Hemagglutination Assay. After a complete course of antibiotic therapy, his memory complaints disappeared completely. Though syphilis is termed as reversible dementia; to the best of our knowledge, this is the first case of MCI with reactive syphilis serology who responded to antimicrobial therapy.

Hippocampal volumes among older Indian adults: Comparison with Alzheimer's disease and mild cognitive impairment.

BACKGROUND: Hippocampal volume data from India have recently been reported in younger adults. Data in older adults are unknown. The present paper describes hippocampal volume from India among older adults and compares the same with patients having Alzheimer's disease (AD) and mild cognitive impairment (MCI). MATERIALS AND METHODS: A total of 32 cognitively normal subjects, 20 patients with AD, and 13 patients with MCI were enrolled. Patients were evaluated for the diagnosis of AD/MCI using the National Institute of Neurological and Communicative Disorders and Stroke and the Related Disorders Association criteria and the Clinical Dementia Rating (CDR) Scale (score = 0.5), respectively. Hippocampal volume was measured using magnetic resonance imaging (MRI) machine by manual segmentation (Megnatom Symphony 1.5T scanner) three-dimensional (3D) sequences. RESULTS: Age and duration of illness in the MCI group were 70.6 ± 8.6 years and 1.9 ± 0.9 years, respectively. In the AD group, age and duration of illness were 72 ± 8.1 years and 3.1 ± 2.2 years, respectively. In cognitively normal subjects, the age range was 45-88 years (66.9 ± 10.32) years. Mean mini-mental status examination (MMSE) score of healthy subjects was 28.28 ± 1.33. In the MCI group, MMSE was 27.05 ± 1.79. In the AD group, MMSE was 13.32 ± 5.6. In the healthy group, the hippocampal volume was 2.73 ± 0.53 cm(3) on the left side and 2.77 ± 0.6 cm(3) on the right side. Likewise, in MCI, the volume on the left side was 2.35 ± 0.42 cm(3) and the volume on the right side was 2.36 ± 0.38 cm(3). Similarly, in the AD group, the volume on the right side was 1.64 ± 0.55 cm(3) and on the left side it was 1.59 ± 0.55 cm(3). Post hoc analysis using Tukey's honestly significant difference (HSD) showed, using analysis of variance (ANOVA) that there was a statistically significant difference between healthy and AD (P ≤ 0.01), and between healthy and MCI (P ≤ 0.01) subjects. There was a correlation between MMSE score and hippocampal volume in the AD group. CONCLUSION: The volume of the hippocampus in older Indian adults was 2.77 ± 0. 6 cm(3) on the right side and 2.73 ± 0.52 cm(3) on the left side. There was a significant hippocampal volume loss in MCI/AD compared to cognitively normal subjects.

Perceived caregiver stress in Alzheimer's disease and mild cognitive impairment: A case control study.

OBJECTIVES: Cross sectional studies have reported a tremendous amount of stress in caregivers of patients with Alzheimer's disease (AD) and Mild Cognitive Impairment (MCI). The present study aimed at evaluating the perceived stress in caregivers of patients with AD and MCI compared to controls. MATERIALS AND METHODS: Caregivers of patients diagnosed with Alzheimer's disease/Mild Cognitive Impairment were recruited at the Memory Clinic of Neurology Department of a Tertiary Care Hospital in Northern India. The controls included caregivers of patients with chronic medical and psychiatric disorders. Caregivers were interviewed using Perceived Stress Scale (PSS) and the patients were assessed using The Blessed Activity of Daily Living (ADL), Mini Mental State Examination (MMSE) and Clinical Dementia Rating scale. The perceived stress of caregivers was compared amongst both groups and correlated with the severity of illness and activities of daily living of the patients. RESULTS: Caregivers of a total of 31 patients of AD/MCI (Males = 24, Females = 7), and 30 controls (Males = 18, Females = 12) were interviewed. PSS Score was 23.29 ± 7.17 in cases and 7.5 ± 3.12 in controls. ADL Score was 7.97±5.53 in cases and 0.00 in controls. There was a significant difference between the PSS and ADL scores between those with AD and controls (P < 0.0001). Caregivers of patients with MCI had lower PSS scores compared to AD caregivers but significantly higher scores compared to caregivers of other chronic disorders. Similarly, correlation between Perceived Stress and ADL was significant (P < 0.001). CONCLUSIONS: Present study shows that caregivers of patients with AD/MCI have a high perceived stress compared to caregivers of patients with other chronic illness.