Illiterate Addenbrooke's Cognitive Examination-III in Three Indian Languages: An Adaptation and Validation Study.

BACKGROUND: Literacy is an important factor that predicts cognitive performance. Existing cognitive screening tools are validated only in educated populations and are not appropriate for older adults with little or no education leading to poor performance on these tests and eventually leading to misdiagnosis. This challenge for clinicians necessitates a screening tool suitable for illiterate or low-literate older individuals. OBJECTIVES: The objective was to adapt and validate Addenbrooke's Cognitive Examination-III (ACE-III) for screening general cognitive functions in illiterate and low-literate older populations in the Indian context in three languages. METHOD: The Indian illiterate ACE-III was systematically adapted by modifying the original items of the Indian literate ACE-III to assess the cognitive functions of illiterates and low-literates with the consensus of an expert panel of professionals working in the area of dementia and related disorders. A total of 180 illiterate or low-literate participants (84 healthy-controls, 50 with dementia, and 46 with mild cognitive impairment [MCI]) were recruited from three different centers speaking Bengali, Hindi, and Kannada to validate the adapted version. RESULTS: The optimal cut-off score for illiterate ACE-III to distinguish controls from dementia in all 3 languages was 75. The optimal cut-off scores in distinguishing between controls and MCI ranged from 79 to 82, with a sensitivity ranging from 93% to 99% and a specificity ranging from 72% to 99%. CONCLUSION: The test is found to have good psychometric properties and is a reliable cognitive screening tool for identifying dementia and MCI in older adults with low educational backgrounds in the Indian context.

Quality of life and Concerns of Parkinson's Disease Patients and their Caregivers during COVID-19 Pandemic: An Indian Study.

Objectives: Parkinson's disease (PD) patients have suffered during the coronavirus disease 2019 pandemic, with worsening of both motor and nonmotor symptoms. We conducted this study to evaluate the quality of life (QoL) and concerns of PD patients and their caregivers. Methods: The study was conducted in mixed method, where the baseline data was taken by face-to-face interview during the unlock phase of December 2020 to March 2021, when there was no lockdown. This included demography, Hoehn and Yahr (HY) stage, Parkinson's Disease Questionnaire-8 (PDQ-8), and Parkinson's Disease Questionnaire for Carer (PDQ-Carer). During the second wave of COVID-19 (April-June 2021), telephonic interview was conducted using Depression, Anxiety Stress Scale- 21 Items (DASS-21), PDQ-8, PDQ-Carer, and open-ended questions regarding their concerns. Results: Compared with the baseline data, PDQ-8 and PDQ-Carer scores showed significant worsening during the second wave. DASS-21 scores had significant correlation with PDQ-Carer and PDQ-8 scores. Female patients reported poorer QoL. Caregivers of non-vaccinated patients had worse PDQ-Carer Strain scores. There was no significant association between worsening of motor symptoms and PDQ-8 and PDQ-Carer scores. More than 80% patients and 70% caregivers reported anxiety and depression. Their concerns were regarding difficulties due to social isolation, restriction of activity, and financial constraints. Additionally, there were worries about patient care, vaccination, and recurrence of the wave. Conclusions: The QoL of both patients and their caregivers were affected by the pandemic. A significant proportion had anxiety and depression, and this correlated with QoL. There were some important concerns on various aspects of the pandemic.

Health status of persons with dementia and caregivers' burden during the second wave of COVID-19 pandemic: an Indian study / Estado de saúde de pessoas com demência e sobrecarga dos cuidadores durante a 2ª onda da pandemia de covid-19: um estudo indiano

ABSTRACT. Due to the disruption of normal flow of treatment during the restrictions related to the coronavirus disease 2019 (COVID-19) pandemic, the health status of persons with dementia (PwD) and their caregivers' burden might worsen. Objective: The article aims to find out the health status of PwD and caregivers' burden during the peak of second wave of COVID-19 and make a comparison with the preceding trough phase. Methods: The study was conducted with 53 PwD and their caregivers in two phases. On their visit to the hospital during the unlock phase (phase 1), data were collected for CDR from PwD, and NPI-Q and ZBI from their caregivers. During the peak of second wave (phase 2), data were collected for NPI-Q, ZBI, and DASS-21 through telephonic communication, and statistical analyses were performed on the collected data. Results: Significantly higher caregiver burden (p=0.001) and neuropsychiatric symptoms (NPSs) [both in severity (p=0.019) and distress (p=0.013)] were observed among the respondents during the peak of second wave of the pandemic as compared to the preceding trough phase. Positive correlations were observed between the caregiver burden and depression, anxiety, and stress of the caregivers (p<0.001) and between the severity of dementia in PwD and caregiver burden (p<0.001) for both the first and second phases. Positive correlation was also observed between the severity of dementia in PwD and depression (p=0.042) and stress (p=0.023) of caregivers. Conclusions: Significant increase in the burden and distress was observed among caregivers due to increased NPSs of PwD during the second wave of COVID-19 pandemic.

RESUMO. Devido à interrupção do fluxo normal de tratamento durante as restrições relacionadas à pandemia de COVID-19, o estado de saúde das pessoas com demência (PcD) e a sobrecarga de seus cuidadores podem piorar. Objetivo: O artigo teve como objetivo conhecer o estado de saúde da PcD e a sobrecarga dos cuidadores durante o pico da 2ª onda de COVID-19 e fazer uma comparação com a fase anterior. Métodos: O estudo foi realizado com 53 PcD e seus cuidadores em duas fases. Em sua visita ao hospital durante a fase de desbloqueio (Fase 1), CDR, NPI-Q e ZBI foram administrados às PcD e seus cuidadores. Durante o pico da segunda onda (Fase 2), NPI-Q, ZBI e DASS-21 foram administrados por telefone e foram realizadas análises estatísticas dos dados coletados. Resultados: Foram observados sobrecarga do cuidador significativamente maior (p=0,001) e sintomas neuropsiquiátricos [tanto em gravidade (p=0,019) quanto angústia (p=0,013)] entre os entrevistados durante o pico da 2ª onda da pandemia em comparação com a fase anterior de passagem. Foram observadas correlações positivas entre sobrecarga do cuidador e depressão, ansiedade e estresse dos cuidadores (p<0,001) e entre gravidade da demência em PcD e sobrecarga do cuidador (p<0,001) tanto para a 1ª quanto para a 2ª fase. Também foi observada correlação positiva entre a gravidade da demência em PcD e depressão (p=0,042) e estresse (p=0,023) dos cuidadores. Conclusões: Foi observado um aumento significativo na sobrecarga e angústia entre os cuidadores devido ao aumento dos sintomas neuropsiquiátricos de PcD durante a 2ª onda da pandemia de COVID-19.

Adaptation and Validation of Addenbrooke's Cognitive Examination-III in Bengali for Screening MCI and Dementia.

OBJECTIVE: Bengali, the 6th most spoken language globally with 268 million speakers, demands a culturally appropriate tool for screening any cognitive compromise in this population. Addenbrooke Cognitive Examination-III (ACE-III) is a standardized tool used for screening and/or diagnostic purpose worldwide. The aim of the present study was to adapt and validate ACE-III into Bengali language. METHODS: The ACE-III UK Version A (2012) was adapted with linguistically and culturally appropriate items and validated on Bengali speakers. The participants consisted of 40 dementia and 22 Mild Cognitive Impairment (MCI) patients and 120 healthy-controls. Reliability and validity were examined. Discriminant function analysis was done. Sensitivity and specificity were evaluated and optimum cut-offs were established for MCI and dementia. RESULTS: Both sensitivity and specificity of ACE-III-Bengali of identifying dementia was 1; sensitivity for MCI ranged from 0.83 to 1, specificity from 0.76 to 1. Discriminant function analysis showed a significant difference in all domains of ACE-III-Bengali between healthy individuals and persons with neurocognitive impairment. Separate optimum ACE-III-Bengali cut-off scores were established according to level of education. For low education (

Exploring Caregiver Burden and Health Condition of Dementia Patients during Lockdown due to COVID-19 Pandemic.

Background: To combat the COVID-19 pandemic, several countries imposed strict lockdown to ensure social distancing to limit the spread of the virus. This caused difficulties in the management and care of patients with various chronic disorders including dementia. Objectives: The objective of the study was to explore the health condition of patients with dementia and assess their caregivers' burden during the lockdown. Methods: A total of 57 caregivers of patients with dementia who had attended the cognitive clinic of the institute for a follow-up within 1 year preceding the lockdown were assessed through telephonic interviews. Caregivers' details were noted following an interview related to the patients' health condition during lockdown and caregiver concerns. Results: Findings showed a deterioration in memory in 66.7% of patients with dementia and an increase in symptoms like agitation, sleeplessness, low mood, restlessness, aggression, etc., Caregivers felt helpless and had to manage new concerns and they were not sure as to how to deal with the situation. Conclusion: The lockdown situation disrupted the health conditions of dementia patients and caregivers faced novel challenges while managing them.

Health status of persons with dementia and caregivers' burden during the second wave of COVID-19 pandemic: an Indian study.

Due to the disruption of normal flow of treatment during the restrictions related to the coronavirus disease 2019 (COVID-19) pandemic, the health status of persons with dementia (PwD) and their caregivers' burden might worsen. Objective: The article aims to find out the health status of PwD and caregivers' burden during the peak of second wave of COVID-19 and make a comparison with the preceding trough phase. Methods: The study was conducted with 53 PwD and their caregivers in two phases. On their visit to the hospital during the unlock phase (phase 1), data were collected for CDR from PwD, and NPI-Q and ZBI from their caregivers. During the peak of second wave (phase 2), data were collected for NPI-Q, ZBI, and DASS-21 through telephonic communication, and statistical analyses were performed on the collected data. Results: Significantly higher caregiver burden (p=0.001) and neuropsychiatric symptoms (NPSs) [both in severity (p=0.019) and distress (p=0.013)] were observed among the respondents during the peak of second wave of the pandemic as compared to the preceding trough phase. Positive correlations were observed between the caregiver burden and depression, anxiety, and stress of the caregivers (p<0.001) and between the severity of dementia in PwD and caregiver burden (p<0.001) for both the first and second phases. Positive correlation was also observed between the severity of dementia in PwD and depression (p=0.042) and stress (p=0.023) of caregivers. Conclusions: Significant increase in the burden and distress was observed among caregivers due to increased NPSs of PwD during the second wave of COVID-19 pandemic.

Devido à interrupção do fluxo normal de tratamento durante as restrições relacionadas à pandemia de COVID-19, o estado de saúde das pessoas com demência (PcD) e a sobrecarga de seus cuidadores podem piorar. Objetivo: O artigo teve como objetivo conhecer o estado de saúde da PcD e a sobrecarga dos cuidadores durante o pico da 2ª onda de COVID-19 e fazer uma comparação com a fase anterior. Métodos: O estudo foi realizado com 53 PcD e seus cuidadores em duas fases. Em sua visita ao hospital durante a fase de desbloqueio (Fase 1), CDR, NPI-Q e ZBI foram administrados às PcD e seus cuidadores. Durante o pico da segunda onda (Fase 2), NPI-Q, ZBI e DASS-21 foram administrados por telefone e foram realizadas análises estatísticas dos dados coletados. Resultados: Foram observados sobrecarga do cuidador significativamente maior (p=0,001) e sintomas neuropsiquiátricos [tanto em gravidade (p=0,019) quanto angústia (p=0,013)] entre os entrevistados durante o pico da 2ª onda da pandemia em comparação com a fase anterior de passagem. Foram observadas correlações positivas entre sobrecarga do cuidador e depressão, ansiedade e estresse dos cuidadores (p<0,001) e entre gravidade da demência em PcD e sobrecarga do cuidador (p<0,001) tanto para a 1ª quanto para a 2ª fase. Também foi observada correlação positiva entre a gravidade da demência em PcD e depressão (p=0,042) e estresse (p=0,023) dos cuidadores. Conclusões: Foi observado um aumento significativo na sobrecarga e angústia entre os cuidadores devido ao aumento dos sintomas neuropsiquiátricos de PcD durante a 2ª onda da pandemia de COVID-19.