Background
Semantic dementia (SD) is a variant of primary progressive aphasia (PPA) which is characterised by impaired confrontation naming, single word comprehension and object recognition with preserved fluency and syntax. Similar to many other neurodegenerative dementias, there is currently no effective treatment for semantic dementia. Neuromodulatory interventions like transcranial direct current stimulation(tDCS) and repetitive transcranial magnetic stimulation(rTMS) along with language training is emerging as a potential treatment strategy for Primary progressive aphasia. Aim: Four patients with semantic dementia were administered concomitant online language training with tDCS to study the feasibility and clinical outcome.
Method
Four patients (2 males) aged between 50‐63 years, diagnosed with semantic dementia after a comprehensive clinical assessment and Addenbrooke’s cognitive examination and Clinical Dementia Rating(CDR) scale by an experienced geriatric Psychiatrist were included in the case series. Detailed assessment of neurolinguistic skills was done using Western Aphasia Battery (WAB‐Kannada/Hindi) before and after 5‐days of tDCS by qualified speech pathologist. Daily tDCS sessions were delivered using 2mA current with anode over the left dorsolateral prefrontal cortex and cathode over right supraorbital area for 30 minutes, except one female patient with moderate dementia who received 2 session daily at an interval of 3 hours. Online cognitive‐linguistic intervention was provided by the speech pathologist during tDCS sessions. Adverse effects were monitored using structured questionnaire.
Result
Three Patients had mild dementia and one had moderate dementia as per CDR. tDCS was tolerated well except for burning sensation in two sessions in one patient and all were able to attend the linguistic training. All subjects improved in the domains of Spontaneous speech, Auditory verbal comprehension, repetition and naming on the WAB.
Conclusion
tDCS can be a potential therapeutic modality in semantic dementia. Randomized Sham Controlled Clinical trials are required to establish the efficacy of tDCS and language training in the treatment of semantic dementia.
Introduction: Older adults are at disproportionate risk of serious disease and mortality due to the novel coronavirus (COVID-19) pandemic. Further, the global response to the lockdown has rendered older adults particularly vulnerable to loneliness and social isolation due to the physical distancing and shelter in place mandate. We hypothesized that both these factors would lead to an increase in geriatric mental health problems during the COVID-19 pandemic.Material and Methods: We undertook a clinical audit of all geriatric patients (above 60 years of age) attending the psychiatry emergency services at a tertiary care hospital. This audit was conducted over a period of 52 days dating from the cessation of non-essential services at the hospital as part of the national response to the COVID-19 pandemic (lockdown).We used descriptive statistics to summarize the number, age, sex, presenting complaint and diagnoses of our patients. We further compared the average number of geriatric patients attending the psychiatry emergency services in the hospital during the lockdown to that of geriatric patients attending the same in the year before the lockdown.Results: A total of 112 geriatric patients attended the psychiatry emergency services during the lockdown period. Of these, 62 were male and 50 female. The average number of geriatric patients attending the emergency services daily during this period (μ1 2.15) was significantly higher (z 5.36, p ≤ 0.01) than the average number of patients attending the emergency services in the year preceding the lockdown (μ2 1.34).The most common presenting complaint was agitation in the preceding weeks. The most common diagnoses were late onset schizophrenia spectrum disorders followed by affective disorders and major neurocognitive disorders.Discussion: The COVID-19 pandemic and the global response to the same constitute life events for older adults. They may contribute to biological, psychological and social risk factors for mental health problems in older adults during this period. The increase in geriatric patients attending our emergency services, despite an increase in restrictions on mobility which act as barriers in the pathway to care, is worrying. Under stimulation in older adults during this period may contribute to an increase in agitation.
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