Background: The clinical syndrome of dementia consists of several subtypes that are distinct in their etiology, clinical profile, management, and outcome. Limited specialized services are available for dementia patients in India. We report the profile of dementia subtypes from a clinic-based dementia registry in India. Methods: Consecutive dementia patients were investigated with clinical evaluation, neuropsychological tests modified for local use, and brain imaging. Results: In 347 consecutive dementia patients, Alzheimer’s disease was the most common subtype of dementia (38.3%), followed by a high proportion of vascular dementia (25.4%). Frontotemporal dementia syndromes were not uncommon (18.7%). Dementia with Lewy bodies was encountered in 8.9% of the patients, and mixed dementia was found in 8.6%. The mean age of the group at presentation was 66.3 years, nearly a decade younger than in developed countries. The proportion of patients with early-onset dementia was high (49.9%). Conclusions: Our results demonstrate that the clinical profiles of dementia subtypes in a clinic population are influenced by the population’s demographic profile, cardiovascular risk factor burden, sociocultural attitudes about cognitive impairment, and possibly genetic factors.

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Background: Increasing evidence suggests that life course factors such as education and bilingualism may have a protective role against dementia due to Alzheimer disease. This study aimed to compare the effects of education and bilingualism on the onset of cognitive decline at the stage of mild cognitive impairment (MCI). Methods: A total of 115 patients with MCI evaluated in a specialty memory clinic in Hyderabad, India, formed the cohort. MCI was diagnosed according to Petersen's criteria following clinical evaluation and brain imaging. Age at onset of MCI was compared between bilinguals and monolinguals, and across subjects with high and low levels of education, adjusting for possible confounding variables. Results: The bilingual MCI patients were found to have a clinical onset of cognitive complaints 7.4 years later than monolinguals (65.2 vs. 58.1 years; p = 0.004), while years of education was not associated with delayed onset (1-10 years of education, 59.1 years; 11-15 years of education, 62.6 years; >15 years of education, 62.2 years; p = 0.426). Conclusion: The effect of bilingualism is protective against cognitive decline, and lies along a continuum from normal to pathological states. In comparison, the role of years of education is less robust.

Background:Carotid intima-media thickness (IMT) is increasingly identified as a marker of atherosclerosis and increased risk of cerebrovascular disease.Aim:We aimed to investigate the prevalence of carotid IMT in asymptomatic Indian individuals, more than 40 years of age, and correlate it with other risk factors for cerebrovascular ischemia.Materials and Methods:Individuals attending outpatient services of Nizam's Institute of Medical Sciences, who were asymptomatic for cerebrovascular ischemia underwent detailed history and carotid Doppler examination. IMT on mid common carotid artery (CCA) was measured. All subjects’ blood was taken for biochemical estimation of fasting blood sugar and total cholesterol levels.Results:Out of 1,392 subjects, 571 (41%) had abnormal IMT and 821 (59%) had normal IMT. On comparison of the two groups, the factors significantly associated with abnormal IMT were mean older age (59 vs 50.7 years; P < 0.0001) and higher prevalence of hypertension (257 (45%) vs 236 (28.7%); P < 0.0001), diabetes (159 (27.8%) vs 139 (16.9%); P < 0.0001), and hypercholesterolemia (124 (21.7%) vs113 (13.7%); P = 0.0001). After adjustment with multiple logistic regression, significant predictors were age (odds 3.2; 95% confidence interval (CI) 2.5-4.1), male gender (odds 1.5; 95% CI 1.1-1.9), hypercholesterolemia (odds 1.5; 95% CI 1.1-2.0), hypertension (odds 1.4; 95% CI 1.1-1.8), and diabetes (odds 1.3; 95% CI 1.0-1.7).Conclusion:We found age, sex, hypertension, diabetes, and hypercholesterolemia to be independent risk factor for abnormal IMT in asymptomatic subjects over 40 years of age.

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