Behavioral and psychological symptoms among Indian patients with mild cognitive impairment

Dhikav, Vikas; Sethi, Manish; Mishra, Pinki; Anand, Kuljeet Singh

doi:10.1017/s1041610215001222

Cited by 3 publications

(4 citation statements)

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“…This confirms that an increasing severity of dementia is associated with greater MTLA. A sex bias[22][23][24] can be seen in the present study and can limit the external validity of the study apart from the small sample size. This sex bias is typical of memory disorders in several developing countries 2 where females are hardly brought in for treatment.…”

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confidence: 77%

“…This is a cross sectional and observational study in which recruited patients with AD/MCI were subjected Those with AD/MCI and CSDD scores greater than 10 were included for cortisol level estimation (10 is the cut off score for depression in dementia). All the scales used in the current study have been well validated and extensively used in Indian patients 2,[22][23][24] .…”

Section: Methodsmentioning

confidence: 99%

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Basal Serum Cortisol Levels, Depression And Medial Temporal Lobe Atrophy In Patients With Mild Cognitive Impairment And Alzheimer’s Disease

Dhikav

Sharma

Mishra

et al. 2015

JDT

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Objectives: Changes in serum cortisol levels have been reported in Alzheimer's disease (AD) and Mild Cognitive Impairment (MCI). Atrophy of Medial Temporal Lobes (MTLs) is common in both conditions. Glucocorticoids are known to be neurotoxic and have been believed to cause damage to memory mechanisms in the brains; whether the same is applicable to AD/MCI is not known. Also, they have long been hypothesized to cause atrophy of MTLs but the proof of the same is lacking. The present study was performed to delineate correlations between serum Cortisol levels, Depression in Dementia and Medial Temporal Lobe Atrophy in patients with AD/MCI. Methods: We randomly recruited 28 patients out of a total of 65 presenting with subjective memory complaints to the Department of Neurology, at a tertiary care institute during the study period (July 2014-2015). Morning serum Cortisol levels (8 AM) were analyzed in all patients (n=28) who met the diagnostic criteria for diagnosis of probable AD e.g. National Institute of Neurological and Communicative Disorders and Stroke, Alzheimer's disease related Disease Association criteria (NINCDS-ARDA) and Clinical Dementia Rating (CDR) for AD and MCI respectively. The Cornell Scale for Depression in Dementia (CSDD) was used to evaluate Depression. Visual Rating of Medial Temporal Lobe Atrophy (MTLA) was done using the Scheltens Visual Rating Scale. An association between the Depression and MTLA was evaluated using Pearson correlation coefficient. Results: A total of 28 Patients (M: F=24:4, AD=13, MCI=15) were recruited for the present study. The mean age was 73.39 ±7.6 years and mean duration of illness was 3.4±3 years. Mean Mini Mental State Examination (MMSE) score was 21.7±7.4. A total of 4 patients (14%) had a high basal serum cortisol. Only one case out of these 4 had MCI and the rest had AD. There was a statistically significant correlation between serum Cortisol levels and MTLA (Pearson Correlation Coefficient=0.39, p<0.05). Similarly, a statistically significant correlation was found between serum Cortisol levels and CSDD scores (Pearson Correlation Coefficient=0.49, p<0.05). Likewise, there was a statistically significant negative correlation between MMSE and CSDD (Pearson Correlation Coefficient=-0.48, p<0.001). Conclusion : Statistically significant correlation between Serum Cortisol and MTA Scores as assessed by Scheltens Visual Rating Scores was found (Pearson Correlation Coefficient=0.39, p<0.05; 95% confidence interval=0.02 to 0.66). Similarly, a significantly correlation was present between serum cortisol and CSDD Scores (Pearson Correlation Coefficient=0.49, p<0.05; 95% confidence interval=0.144 to 0.729). This suggests that glucorticoids and depression and MTA in AD/MCI are interrelated and points towards the possible role that increase in endogenous glucocorticoids may play in pathophysiology of AD/MCI.

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confidence: 77%

Section: Methodsmentioning

confidence: 99%

Basal Serum Cortisol Levels, Depression And Medial Temporal Lobe Atrophy In Patients With Mild Cognitive Impairment And Alzheimer’s Disease

Dhikav

Sharma

Mishra

et al. 2015

JDT

Self Cite

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“…Cardiovascular factors have been reported in other neurodegenerative diseases as well, such as Parkinson's disease [17,18]. These have also been associated with behavioral and psychological symptoms of dementias [19] and hippocampal atrophy, one of the earliest and most severely affected structures [19][20][21][22][23][24][25][26][27]. Perhaps hormones such as glucocorticoids synergize with vascular factors in causing vascular damage [28].…”

Section: Cardiovascular Risk Factors In Other Neurodegenerative Diseasesmentioning

confidence: 99%

Cardiovascular Comorbidities and Cognitive Impairment

Dhikav¹,

Kumar²,

Anand³

2022

OBM Geriatr

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Various grades of cognitive impairment generally occur in older adults over the age of 55, where cardiovascular risk factors such as diabetes and/or hypertension, coronary artery disease, or cerebrovascular accidents are also common. Cognitive impairment occurs in various forms, from mild or amnesia such as forgetting today's date to more ominous and progressive forms, such as frank dementia. Over 5 million people worldwide suffer from dementia, most of whom live in low- and middle-income countries. It has been envisaged from the beginning that dementia or cognitive impairment has neurodegenerative origins. However, recent studies have indicated that dementia may have a mixed origin or may be preceded by vascular insult and then neurodegenerative pathology. From a pathophysiological standpoint, one of the puzzling questions in the field of cognitive impairment and comorbidities is that it is not clear whether cardiovascular comorbidity or cognitive impairment comes first. Cognitive impairment negatively affects mobility and fitness and this can potentially contribute to development of hypertension or/and diabetes. The present review examines this perplexing situation and tries to anser whether the comorbid conditions are innocent bystanders to cognitive impairment or they play greater causative roles. The rationale of the review is that it is possible to address these cardiovascular risk factors for dementia prevention and hence it summarizes the evidence related to cardiovascular risk factors and cognitive impairment.

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“…There are many patients who fail to respond to these drugs [9], leaving a window for the new entry [1]. Since a sizable number of patients do not adequately respond to the available drugs [1,[9][10][11][12], drugs such as ramelteon [9] and carbamazepine [11] Amisulpride is a second generation atypical antipsychotic that selectively binds to dopamine D 2 /D 3 receptors with 5-HT 7 antagonistic effect in the limbic system of the brain [14,15]. Amisulpride has not…”

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confidence: 99%

Amisulpride in Refractory Behavioral and Psychological Symptoms of Dementia

Dhikav¹,

Prajapati²,

Muzaffar³

et al. 2017

Ann Alzheimers Dement Care

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olanzapine, quetiapine and risperidone. There are many patients who fail to respond to these drugs [9], leaving a window for the new entry [1]. Since a sizable number of patients do not adequately respond to the available drugs [1,[9][10][11][12], drugs such as ramelteon [9] and carbamazepine [11] Amisulpride is a second generation atypical antipsychotic that selectively binds to dopamine D 2 /D 3 receptors with 5-HT 7 antagonistic effect in the limbic system of the brain [14,15]. Amisulpride has not IntroductionDementia is a common disease of the elderly and is characterized by cognitive and non-cognitive complaints [1]. Dementias involves loss of cognitive abilities and at least one of the following e.g., aphasia, apraxia, agnosia, disturbances in executive functioning [2]. The behavioural impairment in dementia interferes with a person's Activity of Daily Living [3]. It is a common cause of caregiver stress and burden and leads to poor Quality of Life [4]. Psychosis is the most common disturbance in patients with dementias with behavioral and psychological symptoms of dementia (BPSD) [5], which affects up to 90% of all dementia subjects [6]. Psychotic BPSD include verbal and physical aggression, agitation, hallucinations delusions, irritability, sleep disturbances, oppositional behaviors, and wandering type behaviors [7] etc. Course of dementias is complicated by the occurrence of BPSD [1] and is the single most predictor of hospitalization and caregiver stress [5].Currently, the antipsychotics are the most commonly offlabel drugs used in the management of BPSD [8]. These have been the mainstay of the treatment of BPSD, especially the psychotic behaviours. The commonly used drugs for this purpose include AbstractBackground: Amisulpiride is an atypical antipsychotic used extensively in Schizophrenia and related disorders. The current study explored the safety and tolerability of amisulpride in refractory patients with behavioral and psychological symptoms of dementia (BPSD), especially in agitation and/ or aggression.

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Behavioral and psychological symptoms among Indian patients with mild cognitive impairment

Cited by 3 publications

References 5 publications

Basal Serum Cortisol Levels, Depression And Medial Temporal Lobe Atrophy In Patients With Mild Cognitive Impairment And Alzheimer’s Disease

Basal Serum Cortisol Levels, Depression And Medial Temporal Lobe Atrophy In Patients With Mild Cognitive Impairment And Alzheimer’s Disease

Cardiovascular Comorbidities and Cognitive Impairment

Amisulpride in Refractory Behavioral and Psychological Symptoms of Dementia

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