Ravikesh Tripathi

Neuropsychological markers of mild cognitive impairment: A clinic based study from urban India.

Background: Mild cognitive impairment (MCI) is a transitional stage between normal aging and dementia. Persons with MCI are at higher risk to develop dementia. Identifying MCI from normal aging has become a priority area of research. Neuropsychological assessment could help to identify these high risk individuals. Objective: To examine clinical utility and diagnostic accuracy of neuropsychological measures in identifying MCI. Materials and Methods: This is a cross-sectional study of 42 participants (22 patients with MCI and 20 normal controls [NC]) between the age of 60 and 80 years. All participants were screened for dementia and later a detailed neuropsychological assessment was carried out. Results: Persons with MCI performed significantly poorer than NC on word list (immediate and delayed recall), story recall test, stick construction delayed recall, fluency and Go/No-Go test. Measures of episodic memory especially word list delayed recall had the highest discriminating power compared with measures of semantic memory and executive functioning. Conclusion: Word list learning with delayed recall component is a possible candidate for detecting MCI from normal aging.

Age, education and gender effects on neuropsychological functions in healthy Indian older adults

It is essential to use culturally appropriate, sensitive and specific tests that reflect true cognitive performance. However, several factors including age, education and gender can influence neuropsychological test performance. Objective To examine the effects of age, education and gender on neuropsychological function in older adults using measures of global cognitive screening, attention, working memory, executive functions, memory, construction, language and parietal focal signs. Methods This is a cross sectional normative study of 180 community-dwelling normal older adults. All participants were screened with the Hindi Mental Status Examination (HMSE), Everyday Activities Scale for India (EASI), Edinburgh handedness inventory (EDI) and MINI Screen, and followed by a detailed neuropsychological assessment. Results Stepwise regression analysis revealed that education was associated with better performance on all the neuropsychological tests. Females performed significantly better on measures of memory. Further, most of the illiterate subjects, including low educated participants, refused to cooperate on measures of executive functioning. Conclusion Education was found to be the strongest determinant of neuropsychological test performance followed by age and gender. Our study demonstrates that Indian healthy normal older adults with low education perform poorly on measures of planning and working memory. Traditional measures of planning and working memory should be avoided or used cautiously in the presence of low education. There is an urgent need to develop tasks for measuring executive functions, especially in low educated Indian older adults.

Illiteracy and Cognition in Older Adults

The article “Cognitive dysfunction in normally aging urban older adults” by Tripathi and Tiwari (2011) which appeared in volume 33 (2)[1] is interesting and has raised important issues regarding cognitive assessment in the elderly population. In this study the sample comprised of 89 community-dwelling normal elderly and most of the subjects (68.5%) had education below primary school level. Further, their results indicated that normal elderly had dysfunction in the domains of orientation and concentration. However, the findings of the article raise several questions for further examination. Here we have provided our observations in brief.

Endovascular treatment of vein of Galen dural arteriovenous fistula presenting as dementia

Dural arteriovenous fistula (DAVF) is an important cause of neurological dysfunction that is often misdiagnosed, especially in elderly population. Galenic DAVFs are a subtype of the rare falcotentorial DAVFs with a high risk of hemorrhage and aggressive clinical course. In most cases, DAVFs present with pulsatile tinnitus, headache, or orbital symptoms such as chemosis and proptosis. We report a patient with DAVF of Vein of Galen presented with progressive dementia, treated by Onyx embolisation and had good clinical outcome.

Pseudo-dementia: A neuropsychological review

Annals of Indian Academy of Neurology, January-March 2015, Vol 18, Issue 1 our patient, both these pathways are important and the cavernous sinus pathway has both intracranial and extracranial routes. In addition, there is a third pathway through the scalp and occipital veins as mentioned above. Thus the extracranial collateral pathways through the facial veins, pharyngeal plexus, pterygoid plexus, superficial temporal vein, occipital vein and vertebral venous plexus are very important for drainage. These collateral pathways have a significant impact on the outcome as seen in our patient.

Besides symptoms: unheard narratives in research on schizophrenia.

The question that arises further is what can be other mechanisms of assessment. The answer to that may not be straightforward. Other options include considering clinical achievements and experience, teaching expertise, community service, impact of the work, qualitative assessment of publications, and others. It is incumbent upon the regulatory and sponsoring authorities such as the Medical Council of India and others to consider whether the present method is the best one, or another holistic approach can be promulgated.

Affect intensity and negative mood regulation (NMR) expectancies: A preliminary Indian study

Individuals differ in the intensity with which they typically experience affect as well as in their beliefs regarding their ability to alleviate negative mood states. These variables have been implicated in a range of clinical problems. Most studies utilize a single index of affect intensity. The differential correlates of positive and negative affect intensity, their association with negative mood regulation expectancy and their role as predictors of psychological outcomes have been insufficiently explored. This study aimed at exploring the relationship of affect intensity variables with negative mood regulation (NMR) expectancy, their association with age and gender and examining the role of affect intensity and NMR expectancy as predictors of stress and well being in a community sample of Indian adults. The sample consisted of 206 participants aged between 20 and 60 years. Higher age was associated with higher NMR expectancy but lower positive affect intensity. Positive and negative affect intensity showed differential patterns of association with NMR expectancy. Higher negative affect intensity was associated with lower NMR expectancy whereas higher positive affect intensity was associated with higher NMR expectancy. Affect intensity and NMR expectancy variables jointly predicted 30-39% of variance in perceived stress and well being. Implications for further research are discussed.