Srikala Bharath

P300 in family studies of schizophrenia: review and critique.

The published studies using P300 event-related potential (ERP) as a vulnerability marker in schizophrenia have been summarized and reviewed. Several factors across sibling, offspring, and familial studies appear to contribute to the variegated findings with respect to the utility of P300 as a vulnerability marker for schizophrenia. These include how subject samples are defined in terms of their genetic loading for schizophrenia, sample size, ERP methodology, and the relationship of P300 measures to neuropsychological test outcomes. It was concluded that the P300 holds promise as a vulnerability marker for schizophrenia, if used in conjunction with other neuroimaging and neuropsychological testing methods.

Memory and executive functions in persons with type 2 diabetes: a meta-analysis

Literature suggests that persons with type 2 diabetes mellitus (T2DM) are at risk for cognitive impairment, hence dementia. Common domains reported to be affected in those with T2DM are memory and executive functions. The extent of influence of T2DM on these domains has varied among studies. A systematic review and meta‐analysis was carried out to understand whether sub‐domains contributed to the variations observed in published research. We searched ‘PubMed’, ‘ScienceDirect’, ‘SciVerseHub’, ‘Psychinfo’, ‘Proquest’ ‘Ebsco’ and ‘J‐gate Plus’ databases for published studies on cognition and T2DM among persons aged 50 years and older. Memory, executive functions and processing speed domain and sub‐domain scores were extracted; effect sizes (Cohens d) were calculated and analysed. Eight hundred seventeen articles were found. After various levels of filtering, 15 articles met the inclusion criteria for quantitative analyses. The analyses indicated that in comparison to controls, persons with T2DM showed decrements in episodic memory (d = −0.51), logical memory (d = −0.24), sub‐domain of executive functions which included phonemic fluency (d = −0.35) and cognitive flexibility (d = 0.52), and speed of processing (d = −0.22). We found no difference in the sub‐domains of verbal short‐term memory and working memory. The meta‐analysis revealed a detrimental effect of T2DM on cognitive sub‐domains, namely, episodic memory and cognitive flexibility. There was a trend for the logical memory, phonemic fluency and processing speed to be affected. The analysis indicates that T2DM is a detrimental factor on certain cognitive sub‐domains, rendering the person vulnerable to subsequent dementia. Copyright

Relationship of depression, disability, and quality of life in Parkinson's disease: A hospital-based case-control study

BACKGROUND Depression, anxiety, cognitive impairment, sleep disturbances are common neuropsychiatric manifestations in Parkinsons disease (PD). AIMS To compare the prevalence and severity of depression in PD with a group of patients with other chronic medical illnesses and ascertain the relationship of depression with disability and quality of life in PD. SETTINGS AND DESIGN Hospital-based prospective case-control study. PATIENTS AND METHODS Forty-six PD patients and 30 non-PD controls having chronic medical conditions were studied. All were assessed by Beck Depression Inventory (BDI) and Montgomery Asberg Depression Rating Scale (MADRS), World Health Organization Disability Assessment Schedule (WHODAS II) and World Health Organization Quality of Life Scale-Brief Version (WHOQOL-Bref). Statistical Analysis Used : SPSS Version 13.0 was used for analysis which included descriptive tests, independent t test, chi-square test, Fishers exact test, and Pearsons correlation coefficient. Results : The prevalence of depression was higher and more severe in PD than controls (MADRS: 54.3% vs 23.3%, P<0.01; BDI 49.9% vs 23.4%, P<0.05). PD patients had significantly greater overall disability than controls (36.8±19.4 vs 15.1±15.4; P<0.001), and the difference was observed in all six domains of WHODAS II. CONCLUSIONS PD patients had inferior quality of life than controls in all four spheres of WHOQOL-Bref. In PD, depression correlated positively with various domains of disability (P<0.001) and negatively with quality of life (P<0.001). In summary, the prevalence and severity of depression is significantly higher in PD than can be explained by chronic illness. Depression plays an important role in determining the disability and quality of life.

Apolipoprotein E Polymorphism and Dementia: A Hospital-Based Study from Southern India

Background/Aims: To evaluate the ApoE gene polymorphism among patients with dementia from southern India. Methods: Persons with dementia attending a geriatric clinic in a hospital setting located in southern India and matched controls were recruited. All subjects were evaluated on standard assessments and were diagnosed according to the ICD-10; genotyping was done at the apolipoprotein E (ApoE) locus. Results: The study comprised 212 cases and 195 controls. The ApoE4 allele was significantly more prevalent in dementia (λ = 0.18 vs. λ = 0.07; p = 0.0018), especially in the Alzheimer’s disease subgroup (n = 137; λ = 0.21 vs. λ = 0.07; p < 0.001), with a trend in vascular dementia subtype (n = 31; λ = 0.17 vs. λ = 0.07) in comparison with the control group. ApoE4 carrier status did not differ between the other dementia group (n = 44) and controls (p > 0.20), or between the Alzheimer’s group and vascular dementia groups. Cognitive and functional deficits were not correlated to the presence ApoE4 polymorphism in the dementia group. Conclusion: The study confirmed the positive association of the ApoE4 polymorphism in dementia, both in the Alzheimer’s and vascular etiology subgroups. Influence of this polymorphism on various clinical phenotypes, including extent of cognitive and functional deficits, needs further evaluation.

A study of structural and functional connectivity in early Alzheimer's disease using rest fMRI and diffusion tensor imaging.

Alzheimers disease (AD) is a progressive neurodegenerative condition where in early diagnosis and interventions are key policy priorities in dementia services and research. We studied the functional and structural connectivity in mild AD to determine the nature of connectivity changes that coexist with neurocognitive deficits in the early stages of AD.

Clinical presentation of mania compared with depression: data from a geriatric clinic in India

BACKGROUND This retrospective chart review evaluated a comparison of the clinical profiles of older outpatients having mania and those with unipolar depression. METHODS The charts of elderly outpatients with mania and unipolar depression in tertiary care settings were reviewed and relevant information incorporated regarding clinical presentation, past and family history of affective disorder, treatment history and previous psychiatric and neurological history. RESULTS Charts for 30 patients with mania (23 men and 7 women with mean (+/-SD) age of 68.5(+/- 5.75 years) and 92 with depression (47 men and 45 women with mean (+/-SD) age of 68.18 (+/-6.0 years) were evaluated. Fifteen patients (50%) with manic episodes had psychotic symptoms in the form of delusions and hallucinations while only 33 (35.8%) depressed patients had psychotic symptoms. One-third of manic patients received mood stabilizers at index visit. More than half (n = 16; 53.3%) of the patients in the mania group were prescribed antipsychotic medications. On cognitive functions, patients with manic episodes scored poorly compared with those with depression. CONCLUSIONS These findings suggest that mania in the elderly is a severe form of affective disorder with respect to psychotic and cognitive symptoms. Conclusions from this study are limited due to its retrospective design. Further studies in this area are warranted.

Child and adolescent psychiatry in-patient facility

The short-term in-patent facility of the Child and Adolescent Psychiatry Unit in the Na tional Institute of Mental Health and Neurosciences, Bangalore is described. Its clientele over one year is reviewed. Totally 152 admissions were made. Hysterical neurosis (30.8%), Psychoses (25.2%), Conduct disorder (10.5%) and Hyperkinetic syndrome (9.8%) were the most common di agnoses observed in this population who needed short-term intervention. Average duration of stay was 4–12 weeks. All children were admitted with a parent. In 95.8% of the cases the treatment ex penses were borne partially/fully by the hospital. The policy and functioning of the facility is dis cussed.

Reduced Telomere Length in Neurodegenerative Disorders May Suggest Shared Biology

Early cell death is a feature of neurodegenerative disorders. Telomere shortening is related to premature cellular senescence and could be a marker for cellular pathology in neurological diseases. Relative telomere length in dementia (N=70), Huntingtons disease (N=35), ataxia telangiectasia (N=9), and age-group matched control samples (N=105) was measured as relative telomere copy/single copy gene ratios. Individuals with Huntingtons disease had the lowest relative telomere copy/single copy gene ratio (0.21), followed by ataxia telangiectasia (0.31) and dementia (0.48). The younger control group had the highest relative telomere copy/single copy gene ratio (1.07). The reduced telomere length could be indicative of shared biological pathways across these disorders contributing to cellular senescence.

Clinical validity of NIMHANS neuropsychological battery for elderly: A preliminary report

Background: Neuropsychological assessment plays a crucial role in the assessment of cognitive decline in older age. In India, there is a dearth of culturally appropriate standardized measure to assess cognitive functions in early dementia. The aim of the study was to examine clinical validity of NIMHANS Neuropsychological Battery for Elderly (NNB-E) in identifying early dementia. Objectives: To examine validity (discriminant and concurrent) of NIMHANS Neuropsychological Battery for Elderly (NNB-E). Results: Participants with AD showed significantly poorer performance on every test including memory and non-memory domains. However, tests of episodic and semantic memory were particularly sensitive in discriminating between normal and AD groups. Further scores on various subtests in the NNB-E were positively associated with scores on HMSE and negatively associated with Clinical Dementia Rating and Everyday Abilities Scale for India (EASI) scores. Conclusions: NNB-E was able to differentiate normal controls from AD patients, and it can therefore be an ecologically valid tool for Indian older adults.

Apolipoprotein E4 and brain white matter integrity in Alzheimer's disease: tract-based spatial statistics study under 3-Tesla MRI.

Introduction: Apolipoprotein E4 (ApoE ε4) polymorphism is a known genetic risk factor for Alzheimer’s disease (AD). Objectives: To evaluate the role of ApoE ε4 on white matter structural integrity in AD. Methods: Subjects were 32 patients with probable AD (ApoE ε4-positive: n = 15) and 18 matched controls (ApoE ε4-positive: n = 6). All subjects were right-handed, evaluated using standard scales and genotyped at the ApoE locus. Diffusion tensor imaging was performed with a 3-tesla MRI scanner and analyzed using the tract-based spatial statistics method. Results: AD patients had significantly lower fractional anisotropy (FA) in bilateral temporoparietal, limbic and parahippocampal regions in comparison to healthy comparison subjects. ApoE ε4 carriers among both AD and healthy comparison subjects showed lower FA in limbic and medial temporal regions. Conclusions: There is a modest association between ApoE ε4 carrier status and reduction in white matter tract integrity at medial temporal and limbic regions in both healthy and AD subjects.