Rakesh Kumar Tripathi

Bio: Rakesh Kumar Tripathi is an academic researcher from King George's Medical University. The author has contributed to research in topics: Mini–Mental State Examination & Population. The author has an hindex of 8, co-authored 19 publications receiving 232 citations.

Caregiver burden and quality of life of key caregivers of patients with dementia

Abstract: Background: Dementia is the most devastating cognitive disorder of the elderly and needs extra attention to care. Therefore, this study was conducted to identify the caregiver burden of dementia key caregivers and their Quality of Life (QOL). Materials and Methods: Sample consisted of purposively selected 24 dementia key caregivers fulfilling the inclusion criteria from the in-patient of the Department of Geriatric Mental Health, King George's Medical University, Lucknow, Uttar Pradesh, India. Zarit Burden Interview and World Health Organization QOL-BREF were administered. Mean, standard deviation, t-test, Chi-square with Yate's correction were used to analyze the data. Results: All key caregivers felt mild to moderate level of burden. Gender-wise significant difference was found on burden area of expectation (P < 0.05). Mean scores on physical, psychological, social relationship, and environmental QOL were found to be on lower side. A negative correlation was found between burden and QOL. Conclusion: Professional help and supportive psychotherapy can be provided to the key caregivers of dementia patients to reduce their burden, strengthen the coping skill and thus improve their QOL.

Applicability of the Mini-mental State Examination (MMSE) and the Hindi Mental State Examination (HMSE) to the urban elderly in India: a pilot study.

Abstract: Background: The Mini-mental State Examination (MMSE) is a globally used instrument for cognitive screening, which nevertheless has a bias with respect to education and language. The Indo-U.S. Cross National Epidemiology Study developed a modified version of MMSE, the Hindi Mental State Examination (HMSE), to counter this bias in India among rural and illiterate elderly. Thus, two parallel tests are available for screening the population. This study was conducted to explore and compare the applicability of MMSE and HMSE when scanning for cognitive impairment among urban elderly people.Methods: The sample consisted of 40 subjects (20 illiterate and 20 literate) aged 60 years and above drawn from the urban community who met the inclusion criteria. A systematically translated Hindi version of MMSE (HVMMSE) was administered to both groups. After one month, HMSE was administered to the same groups. χ2 with Yate's correction, percentage, rank order correlation and qualitative analysis were used to analyze data.Results: All illiterate subjects scored below the cut-off on translated HVMMSE while only four of them scored below the cut-off on HMSE. Among literate subjects, the translated HVMMSE and HMSE classified three subjects and one subject respectively as having possible cognitive impairment among urban elderlies.Conclusion: The two instruments are not in agreement with regard to classifying elderly people as having possible cognitive impairment or not. This disagreement is more pronounced in the case of illiterate subjects. The study emphasizes the need to develop a fair cognitive screening instrument for elderly people in India.

P300 latency as an indicator of severity in major depressive disorder

Abstract: Background: Depression is the most common mental health problem across all the age groups. Still diagnostic techniques and laboratory tests are awaited to confirm it. Some studies focus on P300 latency to aid in the diagnosis of depression. Hence, this study was conducted to know whether P300 latency is an indicator of major depressive disorder (MDD). Methods: This study was conducted both on patients admitted in the hospital and those attending outdoor clinic giving written informed consent and fulfilling inclusion/exclusion criteria from the Department of Psychiatry, S.N. Medical College and Hospital, Agra. The sample consisted of 30 consecutive patients suffering from MDD as per the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria and 30 subjects as normal control. Sociodemographic and clinical history proforma, Hamilton Rating Scale for Depression (Ham-D), and P300 were administered on all 60 subjects. Data were analyzed using mean, standard deviation, and t-test. Results: Significant difference (P < 0.0001) has been found in HAM-D mean scores of depressed and nondepressed control group subjects. The mean score of depressed group was significantly high (18.066) compared to nondepressed control group (4.833). Significant difference (P < 0.0001) between the mean of P300 latency in depressed and nondepressed control subjects was also found. Mean score of P300 latency in depressed group was significantly high (346.918 ± 19.515) compared to the nondepressed control subjects (303.741 ± 6.378). There was a significant difference in the mean of P300 latency between mild and severe (P < 0.0001), mild and very severe (P < 0.0003), as well as moderate and severe (P < 0.0001) level of depression. Conclusions: P300 latency may be used as an indicator of MDD and it is directly proportional to the severity of MDD.

Prevalence of psychiatric morbidity amongst the community dwelling rural older adults in northern India.

Abstract: Background & objectives: The population of elderly is growing globally and so are the physical illnesses and psychiatric morbidity. This study was planned to assess the prevalence and patterns of psychiatric morbidity amongst rural older adults in Lucknow, north India. Methods: A survey was conducted in subjects aged 60 yr and above to identify the cases of psychiatric morbidity in rural population from randomly selected two revenue blocks of Lucknow district, Uttar Pradesh, India. All subjects were screened through Hindi Mental Status Examination (HMSE) and Survey Psychiatric Assessment Schedule (SPAS) to identify for the suspected cases of cognitive and the psychiatric disorders, respectively. The subjects screened positive on HMSE and SPAS were assessed in detail on Cambridge Mental Disorder of the Elderly Examination-Revised (CAMDEX-R) and Schedule for Clinical Assessment in Neuropsychiatry (SCAN), to diagnose cognitive disorders and psychiatric disorders (other than the cognitive), respectively on the basis of International Classification of Diseases-10 (ICD-10) diagnostic guidelines. Results: The overall prevalence of psychiatric morbidity in rural older adults was found to be 23.7 per cent (95% CI=21.89-25.53). Mood (affective) disorders were the commonest (7.6%, 95% CI=6.51-8.80), followed by mild cognitive impairment (4.6%, 95% CI=3.72-5.53), mental and behavioural disorders due to substance use (4.0%, 95% CI=3.17-4.87) and dementia (2.8%) [Alzheimer's disease (2.4%, 95% CI=1.81-3.16) and vascular (0.4%, 95% CI=0.16-0.73)]. Interpretation & conclusions: Overall prevalence of psychiatric morbidity amongst rural elderly in this study was found to be less in comparison to those reported in earlier studies from India. However, prevalence pattern of different disorders was found to be similar. Therefore, it appears that a stringent methodology, refined case criteria for diagnosis and assessment by trained professionals restrict false diagnosis.

Novel occupational therapy interventions may improve quality of life in older adults with dementia

Abstract: Background: Dementia is a major health problem in advancing age with no definitive treatment. Occupational therapy interventions are recognized strategies in treatment of dementia. Quality of life (QOL) assessment has been reliably used as an objective index of an individual’s well being pertaining to interventions in dementia. A randomized controlled trial was conducted to study the effects of a novel occupational therapy program in improving QOL of subjects having mild to moderate dementia. Methodology: 273 subjects older than 60 years were screened. 196 were excluded having cognitive impairment with no dementia (CIND). Remaining 77 subjects after satisfying DSM IV criteria for diagnosis of dementia were included in the study and were randomly assigned to experimental and control groups. Experimental group received a novel occupational therapy regimen along with medical treatment, while control group received only medical treatment for 5 weeks. Outcome measures included standard occupational therapy assessment and WHOQOL-BREF. Subjects were assessed at baseline and post intervention. Result: The mean age of participants was 69.39 years with male preponderance (80.5% male, 19.5% female). The quality of life (QOL) scores of physical and psychological domain in experimental groups significantly increased from 37.30 ± 5.42 and 45.13 ± 3.52 to 45.43 ± 7.32 and 51.50 ± 6.46 respectively. The QOL scores in social and environmental domains did not change significantly. The QOL scores in control groups declined in all domains with statistical significance found in social and environmental domain. (29.67 ± 4.58 and 38.49 ± 1.77 to 28.45 ± 5.26 and 38.18 ± 2.15 respectively). Conclusion: This novel occupational therapy program improved the short term physical performance and psychological well being domain of quality of life in older adults with dementia. An improved physical performance is achieved by physical exercise of novel program and it creates sense of independency, increased motivation, positive outlook and reduced behavioral and psychological symptoms. The long term effects of the intervention can be ascertained in a study with longer period of intervention and follow-up.

Validation of a Mini-Mental State Examination (MMSE) for the Persian Population: A Pilot Study

Abstract: The objective of the study was to develop and validate a translated and culturally adapted Mini-Mental State Examination (MMSE) for the Persian-speaking population. The MMSE was translated into Persian. Two groups of neurologically intact subjects (n = 100) and subjects with Alzheimer's disease (n = 13) were studied. The difference between groups on the mean total scores of the Persian MMSE was statistically significant (control = 28.62 ± 2.09; subjects with Alzheimer's disease = 11.77 ± 5.66; p < .001). The cutoff score of 23 was the best cutoff score for our subjects with a sensitivity and specificity of 98% and 100%, respectively. There was a significant correlation between the Persian MMSE score and the level of education (r = .46) and with age (r = −.77). There was no significant correlation between the Persian MMSE and gender. The Persian MMSE was found to be valid for discrimination of cognitive impairment in the Persian-speaking community.

Applicability of the MoCA-S test in populations with little education in Colombia.

Abstract: Objectives The objectives of this study were to report on the use of the Spanish version of the Montreal Cognitive Assessment (MoCA-S) as cognitive screening tool in a population aged 65 to 74 years in the Andes Mountains of Colombia, assessing the influence of education, and to examine its test–retest reliability. Methods We performed a cross-sectional study of 150 subjects aged 65 to 74 years recruited from older community social centers in Manizales, Colombia. The Leganes Cognitive Test (LCT), a cognitive screening test for populations with low education, was used to exclude those who were likely to have dementia. The associations between the MoCA total score and cognitive domains and education were examined in the total sample and in those likely free of dementia. MoCA-S test–retest reliability was estimated by the intraclass correlation coefficient (ICC) between two measurements taken 7 days apart. Results Participants had low levels of formal education (mean years of schooling, 4.8). According to the LCT, the proportion of people screening positive for dementia was 16% (n = 24). The mean MoCA-S scores were 16.1/30 among illiterate subjects, 18.2/30 among those with incomplete primary school, and 20.3/30 among those with complete primary school (p < 0.001). Errors were frequent in the cube and clock drawing, attention-serial subtraction, verbal fluency, and abstraction. Test–retest reliability was high, ICC = 0.86, 95% CI (0.76–0.93). Conclusion The MoCA-S has high reliability in low-educated older Colombians, but scores were strongly dependent on years of education. Social and cultural factors must be considered when interpreting MoCA-S given the high error rates on items that depend on the ability to read and write and on culture. Copyright © 2012 John Wiley & Sons, Ltd.

Bidirectional relationship between caregiver burden and neuropsychiatric symptoms in patients with Alzheimer's disease: A narrative review

Abstract: Objective The aim of this review is to make a state of the art of the potential influence of neuropsychiatric symptoms (NPs) on caregiver stress and vice versa. Methods We searched PubMed and Google Scholar for potential eligible articles. Results Patients with Alzheimer's disease (AD) usually need high levels of care in all activities of daily living, most of them provided by family members, friends, or informal caregivers. Caregivers have to cope with both age-related conditions and dementia-related factors. Therefore, caregiving in dementia is more difficult and stressful than caregiving for older adults, affected by other conditions. Neuropsychiatric symptoms, such as anxiety, agitation, disinhibition, aggressive behavior, and sleep disturbances are more closely related to caregiver burden, and associated with more negative outcomes such as decline in their general health, quality of life, and social isolation. Caregiver burden worsens relationship between caregiver and patients with AD. Thus, this relationship may increase the frequency and severity of NPs. Predictors of burden were being a woman, a spouse, and old person with immature coping mechanisms, social isolation, with insufficient knowledge about dementia, poor premorbid relationship with patient, and high levels of negative expressed emotions. Conclusion Because of the bidirectional relationship between caregiver burden and NPs, the active management strategies of dementia care should include early identification and treatment risk factors for both caregiver stress and NPs in patients with AD. Therefore, to improve one of them can be exert beneficial for the other.