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Menon RN, Varghese F, Paplikar A, Mekala S, Alladi S, Sharma M, Aralikatte Onkarappa S, Gollahalli D, Dutt A, Ghosh A, Dhaliwal RS, Hooda R, Iyer GK, Justus S, Kandukuri R, Kaul S, Banu Khan A, Nandi R, Narayanan J, Nehra A, Vasantha PM, Pauranik A, Mathew R, Ramakrishnan S, Sarath L, Shah U, Tripathi M, Padmavathy Narayana S, Varma RP, Verma M, Vishwanath Y. Validation of Indian Council of Medical Research Neurocognitive Tool Box in Diagnosis of Mild Cognitive Impairment in India: Lessons from a Harmonization Process in a Linguistically Diverse Society. Dement Geriatr Cogn Disord 2021; 49:355-364. [PMID: 33412549 DOI: 10.1159/000512393] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/16/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS In a linguistically diverse country such as India, challenges remain with regard to diagnosis of early cognitive decline among the elderly, with no prior attempts made to simultaneously validate a comprehensive battery of tests across domains in multiple languages. This study aimed to determine the utility of the Indian Council of Medical Research-Neurocognitive Tool Box (ICMR-NCTB) in the diagnosis of mild cognitive impairment (MCI) and its vascular subtype (VaMCI) in 5 Indian languages. METHODS Literate subjects from 5 centers across the country were recruited using a uniform process, and all subjects were classified based on clinical evaluations and a gold standard test protocol into normal cognition, MCI, and VaMCI. Following adaptation and harmonization of the ICMR-NCTB across 5 different Indian languages into a composite Z score, its test performance against standards, including sensitivity and specificity of the instrument as well as of its subcomponents in diagnosis of MCI, was evaluated in age and education unmatched and matched groups. RESULTS Variability in sensitivity-specificity estimates was noted between languages when a total of 991 controls and 205 patients with MCI (157 MCI and 48 VaMCI) were compared due to a significant impact of age, education, and language. Data from a total of 506 controls, 144 patients with MCI, and 46 patients with VaMCI who were age- and education-matched were compared. Post hoc analysis after correction for multiple comparisons revealed better performance in controls relative to all-cause MCI. An optimum composite Z-score of -0.541 achieved a sensitivity of 81.1% and a specificity of 88.8% for diagnosis of all-cause MCI, with a high specificity for diagnosis of VaMCI. Using combinations of multiple-domain 2 test subcomponents retained a sensitivity and specificity of >80% for diagnosis of MCI. CONCLUSIONS The ICMR-NCTB is a "first of its kind" approach at harmonizing neuropsychological tests across 5 Indian languages for the diagnosis of MCI due to vascular and other etiologies. Utilizing multiple-domain subcomponents also retains the validity of this instrument, making it a valuable tool in MCI research in multilingual settings.
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Affiliation(s)
- Ramshekhar N Menon
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India,
| | - Feba Varghese
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Avanthi Paplikar
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Shailaja Mekala
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.,Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India.,Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | | | | | - Divyaraj Gollahalli
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Aparna Dutt
- Apollo Gleneagles Hospital, Cognitive Neurology Unit, Kolkata, India.,Duttanagar Mental Health Centre, Neuropsychology & Clinical Psychology Unit, Duttanagar, Kolkata, India
| | - Amitabha Ghosh
- Apollo Gleneagles Hospital, Cognitive Neurology Unit, Kolkata, India
| | | | - Roopa Hooda
- Departments of Neurology and Neuropsychology, All India Institute of Medical Sciences, Delhi, India
| | - Gowri K Iyer
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India.,Indian Institute of Public Health, Hyderabad, India
| | - Sunitha Justus
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Rajmohan Kandukuri
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Subhash Kaul
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India.,Department of Neurology, Krishna Institute of Medical Sciences, Hyderabad, India
| | - Arfa Banu Khan
- Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belagavi, India
| | - Ranita Nandi
- Apollo Gleneagles Hospital, Cognitive Neurology Unit, Kolkata, India
| | | | - Ashima Nehra
- Departments of Neurology and Neuropsychology, All India Institute of Medical Sciences, Delhi, India
| | - Padma M Vasantha
- Departments of Neurology and Neuropsychology, All India Institute of Medical Sciences, Delhi, India
| | | | - Robert Mathew
- Department of Neurology, Sree Mookambika Institute of Medical Sciences, Tamil Nadu, India
| | - Subasree Ramakrishnan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Lekha Sarath
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | - Manjari Tripathi
- Departments of Neurology and Neuropsychology, All India Institute of Medical Sciences, Delhi, India
| | - Sylaja Padmavathy Narayana
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Ravi Prasad Varma
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | - Mansi Verma
- Departments of Neurology and Neuropsychology, All India Institute of Medical Sciences, Delhi, India
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Alladi S, Bak TH, Shailaja M, Gollahalli D, Rajan A, Surampudi B, Hornberger M, Duggirala V, Chaudhuri JR, Kaul S. Bilingualism delays the onset of behavioral but not aphasic forms of frontotemporal dementia. Neuropsychologia 2017; 99:207-212. [PMID: 28322905 DOI: 10.1016/j.neuropsychologia.2017.03.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 03/04/2017] [Accepted: 03/16/2017] [Indexed: 12/14/2022]
Abstract
Bilingualism has been found to delay onset of dementia and this has been attributed to an advantage in executive control in bilinguals. However, the relationship between bilingualism and cognition is complex, with costs as well as benefits to language functions. To further explore the cognitive consequences of bilingualism, the study used Frontotemporal dementia (FTD) syndromes, to examine whether bilingualism modifies the age at onset of behavioral and language variants of Frontotemporal dementia (FTD) differently. Case records of 193 patients presenting with FTD (121 of them bilingual) were examined and the age at onset of the first symptoms were compared between monolinguals and bilinguals. A significant effect of bilingualism delaying the age at onset of dementia was found in behavioral variant FTD (5.7 years) but not in progressive nonfluent aphasia (0.7 years), semantic dementia (0.5 years), corticobasal syndrome (0.4 years), progressive supranuclear palsy (4.3 years) and FTD-motor neuron disease (3 years). On dividing all patients predominantly behavioral and predominantly aphasic groups, age at onset in the bilingual behavioral group (62.6) was over 6 years higher than in the monolingual patients (56.5, p=0.006), while there was no difference in the aphasic FTD group (60.9 vs. 60.6 years, p=0.851). The bilingual effect on age of bvFTD onset was shown independently of other potential confounding factors such as education, gender, occupation, and urban vs rural dwelling of subjects. To conclude, bilingualism delays the age at onset in the behavioral but not in the aphasic variants of FTD. The results are in line with similar findings based on research in stroke and with the current views of the interaction between bilingualism and cognition, pointing to advantages in executive functions and disadvantages in lexical tasks.
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Affiliation(s)
- Suvarna Alladi
- Department of Neurology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad 500082, India.
| | - Thomas H Bak
- Department of Psychology, Centre for Cognitive Aging and Cognitive Epidemiology (CCACE) and Centre for Clinical Brain Sciences (CCBS), University of Edinburgh, Edinburgh, UK.
| | - Mekala Shailaja
- Department of Neurology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad 500082, India.
| | - Divyaraj Gollahalli
- Department of Neurology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad 500082, India.
| | - Amulya Rajan
- Department of Neurology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad 500082, India.
| | - Bapiraju Surampudi
- Cognitive Science Lab, International Institute of Information Technology, Hyderabad & Centre for Neural and Cognitive Sciences, University of Hyderabad, Hyderabad, India.
| | | | | | | | - Subhash Kaul
- Department of Neurology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad 500082, India.
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Iyer GK, Alladi S, Bak TH, Shailaja M, Mamidipudi A, Rajan A, Gollahalli D, Chaudhuri JR, Kaul S. Dementia in developing countries: Does education play the same role in India as in the West? Dement Neuropsychol 2014; 8:132-140. [PMID: 29213894 PMCID: PMC5619120 DOI: 10.1590/s1980-57642014dn82000008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 05/20/2014] [Indexed: 11/21/2022] Open
Abstract
Evidence suggests that education protects from dementia by enhancing cognitive reserve. However, this may be influenced by several socio-demographic factors. Rising numbers of dementia in India, high levels of illiteracy and heterogeneity in socio-demographic factors provide an opportunity to explore this relationship. OBJECTIVE To study the association between education and age at dementia onset, in relation to socio-demographic factors. METHODS Association between age at dementia onset and literacy was studied in relationship to potential confounding factors such as gender, bilingualism, place of dwelling, occupation, vascular risk factors, stroke, family history of dementia and dementia subtypes. RESULTS Case records of 648 dementia patients diagnosed in a specialist clinic in a University hospital in Hyderabad, India were examined. All patients were prospectively enrolled as part of an ongoing longitudinal project that aims to evaluate dementia subjects with detailed clinical, etiological, imaging, and follow-up studies. Of the 648 patients, 98 (15.1%) were illiterate. More than half of illiterate skilled workers were engaged in crafts and skilled agriculture unlike literates who were in trade or clerical jobs. Mean age at onset in illiterates was 60.1 years and in literates 64.5 years (p=0.0002). Factors independently associated with age at dementia onset were bilingualism, rural dwelling and stroke, but not education. CONCLUSION Our study demonstrates that in India, rural dwelling, bilingualism, stroke and occupation modify the relationship between education and dementia.
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Affiliation(s)
- Gowri K. Iyer
- Department of Neurology, Nizam’s Institute of Medical
Sciences, Hyderabad, India
| | - Suvarna Alladi
- Department of Neurology, Nizam’s Institute of Medical
Sciences, Hyderabad, India
| | - Thomas H. Bak
- Department of Psychology, Centre for Cognitive Aging and
Cognitive Epidemiology (CCACE) and Centre for Clinical Brain Sciences (CCBS),
University of Edinburgh
| | - Mekala Shailaja
- Department of Neurology, Nizam’s Institute of Medical
Sciences, Hyderabad, India
| | - Annapurna Mamidipudi
- Department of Science, Technology and Society studies,
Maastricht University, Netherlands
| | - Amulya Rajan
- Department of Neurology, Nizam’s Institute of Medical
Sciences, Hyderabad, India
| | - Divyaraj Gollahalli
- Department of Neurology, Nizam’s Institute of Medical
Sciences, Hyderabad, India
| | | | - Subhash Kaul
- Department of Neurology, Nizam’s Institute of Medical
Sciences, Hyderabad, India
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