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Fulltext A cross-sectional study to assess prevalence and factors associated with mild cognitive impairment among older adults in an urban area of Kerala, South India

Mohan D, Iype T, Varghese S, Usha A, Mohan M

BMJ Open, 2019 03 20;9(3):e025473.
PMID: 30898818 DOI: 10.1136/bmjopen-2018-025473

OBJECTIVES: To assess the prevalence and factors associated with mild cognitive impairment (MCI) among older adults in an urban area of South India.
SETTING: The study was conducted in the capital city of Thiruvananthapuram in the South Indian state of Kerala.
PARTICIPANTS: The study participants were community-dwelling individuals aged 60 years and above.
PRIMARY OUTCOME MEASURE: MCI was the primary outcome measure and was defined using the criteria by European Alzheimer's Disease Consortium. Cognitive assessment was done using the Malayalam version of Addenbrooke's Cognitive Examination tool. Data were also collected on sociodemographic variables, self-reported comorbidities like hypertension and diabetes, lifestyle factors, depression, anxiety and activities of daily living.
RESULTS: The prevalence of MCI was found to be 26.06% (95% CI of 22.12 to 30.43). History of imbalance on walking (adjusted OR 2.75; 95 % CI of 1.46 to 5.17), presence of depression (adjusted OR 2.17, 95 % CI of 1.21 to 3.89), anxiety (adjusted OR 2.22; 95 % CI of 1.21 to 4.05) and alcohol use (adjusted OR 1.99; 95 % CI of 1.02 to 3.86) were positively associated with MCI while leisure activities at home (adjusted OR 0.33; 95 % CI of 0.11 to 0.95) were negatively associated.
CONCLUSION: The prevalence of MCI is high in Kerala. It is important that the health system and the government take up urgent measures to tackle this emerging public health issue.
Fulltext Normative Scores for Malayalam Cognitive Screening Test Battery among Older Adults in Kerala, India

Radhakrishnan PJ, Raghunath SP, Mohan D, Rajan R, Iype T

Ann Indian Acad Neurol, 2023;26(1):44-53.
PMID: 37034046 DOI: 10.4103/aian.aian_695_22

BACKGROUND: Many neuropsychological tests are primarily developed in high-income countries, and normative data are not readily available for low- and middle-income countries (LMICs). We need culturally appropriate cognitive screening tests for India.
OBJECTIVE: Hence, we decided to translate the Hindi cognitive screening test battery (HCSTB) tool to Malayalam and establish the age and education-stratified norms for a Malayalam cognitive screening test battery (MCSTB).
MATERIAL AND METHODS: HCSTB was translated to Malayalam, back-translated by bilinguals conversant in Malayalam and English, and pretested on 30 older normal adults. Using a multistage sampling technique, we conducted a descriptive cross-sectional survey in the Thiruvananthapuram district of Kerala, India. We approached older adults aged ≥60 years for informed and written consent. We excluded subjects with depression, functional impairment, cognitive impairment, history of stroke, psychosis, and visual/hearing loss that impaired cognitive assessment.
RESULTS: The normative data were derived from 441 older adults: 226 (51%) from rural areas and 215 (49%) from urban areas. Age and education affected the cognitive scores. The time to administer MCSTB among normal adults was approximately 17 minutes.
DISCUSSION AND CONCLUSION: The derived normative data showed lower values than the published literature. A limitation of our study was the small number of older people with ≥12 years of education and the lack of neuroimaging of the subjects.
Characterization of fibromyalgia using sleep EEG signals with nonlinear dynamical features

Paul JK, Iype T, R D, Hagiwara Y, Koh JW, Acharya UR

Comput Biol Med, 2019 08;111:103331.
PMID: 31284155 DOI: 10.1016/j.compbiomed.2019.103331

Fibromyalgia is an intense musculoskeletal pain causing sleep, fatigue, and mood problems. Sleep studies have suggested that 70%-80% of fibromyalgia patients complain of non-restorative sleep. The abnormalities in sleep have been implicated as both a cause and effect of the disease. In this paper, the electroencephalogram (EEG) signals of sleep stages 2 and 3 are used to classify the normal and fibromyalgia classes automatically. We have used various nonlinear parameters, namely sample entropy (SampEn), fractal dimension (FD), higher order spectra (HOS), largest Lyapunov exponent (LLE), Kolmogorov complexity (KC), Hurst exponent (HE), energy, and power in various frequency bands from the EEG signals. Then these features are subjected to Student's t-test to select the clinically significant features, and are classified using the support vector machine (SVM) classifier. Our proposed method can classify normal and fibromyalgia subjects using the stage 2 sleep EEG signals with an accuracy of 96.15%, sensitivity and specificity of 96.88% and 95.65%, respectively. Performance of the developed system can be improved further by adding more subjects in each class, and can be employed for clinical use.
Fulltext Contrasting Associations Between Diabetes and Cardiovascular Mortality Rates in Low-, Middle-, and High-Income Countries: Cohort Study Data From 143,567 Individuals in 21 Countries in the PURE Study

Anjana RM, Mohan V, Rangarajan S, Gerstein HC, Venkatesan U, Sheridan P, et al.

Diabetes Care, 2020 12;43(12):3094-3101.
PMID: 33060076 DOI: 10.2337/dc20-0886

OBJECTIVE: We aimed to compare cardiovascular (CV) events, all-cause mortality, and CV mortality rates among adults with and without diabetes in countries with differing levels of income.
RESEARCH DESIGN AND METHODS: The Prospective Urban Rural Epidemiology (PURE) study enrolled 143,567 adults aged 35-70 years from 4 high-income countries (HIC), 12 middle-income countries (MIC), and 5 low-income countries (LIC). The mean follow-up was 9.0 ± 3.0 years.
RESULTS: Among those with diabetes, CVD rates (LIC 10.3, MIC 9.2, HIC 8.3 per 1,000 person-years, P < 0.001), all-cause mortality (LIC 13.8, MIC 7.2, HIC 4.2 per 1,000 person-years, P < 0.001), and CV mortality (LIC 5.7, MIC 2.2, HIC 1.0 per 1,000 person-years, P < 0.001) were considerably higher in LIC compared with MIC and HIC. Within LIC, mortality was higher in those in the lowest tertile of wealth index (low 14.7%, middle 10.8%, and high 6.5%). In contrast to HIC and MIC, the increased CV mortality in those with diabetes in LIC remained unchanged even after adjustment for behavioral risk factors and treatments (hazard ratio [95% CI] 1.89 [1.58-2.27] to 1.78 [1.36-2.34]).
CONCLUSIONS: CVD rates, all-cause mortality, and CV mortality were markedly higher among those with diabetes in LIC compared with MIC and HIC with mortality risk remaining unchanged even after adjustment for risk factors and treatments. There is an urgent need to improve access to care to those with diabetes in LIC to reduce the excess mortality rates, particularly among those in the poorer strata of society.
Global variations in the prevalence, treatment, and impact of atrial fibrillation in a multi-national cohort of 153 152 middle-aged individuals

Joseph PG, Healey JS, Raina P, Connolly SJ, Ibrahim Q, Gupta R, et al.

Cardiovasc Res, 2021 05 25;117(6):1523-1531.
PMID: 32777820 DOI: 10.1093/cvr/cvaa241

AIMS: To compare the prevalence of electrocardiogram (ECG)-documented atrial fibrillation (or flutter) (AF) across eight regions of the world, and to examine antithrombotic use and clinical outcomes.
METHODS AND RESULTS: Baseline ECGs were collected in 153 152 middle-aged participants (ages 35-70 years) to document AF in two community-based studies, spanning 20 countries. Medication use and clinical outcome data (mean follow-up of 7.4 years) were available in one cohort. Cross-sectional analyses were performed to document the prevalence of AF and medication use, and associations between AF and clinical events were examined prospectively. Mean age of participants was 52.1 years, and 57.7% were female. Age and sex-standardized prevalence of AF varied 12-fold between regions; with the highest in North America, Europe, China, and Southeast Asia (270-360 cases per 100 000 persons); and lowest in the Middle East, Africa, and South Asia (30-60 cases per 100 000 persons) (P