Indian Journal of Psychological Medicine

Depression and cognitive impairment often coexist in older adults. The relation between depression and cognitive impairment is complex. The objective of this article is to review recent literature on cognitive impairment in older adults with depression and provide clinicians an update.

We searched PubMed, Google Scholar, Science Direct, and Psych Info for the articles published in the English language related to late-life depression (LLD)/geriatric depression and cognitive impairment. We considered original research articles, relevant systematic reviews, chapters, and important conceptual articles published in the last 9 years (2011–2019). We selected relevant articles for this narrative review.

The concept pseudodementia, indicating depression with cognitive impairment mimicking dementia, is now seen only as a historical concept. The current literature strongly agrees with fact that cognitive deficits often exist in LLD. The cognitive deficits in depression were initially seen as trait marker; however, some recent studies suggest that cognitive deficits persist even in the remission phase. There is heterogeneity among the studies in terms of the nature of the cognitive deficits, but higher number of studies reported impairment in attention and executive function. LLD with cognitive deficits is at a higher risk of progression to dementia. In older adults, depression with cognitive impairments requires a comprehensive evaluation. Electroencephalography, event-related potentials, fluorodeoxyglucose–positron emission tomography, amyloid positron emission tomography, and CSF amyloid will supplement clinical evaluation in differentiating functional depressive disorder with cognitive impairment from depression with an underlying degenerative condition.

The outbreak of COVID-19 led to a significant psychological impact on individuals, particularly those belonging to vulnerable groups. This study aimed to synthesize literature on the psychological impact of COVID-19 among children and adolescents.

Electronic search engines were used to identify studies till March 2021 that reported symptoms of psychological origin in children and adolescents. Information was extracted using a predefined template, and qualitative analysis was conducted using STROBE.

One hundred and two relevant papers were identified. Most of the studies were conducted online or telephonically. The study designs were primarily single group cross-sectional, though a few prospective/retrospective designs were also identified. Studies assessing emotional distress showed variable levels of anxiety and depressive symptoms in the study population, with greater severity of anxiety symptoms among females and older adolescents. Reduced physical activity; delayed sleep time; increased sleep duration, screen time, internet use, and sedentary habits, poor quality of life were other notable findings, often correlating with anxiety/depression. Efforts to address bias, discussion on generalizability of their results, and sample size calculation were not reported in most studies.

Psychological impact on children/adolescents is significant, either due to the fear of the illness or social isolation related to COVID-19. One may focus on improving sleep habits and physical activity and regulating internet use for maintaining psychological well-being.

There is a decline in cognitive and functional skills in older adults. The objective of this study was to compare the effects of cognitive and mind-motor training (MMT) on cognition and functional skills in a community-dwelling sample of older adults.

In this observer-blinded randomized clinical trial, 40 older adults with medical stability, ability to comprehend and respond to simple verbal instructions, no diagnosed psychological disorders, absence of severe visual and hearing problems, the capacity to walk independently, and a score of more than 46 in Berg Balance Scale were included. They were randomly allocated into cognitive or MMT groups. Cognitive training (CT) was practiced with activities for memory and attention, using paper–pencil tasks. MMT was practiced using a simple, indoor based square-stepping exercise. They practiced one-hour of training per day, three days a week, for eight weeks.

General linear model analysis showed that the time by groups was not statistically significant. The mean (standard deviation) scores in General Practitioner Assessment of Cognition Scale and Hindi Mental State Examination improved significantly (P < 0.001) following MMT [1.75 (1.29); 2.4 (1.34)] and CT [1.5 (1.36); 2.7 (0.99)]. The functional skills measured using Lawton Instrumental Activities of Daily Living Scale revealed beneficial changes for both the groups. None of the outcomes were statistically significant between the groups (P > 0.05).

Both cognitive and MMTs showed similar practice effects on cognition and functional skills in community-dwelling older adults.

Over the past 30 years, the clock drawing test (CDT) has generated considerable interest due to its usefulness in the early detection of cognitive impairments, particularly those seen in neurodegenerative dementias (including Alzheimer’s disease), vascular dementia, and mixed dementia. The present study aimed to determine whether the results of the “30-Point Clock Face Test” (CFT-30), a standardized version of the CDT that uses a 30-point scale, correlate with those of the Mini-Mental State Examination (MMSE).

This is a retrospective, observational study. All patients hospitalized in a Hospital-University Clinic Geriatrics Unit (Grenoble Alpes University Hospital, Grenoble, France), from January 1, 2017, to December 31, 2018, were included. Patient data and scores were retrieved from hospital archives, and the results of the two tests of interest, MMSE and the CFT-30, were analyzed.

We included 214 patients aged ≥75 years. The mean ± SD age was 86.4 ± 5.6 years, and 68.7% were female. A strongly positive, significant correlation was seen between the CFT-30 and MMSE (r = 0.73, P < 0.001) scores. The total scores obtained by these two tests were identical (t = 1.22, P = 0.22).

CFT-30 is a good complement to the tools usually used in the investigation of cognitive impairments in older people. In addition to its metrological qualities, the standardized and normalized CFT-30 is extremely simple and very fast to use.

Little is known about elder abuse in the domestic environment. In lower-middle income countries like India, the demographic transition is throwing novel challenges. The older adults are relatively more vulnerable because of coexisting medical and psychological problems. Any form of abuse affects mental health and increases the chances of anxiety and depression among the older adults. The study aimed to assess the burden of abuse amongst older adults visiting a primary health care center of north India.

This is secondary data analysis conducted on the data collected in the primary study between September 2017 and June 2018 in northern India among 311 older adult patients attending the noncommunicable disease clinic. Diabetes mellitus and hypertension were diagnosed as per standard guidelines. Vulnerability to Abuse Screening Scale (VASS) was used to assess elder abuse. Depression, anxiety, and loneliness were assessed by using the Patient Health Questionnaire (PHQ)-9, Generalized Anxiety Disorder (GAD)-7, and University of California, Los Angeles (UCLA) loneliness 20-item scale, respectively. Multiple logistic regression was carried out to explore the factors associated with elder abuse after ruling out collinearity between independent variables.

About 24% of older adults experienced abuse in the last 12 months. One-fourth of the older adults reported vulnerability, nearly half reported coercion and dejection, and most of them reported experiencing dependence. Participants also had a high prevalence of anxiety (39%), depression (54%), and features suggestive of loneliness (38.6%). Multiple logistic regression analysis showed that abuse was predicted by educational status, per-capita income, and loneliness.

About one-fourth of the older adults experience abuse. This highlights the importance of routine screening of older adults at the primary care level.

A limited number of studies have evaluated the psychometric properties of rating scales used to assess depression in the older adults. The present study aimed to assess the validity of the Hindi Geriatric Depression Scale (GDS, 30, 15, 10, 5, 4, and 1 item version) and Hindi Patient Health Questionnaire (nine and two items version) in a group of older adults residing in a rural community.

The psychometric properties of these scales were assessed against the diagnosis of depression a qualified psychiatrist made by using a semistructured interview.

Total 125 older adults were recruited from a rural community, with a mean age of 65.5 (SD: 6.4) years. The prevalence of depression was 36.8% as per the evaluation by the psychiatrist. When the agreement of different scales with the clinicians’ diagnosis was evaluated, it was seen that sensitivity, specificity, and Cohen Kappa value of GDS-30 and 15 were better than the other scales used to assess depression. When the sensitivity and specificity were evaluated using newer cutoffs, the specificity and sensitivity of GDS-30 were more than that of other scales.

Hindi version of GDS-30 with a cutoff of 13 has excellent psychometric properties.

Cognitive impairment is usually associated with impairment in everyday activities. Scales to assess activities of daily living, like the Everyday Abilities Scale for India (EASI), have been employed as screening tools for dementia or major neurocognitive disorder. EASI had not been validated in Malayalam. This study’s objective was to validate the Malayalam version of EASI (M-EASI) in those aged ≥60 years.

In a study undertaken in a tertiary care center, those aged ≥60 years attending psychiatry, neurology, or geriatric clinic of general medicine departments were evaluated using M-EASI and the Malayalam version of Addenbrooke’s Cognitive Examination (M-ACE). A total of 304 participants were recruited for this questionnaire validation. Information for M-EASI was obtained from a reliable informant.

The mean age of the sample was 70.04 years (standard deviation—7.33). The majority of them were males (58.6%) and educated up to primary school (42.4%), while the majority of the informants were sons/daughters/siblings (47.7%) and were females (73.7%). Taking M-ACE scores as the gold standard for diagnosing MNCD according to Diagnostic and Statistical Manual of Mental Disorders—Fifth Edition criteria, there were 162 cases of MNCD and 142 normal controls. Cronbach’s α was 0.91. At an optimal cut-off of 4.5, adequate sensitivity (77.8%), and specificity (75.4%) were observed. The positive predictive value was 78.6%, and the negative predictive value, 74.5%.

M-EASI has adequate psychometric properties as a screening tool for MNCD.

The COVID-19 pandemic has led to the risk of common mental illnesses. Consultation liaison psychiatry has been one of the most requested services in the face of this pandemic. We aimed to assess (a) the prevalence of psychiatric illness, (b) different types of psychiatric diagnoses, (c) presenting complaints, (d) reasons for psychiatric referrals, and (e) psychiatric intervention done on COVID-19 positive inpatients referred to consultation liaison psychiatry at tertiary care hospital.

This was a retrospective study of data collected from April 1, 2020, to September 15, 2020. Total 300 patients were referred and diagnosed with clinical interview and Diagnostic and Statistical Manual for Mental Disorder Fifth Edition criteria. Analysis was done using chi-square test, Kruskal–Wallis test, and fisher exact test.

Out of 300 patients, 26.7% had no psychiatric illness. Adjustment disorder was the commonest psychiatric diagnosis (43%), followed by delirium (10%). Statistically significant differences were found for parameters like Indian Council of Medical Research Category 4 of the patient, (hospitalized severe acute respiratory infection) (P value < 0.001), medical comorbidity (P value = 0.023), and past history of psychiatric consultation (Fisher exact test statistic value <0.001). Behavioral problem (27.6%) was the commonest reason for psychiatric referral. Worrying thoughts (23.3%) was the most frequent complaint. A total of 192 (64.3%) patients were offered pharmacotherapy.

Psychiatric morbidity was quite high (73.3%) among them and adjustment disorder was the commonest (43%) psychiatric diagnosis followed by delirium (10%). Pharmacotherapy was prescribed to 64.3% patients and psychosocial management was offered to most of the referred patients.

Published literature shows the overall challenges associated with artificial intelligence (AI)-enabled medicine and telepsychiatry more from the western perspective, with no specific mention from the perspective of individual stakeholders or Indians. This study was conceptualized to understand the perceived challenges of building, deploying, and using AI-enabled telepsychiatry for clinical practice from the perspectives of psychiatrist, patients, and the technology experts (who build such services) in urban India.

Between February 2020 and April 2020, a semistructured topic guide was drafted for qualitative exploratory study among psychiatrists (n = 14), their patients (n = 14), technology experts (n = 13), and Chief Executive Officers (CEOs) (n = 5) of health technology incubation centers. Interviews were conducted over the phone, recorded, and analyzed using the grounded theory approach.

Almost all respondents cited ethical, legal, accountability, and regulatory implications as challenges. The major issues stated by patients were privacy/confidentiality, ethical violations, security/ hacking, and data ownership. Psychiatrists cited lack of clinical validation, lack of established studies or trials, iatrogenic risk, and healthcare infrastructure issues as the main challenges. Technology experts stated data-related issues as the major challenge. The CEOs quoted the lack of interdisciplinary experts as one of the main challenges in building deployable AI-enabled telepsychiatry in India.

There are challenges to deploy an AI-enabled telepsychiatry platform in India. There is a need to constitute an interdisciplinary team to systematically address these challenges. Deployment of AI-enabled telepsychiatry is not possible without clinical validation and addressing current challenges.

Preliminary reports suggest that during the COVID-19 pandemic, telecounseling could be an effective model of psychological intervention for the frontline healthcare workers (fHCW) with psychological problems. Literature is sparse in this area, particularly from low- and middle-income countries, including India. We aimed to investigate the feasibility and the effectiveness of telecounseling (vs. general education) on the psychological problems of the fHCW over three time-points (baseline vs. end-of-session and at two and four weeks after the intervention).

The study followed a single-blind, active arm versus general education, parallel-group randomized control design, with participant allocation in 1:1. Active healthcare workers (HCWs) with mild- to-severe or clinically concerning scores on any of the sub-scales of Depression, Anxiety and Stress Scale (DASS-21) or Impact of Event Scale-Revised (IES-R; represented by higher scores) were included, while those with known psychiatric illness were excluded. Chi-square and Mann-Whitney U test and linear-mixed effect model (group-, time, and group by time-effect) were used for analysis.

There were no baseline group differences (telecounseling group, active arm, n = 9; general education group, control arm, n = 10). A significant time-effect (P = 0.044 to <.001) was found on DASS-21 on intention-to-treat analysis. Per-protocol analysis, additionally, found a significant group effect on Impact of Event Scale-Revised (IES-R; P = 0.036). A significant random effect of the participants was also found (P <.001).

Telecounseling could be a feasible and scalable model of psychological interventions for the fHCW with psychological problems, albeit with some feasibility challenges.