Prevalence of neuropsychiatric conditions and cognitive impairment in two parallel, aging study cohorts from rural and urban India.

INTRODUCTION: With the rising proportion of the elderly in India, the burden of neuropsychiatric conditions and cognitive impairment is escalating. METHODS: Baseline data of cognitively healthy subjects ≥45 years of age, from two longitudinal, aging cohorts in rural (n = 3262) and urban (n = 693) India, were used to calculate prevalence of depression, early-life stressful events, stroke, head injury, and cognitive impairment. RESULTS: Depression prevalence was significantly higher in rural than urban subjects, with female preponderance in both groups. Early life stressor (parental death) and head injury were significantly more common in rural than in urban India, whereas stroke was more in urban India. There was no significant difference in overall prevalence of cognitive impairment between the rural and urban cohorts; however, women had higher prevalence than men in rural, whereas this was reverse in urban subjects. Depression and stroke were significantly associated with cognitive impairment in the rural cohort. DISCUSSION: Longitudinal assessment of these neuropsychiatric conditions, with parallel cognitive monitoring, will help identify their causal relationship with dementia.

Approaches to engage an aging, rural cohort in southern India during the COVID-19 crisis and the psychological impact of COVID-19 in this cohort.

INTRODUCTION: The COVID-19 pandemic produced an unprecedented crisis across the world. Long-term cohort studies were stalled, including our longitudinal aging cohort study in rural India. METHODS: We describe approaches undertaken to engage with our cohort (n = 1830) through multiple rounds of calls and how we provided useful services to our subjects during the lockdown period. Consenting subjects also underwent telephonic assessments for depression and anxiety using validated, self-report questionnaires. RESULTS: Subjects reported benefitting from our telephonic engagement strategies, including the COVID-related safety awareness and counselling service. The proportion of subjects with depression increased from 7.42% pre-COVID to 28.97% post-COVID. DISCUSSION: We envisage that such engagement strategies would improve subject rapport and cohort retention, and thus, could be adopted by similar cohort studies across the world. This marginalized, rural Indian community had severe, adverse psychological impact in this pandemic. Urgent public health measures are needed to mitigate this impact and develop appropriate preventive strategies.

Depression and anxiety during the first and second waves of the COVID-19 pandemic in two large, prospective, aging cohorts in rural and urban India.

Introduction: The COVID-19 pandemic resulted in a wide variety of adverse consequences, including disruption of long-term, human research studies globally. Two long-term, prospective, aging cohort studies, namely, Srinivaspura Aging, Neurosenescence and COGnition (SANSCOG) study and Tata Longitudinal Study of Aging (TLSA), conducted in rural and urban India, respectively, had to be suspended during first and second waves of COVID-19. Methods: We conducted telephonic assessments to screen for depression and anxiety in the above two cohorts comprising of adults ≥45 years, during the first wave (2020) and second wave (2021) lockdown periods in India. Further, we included depression assessments data from two additional time periods-pre-COVID (2019) and the "inter-wave" period (between the first and second waves) to compare proportions of depression in these cohorts, during four distinct time periods-(i) pre-COVID, (ii) COVID first wave lockdown, (iii) inter-wave period, and (iv) COVID second wave lockdown (rural: 684, 733, 458, 611 and urban: 317, 297, 204, 305 respectively). Results: During COVID first wave, 28.8% and 5.5% had depression and anxiety, respectively in the rural cohort. Corresponding figures in the urban cohort were 6.5% and 1.7%. During second wave, 28.8% of rural subjects had depression and 3.9% had anxiety, whereas corresponding figures in urban subjects were 13.1% and 0.66%. During the above-mentioned four time periods, proportions of depression were: rural-8.3%, 28.8%, 16.6%, 28.8%; urban-12%, 6.1%, 8.8%, 13.1%. Conclusions: Multi-fold increase in depression among aging, rural Indians during first and second waves, with high depression among subjects ≥65 years and those with comorbidities during the first wave, is concerning. Urgent public health measures are needed to address this added mental health burden and thereby, prevent further potential adverse consequences.