The efficacy of neurofeedback for alcohol use disorders - a systematic review.

BACKGROUND: Alcoholism is a serious social, economic and public health problem. Alcoholism can affect the gastrointestinal, neurological, cardiovascular and respiratory systems, and it can be fatal, costing the healthcare system huge amounts of money. Despite the availability of cognitive-behavioural and psychosocial therapies, alcoholism has a high recurrence rate and a dismal prognosis, with a wide inter-individual variation. As a result, better or adjuvant therapies that improve or facilitate alcoholism therapy are required. We conducted a systematic review to look into the published studies that reported the effectiveness of non-pharmacological neurofeedback (NF) interventions in patients with alcohol use disorders (AUDs). METHODS: PubMed, Google Scholar, The Cochrane Library, Science Direct and Clinicaltrial.gov were searched until 4 April 2022. Original articles of any design reporting on the use of NF approaches in the treatment of AUDs were included. Information related to study design, participants, control group, neuromodulation therapy, number of sessions and key findings of the study were extracted. The Joanna Briggs Institute's (JBI) Critical Appraisal Checklist for Studies was used to assess the quality of studies. RESULTS: A total of 20 research articles (including 618 participants) were retrieved and included for qualitative analysis. The sample size ranged from 1 (case report) to 80, with years of publication ranging from 1977 to 2022. Nine of the 20 articles included in the study were conducted in the United States, followed by Germany, the United Kingdom, India, the Netherlands and South Korea. Out of the 20 studies included, 8 (40%) had a moderate risk of bias, while the other, i.e. 60% had a low risk of bias. The effectiveness of various neurological treatments in the treatment of AUDs was established in these 20 studies. There have been 11 studies on EEG NF training, three studies on real-time FMRI NF, two studies each on transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS), and one study each on deep brain stimulation (DBS) and theta burst stimulation (TBS). These alternative neurological therapies have been demonstrated to lower alcohol cravings and consumption temporarily, reduce anxiety and depression scores, reduce relapse rates and increase control of brain activity. CONCLUSIONS: The use of various neuromodulation approaches to the treatment of AUD shows promise. However, more research with larger sample size is required.

Association between aluminium exposure and cognitive functions: A systematic review and meta-analysis.

INTRODUCTION: Chronic Aluminium (Al) exposure is reported to be linked with neuro-cognitive impairment. However, there is limited synthesized information on the role of chronic Al exposure on individual cognitive domains. This knowledge gap is explored here by systematic review and meta-analysis of the published literature. METHODS: Observational studies that reported the association between Al exposure and cognitive functions were systematically searched in PubMed, Scopus and Embase databases since inception to June 2019 and updated on September 2020. PRISMA guidelines were adhered in this study. Meta-analysis was performed using a random-effect model if the included studies exhibited heterogeneity, in the absence of heterogeneity fixed effect model was used. Heterogeneity was assessed using Cochran-Q test and I2 statistic. Risk of bias was assessed using the risk of bias in non-randomized studies of exposures. Sub-group analysis and meta regression analysis were explored. RESULTS: Twenty-three studies including 1781 Al exposed and 1186 unexposed were part of the final results. The pooled standardized mean difference of global cognitive scores (-0.65, 95%CI: -1.09 to -0.22, I2 = 91.09%), memory (-0.45, 95% CI: -0.69 to -0.21, I2 = 81.67%), working memory (-0.3, 95%CI: -0.45 to -0.15, I2 = 0%) and processing speed domains were significantly inferior among Al exposed as compared to unexposed. The other evaluated cognitive domains, such as cognitive flexibility, visuospatial abilities and psychomotor functions did not significantly differ between the two groups. We observed a serious risk of bias in most of the included studies. CONCLUSION: Current pieces of evidence suggest an association between chronic Al exposure and impaired cognitive function in majority of domains including memory, processing speed and working memory while no significant influence in other cognitive domains. However, considering high heterogeneity and low quality of primary evidence, further high-quality studies are necessary for conclusive evidence in this regard.

Indian older adults and the digit span A preliminary report.

The digit span test is widely used to assess attention and working memory. It is a portable, relatively culture-free and frequently used test. However, the cultural validity of this test, particularly in the Indian older population, is not well established. OBJECTIVE: This study explores the usefulness of the digit span test for Indian older adults with different levels of education. METHODS: Two hundred and fifty-eight community-dwelling healthy normal older adults formed the sample of this study. All study participants were screened using a semi-structured interview schedule, the modified MINI Screen, the Indian version of the Mini-Mental State Examination, a measure of activities of daily living and the digit span test administered verbally. RESULTS: The results indicated that participants with higher educational level performed significantly better than low-educated participants on the digit span test. Participants with low education often struggled with the digit span test and resorted to guessing the digits. CONCLUSION: Our study clearly demonstrates that the digit span test can be useful for educated participants. However, its usefulness and ecological validity is questionable for those with low education and low literacy, warranting future research.

O teste de span de dígitos é amplamente utilizado para avaliar a atenção e a memória de trabalho. É um teste portátil, relativamente livre de cultura e frequentemente usado. No entanto, a validade cultural deste teste, particularmente na população idosa indiana, não está bem estabelecida. OBJETIVO: Este estudo explora a utilidade do teste de amplitude de dígitos para idosos indianos com diferentes níveis de educação. MÉTODOS: Duzentos e cinquenta e oito idosos saudáveis ​​normais residentes na comunidade formaram a amostra deste estudo. Todos os participantes da pesquisa foram selecionados usando uma entrevista semiestruturado, MINI Screen modificado, versão indiana do Mini Mental State Examination, uma medida de atividade da vida diária e teste do span de dígitos administrados verbalmente. RESULTADOS: Os resultados indicaram que os participantes com alto nível de escolaridade tiveram desempenho significativamente melhor do que os participantes com baixo nível de escolaridade no teste de amplitude de dígitos. Participantes com baixa escolaridade muitas vezes enfrentaram difficuldades com o teste de amplitude de dígitos e recorreram a adivinhar os dígitos. CONCLUSÃO: Nosso estudo demonstra claramente que o teste de amplitude de dígitos pode ser útil para participantes instruídos. No entanto, sua utilidade e validade ecológica são questionáveis ​​para aqueles com baixa escolaridade e letramento, requerendo pesquisas futuras.

Indian older adults and the digit span: a preliminary report / Idosos indianos e extensão de dígitos: um relatório preliminar

ABSTRACT: The digit span test is widely used to assess attention and working memory. It is a portable, relatively culture-free and frequently used test. However, the cultural validity of this test, particularly in the Indian older population, is not well established. Objective: This study explores the usefulness of the digit span test for Indian older adults with different levels of education. Methods: Two hundred and fifty-eight community-dwelling healthy normal older adults formed the sample of this study. All study participants were screened using a semi-structured interview schedule, the modified MINI Screen, the Indian version of the Mini-Mental State Examination, a measure of activities of daily living and the digit span test administered verbally. Results: The results indicated that participants with higher educational level performed significantly better than low-educated participants on the digit span test. Participants with low education often struggled with the digit span test and resorted to guessing the digits. Conclusion: Our study clearly demonstrates that the digit span test can be useful for educated participants. However, its usefulness and ecological validity is questionable for those with low education and low literacy, warranting future research.

RESUMO: O teste de span de dígitos é amplamente utilizado para avaliar a atenção e a memória de trabalho. É um teste portátil, relativamente livre de cultura e frequentemente usado. No entanto, a validade cultural deste teste, particularmente na população idosa indiana, não está bem estabelecida. Objetivo: Este estudo explora a utilidade do teste de amplitude de dígitos para idosos indianos com diferentes níveis de educação. Métodos: Duzentos e cinquenta e oito idosos saudáveis ​​normais residentes na comunidade formaram a amostra deste estudo. Todos os participantes da pesquisa foram selecionados usando uma entrevista semiestruturado, MINI Screen modificado, versão indiana do Mini Mental State Examination, uma medida de atividade da vida diária e teste do span de dígitos administrados verbalmente. Resultados: Os resultados indicaram que os participantes com alto nível de escolaridade tiveram desempenho significativamente melhor do que os participantes com baixo nível de escolaridade no teste de amplitude de dígitos. Participantes com baixa escolaridade muitas vezes enfrentaram difficuldades com o teste de amplitude de dígitos e recorreram a adivinhar os dígitos. Conclusão: Nosso estudo demonstra claramente que o teste de amplitude de dígitos pode ser útil para participantes instruídos. No entanto, sua utilidade e validade ecológica são questionáveis ​​para aqueles com baixa escolaridade e letramento, requerendo pesquisas futuras.

Recent developments in the use of smartphone interventions for mental health.

PURPOSE OF REVIEW: The purpose of this update is to provide an overview of the breadth of research studies published from April 2017 to April 2018 on mobile-based interventions for mental health, with a special emphasis on smartphone-based interventions. RECENT FINDINGS: Several studies during the review period have described the process of applying user-centred design in the development of mental health apps and novel approaches to enhance user-engagement. Studies on consumer perspectives indicate largely positive findings about open-ness to utilize mental health apps. There is a scarcity of similar studies on health providers. Efficacy studies have provided evidence for apps for a variety of psychiatric disorders. There are fewer studies on preventive and promotive interventions. Although a plethora of mental health apps is available for public, most have not undergone scientific evaluation. Many well researched apps are not accessible to public. The potential of smartphone technology in enhancing healthcare service delivery in low-resource settings has also been examined in a few studies. SUMMARY: Evidence for acceptability, feasibility and efficacy of mobile-based mental health interventions for facilitating recovery is on the rise. More research is needed on implementation and integration of these interventions in diverse real-world clinical and community contexts.

Irritable bowel syndrome and its psychological management.

Irritable Bowel Syndrome (IBS) is a chronic and disabling gastrointestinal problem that affects psychosocial functioning as well as the quality of life. This case study reports the utility of cognitive behavior therapy as a psychological intervention procedure in a chronic case of IBS. The use of psychological intervention was found to result in a reduction of anxiety; amelioration of the symptoms associated with IBS and improved functioning.

Neuropsychological markers of mild cognitive impairment: A clinic based study from urban India.

BACKGROUND: Mild cognitive impairment (MCI) is a transitional stage between normal aging and dementia. Persons with MCI are at higher risk to develop dementia. Identifying MCI from normal aging has become a priority area of research. Neuropsychological assessment could help to identify these high risk individuals. OBJECTIVE: To examine clinical utility and diagnostic accuracy of neuropsychological measures in identifying MCI. MATERIALS AND METHODS: This is a cross-sectional study of 42 participants (22 patients with MCI and 20 normal controls [NC]) between the age of 60 and 80 years. All participants were screened for dementia and later a detailed neuropsychological assessment was carried out. RESULTS: Persons with MCI performed significantly poorer than NC on word list (immediate and delayed recall), story recall test, stick construction delayed recall, fluency and Go/No-Go test. Measures of episodic memory especially word list delayed recall had the highest discriminating power compared with measures of semantic memory and executive functioning. CONCLUSION: Word list learning with delayed recall component is a possible candidate for detecting MCI from normal aging.

Endovascular treatment of vein of Galen dural arteriovenous fistula presenting as dementia.

Dural arteriovenous fistula (DAVF) is an important cause of neurological dysfunction that is often misdiagnosed, especially in elderly population. Galenic DAVFs are a subtype of the rare falcotentorial DAVFs with a high risk of hemorrhage and aggressive clinical course. In most cases, DAVFs present with pulsatile tinnitus, headache, or orbital symptoms such as chemosis and proptosis. We report a patient with DAVF of Vein of Galen presented with progressive dementia, treated by Onyx embolisation and had good clinical outcome.

Age, education and gender effects on neuropsychological functions in healthy Indian older adults / Efeitos da idade, educação e gênero nas funções neuropsicológicas em indianos adultos idosos saudáveis

It is essential to use culturally appropriate, sensitive and specific tests that reflect true cognitive performance. However, several factors including age, education and gender can influence neuropsychological test performance. OBJECTIVE: To examine the effects of age, education and gender on neuropsychological function in older adults using measures of global cognitive screening, attention, working memory, executive functions, memory, construction, language and parietal focal signs. METHODS: This is a cross sectional normative study of 180 community-dwelling normal older adults. All participants were screened with the Hindi Mental Status Examination (HMSE), Everyday Activities Scale for India (EASI), Edinburgh handedness inventory (EDI) and MINI Screen, and followed by a detailed neuropsychological assessment. RESULTS: Stepwise regression analysis revealed that education was associated with better performance on all the neuropsychological tests. Females performed significantly better on measures of memory. Further, most of the illiterate subjects, including low educated participants, refused to cooperate on measures of executive functioning. CONCLUSION: Education was found to be the strongest determinant of neuropsychological test performance followed by age and gender. Our study demonstrates that Indian healthy normal older adults with low education perform poorly on measures of planning and working memory. Traditional measures of planning and working memory should be avoided or used cautiously in the presence of low education. There is an urgent need to develop tasks for measuring executive functions, especially in low educated Indian older adults.

É essencial o uso de testes específicos, sensíveis e culturalmente apropriados que reflitam o verdadeiro desempenho cognitivo. Todavia, vários fatores como idade, educação e gênero podem influenciar o desempenho neuropsicológico em testes. OBJETIVO: Examinar os efeitos de idade, educação e gênero na função neuropsicológica em adultos idosos usando medidas de rastreio cognitivo global, atenção, memória operacional, funções executivas, memória, construção, linguagem e sinais parietais focais. MÉTODOS: Este é um estudo normativo de corte transversal de 180 idosos vivendo em comunidade. Todos os paticipantes foram rastreados com o Exame do Estado Mental Hindu (HMSE), Escala de Atividades de Vida Diária para Índia (EASI), Inventário de Dominância Manual de Edinburgh (EDI) e MINI Screen seguidos por uma detalhada avaliação neuropsicológica. RESULTADOS: A análise de regressão stepwise revelou que a educação esteve associada ao melhor desempenho cognitivo em cada teste neuropsicológico. As mulheres tiveram desempenho significativamente melhor em medidas de memória. Além disso, a maioria dos analfabetos incluindo idosos com baixo nível educacional recusou-se a participar em medidas de função executiva. CONCLUSÃO: Educação foi o mais forte determinante do desempenho em testes neuropsicológicos seguido por idade e gênero. Nosso esrudo demonstra que idosos indianos saudáveis com baixo nível educacional tem desempenho pobre em medidas de planejamento e memória de trabalho. Medidas tradicionais de planejamento e memória de trabalho devem ser evitadas ou usadas cautelosamente na presença de baixa escolaridade. Há necessidade urgente do desenvolvimento de tarefas de funções executivas especialmente para idosos indianos com baixo nível educacional.

Age, education and gender effects on neuropsychological functions in healthy Indian older adults.

It is essential to use culturally appropriate, sensitive and specific tests that reflect true cognitive performance. However, several factors including age, education and gender can influence neuropsychological test performance. OBJECTIVE: To examine the effects of age, education and gender on neuropsychological function in older adults using measures of global cognitive screening, attention, working memory, executive functions, memory, construction, language and parietal focal signs. METHODS: This is a cross sectional normative study of 180 community-dwelling normal older adults. All participants were screened with the Hindi Mental Status Examination (HMSE), Everyday Activities Scale for India (EASI), Edinburgh handedness inventory (EDI) and MINI Screen, and followed by a detailed neuropsychological assessment. RESULTS: Stepwise regression analysis revealed that education was associated with better performance on all the neuropsychological tests. Females performed significantly better on measures of memory. Further, most of the illiterate subjects, including low educated participants, refused to cooperate on measures of executive functioning. CONCLUSION: Education was found to be the strongest determinant of neuropsychological test performance followed by age and gender. Our study demonstrates that Indian healthy normal older adults with low education perform poorly on measures of planning and working memory. Traditional measures of planning and working memory should be avoided or used cautiously in the presence of low education. There is an urgent need to develop tasks for measuring executive functions, especially in low educated Indian older adults.

É essencial o uso de testes específicos, sensíveis e culturalmente apropriados que reflitam o verdadeiro desempenho cognitivo. Todavia, vários fatores como idade, educação e gênero podem influenciar o desempenho neuropsicológico em testes. OBJETIVO: Examinar os efeitos de idade, educação e gênero na função neuropsicológica em adultos idosos usando medidas de rastreio cognitivo global, atenção, memória operacional, funções executivas, memória, construção, linguagem e sinais parietais focais. MÉTODOS: Este é um estudo normativo de corte transversal de 180 idosos vivendo em comunidade. Todos os paticipantes foram rastreados com o Exame do Estado Mental Hindu (HMSE), Escala de Atividades de Vida Diária para Índia (EASI), Inventário de Dominância Manual de Edinburgh (EDI) e MINI Screen seguidos por uma detalhada avaliação neuropsicológica. RESULTADOS: A análise de regressão stepwise revelou que a educação esteve associada ao melhor desempenho cognitivo em cada teste neuropsicológico. As mulheres tiveram desempenho significativamente melhor em medidas de memória. Além disso, a maioria dos analfabetos incluindo idosos com baixo nível educacional recusou-se a participar em medidas de função executiva. CONCLUSÃO: Educação foi o mais forte determinante do desempenho em testes neuropsicológicos seguido por idade e gênero. Nosso esrudo demonstra que idosos indianos saudáveis com baixo nível educacional tem desempenho pobre em medidas de planejamento e memória de trabalho. Medidas tradicionais de planejamento e memória de trabalho devem ser evitadas ou usadas cautelosamente na presença de baixa escolaridade. Há necessidade urgente do desenvolvimento de tarefas de funções executivas especialmente para idosos indianos com baixo nível educacional.

Therapist concerns and process issues in grappling with functional autobiographical amnesia.

Dissociative amnesia is relatively rare form of the dissociative disorder. This paper aims at describing the salient features of a case of functional autobiographical amnesia in a young adult and the approach adopted in the psychological management of this case. The case highlights concerns of the therapist at various stages of the therapy process.

Clinical validity of NIMHANS neuropsychological battery for elderly: A preliminary report.

BACKGROUND: Neuropsychological assessment plays a crucial role in the assessment of cognitive decline in older age. In India, there is a dearth of culturally appropriate standardized measure to assess cognitive functions in early dementia. The aim of the study was to examine clinical validity of NIMHANS Neuropsychological Battery for Elderly (NNB-E) in identifying early dementia. OBJECTIVES: To examine validity (discriminant and concurrent) of NIMHANS Neuropsychological Battery for Elderly (NNB-E). RESULTS: Participants with AD showed significantly poorer performance on every test including memory and non-memory domains. However, tests of episodic and semantic memory were particularly sensitive in discriminating between normal and AD groups. Further scores on various subtests in the NNB-E were positively associated with scores on HMSE and negatively associated with Clinical Dementia Rating and Everyday Abilities Scale for India (EASI) scores. CONCLUSIONS: NNB-E was able to differentiate normal controls from AD patients, and it can therefore be an ecologically valid tool for Indian older adults.

Affect intensity and negative mood regulation (NMR) expectancies: a preliminary Indian study.

Individuals differ in the intensity with which they typically experience affect as well as in their beliefs regarding their ability to alleviate negative mood states. These variables have been implicated in a range of clinical problems. Most studies utilize a single index of affect intensity. The differential correlates of positive and negative affect intensity, their association with negative mood regulation expectancy and their role as predictors of psychological outcomes have been insufficiently explored. This study aimed at exploring the relationship of affect intensity variables with negative mood regulation (NMR) expectancy, their association with age and gender and examining the role of affect intensity and NMR expectancy as predictors of stress and well being in a community sample of Indian adults. The sample consisted of 206 participants aged between 20 and 60 years. Higher age was associated with higher NMR expectancy but lower positive affect intensity. Positive and negative affect intensity showed differential patterns of association with NMR expectancy. Higher negative affect intensity was associated with lower NMR expectancy whereas higher positive affect intensity was associated with higher NMR expectancy. Affect intensity and NMR expectancy variables jointly predicted 30-39% of variance in perceived stress and well being. Implications for further research are discussed.