Letters to the Editor
Author’s response on “Neuropsychiatric profiles in patients with Alzheimer’s disease and vascular dementia” Sir, We sincerely thank the reader(s) for his/her/their interest in our article entitled “Neuropsychiatric profiles in patients with Alzheimer’s disease and vascular dementia” published in Ann Indian Acad Neurol (2015;18:120-21).[1] As written in the article, we have used the mini-mental status examination (MMSE) for initial screening of our patients. The usual protocol we follow at our clinic is to apply the MMSE at the beginning and get the score. It gives us an estimate about the domains involved in a given patient. The qualitative assessment of MMSE (i.e., how a patient is performing while applying MMSE) tells more about the impairment the patient is having than the crude score itself. Similar to CDR (Clinical Dementia Rating) score, MMSE also used to determine the stage of dementia. Therefore, in our study, MMSE was not meant to select or reject patients but it was part of the whole assessment. We applied this initial test before embarking upon the full assessment. The second concern of the reader(s) was why we did not use the Bengali version of MMSE in our subjects. We did not use a vernacular version because the available Hindi and Bengali versions of MMSE have limitations. The Hindi adaptation of the MMSE was developed by Ganguli et al. while developing a screening tool for rural illiterate Indian elderly subjects.[2] Thus, it was modified to enable an illiterate subject to complete the test without difficulty. The Bengali version of MMSE was an adaptation of the Hindi version.[3] While these are useful for illiterate subjects, both the batteries are too easy for an urban educated subject. The ‘ceiling effect’ is observed while generating the cut-off scores for educated subjects.[2,3] This means the 10th percentile score of normative data for educated subject touches the highest possible score. Thus, early impairment is missed if these instruments are used for educated subjects. Hence, both Hindi and Bengali versions of MMSE are not useful for testing an educated subject. Conversely, MMSE is an accepted and widely used global cognitive screening scale used across the world. It is comprehensive, easy to apply, and useful for comparison. We therefore used MMSE for testing educated subjects in our clinic.
Tushar Kanti Bandyopadhyay, Atanu Biswas, Arijit Roy, Deb Sankar Guin, Goutam Gangopadhyay, Sujit Sarkhel1, Malay Kumar Ghoshal2, Asit Kumar Senapati Department of Neurology, Bangur Institute of Neurosciences, Kolkata, 1Department of Psychiatry, Institute of PostGraduate Medical Education and Research, Kolkata, 2 Department of Psychiatry, Calcutta Medical College, Kolkata, West Bengal, India For correspondence: Dr. Atanu Biswas, Department of Neurology, Bangur
Institute of Neurosciences, 52/1A, S.N. Pandit Street, Kolkata - 700 025, West Bengal, India. E-mail: [email protected]
References 1. 2.
3.
Raina SK, Neuropsychiatric profiles in patients with Alzheimer’s disease and vascular dementia. Ann Indian Acad Neurol 2015;18:120-21. Ganguli M, Ratcliff G, Chandra V, Sharma S, Gilby J, Pandav R, et al. A Hindi version of the MMSE: The development of a cognitive screening instrument for a largely illiterate rural elderly population in India. Int J Geriatr Psychiatry 1995;10:367-77. Das SK, Banerjee TK, Mukherjee CS, Bose P, Biswas A, Hazra A, et al. An urban community based study of cognitive functions among non-demented elderly population in India. Neurol Asia 2006;11:37-48. Access this article online Quick Response Code:
Website: www.annalsofian.org
DOI: 10.4103/0972-2327.156565
Refractory status epilepticus from NMDA receptor encephalitis successfully treated with an adjunctive ketogenic diet Sir, N-methyl D-aspartate receptor encephalitis (NMDARE) is characterized by the presence of NMDAR antibodies in the Annals of Indian Academy of Neurology, April-June 2015, Vol 18, Issue 2
CSF, and it can progress to psychosis and refractory status epilepticus (RSE). We report a case of the use of a ketogenic diet (KD) as an adjunct in RSE from NMDARE.
Copyright of Annals of Indian Academy of Neurology is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Author’s response on “Neuropsychiatric profiles in patients with Alzheimer’s disease and vascular dementia” Sir, We sincerely thank the reader(s) for his/her/their interest in our article entitled “Neuropsychiatric profiles in patients with Alzheimer’s disease and vascular dementia” published in Ann Indian Acad Neurol (2015;18:120-21).[1] As written in the article, we have used the mini-mental status examination (MMSE) for initial screening of our patients. The usual protocol we follow at our clinic is to apply the MMSE at the beginning and get the score. It gives us an estimate about the domains involved in a given patient. The qualitative assessment of MMSE (i.e., how a patient is performing while applying MMSE) tells more about the impairment the patient is having than the crude score itself. Similar to CDR (Clinical Dementia Rating) score, MMSE also used to determine the stage of dementia. Therefore, in our study, MMSE was not meant to select or reject patients but it was part of the whole assessment. We applied this initial test before embarking upon the full assessment. The second concern of the reader(s) was why we did not use the Bengali version of MMSE in our subjects. We did not use a vernacular version because the available Hindi and Bengali versions of MMSE have limitations. The Hindi adaptation of the MMSE was developed by Ganguli et al. while developing a screening tool for rural illiterate Indian elderly subjects.[2] Thus, it was modified to enable an illiterate subject to complete the test without difficulty. The Bengali version of MMSE was an adaptation of the Hindi version.[3] While these are useful for illiterate subjects, both the batteries are too easy for an urban educated subject. The ‘ceiling effect’ is observed while generating the cut-off scores for educated subjects.[2,3] This means the 10th percentile score of normative data for educated subject touches the highest possible score. Thus, early impairment is missed if these instruments are used for educated subjects. Hence, both Hindi and Bengali versions of MMSE are not useful for testing an educated subject. Conversely, MMSE is an accepted and widely used global cognitive screening scale used across the world. It is comprehensive, easy to apply, and useful for comparison. We therefore used MMSE for testing educated subjects in our clinic.
Tushar Kanti Bandyopadhyay, Atanu Biswas, Arijit Roy, Deb Sankar Guin, Goutam Gangopadhyay, Sujit Sarkhel1, Malay Kumar Ghoshal2, Asit Kumar Senapati Department of Neurology, Bangur Institute of Neurosciences, Kolkata, 1Department of Psychiatry, Institute of PostGraduate Medical Education and Research, Kolkata, 2 Department of Psychiatry, Calcutta Medical College, Kolkata, West Bengal, India For correspondence: Dr. Atanu Biswas, Department of Neurology, Bangur
Institute of Neurosciences, 52/1A, S.N. Pandit Street, Kolkata - 700 025, West Bengal, India. E-mail: [email protected]
References 1. 2.
3.
Raina SK, Neuropsychiatric profiles in patients with Alzheimer’s disease and vascular dementia. Ann Indian Acad Neurol 2015;18:120-21. Ganguli M, Ratcliff G, Chandra V, Sharma S, Gilby J, Pandav R, et al. A Hindi version of the MMSE: The development of a cognitive screening instrument for a largely illiterate rural elderly population in India. Int J Geriatr Psychiatry 1995;10:367-77. Das SK, Banerjee TK, Mukherjee CS, Bose P, Biswas A, Hazra A, et al. An urban community based study of cognitive functions among non-demented elderly population in India. Neurol Asia 2006;11:37-48. Access this article online Quick Response Code:
Website: www.annalsofian.org
DOI: 10.4103/0972-2327.156565
Refractory status epilepticus from NMDA receptor encephalitis successfully treated with an adjunctive ketogenic diet Sir, N-methyl D-aspartate receptor encephalitis (NMDARE) is characterized by the presence of NMDAR antibodies in the Annals of Indian Academy of Neurology, April-June 2015, Vol 18, Issue 2
CSF, and it can progress to psychosis and refractory status epilepticus (RSE). We report a case of the use of a ketogenic diet (KD) as an adjunct in RSE from NMDARE.
Copyright of Annals of Indian Academy of Neurology is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
