Kithsiri Dedduwa Pathirana

As the elderly population and prevalence of dementia is increasing, it is necessary to have a better comprehension of the influence of specific factors on cognitive function. Dementia is not an inevitable consequence of ageing. Lifestyle factors might either increase or decrease the risk. Even though different studies have focused on individual factors, only a few studies are available which assess all these factors as a whole. Available evidence on these factors is mainly from high income countries and much less evidence is available from low and middle income countries. As cognition is critical for elderly people to engage in a physically independent life, we aimed to identify the associated factors of cognition. This was a descriptive cross sectional study performed with 421 elderly people dwelling in residential care facilities for the aged in two selected districts in the Southern Province of Sri Lanka. Cognition was assessed using the Mini Mental State Examination (MMSE). Independent sample t test, ANOVA and regression analyses were used to explore associated factors for cognition. The statistical significance was kept at bonferroni adjusted p < 0.004. The study included elderly people with a mean age of 71.9 ± 6.7 years and of them 65.8% were females. Factors affecting higher level of cognition were, having upper secondary, advanced and higher education; being married; arriving at the facility on one’s own accord; being visited by family members; higher physical activity levels and engaging in social and leisure activities (p < 0.004). The factors, namely physical activity level, educational status, visits by family members and engaging in leisure activities were the predictors of cognition in the regression model. Though there were several factors that associated with the level of cognition such as educational status, marital status, reason for attending the facility, visits by family members, physical activity levels and participation in social and leisure activities, only the factors, such as physical activity levels, visits by family members, educational status and engaging in leisure activities were the predictors of cognition.

Although cognitive functions affect the health related quality of life (QoL), the relationship between perceived QoL and cognition including executive functions has not been studied adequately. Available studies show moderate to weak correlations. We evaluated the association of cognition and executive functions, namely working memory (WM) and inhibitory control (IC) with the perceived QoL of a sample of elderly people dwelling in residential aged care facilities (RACFs) in Southern Province of Sri Lanka. Cognition was assessed using Mini-Mental State Examination (MMSE), while verbal WM (VWM), visuo-spatial WM (VSWM) and IC (interference control, inhibition of pre potent and ongoing responses) were assessed using VWM, VSWM tasks, colour word Stroop (CWS), go/no-go (GNG) and stop signal (SS) tasks respectively. WHOQoL-Bref (Total score and domain scores) were used to assess QoL. The relationship was analysed using Pearson correlation and hierarchical multiple regression analysis. Study included 237 elderly people with a mean age of 71.11 ± 6.44 years. Participants scored the highest in the domain of environment (63.48 ± 10.63) and lowest in the domain of social relationships (55.43 ± 21.84) of QoL. Psychological health domain positively correlated with MMSE, VSWM and VWM scores and negatively correlated with CWS, SS and GNG task errors. Both physical health domain and total QoL demonstrated positive correlations with MMSE, VSWM and VWM scores, while negative correlations were observed with CWS task errors. Social relationships domain demonstrated a significant positive correlation with VSWM score. Environment domain positively correlated with MMSE, VSWM and VWM scores and negatively correlated with CWS and SS task errors. All were significant but weak correlations. When controlled for covariates, such as educational status, physical activity and marital status, cognition was a predictor of the domain of environment of QoL, while executive functions were not predictors of total QoL and domains of QoL. Cognition and executive functions weakly but significantly correlated with different domains of QoL. Only the level of cognition measured by MMSE was a predictor of the domain of environment of QoL and executive functions were not predictors of total QoL and domains of QoL in elderly people with normal cognitive functions dwelling in RACFs.

Cerebral malaria is arguably one of the most common non-traumatic encephalopathies in the developing world. Unless the diagnosis of cerebral malaria is made promptly, the consequence could be disastrous. Even though the diagnosis of cerebral malaria can be made relatively easily in majority of cases atypical presentation can often lead to misdiagnosis or delayed diagnosis. We report a case of an uncommon presentation of Plasmodium falciparum infection in a 17-year-old school girl with altered sensorium, seizures and phobic spasms. A previously healthy 17-year-old school girl was admitted to our hospital with acute condition characterised by comatose state, recurrent seizures and phobic spasms. She initially presented to a local hospital with agitation and over talkativeness and was diagnosed as having an acute psychotic state. Few days later she became drowsy and developed recurrent seizures and marked phobic spasms which prompted the treating physician to diagnose human rabies. However, further investigations carried out in our unit (including rapid antigenic test for P. falciparum and peripheral blood smear) were positive for P. falciparum. She was treated as for cerebral malaria with intravenous quinine and discharge from hospital with no residual neurological deficit. Atypical presentation of cerebral malaria can often lead to misdiagnosis. This patient presented with encephalopathic illness with phobic spasms was initially misdiagnosed as human rabies. Therefore, the physicians in malarial endemic areas should be vigilant of similar presentations and should consider cerebral malaria as a possibility.