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Advanced Neurology LBD prevalence and incidence in India

from the Longitudinal Aging Study in India (LASI) LBD is expected to increase. This systematic review
reported that over 8.8 million people aged ≥60 years (7.4% aimed to review published literature investigating the
of this population) are living with dementia. 3 incidence and prevalence of LBD in Indian populations.
In 2019, dementia cost the global economy 1.3 trillion As secondary aims, we sought to determine the designs,
USD, half of which was related to informal care from diagnostic criteria, and cohort classification (LBD,
family and friends. Care partners spend an average of 5 h PDD, or DLB) adopted by the included studies, as each
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daily on providing care, which impacts their physical and could influence prevalence and incidence. Finally, we
emotional wellbeing. The expenses associated with caring determined the use of biomarkers and cognitive tools in
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for an individual with dementia in India differ based on the each study, acknowledging their influence on detection
extent of the condition. The annual costs can range from and, consequently, on epidemiology.
₹The expenses associ(545 – 2423 USD) in cities and from 2. Methods
₹20,300 to ₹66,025 (242 – 791 USD) in rural areas. The
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costs increase as the disease advances. 5 2.1. Search strategy
The LASI study highlighted variations in all-cause This systematic review was conducted as part of HPK’s
dementia prevalence across different Indian states and Masters in Public Health program at Queen’s University
reported that the differing influence of sex, age, education, Belfast. We devised a search strategy (Appendix 1) and were
and urban/rural status required policy and resource assisted by a medical research librarian. The search was
allocation tailored to each state’s needs. However, it did not conducted on June 22, 2023, and included all observational
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investigate the prevalence of different dementia subtypes, studies involving an adult Indian population, published in
which are associated with variations in demographic English after 1996, when the diagnostic criteria for LBD
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characteristics and disease burden. 6 were first established. The exclusion criteria comprised
papers published in languages other than English, case
Lewy body dementia (LBD) is neurodegenerative
dementia comprising Parkinson’s disease dementia (PDD) series, and case studies.
– in which dementia emerges in the context of established Recognizing that epidemiological studies may not
PD – and dementia with Lewy bodies (DLB) – wherein have mentioned LBD prevalence in their titles, abstracts,
dementia occurs within a year of Parkinsonian symptoms. or aims, we included the names of other forms of
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DLB is clinically characterized by the symptom tetrad of dementia in our search strategy: “Alcohol-related brain
visual hallucinations, spontaneous parkinsonism, rapid injury,” “Alzheimer’s disease,” “Frontal lobe dementia,”
eye movement (REM), sleep behavior disorder, and “Frontotemporal dementia,” “Mixed dementia,” “Korsakoff
fluctuations in cognition with variations in alertness. 7 psychosis,” and “Vascular dementia.” Parkinson’s disease
Although believed to be driven by the same was also included as a search term to avoid excluding
neuropathological process – the aggregation of α-synuclein studies that included PDD prevalence. The search criteria
into the Lewy bodies and Lewy neuritis – DLB and PDD included both anglicized and native names of Indian
are thought to represent two distinct but converging states, union territories, and capitals. The search included
clinical phenotypes. LBD is associated with more frequent EMBASE, MEDLINE, and APA PsychINFO databases. We
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rates of hospitalization, a worse prognosis, and increased used the Covidence platform (covidence.org), which differs
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caregiver stress compared to Alzheimer’s disease. from manual extraction by automating and organizing
many systematic review tasks, such as citation screening,
Although neuropathological evidence of LBD was full-text review, and data extraction, thus reducing time,
found in >25% of people with dementia who underwent minimizing errors, and enhancing collaboration among
postmortem, it was diagnosed in <5% of cases reviewers. HPK and NM screened the title and abstract
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antemortem, with significant variation observed between and also conducted full-text reviews where appropriate.
different geographical areas. Of individuals with PD, 20 JK cast the deciding vote when disagreements emerged
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– 30% are estimated to have PDD, but significant variation between HPK and NM.
between cohorts is observed. 12,13 Accurate LBD diagnosis
is crucial, as it directs clinicians toward appropriate 2.2. Quality assessment
treatment strategies. Critically, these strategies include We used the Joanna Briggs Institute’s (JBI’s) quality
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the avoidance of antipsychotic agents, as patients with LBD assessment tool and JBI’s critical appraisal checklist for
can exhibit severe sensitivity to them. 7 studies reporting prevalence data to evaluate the quality
With the increasing incidence and prevalence of and risk of bias for each study. Quality assessment was
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dementia in India, the number of people living with tracked using a bespoke Microsoft Excel spreadsheet.

Volume 3 Issue 4 (2024) 2 doi: 10.36922/an.4098