Mathew Varghese

• MD (Psychiatry)
• Professor at National Institute of Mental Health and Neuro Sciences

Behavioral and psychological symptoms of dementia (BPSD) are common in developing countries, yet their prevalence and associations remain poorly understood. This study by the 10/66 dementia research group, assessed 555 individuals with mild to moderate dementia across 21 centers in 17 developing countries using standardized psychiatric assessments....

BACKGROUND: Huntington disease (HD) is an inherited, neurodegenerative disorder, caused by the expansion of an unstable CAG repeat sequence in the HTT gene. The prevalence of HD, allelic diversity, rate of novel expansions, and the clinical correlates, vary across populations. OBJECTIVE: To analyze the diversity of alleles and their clinical correl...

Background The escalating prevalence of dementia in India highlights the need for effective dementia care, particularly in a context marked by limited specialized services and resources. In response to this growing challenge, we sought to contribute to the understanding of societal expectations of multidisciplinary dementia care by exploring the qu...

Background About 16% of worldwide dementia cases are in India. Evaluating the prospects for dementia prevention in India requires knowledge of context-specific risk factors, as relationships between risk factors and dementia observed in high-income countries (HICs) may not apply. Methods We computed population attributable fractions (PAFs) for dem...

Introduction Substance-use disorders (SUDs) are a public health problem. The Global Adult Tobacco Survey (GATS) and National Family Health Survey (NFHS) provide evidence of high usage. Hence, the National Mental Health Survey (NMHS) WB data were analyzed to estimate the prevalence, pattern, disability burden, and service utilization of SUD. Method...

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Objectives In India, globalisation is purported to have contributed to shifting family structures and changing attitudes to long‐term care (LTC) facility use. We investigated the attitudes to and usage frequency of LTC in India. Methods We conducted secondary analyses of: (a) The Moving Pictures India Project qualitative interviews with 19 carers...

Objective Using the concept of relational solidarity, we examine how autonomy, equality, dignity, and personhood are practiced in the care of people living with dementia at home in urban India. Methods Video interviews with 19 family carers and 25 health providers conducted in English, Hindi, and Kannada in Bengaluru between March to July 2022. Da...

Two of every three persons living with dementia reside in low‐ and middle‐income countries (LMICs). The projected increase in global dementia rates is expected to affect LMICs disproportionately. However, the majority of global dementia care costs occur in high‐income countries (HICs), with dementia research predominantly focusing on HICs. This imb...

Introduction India, with its rapidly aging population, faces an alarming burden of dementia. We implemented DSM-5 criteria in large-scale, nationally representative survey data in India to characterize the prevalence of mild and major Neurocognitive disorder. Methods The Harmonized Diagnostic Assessment of Dementia for the Longitudinal Aging Study...

Objectives To identify factors associated with malnutrition (undernutrition and overnutrition) and determine appropriate cut-off values for mid-arm circumference (MAC) and calf circumference (CC) among community-dwelling Indian older adults. Design Data from the first wave of harmonised diagnostic assessment of dementia for Longitudinal Ageing Stu...

Background Transcranial direct current stimulation (tDCS) is a safe non‐invasive brain stimulation (NIBS) procedure which helps to stimulate a particular region of interest by modulating the neuronal firing rate, thereby modulating the cognitive functioning. The tDCS intervention is known to show improvement on memory recall and recognition in pati...

Background There is a “diversity” crisis in brain research, as most brain research is conducted in Caucasian populations. This lack of ethnic diversity means that we do not know if predictors of health (and disease) generalize to other ethnic groups. We have recently launched the India ENIGMA Initiative for Global Aging & Mental Health ‐ a globally...

Background Despite the rapid proliferation of smartphones in low and middle‐income countries (LMICs), few studies have explored how to harness this technology to improve dementia care. Using a case‐study from India, where 830 million people are smartphone users, we describe the co‐design of a fully digitalised dementia care intervention for family...

Background World Health Organization (WHO) has developed iSupport for Dementia carers, an online program that aims to improve caregivers’ knowledge and skills, reduce emotional distress and improve the quality of life for both person with dementia and their caregivers. The program has been translated and culturally adapted in 33 countries and rando...

Background The National Mental Health Survey was borne out of the felt need for a comprehensive epidemiological survey on mental health to understand the magnitude of psychiatric morbidities in India to aid in mental health policymaking, service planning, and delivery. Kerala was one of the 12 surveyed states, representing southern India. Aims To...

Background The lifetime prevalence of mental morbidity in Assam is estimated at 8% (NMHS 2015–16). Understanding the distribution patterns of different types of mental disorders among persons with mental morbidity in different districts would facilitate evidence-driven district mental health programming in Assam. Given the varied socio-geopolitical...

Background and Aims There is no data on the treatment gap and health care utilization for mental disorders from Punjab. The present study reports on the same by using the data collected during the National Mental Health Survey. Settings and Design Multisite, multistage, stratified, random cluster sampling study conducted in four districts, namely...

Background West Bengal, situated in eastern India, comprising 19 districts as of 2016 and consisting of 9.13 crore population, had been one of the participating states in the National Mental Health Survey, 2015–16. Aim To estimate the prevalence and pattern of mental disorders in a representative population in West Bengal. Materials and Methods B...

Background Social anxiety disorder (SAD), also termed as social phobia, is a disabling psychiatric condition with limited epidemiological research on it in India. This study, using data from the National Mental Health Survey (NMHS), 2016, is the first to explore its current prevalence and associated factors in India. Materials and Methods The NMHS...

Introduction Post-traumatic stress disorder (PTSD) is a chronic psychiatric condition associated with significant distress and dysfunction. While worldwide estimates of prevalence range from 3.9% to 24%, little research has been conducted to identify the prevalence of PTSD in the general population of India. This study analyzes data from the Nation...

Introduction Generalized anxiety disorder (GAD) is one of the common anxiety disorders leading to impairment and burden. However, GAD remains the least studied anxiety disorder. There is a need for nationally representative epidemiological data of GAD to understand the current burden and plan the mental health policies and programs to attain their...

Background Disability associated with mental illness has a disproportionate impact on the work, social, and family responsibilities of an individual toward society. The evidence for disability in mental illnesses would help the clinician, caregivers, policymakers, and various stakeholders to come up with sustainable solutions not only to help fill...

Background Common mental disorders (CMDs) have a higher prevalence among women in their reproductive age (WRA) compared to the general population. Large Indian epidemiological studies focusing on the prevalence and socioeconomic correlates of CMDs among WRA are lacking. The associated disability and treatment gap particularly in the women populatio...

Background A staggering 85% of the global population resides in low- and middle-income countries (LAMICs). India stands as an exemplary pioneer in the realm of mental health initiatives among LAMICs, having launched its National Mental Health Program in 1982. It is imperative to effectively evaluate mental health systems periodically to cultivate a...

The National Mental Health Survey of India (NMHS) was a ground-breaking nationwide study that harnessed a uniform, standardized methodology blending quantitative and qualitative approaches. Covering data from 12 states across diverse regions, its mission was to gauge the prevalence of psychiatric disorders, bridge treatment gaps, explore service ut...

Background Existing psychiatric epidemiological studies from Tamil Nadu with methodological limitations and variations had under-reported the prevalence of mental morbidity. Robust data from a representative population-based epidemiological study are not readily available to guide mental health programs in Tamil Nadu. Aim This study aimed to estim...

Schizophrenia spectrum disorders represent a significant global health concern, contributing significantly to the global burden of disease. The National Mental Health Survey (NMHS) of India, conducted between 2015 and 2016, investigated the prevalence and epidemiological correlates of schizophrenia spectrum disorders in India. The NMHS conducted a...

Introduction Bipolar Affective Disorder (BPAD) merits careful consideration within the medical and healthcare communities, researchers, and policymakers. This is due to its substantial disability burden, elevated prevalence of co-morbidities, heightened lifetime risk of suicidality, and a significant treatment gap. This article focuses on the lifet...

Introduction Panic disorder (PD) is one of the most common and debilitating anxiety disorder. Individuals with PD seek frequent healthcare and emergency services leading to frequent work absenteeism and economic burden. However, its prevalence patterns in the Indian context are poorly understood. Hence, this article discusses the epidemiology, disa...

Objectives Ethnically diverse family carers of people living with dementia (hereafter carers and people with dementia) experience more psychological distress than other carers. To reduce this inequality, culturally adapted, multilingual, evidence-based practical assistance is needed. This paper details the Draw-Care study protocol including a rando...

Malnutrition in low-and middle-income countries causes cognitive decline and other health problems. Harmonized Diagnostic Assessment of Dementia for Longitudinal Aging Study in India (LASI DAD) is an extensive study on late-life cognition and dementia. This study examines the link between nutrition and cognitive abilities in older adults using data...

Huntington's disease (HD) is caused by an increase in the number of CAG triplet repeats in exon 1 of the Huntingtin ( HTT ) gene. Expansions that contain more than 39 repeats predispose to disease. Some specific genetic elements (SNPs), and the haplotypes they create (haplogroups A, B, and C), located at the HTT locus seem to impact CAG repeat inst...

Introduction: India, with its rapidly aging population, faces an alarming burden of dementia. We implemented DSM-5 criteria in large-scale, nationally representative survey data in India to characterize the prevalence of mild and major Neurocognitive disorder. Methods: The Longitudinal Aging Study in India's Diagnostic Assessment of Dementia (LASI-...

Objectives: Resources to support dementia carers from ethnically diverse families are limited. We explored carers' and service providers' views on adapting the World Health Organization's iSupport Lite messages to meet their needs. Methods: Six online workshops were conducted with ethnically diverse family carers and service providers (n = 21) f...

Background The ε4 variant of the apolipoprotein E gene (APOE4) is associated with the risk of Alzheimer’s dementia (AD). Previous studies have reported APOE4 status association with familial loading and vascular changes in AD. With a diverse ethnic population, and high rates of metabolic syndromes, the consequences of being a carrier of the APOE4 p...

Background: Mental illnesses often cluster in families, and their impact on affected and unaffected members within families need to be understood from a social perspective. Methods: Data was derived from 202 families with multiple affected individuals, identified under Accelerator program for Discovery in Brain disorders using Stem cells (ADBS) stu...

Mental disorders in India form a major public health concern and the efforts to tackle these dates back to four decades, by way of the National Mental Health Programme (NMHP) and its operational arm, the District Mental Health Programme (DMHP). Although the progress of NMHP (and DMHP) was relatively slower till recently, the last 4-5 years have see...

The Harmonized Diagnostic Assessment of Dementia for the Longitudinal Aging Study in India (LASI-DAD) is a nationally representative in-depth study of cognitive aging and dementia. We present a publicly available dataset of harmonized cognitive measures of 4,096 adults 60 years of age and older in India, collected across 18 states and union territo...

Background: There is rapid growth of older people in Low- and Middle- Income Countries (LMICs). The aim of this review was to assess the literature on prevalence of anxiety and depression in this demographic, which to our knowledge, has not yet been conducted. Methods: Databases including Medline, PsychInfo, Embase, Scielo and African Journals O...

Background Psychiatric disorders are among the leading contributors to disability in India and worldwide. The pattern, prevalence, and distribution of psychiatric disorders in the country and its regions need to be assessed to facilitate early diagnosis and treatment. No study on the epidemiology of psychiatric disorders has been conducted in the C...

Background: There are more than 5 million people with dementia in India. Multicentre studies looking at details of treatment for people with dementia In India are lacking. Clinical audit is a quality improvement process which aims to systematically assess, evaluate, and improve patient care. Evaluating current practice is the key to a clinical aud...

Introduction: Prior estimates of dementia prevalence in India were based on samples from selected communities, inadequately representing the national and state populations. Methods: From the Longitudinal Aging Study in India (LASI) we recruited a sample of adults ages 60+ and administered a rich battery of neuropsychological tests and an informa...

Background The global population is ageing rapidly, with low- and middle-income countries (LMICs) undergoing a fast demographic transition. As the number of older adults in LMICs increases, services able to effectively address their physical and mental health needs will be increasingly important. Objective We review the health and socioeconomic re...

Whole Exome Sequencing (WES) studies provide important insights into the genetic architecture of serious mental illness (SMI). Genes that are central to the shared biology of SMIs may be identified by WES in families with multiple affected individuals with diverse SMI (F-SMI). We performed WES in 220 individuals from 75 F-SMI families and 60 unrela...

When data is pooled across multiple sites, the extracted features are confounded by site effects. Harmonization methods attempt to correct these site effects while preserving the biological variability within the features. However, little is known about the sample size requirement for effectively learning the harmonization parameters and their rela...

Background Family studies in obsessive-compulsive disorder (OCD) indicate higher rates of psychosis among their first-degree relatives (FDRs). However, the etiological and clinical relationships between the two disorders remain unclear. We compared the clinical characteristics and pharmacological treatment response in patients diagnosed with OCD wi...

Background Huntington’s disease (HD), caused by a pathogenic expansion of CAG triplet repeats in exon 1 of the Huntingtin (HTT) gene, has also been linked to three major haplogroups (A, B, and C), which may impact the prevalence of HD. The distribution of these haplotypes in diverse populations is thus important. Aim To study the haplotype structu...

Background Depression is a major public health challenge linked with several poor health outcomes and disabilities among adults aged 45 years and older in India. We aimed to describe the prevalence of depression and its association with a variety of sociodemographic correlates and co-existing health conditions for this age group in India and its st...

Interpersonal issues that present in the older couple are sometimes differences that were not resolved early in the couple’s marriage. As a family passes through different life cycle stages starting with the children’s upbringing, it is quite likely that conflictual issues between the couple get brushed under the carpet in the hustle and bustle of...

Objective The study aimed to evaluate the effectiveness of a program based on the telementoring model [Extension for Community Healthcare Outcomes (ECHO)] for primary care physicians in diagnosing and treating patients with dementia. Method The ECHO model was adapted through 12 live sessions of 2 h every 2 weeks consisting of a didactic presentati...

Key points Equity and balance in international partnerships between high‐ and low‐and‐middle income countries for applied dementia research may guard against research imperialism. International partnerships should be transparent, fair, inclusive, sustainable and involve bidirectional learning. International partnerships should include capacity and...

Developmental adversities early in life are associated with later psychopathology. Clustering may be a useful approach to group multiple diverse risks together and study their relation with psychopathology. To generate risk clusters of children, adolescents, and young adults, based on adverse environmental exposure and developmental characteristics...

Thalamus is a group of nuclei located deep inside the brain, well known for its sensory and cognitive functions. However, its role in the reward and behavior regulation is less explored. In this case series, we have presented four cases with inappropriate sexual behaviors (ISB) that are temporally related to thalamic infarction. We have discussed a...

BACKGROUND India is undergoing a demographic transition characterised by population ageing and is witnessing a high dementia rate. Although, around 4.4 million people live with dementia in India, dementia awareness is poor and current resources addressing dementia care are basic and often incomplete, duplicated, and/or conflicting. To address this...

Background: India is undergoing a demographic transition characterized by population aging and is witnessing a high dementia rate. Although nearly 7 million people live with dementia in India, dementia awareness is poor, and current resources addressing dementia care are basic and often incomplete, duplicated, or conflicting. To address this gap,...

Introduction: Anxiety disorders (ADs) impact the quality of life and productivity at an individual level and result in substantial loss of national income. Representative epidemiological studies estimating the burden of ADs are limited in India. National Mental Health Survey (NMHS) 2016 of India aimed to strengthen mental health services across In...

Background Working memory and executive function deficits are the characteristic features of Mild Cognitive Impairment and mild Alzheimer’s Disease (mild AD). Studies exploring the alterations in working memory and executive functions show disrupted functional connectivity in Dorsolateral Pre Frontal Cortices (DLPFC) and Angular Gyrus (AG). Transcr...

Based on the reduction of amyloid β plaques, US FDA has recently approved Aducanumab as a disease modifying treatment for Alzheimer’s disease (AD). With high pricing and the potential risks likely with this treatment, certainty of AD diagnosis becomes crucial. The current pilot study evaluated plasma levels of neurofilament L, an axonal injury mark...

This chapter would provide an overview of the caregiving scenario in India with a focus on families as the mainstay of support and care for people with dementia. The various aspects of caregiving in dementia would be discussed in the light of the Indian sociocultural context. The impact of caregiving and challenges faced by the family and informal...

Background Huntington’s disease (HD) is a progressive adult-onset neurodegenerative disorder, caused by pathogenic instability of CAG repeats in exon 1 of the HTT gene. Various subcellular structures and their function are known to be impaired, perhaps due to htt poly Q aggregates. Mitochondrial dysfunction and Telomeres shortening are among them....

Objective: to examine if smaller size at birth, an indicator of growth restriction in utero, is associated with lower cognition in late life, and whether this may be mediated by impaired early life brain development and/or adverse cardiometabolic programming. Design: longitudinal follow-up of a birth cohort. Setting: CSI Holdsworth Memorial Hosp...

Background Minor physical anomalies (MPA) are markers of impaired neurodevelopment during the prenatal stage. Assessing MPA across psychiatric disorders may help understand their shared nature. In addition, MPA in family members would indicate a shared liability and endophenotype potential. We examined familial aggregation of MPA and their role as...

Background: Mental illness affects over one-third of the Indian population, and only a little is known about the exact situation of health systems in Madhya Pradesh, India. Therefore, the present research work provides an assessment of state mental health systems in Madhya Pradesh. Methods: The present cross-sectional study was conducted as a pa...

Background and purpose Facial features can be potentially reconstructed from structural magnetic resonance images, thereby compromising the confidentiality of study participants. Defacing methods can be applied to MRI images to ensure privacy of study participants. These methods remove facial features, thereby rendering the image unidentifiable. It...

Support for caregivers of people with dementia has been identified as an action area in the Global Action Plan on the Public Health Response to Dementia 2017-2025 by the World Health Organization (WHO). As a step towards that, WHO developed iSupport - an online program to provide support and training for caregivers of people with dementia. To addre...

Objectives Internet‐based interventions involving elements of cognitive behaviour therapy, psychoeducation, relaxation and skills training for caregivers of people with dementia have been found to be promising in Western countries. Given these outcomes, the adapted version of a multi‐component online caregiver skills training and support program of...

Background Depression and cognitive impairment often coexist in older adults. The relation between depression and cognitive impairment is complex. The objective of this article is to review recent literature on cognitive impairment in older adults with depression and provide clinicians an update. Methods We searched PubMed, Google Scholar, Science...

Ageing of the population is a serious global concern including in India. This brings many challenges in terms of health care. India is home to 103 million older adults, with the majority residing in rural areas. Mental illnesses are a frequent contributor to morbidity in older adults. Nearly 10-15% of older adults have a diagnosable mental illness....

Objectives Common mental disorders (CMDs), particularly depression, are major contributors to the global mental health burden. South Asia, while diverse, has cultural, social, and economic challenges, which are common across the region, not least an aging population. This creates an imperative to better understand how CMD affects older people in th...

Huntington disease (HD), a rare neurodegenerative disorder, is inherited in an autosomal dominant manner, and caused by a pathological trinucleotide expansion at exon1 of the HTT locus. Previous studies have described the haplogroups at the HTT locus that can explain the differences in prevalence of HD. We have selected three informative SNPs (rs76...

Syndromes of schizophrenia, bipolar disorder, obsessive-compulsive disorder, substance use disorders, and Alzheimer's dementia are highly heritable. About 10-20% of subjects have another affected first-degree relative (FDR), and thus represent a ‘greater’ genetic susceptibility. We screened 3583 families to identify 481 families with multiple affec...

Background: Low and middle-income countries like India with a large youth population experience a different environment from that of high-income countries. The Consortium on Vulnerability to Externalizing Disorders and Addictions (cVEDA), based in India, aims to examine environmental influences on genomic variations, neurodevelopmental trajectorie...

Background In Alzheimer’s disease (AD), structural changes in the corpus callosum are known to precede clinical signs. Transcranial magnetic stimulation (TMS) can be used to study functional integrity of the corpus callosum through ipsilateral silent period (iSP). We examined iSP duration between patients with mild cognitive impairment (MCI)/AD and...

Background The World Health Organization’s online program ‘ iSupport’ for family caregivers of people with dementia was adapted and pilot‐tested in India. Although there are promising outcomes of Internet‐based interventions in Western countries, there has hardly been any research on the use and effectiveness of such interventions in developing cou...

Background: Phenotyping dementia is always a complex task for a clinician. There is a need for more practical biomarkers to aid clinicians. Objective: The aim of the study is to investigate the shape profile of corpus callosum (CC) in different phenotypes of dementia. Materials and Methods: Our study included patients who underwent neuroimaging in...

Objective Adverse childhood experiences are linked to the development of a number of psychiatric illnesses in adulthood. Our study examined the pattern of adverse childhood experiences and their relation to the age of onset of major psychiatric conditions in individuals from families that had ⩾2 first-degree relatives with major psychiatric conditi...

Background: Drugs with anticholinergic properties are known to be associated with deleterious effects on cognition in older adults. There is a paucity of literature in this aspect in older adults with psychiatric disorders. Objective: To examine the anticholinergic cognitive burden and its predictors in hospitalised older adults having psychiatric...

Background: Older adults with depression often have cognitive deficits contributing to higher morbidity and increased risk for conversion to dementia. Research on this area is limited from India. Objective: The objective of the current study is to examine the neuropsychological measures in older adults with Late-onset depression (LOD) compared to...

OBJECTIVES To introduce cost‐effective expert clinical diagnoses of dementia into population‐based research using an online platform and to demonstrate their validity against in‐person clinical assessment and diagnosis. DESIGN The online platform provides standardized data necessary for clinicians to rate participants on the Clinical Dementia Rati...