INTRODUCTION:

Cognitive function plays a vital role in the quality of life of any individual. Where cognitive function is said to be sharp in young age, it is said to deteriorate with age. Elder people tend to forget things which in turn may have an effect on their psychomotor functions. It also affects the confidence in elderly. They tend to become dependent on others for their daily chores. They feel as a liability to their family members.^1-5

If treated on time, it will help not only to boost their moral but also improve their quality of life. They will be able to lead a good quality of life and enjoy with their family members.^6,7,8

They will not feel forsaken, as burden to the society. This will also improve their psychomotor functioning.^9,10,11

Mini-Mental State Examination is one such technique used to assess the cognitive function in elderly. It is also useful to assess the efficacy of any therapeutic agents indicated for improving the cognitive function of the individual.¹²

Homoeopathy has a lot to offer in such cases. Homoeopathic medicines are safe to use without any adverse effects in such cases. They act on the constitutional level of the individual and help in improving the quality of life as a whole. There are many homoeopathic medicines in homoeopathic Materia medica which have indications on cognitive function of the individual and help improve the memory.

The current study aims at assessing the efficacy of homoeopathic medicine in improving the cognitive function in elderly employing MMSE.

AIM:

To assess the efficacy of PlumbumMetallicum Homoeopathic Medicine in improving the cognitive function in elderly employing MMSE.

OBJECTIVES:

1. To assess the utility of Mini-Mental State Examination in assessing the cognitive function in elderly.

2. To assess the efficacy of homoeopathy in improving the quality of life with respect to cognitive function in elderly.

MATERIALS AND METHODS:

The ethical approval for the study was obtained from the Institutional Ethics Committee.

Elderly patients visiting the OPD of Dr. D.Y. Patil Homoeopathic Medical College were included in the study.

Inclusion Criteria:¹³

Both males and females.

Age: Between age group 50-65 years

Patients coming with complaints of weak memory.

Relatives of the patients complaining of weak memory of the patient.

Exclusion Criteria^13,14

Patients more than 70 years age

Patients diagnosed with neurological disorders like Parkinsonism, motor neuron disease.

Patients diagnosed with Alzheimer disease.

Patients diagnosed with ADHD, Epilepsy, diseases of brain and spinal cord.

Patients diagnosed with visual impairment, partial or total hearing loss.

Patients in comatose state.

Paralysed patients.

Patients with complications like uncontrolled Diabetes Mellitus, Hypertension, Cardio-Vascular accidents.

METHODOLOGY:

Table.1: Mini Mental State Examination Scoring:^13,14

Sr. No	Education Level	MMSE Score
1	7^th grade	22
2	8^th grade	24
3	High school	25
4	College level	26

Table.2- Response Score^13,14

Sr. No	Responses	Score
1	Incorrect	0
2	Correct	1
3	Does not answer	6
4	Unknown	9

Statistical analysis:

Cognitive function response score was be calculated before administering the homoeopathic medicine employing MMSE.

Predetermined validated questionnaire was prepared common to all participants.

The homoeopathic Medicine PlumbumMetallicumwas administered to all patients in potency 200 C, Globules number 30, 3 globules four times a day for 1 month.

The Cognitive function response score was calculated 1 month after administering the homoeopathic medicine employing MMSE.

The study follow up was for 6 months.

MMSE score was calculated after every 1 month.

Final scoring was statistically analyzed using paired t-test.

Observations and Statistical Analysis:

A sample of 50 cases from patients who attended the Out-Patient Department of OPD of Dr. D.Y. Patil Homoeopathic Medical College was taken for this study. All the 50cases were followed up for a period of 6 months to 1 year. These cases were subjected to statistical study. The following tables reveal the observation and result of this study.

Table no. 3- Distribution of cases according to their Gender:

Gender	Number of cases	Percentage
Female	20	40%
Male	30	60%
Total	50	100%

Figure 1: Distribution of cases according to their Gender

Statistical Analysis:

Intention to treat (ITT) population were subjected to statistical analysis.

The analysis was performed on demographic data and treatment outcomes to test the group differences using paired t test.

X= score before treatment Y= score after treatment

A= difference between the scores.

Ā=mean of the difference between the scores

S=S.D of Differences S E= Standard Error of Mean

Now we assume,

Ho – null hypothesis states that homoeopathy is not useful in improving the cognitive function of elderly.

H1 – alternate hypothesis states that homoeopathy is useful in improving the cognitive function of elderly.

Ā = Σ A / n = 3.46

S = √Σ (A - Ā) ² / n-1 = √344.57/49 =2.65

SE= S /√n = 0.37

t = Ā / SE= 6.86/0.37= 9.35

Thus t =9.35

At 5% level for 49 degrees of level of freedom the value of t = 1.67

At 1% level for 49 degrees of level of freedom the value of t = 2.68

Thus, the value obtained is more than the above values so; we reject the null hypothesis and accept the alternative hypothesis.

Thus, the difference in values obtained is significant.

Therefore, Homoeopathic Medicine Plumbum Metallicum is useful in improving cognitive function in elderly patients.

DISCUSSION:

In this study, the effectiveness of PlumbumMetallicum Homoeopathic Medicine in improving the cognitive function in elderly was evaluated over a time period of 1year on 50 patients fulfilling the inclusion and exclusion criteria. The evaluation was based on improvement with respect to response score before and after administering MMSE.

Out of the 50patients treated none showed any complications.

Significant improvement in MMSE score was reported in 37 cases out of the 50 cases. 8cases showed no significant change.5 cases were lost in follow up.

If we were to refer to the Homoeopathic Materia Medica of Plumbum Metallicum, it is one of the leading homoeopathic medicine prescribed for weak memory. Plumbum Metallicum is a fore runner in mental depression. Perception of Plumbum Metallicum is very slow. There is weakness of memory where the patient forgets words or sentence. Intellectual apathy is marked. Impairment of memory with paretic dementia is keynote of Plumbum Metallicum. Therefore, the homoeopathic medicine Plumbum Metallicum was selected for this study.¹⁵

SUMMARY AND CONCLUSION:

From the statistical analysis it is evident that Homoeopathic medicine Plumbum Metallicum is useful in improvement of cognitive function in elderly.

Statistical analysis also shows that there is great difference in MMSE scores before treatment and after treatment in cases treated with Plumbum Metallicum.

To conclude, Homoeopathy can play a vital role in improving the quality of life with respective to cognitive function in elderly.

ABBREVIATIONS:

MMSE- Mini-Mental State Examination

C- Centesimal

%- percentage

ACKNOWLEDGEMENT:

Firstly, we would like to thank Hon’ble Chancellor of Dr. D.Y. Patil Vidyapeeth, Pune, Dr. P.D. Patil Sir for giving us the opportunity to take up this research project. We would also like to thank Hon’ble Trustee Dr. Smita Jadhav Mam for her continuous guidance and support. We would also like to thank the Vice-Chancellor of Dr. D.Y. Patil Vidyapeeth, Pune, Prof. Dr. N.J. Pawar Sir for his constant support and guidance. We would also like to thank the registrar of Dr. D.Y. Patil Vidyapeeth, Dr. A.N. Suryakar Sir for his support and guidance. We would also like to thank the Ethics committee of the college for approving this research project. Last but not the least, we would also like to thank all the patients and their relatives for giving written consent and participating in this study.

CONFLICT OF INTEREST:

There is no conflict of interest amongst the authors.

LIMITATIONS OF THE STUDY:

The study assesses the efficacy of Plumbum Metallicum Homoeopathic Medicine in improving the cognitive function in elderly. Other studies can be taken up involving many such homoeopathic medicines having action on memory of the patient. Also sample size selected is 50. Further research can be taken up on a larger sample size. Also, there was no comparator in the study. Further research can be undertaken using a comparator.

REFERENCES:

1. Fernández, M., Gobartt, A.L., Balañá, M. et al. Behavioural symptoms in patients with Alzheimer's disease and their association with cognitive impairment. BMC Neurol 10, 87 (2010) doi: 10.1186/1471-2377-10-87

2. Manjunath M.Sogalad. Effectiveness of Awareness Program on Dementia among the Elderly residing at Selected Old Age Home of Belgaum, Karnataka, Asian J. Nur. Edu. and Research 5(1): Jan.-March 2015; Page 58-63 DOI: 10.5958/2349-2996.2015.00013.0

3. Dhanya George, Anu Jacob Kachappillil. The level of Memory Impairment among elderly in a rural community of Ernakulam District. Asian J. Nursing Education and Research. 2020; 10(1): 107-109. DOI: 10.5958/2349-2996.2020.00024.5

4. Sonam Soni, Pravin Kumar, Vinay Sagar Verma, Mukesh Sharma. Significance of Indian Medicinal Plants used for Treatment of Dementia. Asian J. Res. Pharm. Sci. 4(4): Oct.-Dec. 2014; Page 202-205. Available on: https://ajpsonline.com/AbstractView.aspx?PID=2014-4-4-9

5. Ajesh kumar T. K. An Insight into Assessment and Management of Dementia. Int. J. Adv. Nur. Management 2(3): July-Sept.,2014; Page 180-182. DOI: 10.5958/2454-2652

6. Jayarani. N . A study to evaluate the effectiveness of educational intervention among the caretakers of elderly with cognitive impairment. Asian J. Nur. Edu. and Research 5(3): July- Sept.2015; Page 366-372. DOI: 10.5958/2349-2996.2015.00074.9

7. G. Ramamurthy ,Danasu , P. Tamilselvi. A study to assess the prevalence of depression among elderly residing in selected old age home, Kancheepuram District, Tamil Nadu, 2015. Asian J. Nur. Edu. and Research 5(3): July- Sept.2015; Page 381-384. DOI: 10.5958/2349-2996.2015.00076.2

8. Maryam Heydari, FaridehRazban, Tayebeh Mirzaei, Shahin Heidari. The Effect of Problem Oriented Coping Strategies Training on Quality of Life of Family Caregivers of Elderly with Alzheimer. Asian J. Nur. Edu. and Research.2017; 7(2): 168-172. DOI:10.5958/2349-2996.2017.00034.9

9. Neetu Tripathi. Quality of life among elderly people in selected area at Bhilai, Durg, C.G. Asian J. Nursing Education and Research. 2019; 9(3):341-345. DOI: 10.5958/2349-2996.2019.00073.9

10. Anu Jacob Kachappillil, Ninu Sophia, AnjithaSaji et.al, Functional Status of Elderly in a Rural community at Ernakulam District. Asian J. Nursing Education and Research. 2019; 9(4):519-521. DOI: 10.5958/2349-2996.2019.00110.1

11. Sangroyangla, Temjentula, TemjenyanglaImchen et al., Prevalence of Depression and the associated risk factors among the Elderly. Asian J. Nursing Education and Research. 2019; 9(4):552-554. DOI: 10.5958/2349-2996.2019.00119.8

12. Pezzotti, P., Scalmana, S., Mastromattei, A. et al. The accuracy of the MMSE in detecting cognitive impairment when administered by general practitioners: A prospective observational study. BMC Fam Pract 9, 29 (2008) DOI: 10.1186/1471-2296-9-29

13. Arevalo-Rodriguez, Ingrid et al. “Mini-Mental State Examination (MMSE) for the detection of Alzheimer's disease and other dementias in people with mild cognitive impairment (MCI).” The Cochrane database of systematic reviews vol. 2015,3 DOI: 10.1002/14651858.CD010783.pub2

14. Creavin ST, Wisniewski S, Noel‐Storr AH et.al Mini‐Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations. Cochrane Database of Systematic Reviews 2016, Issue 1 DOI: 10.1002/14651858.CD011145.pub2

15. Boricke W, New Manual of Homoeopathic Materia Medica and Repertory, Augmented edition based on 9th edition, page 508-510

Received on 24.02.2021 Modified on 18.01.2022

Research J. Pharm. and Tech 2022; 15(12):5537-5540.

DOI: 10.52711/0974-360X.2022.00934