|
 
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| REVIEW ARTICLE |
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| Year : 2020 | Volume
: 7
| Issue : 2 | Page : 47-54 |
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Pishacha grahonmada – Frontotemporal dementia with Vitamin B12 deficiency?
Prasad Mamidi, Kshama Gupta
Department of Kaya Chikitsa, R. B. Ayurvedic Medical College and Hospital, Agra, Uttar Pradesh, India
| Date of Submission | 27-Mar-2021 |
| Date of Decision | 19-Jun-2021 |
| Date of Acceptance | 23-Jun-2021 |
| Date of Web Publication | 25-Aug-2021 |
Correspondence Address:
Dr. Prasad Mamidi
Department of Kaya Chikitsa, R. B. Ayurvedic Medical College and Hospital, Agra, Uttar Pradesh
India
 Source of Support: None, Conflict of Interest: None  | 2 |
DOI: 10.4103/AYUHOM.AYUHOM_23_21
Description of 18 types of bhutonmada or grahonmada (psychiatric diseases caused by idiopathic factors) has been documented by Maharshi Vagbhata. Pischacha grahonmada (PG) is one among those 18 types. No works are available on PG till date. The concept of PG and its clinical application is unclear due to the scarcity of published literature on this topic. The aim of the present study is to explore the condition of PG in terms of contemporary psychiatric literature. Ayurvedic literature pertaining to “Pishacha grahonmada” has been collected from major classical Ayurvedic texts and their commentaries. Electronic databases have been searched to find out the relevant psychiatric and/or neuropsychiatric conditions which are similar to PG by using relevant keywords. PG is characterized by clinical features like Aswastha chittam (feeling uneasy), naikatra tishtantam (unable to sit at one place), paridhaavinam (wandering/pacing/running), dayita nritya geeta haasa ucchishta ratim (hypomania or mania like features), madya maamsa ratim (fond of eating meat, alcohol abuse), shunya nivaasa ratim (staying alone/social withdrawal), nirbhartsanaat (threatening others), deena shankita vadanam (depression with suspiciousness), nakhai aatma vapushi likhantam (self-injurious behavior with nails), nashta smriti (memory loss), baddhaabaddha bhaashinam (irrelevant speech), akasmaat rudantam (crying suddenly), dukhaani aavedayamaana (sharing his sorrows to everyone)/dukhaani avedayamaana (unable to feel pain), uddhvasta (nakedness), rooksha deha and swara (rough emaciated body and voice), durgandham/ashuchi (unhygienic), rathya chaila trina aabharanam (gross abnormal behavior), and bahvaashinam (hyperphagia). “Nashta smriti” is the unique symptom of PG and it denotes memory impairment commonly seen in conditions like dementia. The clinical features of PG have shown similarity with “Frontotemporal dementia” associated with malnutrition and/or Vitamin B12 deficiency. The present study provides inputs for future research works.
Keywords: Bhutonmada, depression, frontotemporal dementia, grahonmada, Pishacha grahonmada, Vitamin B12 deficiency
How to cite this article:
Mamidi P, Gupta K. Pishacha grahonmada – Frontotemporal dementia with Vitamin B12 deficiency?. AYUHOM 2020;7:47-54 |
| Introduction | |  |
Bhutonmada or Grahonmada (both the words bhutonmada and grahonmada have been used synonymously throughout the present article) are broad terms representing various psychiatric conditions caused by unknown or idiopathic factors. Bhutonmada is characterized by behavioral abnormalities along with abnormal energy levels and motivation, defects in perception, attention, concentration and memory, abnormality in speech and self-perception.[1] Maharshi Vagbhata has documented 18 types of grahonmadas (deva, asura, rushi, guru, vruddha, siddha, pitru, gandharva, yaksha, rakshasa, sarpa, brahma rakshasa, pishacha, kushmanda, nishada, preta, maukirana, and vetala). Pischacha grahonmada (PG) is one among the 18 types of bhutonmada's.[1]
Various grahonmadas have shown similarity with various psychiatric and/or neuropsychiatric conditions according to the previous works.[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16] Description of PG is available in all major classical texts of Ayurveda but there is dissimilarity of the description of clinical features of PG among various texts.[17],[18],[19] The clinical features of PG includes, Aswastha chittam (feeling uneasy), Sthaanamalabhamaanam (pacing/wandering), nritya geeta haasinam (engaged in dance, singing, and jocularity), baddhaabaddha pralaapinam (irrelevant speech), sankara koota malina rathya chela trinaashma kaashta adhirohanaratim (sitting on the heap of sweepings, wearing dirty and torn clothes, wearing garlands prepared by grass as ornaments), bhinna rooksha swaram (dry or rough or harsh voice), nagnam vidhaavantam (wandering without clothes), naikatra tishtantam (unable to sit at one place), dukhaani aavedayantam (sharing his sorrows to everyone)/dukhaani avedayantam (unable to feel pain) and nashta smriti (memory loss) according to Acharya Charaka.[17] According to Sushruta Acharya PG is characterized by Uddhastaha/udvastraha (nakedness/disgusting appearance), krisha (emaciated), parusha bhaashinam (harsh speech/hostile comments), chira pralaapi (excessive irrelevant speech), durgandham and ashuchi (unhygienic), ati lola (gluttony/greedy), bahvaashi (excessive eating/hyperphagia), vijana sevi (social withdrawal), himaambu sevi (fond of cold water), raatri sevi (increased nocturnal activity), vyavigna bhramati (agitation/wandering/hyperactivity) and rodana (crying spells/depression).[18] There is no difference in the description of PG in “Madhava nidaana” and Sushruta samhita.[19]
In Ashtanga samgraha (an Ayurvedic text composed by Acharya Vriddha Vagbhata), detailed description of the clinical features of PG is available. Aswastha chittam (feeling uneasy), naikatra tishtantam (unable to sit at one place), paridhaavinam (wandering/pacing/running), dayita nritya geeta haasa ucchishta ratim (engaged in dancing, singing, jocularity) madya maamsa ratim (fond of eating meat, alcohol abuse), shunya nivaasa ratim (staying alone/social withdrawal), purastaat abhihanantam (starting attacking), nirbhartsanaat (threatening others), deena vadanam (depressed looks), shankita vadanam (suspicious), nakhai aatma vapushi likhantam (self-injurious behavior with nails), nashta smriti (memory loss), baddhaabaddha bhaashinam (irrelevant speech), akasmaat rudantam (crying suddenly), dukhaani aavedayamaana (sharing his sorrows to everyone)/dukhaani avedayamaana (unable to feel pain), uddhvasta (nakedness), rooksha deha (rough emaciated body), rooksha swara (rough or harsh voice), durgandham/ashuchi (unhygiene), nagnam (naked), malinam (unhygienic), rathya chaila trina aabharanam (wearing grass, torn clothes etc. as ornaments), sankara koota kaashta avarohinam (sitting on heap of sweepings), lolam (greediness) and bahvaashinam (hyperphagia) etc., are explained as lakshana's (signs and symptoms) of PG.[20] Ashtanga hridaya (an Ayurvedic text composed by Acharya Vagbhata) has also expressed similar views.[21] Till date, no studies have been conducted on PG and it is the least explored concept in Ayurveda.
Aim and objective
The present study aims at better understanding of PG with the help of contemporary psychiatric literature.
| Review Methodology | | |
Ayurvedic literature regarding “bhutonmada,” “grahonmada” and “pishacha grahonmada” has been collected from major classical Ayurvedic texts and their commentaries. Electronic database “Google scholar” has been searched to find out the relevant studies and reviews published till April 2021, irrespective of their appearance or year of publication. Relevant keywords have been used for search such as, “Unmada,” “Bhutonmada,” “Grahonmada,” “Dementia,” “Frontotemporal dementia,” “FTD,” “Vitamin B12 deficiency,” “BPSD,” “Behavioral and psychological symptoms of dementia,” “Disinhibition,” “Hyperphagia,” “Bipolar psychosis,” “Organic psychosis,” “Mania with psychotic features,” “Neurodegenrative psychiatric disorders,” “Demyelinating psychiatric disorders,” “Nutritional neuroscience,” and “Secondary psychosis.” Both abstracts and full texts having open access and published in the English language were only considered. Relevant Ayurvedic and contemporary psychiatric literature has been collected from the textbooks available at the institutional library where the present work has been carried out.
| Discussion | | |
FTD represents a heterogeneous group of disorders having a wide variety of clinical manifestations.[22] FTD is early onset dementia characterized by progressive behavioral abnormalities, executive dysfunctions, and language problems. Clinical features of FTD include changes in personality, restlessness, apathy, disinhibition, social withdrawal, and impulsiveness. FTD patients show socially inappropriate behaviors, compulsive acts, hallucinations, and paranoid delusions associated with poor insight.[23] FTD is classified into 3 subtypes, “Behavioral variant (FTD bv),” “Semantic variant (SD)” and “Progressive Non fluent Aphasia (PNFA)”. “FTD bv” is characterized by clinical features such as childishness, inappropriate jokes, hypersexuality, poor self-hygiene, changes in eating habits, compulsions, and excessive religiosity. “SD” subtype of FTD is characterized by language impairment which is insidious and slowly progressive (fluent aphasia) and compulsive symptoms. “PNA” subtype of FTD is characterized by clinical features such as language disorder, nonfluent speech, anomia, agrammatism, and paraphasia.[24]
Similarity between frontotemporal dementia and Pischacha grahonmada
There is a profound similarity between the conditions like PG and FTD in terms of etiology, pathogenesis, prognosis, and clinical features [Table 1]. Clinical features of conditions like vitamin deficiencies (especially Vitamin B12, folate), malabsorption and/or malnutrition, etc., have also been found along with the features of FTD in PG. Etiology of sporadic FTD is unknown. The pathophysiology of FTD has not been understood yet.[25] The pathophysiology of FTD is still not clear.[26] Till date, there is no specific and effective treatment for FTD.[23] There is no specific etiology, pathogenesis and prognosis explained for PG hence the common etiology, pathogenesis, and prognosis explained for bhutonmada's, in general, is also applicable for PG.[20] In bhutonmada, causative factors can't be traced out and pragnaaparaadha (intellectual blasphemy) or karma (idiopathic) plays an important role in the pathogenesis of bhutonmada. The reasons explained for grahavesha (affliction by evil spirit/supernatural power) is prgnaaparaadha in the present life or previous life.[1] As there is no clear description of etiology, pathogenesis and management which are specific for PG in Ayurvedic texts, in a similar way for FTD also there is no specific etiology, pathophysiology, and management, are available [Table 1]. Compared to other Ayurvedic texts, “Ashtanga samgraha” and “Ashtanga hridaya” have mentioned the clinical features of PG in an elaborated form.[21] The following sections explore the similarity between the clinical features of PG and Vitamin B12 deficiency-induced FTD [Table 1]. | Table 1: Similarity between Pischacha grahonmada and Vitamin B12 deficiency induced frontotemporal dementia
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Aswastha chittam and Vyavigna – agitation/irritability/anxiety
Serotonin dysfunction has been found associated with features such as irritability, mood changes, and impulsivity which are all also common features of FTD.[24] A subgroup of FTD known as BDD (behavioral disorder and dysexecutive syndrome) is characterized by stereotyped and perseverative behavior, impersistence, poor insight, emotional unconcern, lack of empathy, irritability, atypical depression, psychosis, and mania.[25] “FTD bv” patients display behavior and personality changes, mood changes, changes in motivation and inhibition, and impaired social conduct.[26] Agitation, restlessness, and compulsive acts were found in FTD patients with trichotillomania.[27] These cognitive disturbances along with mood changes of FTD are similar to ”Aswastha chittata” and “Vyavigna” of PG.
Naikatra tishtantam, paridhaavinam, and vyacheshta-inattention/hyperactivity
Hyperactivity, attention deficits, poor abstraction, difficulty shifting mental set, and perseveration are commonly seen cognitive abnormalities in the patients of FTD. Deficits in planning, organization, and other aspects of executive function can also be found in FTD patients. Some FTD patients are fatuous, purposelessly hyperactive, easily distractible, and lack concern.[24] Distractibility is one of the important features of FTD.[25] Aberrant motor behavior and behavioral eccentricities are common in FTD.[28] Seeking exits, eloping, and boundary transgression, etc., can be seen in dementia patients.[29] Distractibility and purposeless hyperactivity are linked with atrophy of the orbito-medial frontal lobes and temporal pole in FTD patients.[30] Naikatra tishtantam, paridhaavinam and vyacheshta etc. behavioral symptoms of PG are similar to deficits in attention and hyperactivity seen in FTD patients.
Raatri sevi – Wandering at nights/Sleep disturbances
Patients with FTD are at risk for elopement and they may require “wander guards.”[24] FTD is associated with disruption of the sleep-wake cycle. Increased nocturnal activity with decreased sleep efficiency and decreased total sleep has been found in FTD patients. Severe frontal and temporal neuronal loss may be the reason for sleep fragmentation and disrupted sleep-wake cycle in FTD patients.[31] Sleep disturbances were found in FTD patients.[28] Sleep disorders are comparable to other dementias.[32] Wandering is one of the most challenging symptoms of dementia (BPSD) manifested in people with dementia.[33] Providing a wandering area at night time in hospitals may allow dementia patients suffering from hyperactivity not to be forced to stay in bed.[32] According to previous works, the median distance moved per day exceeded 10 km in some dementia patients.[32] It seems that “Raatri sevi” mentioned in PG resembles with the sleeplessness and night wandering of FTD patients.
Nritya geeta haasa ratim – hypomania/mania like symptoms
Patients of FTD often lack appropriate basic and social emotions. Impulsivity and disinhibition are common in FTD patients.[24] Clinical features of FTD include personality changes, disinhibition, and socially inappropriate behaviors. Hypomania-like behavior can be seen when temporal areas are afflicted in the patients of FTD. Euphoria, inappropriate joking, excessive self-confidence, etc. mania/hypomania-like features can also be found in FTD patients.[8] Poor social awareness also can be seen in some FTD cases.[34] Patients with FTD commonly violate social norms such as making sexually inappropriate comments, stealing, and public urinating. Disinhibition affects domains of interpersonal conduct (social intrusiveness, rudeness, inappropriate singing, and making abnormal noises), regulation (inappropriate laughter), and sexual propriety (inappropriate touching, kissing, grabbing, sexual advances or public masturbation).[35] Repetitive behaviors such as lip-smacking, hand rubbing/clapping, counting aloud, humming, checking, cleaning, wandering in a fixed route, collecting and hoarding objects, pathological gambling, rituals involving touching, grabbing, and superstitious acts can be seen in FTD patients. Puerile, childish, frivolous, silly behavior associated with foolish or silly euphoria can be seen in some FTD patients.[28]
Madya and Maamsa ratim – Cravings for alcohol and nonvegetarian foods
Strange eating habits are one of the features of FTD.[24] Patients with semantic dementia have shown changes in appetite and food preference.[22] Stereotypic eating behaviors are common in FTD. Altered cortical serotonin levels in FTD may contribute to the changes in satiety and food preferences in the patients of FTD.[34] FTD patients develop obsessions with particular foods and alcoholism. Alterations in eating behavior occur in 80% of FTD patients. Semantic dementia patients are more likely to exhibit food fads or alterations in food preferences.[28] Preference for “Madya” and “Maamsa” in PG patients is similar to altered food preferences mentioned in FTD patients.
Vitamin B12 deficiency, malnutrition, cravings, and frontotemporal dementia
Deficiencies of folate or Vitamin B12 are linked with cognitive deficits, brain atrophy, and dementia.[36] Borderline thiamine status in women is linked with mood swings. Reduced thiamin can contribute to Alzheimer's dementia. Deficiency in Vitamin B12 induces neurological disorders and psychological disturbances. Significant Vitamin B12 deficiency is linked with severe depression. Pernicious anemia is considered a sign of dementia and it is associated with Vitamin B12 deficiency. Vitamin B12 is exclusively present in nonvegetarian foods such as meat, eggs, shellfish, and fish.[37] Cases of FTD like dementia associated with Vitamin B12 deficiency and presenting as a disinhibited behavioral syndrome have been documented.[38] The neuropsychiatric symptoms linked with Vitamin B12 deficiency include slow cerebration, confusion, amnesia, delusions, hallucinations, depression, and psychosis.[39] Vitamin B12 deficiency has been implicated as a cause of psychosis, depression, and dementia.[40] Vitamin B12 deficiency leads to defective myelin synthesis, myelopathy, neuropathy, and neuropsychiatric abnormalities. Psychiatric conditions induced by B12 deficiency are mood disorders (depression and mania), chronic fatigue syndrome, and psychosis. FTD-like syndrome can be caused by B12 deficiency. Chronic alcohol abuse also may lead to Vitamin B complex deficiency.[41] “Madya ratim” mentioned in PG denotes alcoholism which induces Vitamin B12 deficiency or malnutrition or malabsorption finally causing dementia. “Maamsa ratim” denotes the cravings for meat in PG patients which denotes the underlying nutritional deficiency (Vitamin B12/all other vitamins and micronutrients/malnutrition/malabsorption).
Shunya nivaasa ratim/Vijana ratim, Deena vadanam, Akasmaat rudantam, Rudantam animittataha, Dukhaani aavedayamaana-Social withdrawal/Depression
Apathy, emotional blunting, and mutism can be seen in FTD patients. Patients with semantic dementia may display an exaggerated response to pain (dukhaani aavedayamaana?).[24] “FTD bv” is characterized by impaired social function, apathy, withdrawal, and anhedonia.[42] Apathetic subtype of FTD is characterized by anhedonia and avolition, loss of social emotions, and loss of social and interpersonal skills.[35] Apathy-abulia is the most common symptom of FTD. Emotional blunting is most common and worse in FTD patients when compared to patients of Alzheimer's and vascular dementia.[28] Features like apathy, inertia and loss of volition can be seen in FTD patients.[30] The presence of hypochondriacal complaints (dukhaani aavedayamaana?) among FTD patients were also documented.[28] Features like “Shunya nivaasa ratim/Vijana ratim,” ”Deena vadanam,” ”Akasmaat rudantam,” “Rudantam animittataha” and ”Dukhaani aavedayamaana” of PG are similar to social withdrawal, emotional blunting, apathy and depression of FTD.
Nirbhartsanaat, Parusha bhaashanam and Purastaat abhihanantam – threatening/aggressiveness/violence
Some behavioral abnormalities seen (such as moral agnosia or inability to differentiate right from wrong) in patients with FTD are similar to the patients having “Anti-social personality disorder.” Anti-social behavior, poor impulse control, and disinhibition can be found in FTD patients. Verbally inappropriate and sexual comments and gestures can also be seen in FTD patients.[24] Impulsivity, irritability, lack of empathy, etc. can be seen in FTD patients.[25],[42] FTD patients have disturbed moral and social behavior (social inadequacy/awkwardness, tactlessness, decreased propriety and manners, disagreeableness, unacceptable physical contact, and improper physical and verbal acts). FTD patients may engage in stealing, shoplifting, driving violations, inappropriate sexual behavior or comments, indecent exposure, public urination and violence.[28] Features like “Nirbhartsanaat,” ”Parusha bhaashanam” and “Purastaat abhihanantam” of PG are similar to anti-social behavior found in FTD patients.
Shankita vadanam – Paranoid
Persecutory delusions are common in FTD patients.[43] Inappropriate behavior and psychotic symptoms (delusions) are common in FTD patients.[25] FTD patients may display socially inappropriate behavior, poor insight, and psychiatric features (hallucinations and paranoid delusions).[23] Delusions and hallucinations of FTD may be due to an underlying Vitamin B12 deficiency.[28] ”Shankita vadanam” (suspicious looks/paranoid) is one of the features of PG which denotes an underlying persecutory delusion. Based on the above references it can be assumed that “Shankita vadanam” of PG represents the persecutory delusions or paranoia in FTD patients.
Nakhai aatma vapushi likhantam-self injurious behavior
Self-injurious behaviors and impulsiveness can be seen in some FTD patients either in the form of suicide or other self-injurious acts.[44] Restlessness, agitation, compulsive and self-injurious behaviors were documented in a dementia patient with trichotillomania. Simple motor stereotypy (skin picking, head rocking, and lip pursing) and complex motor stereotypy (hair pulling, hand flapping, and wriggling) denote fronto-striatal disease or dysfunction. Serotonin imbalance may play a role in the manifestation of self-injurious behaviors.[27] Threatening self-harm is found in dementia patients along with hyperphagia.[45] Self-injurious behaviors (trichotillomania and picking at fingers) to the point of excoriation are reported in FTD patients.[28] “Nakhai aatma vapushi likhantam” of PG denotes self-injurious behaviors seen in FTD patients.
Nashta smriti-memory impairment
Memory impairment is required to make the diagnosis of dementia. Patients with dementia become impaired in learning new material, or they forget learned material. In advanced stages, the person may forget his or her occupation, family members, schooling, birthday, and sometimes even name. Memory difficulties usually appear later in the course of FTD.[43] Loss of memory for words or a loss of word meaning can be seen in temporal FTD. FTD patients may lose the ability to name and understand words and faces, objects, and other sensory stimuli.[24] The ”Nashta smriti” of PG clearly indicates the memory impairment-related disorder especially FTD.
Baddhaabaddha bhaashinam/Chira pralaapi – aphasia/irrelevant speech
Progressive nonfluent aphasia (PNFA)/Progressive aphasia is one among the three subgroups of FTD. PNFA is an expressive language disorder characterized by severe problems in word retrieval, anomia, agrammatism, and paraphasia. Patients present with changes in speech fluency, word pronunciation, and difficulties in word-finding.[24] Semantic dementia is characterized by language impairment (fluent aphasia). Speech is fluent, empty, and spontaneous in semantic dementia patients.[23] Patients with temporal variant of FTD may display anomia and impaired comprehension.[34] This inappropriate speech or aphasia of FTD resembles with ”Baddhabaddha bhaashinam” or ”Chira pralaapi” of PG.
Dukhaani avedayamaana – Decreased sensitivity to pain/neuropathy
Decreased pain response is one of the features of FTD.[35] Apathetic FTD patients have shown higher pain threshold.[24] Decreased sensitivity to pain or neuropathy (sensorimotor peripheral polyneuropathy, mononeuropathies, autonomic neuropathies, and combined forms) may also denote an underlying Vitamin B12 deficiency. Paraesthesia, skin numbness, unsteady gait, coordination disorders, and paralysis are the most common neurological symptoms manifested by an underlying Vitamin B12 deficiency. Confusion, stupor, apathy, memory and judgment disorders, psychosis, depression, dementia, etc., features of cerebral disorders can also be seen in Vitamin B12 deficiency patients.[46] “Dukhaani avedayamaana” of PG indicates either apathy or increased pain threshold of FTD or underlying neuropathy due to Vitamin B12 deficiency in FTD patients.
Udhvastra/Nagna– Disinhibition
Disinhibition is one of the characteristic features of FTD.[24] Clinical features of FTD include disinhibition, inappropriate social behavior, and pervert sexual behaviors.[23] Early signs of disinhibition are one of the core diagnostic features of FTD.[25] Hypersexuality can also be seen in FTD patients.[42] Patients with FTD violate social norms and may display hypersexual behaviors such as sexually inappropriate comments, public urinating, inappropriate touching, grabbing, kissing, and public masturbation.[35] Patients of FTD may show abnormal social behaviors such as awkwardness, decreased manners and propriety, inappropriate sexual behaviors, indecent exposure, and sexual comments.[28] The “Udvastra” or “Nagna” explained in PG denotes disinhibition or hypersexuality of FTD.
Rooksha deham/Rooksha swara/Krisha/Durbala – malnutrition
Demented older people have a lower body mass index (<23) and malnutrition. Alzheimer's disease patients are more prone to develop protein energy malnutrition. Inadequate dietary intake, increased energy expenditure and dementia related metabolic disturbances may be the reasons for weight loss in dementia patients.[47] Patients with dementia are prone to develop macro and micronutrient deficiencies. Histopathological studies of patients with dementia have revealed deficiency of Vitamin B12, demyelination, neuronal loss, and brain atrophy. Folate deficiency is also linked with dementia and Alzheimer's disease.[48] Patients of dementia should undergo weight monitoring and nutritional assessment.[29] PNFA patients may display reduced and effortful speech with halting. Speech becomes limited, shortened, and finally leads to grunting (rooksha swara?).[25] Verbal stereotypies are common in FTD patients. Frontal lobe dysfunctions would lead to elementary repetitive behaviors (grunting, humming etc).[30] ”Rooksha deha,” ”Krisha” and ”Durbala” (emaciated) are mentioned in PG lakshana's at the same time symptoms like ”Maamsa priya” and ”Bahvaashinam” are also mentioned. It seems that even though the patient of PG takes excessive nutritional food (maamsa priyata and bahvaashinam) he suffers with ”Rooksha deha,” ”Krisha” and ”Durbala” etc.; problems due to underlying malabsorption which ultimately leads to malnutrition, various vitamin deficiencies and cravings.
Durgandham, Ashuchi, Ucchishta ratim, Malinam, Rathya chaila trina aabharanam and Sankara koota kaashta avarohinam – Lack of personal hygiene and inappropriate behavior
Bizarre alterations in dressing, personal neglect, inappropriateness disorganization, and poor insight are seen in FTD patients.[24] Poor-self hygiene and collecting weird objects can be seen in “FTD bv.”[23] Impaired self-care or decline in self-interest is seen in “FTD bv.”[42] Loss of hygiene and self-care are commonly found in FTD patients.[28] Excessive wandering, unpredictable behavior, inappropriate dressing, and bodily concerns are seen in dementia patients.[45] Personal neglect is one of the common behavioral changes of FTD.[30] PG lakshana's like “Durgandham,” ”Ashuchi,” ”Ucchishta ratim,” ”Malinam,” ”Rathya chaila trina aabharanam” and ”Sankara koota kaashta avarohinam” denotes lack of personal hygiene and various inappropriate behaviors of FTD.
Lolam and Bahvaashinam – hyperphagia/gluttony
Overeating or hyperorality with a preference to sweet foods is seen in FTD patients. Strange eating habits can also be seen in FTD patients.[24] Alterations in eating habits like food addiction with high carbohydrate content can be found in FTD patients.[23] Hyperorality of FTD may manifest as gluttony, dietary compulsions, and attempts to consume inedible objects.[25] Increased appetite with a tendency for sweet foods and hyperorality can be seen in FTD patients at advanced stages.[42] Altered food preference toward sweet foods is a prominent early symptom of semantic dementia. Alterations in satiety and food preferences may occur due to the changes in serotonin levels.[34] FTD patients develop gluttony, sweets and carbohydrate cravings, and also obsessions with particular foods.[28] Excessive eating or hyperphagia is present in dementia patients.[45] Alterations in eating behavior are one of the diagnostic criteria for “FTD bv.”[49] Gluttony, food cramming, and indiscriminate eating are particularly seen in apathetic FTD patients.[30] Patients with dementia may exhibit pathological eating habits, food fads, and hyperphagia. Eating alterations are more common in patients with FTD compared to other types of dementia.[50] “Bahvashinam” and “Lolam” of PG denotes hyperphagia or hyperorality and gluttony of FTD.
| Conclusion | | |
PG is one among 18 types of bhutonmada/grahonmada mentioned in various Ayurvedic classical texts. Various similarities have been found between PG and FTD in terms of etiopathology, clinical features, and prognosis. “Nashta smriti” is the unique symptom of PG that denotes memory impairment commonly observed in conditions like dementia. The clinical features of PG have shown similarity with FTD associated with malnutrition and/or Vitamin B12 deficiency. The descriptive results of the present work provide basic understanding of PG and pave the path for future research directions.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Mamidi P, Gupta K. Obsessive compulsive disorder – 'Sangama graha': An Ayurvedic view. J Pharm Sci Innov 2015;4:156-64.  |
| 2. | Mamidi P, Gupta K. Guru, Vriddha, Rishi and Siddha grahonmaada: Geschwind syndrome? Int J Yoga Philos Psychol Parapsychol 2015;3:40-5. |
| 3. | Gupta K, Mamidi P. Gandharva grahonmada: Bipolar disorder with obsessive-compulsive disorder/mania? Int J Yoga Philos Psychol Parapsychol 2017;5:6-13. |
| 4. | Mamidi P, Gupta K. Vetaala Grahonmada: Parkinson's disease with obsessive-compulsive disorder? Autoimmune neuropsychiatric disorder? Int J Yoga Philos Psychol Parapsychol 2017;5:35-41. |
| 5. | Gupta K, Mamidi P. Deva shatru/Daitya/Asura grahonmada: Antisocial/Narcissistic/Borderline personality disorder? Int J Yoga Philos Psychol Parapsychol 2018;6:10-5. |
| 6. | Gupta K, Mamidi P. Yaksha grahonmada: Bipolar disorder with obsessive-compulsive disorder? Int J Yoga Philos Psychol Parapsychol 2018;6:16-23. |
| 7. | Gupta K, Mamidi P. Deva grahonmada: Interictal behavior syndrome of temporal lobe epilepsy?/Obsessive-compulsive disorder with mania? Int J Yoga Philos Psychol Parapsychol 2018;6:41-50. |
| 8. | Mamidi P, Gupta K. Rakshasa grahonmada: Antisocial personality disorder with psychotic mania? Int J Yoga Philos Psychol Parapsychol 2018;6:24-31. |
| 9. | Mamidi P, Gupta K. Brahma rakshasa grahonmada: Borderline personality disorder?/tourette syndrome – plus? Int J Yoga Philos Psychol Parapsychol 2018;6:32-40. |
| 10. | Gupta K, Mamidi P. Nishaada grahonmada: Behavioral and pscyhological symptoms of dementia?/Frontotemporal dementia?/Hebephrenia? J Neurobehav Sci 2018;5:97-101. |
| 11. | Mamidi P, Gupta K. Uraga grahonmada: Extrapyramidal movement disorder?/Tourette syndrome-Plus? Indian J Health Sci Biomed Res 2018;11:215-21. [Full text] |
| 12. | Gupta K, Mamidi P. Preta grahonmada-Catatonia? Med J DY Patil Vidyapeeth 2018;11:461-5. [Full text] |
| 13. | Mamidi P, Gupta K. Maukirana grahonmada – Psychiatric manifestations of Graves' hyperthyroidism and ophthalmopathy? Med J DY Patil Vidyapeeth 2018;11:466-70. [Full text] |
| 14. | Gupta K, Mamidi P. Kushmanda grahonmada-Paraneoplastic neurological syndrome with testicular cancer? J Neurobehav Sci 2018;5:172-6. |
| 15. | Gupta K, Mamidi P. Bhutonmada's of Harita samhita-An explorative study. Int J Yoga Philos Psychol Parapsychol 2020;8:3-12. |
| 16. | Mamidi P, Gupta K. Vishesha or Upa Grahonmadas: Various psychiatric and neuropsychiatric conditions. Int J Yoga Philos Psychol Parapsychol 2021;9:23-31. |
| 17. | Agnivesha, Elaborated by Charaka and Dridhabala commentary by Chakrapani. Charaka samhita, Chikitsa Sthana, Unmada Chikitsitam Adhyaya, 9/20-21, Edited by Vaidya Jadavji Trikamji Acharya. Varanasi: Chaukhamba Surbharati Prakashan; 2008. p. 469-70. |
| 18. | Sushruta. Sushruta Samhita, Commentary by Dalhana. Uttara Tantra, Amanusha Upasarga Pratishedha Adhyaya, 60/15, Edited by Vaidya Jadavji Trikamji Acharya and Narayana Ram Acharya. Varanasi: Chaukhamba orientalia; 2009. p. 795. |
| 19. | Madhavakara. Rogavinischaya/Madhava Nidana, Unmada nidana, 20/25, Commentary 'Madhukosha' by Vijayarakshita and Shrikanthadatta, Edited by Dr. Brahmananda Tripathi. 1 st ed. Varanasi: Chaukhamba Surbharati Prakashan; 2012. p. 491-2. |
| 20. | Vriddha Vagbhata. Ashtanga Sangraha, Commentary by Indu, Uttara Tantra, Bhoota Vigyaneeyam Adhyaya, 7/4-34, Edited by Dr. Shivprasad Sharma. 3 rd ed. Varanasi: Chowkhamba Sanskrit Series Office; 2012. p. 670. |
| 21. | Vagbhata. Ashtanga Hridaya, Commentary by Arunadatta and Hemadri, Uttara Tantra, Bhoota Vigyaneeyam Adhyaya, 4/30-33, Edited by Bhishagacharya Harishastri Paradkara Vaidya. 9 th ed. Varanasi: Chowkhamba Sanskrit Series Office; 2005. p. 792. |
| 22. | Edwards-Lee T, Miller BL, Benson DF, Cummings JL, Russell GL, Boone K, et al. The temporal variant of frontotemporal dementia. Brain 1997;120:1027-40. |
| 23. | Onur E, Yalinay PD. Frontotemporal dementia and psychiatric symptoms. Dusunen Adam 2011;24:228. |
| 24. | Weder ND, Aziz R, Wilkins K, Tampi RR. Frontotemporal dementias: A review. Ann Gen Psychiatry 2007;6:15. |
| 25. | Grossman M. Frontotemporal dementia: A review. J Int Neuropsychol Soc 2002;8:566-83. |
| 26. | Hornberger M, Piguet O, Kipps C, Hodges JR. Executive function in progressive and nonprogressive behavioral variant frontotemporal dementia. Neurology 2008;71:1481-8. |
| 27. | Paholpak P, Mendez MF. Trichotillomania as a manifestation of dementia. Case Rep Psychiatry. 2016. 2016: 9782702. [doi: 10.1155/2016/9782702]. |
| 28. | Mendez MF, Lauterbach EC, Sampson SM, ANPA Committee on Research. An evidence-based review of the psychopathology of frontotemporal dementia: A report of the ANPA Committee on Research. J Neuropsychiatry Clin Neurosci 2008;20:130-49. |
| 29. | Yayama S, Yamakawa M, Suto S, Greiner C, Shigenobu K, Makimoto K. Discrepancy between subjective and objective assessments of wandering behaviours in dementia as measured by the Algase Wandering Scale and the Integrated Circuit tag monitoring system. Psychogeriatrics 2013;13:80-7. |
| 30. | Snowden JS, Bathgate D, Varma A, Blackshaw A, Gibbons ZC, Neary D. Distinct behavioural profiles in frontotemporal dementia and semantic dementia. J Neurol Neurosurg Psychiatry 2001;70:323-32. |
| 31. | Anderson KN, Hatfield C, Kipps C, Hastings M, Hodges JR. Disrupted sleep and circadian patterns in frontotemporal dementia. Eur J Neurol 2009;16:317-23. |
| 32. | Billiard M, Dauvilliers Y. Neurodegenerative diseases and sleep disorders. Schweiz Arch Neurol Psychiatr 2003;154:384-90. |
| 33. | Yamakawa M, Suto S, Shigenobu K, Kunimoto K, Makimoto K. Comparing dementia patients' nighttime objective movement indicators with staff observations. Psychogeriatrics 2012;12:18-26. |
| 34. | Ikeda M, Brown J, Holland AJ, Fukuhara R, Hodges JR. Changes in appetite, food preference, and eating habits in frontotemporal dementia and Alzheimer's disease. J Neurol Neurosurg Psychiatry 2002;73:371-6. |
| 35. | Adamec I, Klepac N, Mubrin Z, Habek M. Genital self mutilation in a patient with frontotemporal dementia. Neurol. Croat 2013;62:1-2. |
| 36. | Smith AD. The worldwide challenge of the dementias: A role for B vitamins and homocysteine? Food Nutr Bull 2008;29:S143-72. |
| 37. | Bourre JM. Effects of nutrients (in food) on the structure and function of the nervous system: update on dietary requirements for brain. Part 1: Micronutrients. J Nutr Health Aging 2006;10:377-85. |
| 38. | Blundo C, Marin D, Ricci M. Vitamin B12 deficiency associated with symptoms of frontotemporal dementia. Neurol Sci 2011;32:101-5. |
| 39. | Kalita J, Agarwal R, Chandra S, Misra UK. A study of neurobehavioral, clinical psychometric, and P3 changes in Vitamin B12 deficiency neurological syndrome. Nutr Neurosci 2013;16:39-46. |
| 40. | Kannan R, Ng MJ. Cutaneous lesions and Vitamin B12 deficiency: An often-forgotten link. Can Fam Physician 2008;54:529-32. |
| 41. | Briani C, Dalla Torre C, Citton V, Manara R, Pompanin S, Binotto G, et al. Cobalamin deficiency: Clinical picture and radiological findings. Nutrients 2013;5:4521-39. |
| 42. | Manes FF, Torralva T, Roca M, Gleichgerrcht E, Bekinschtein TA, Hodges JR. Frontotemporal dementia presenting as pathological gambling. Nat Rev Neurol 2010;6:347-52. |
| 43. | American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders – Text Revision (DSM-IV-TR). Dementia-Delirium, Dementia, and Amnestic and Other Cognitive Disorders. 4 th ed. New Delhi: Jaypee Publications; 2000. p. 148-66. |
| 44. | Fonseca L, Machado Á. Suicidal behaviour in frontotemporal dementia patients – A retrospective study. Int J Geriatr Psychiatry 2014;29:217-8. |
| 45. | Smith G, Vigen V, Evans J, Fleming K, Bohac D. Patterns and associates of hyperphagia in patients with dementia. Neuropsychiatry Neuropsychol Behav Neurol 1998;11:97-102. |
| 46. | Gröber U, Kisters K, Schmidt J. Neuroenhancement with Vitamin B12-underestimated neurological significance. Nutrients 2013;5:5031-45. |
| 47. | Faxén-Irving G, Basun H, Cederholm T. Nutritional and cognitive relationships and long-term mortality in patients with various dementia disorders. Age Ageing 2005;34:136-41. |
| 48. | Kiliç MK, Sümer F, Ülger Z. Nutritional issues in dementia patients. Turk J Med Sci 2015;45:1020-5. |
| 49. | Ahmed RM, Latheef S, Bartley L, Irish M, Halliday GM, Kiernan MC, et al. Eating behavior in frontotemporal dementia: Peripheral hormones vs hypothalamic pathology. Neurology 2015;85:1310-7. |
| 50. | Aiello M, Silani V, Rumiati RI. You stole my food! Eating alterations in frontotemporal dementia. Neurocase 2016;22:400-9. |
[Table 1]
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