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Aims: Subjective Cognitive Decline (SCD) represents the earliest, reversible stage in Alzheimer’s dementia (AD) spectrum, marked by self-appraised cognitive deterioration, that escapes objective detection. The intricate fine-tuning of cognition by cerebellum has been substantiated by the Cerebellar Cognitive Affective Syndrome and “Dysmetria of thought” theory. However, the role of cerebellum in SCD is understated in research. This study aims to determine the relationship between cerebellar neuroimaging parameters and cognition in patients with SCD. Methods: Patients with SCD, with a Clinical Dementia Rating score of 0, were assessed on Addenbrooke’s Cognitive Examination-III (ACE). Multiparametric MRI (Volumetric analysis of cerebellum, Diffusion tensor imaging at Middle Cerebellar Peduncles (MCP), Magnetic resonance spectroscopy (MRS)) was carried out. Relationship between cognition and neuroimaging parameters was determined. Results: A total of 28 SCD patients with a mean age of 70.89±3.89 years were included. There were significant positive correlations of attention with axial diffusivities (AxD) at bilateral MCP; fluency with right cerebellar white matter volumes (CWMV); visuospatial function with left CWMV and fractional anisotropy (FA); total ACE scores with total CWMV, bilateral AxD. Significant negative correlations of myoinositol/creatine (mI/Cr) with attention, fluency and memory were revealed on MRS. Linear regression analysis exhibited significant associations between total ACE scores and CWMV; attention and axial diffusivities; memory and right cerebellar volume; fluency and CWMV, Cerebellar cortical volumes; Visuo-spatial function and FA at left MCP. Conclusion: The aforementioned significant relationships highlight the unique role of multiparametric neuroimaging in early detection of cerebellar ultrastructural alterations, and the modulatory impact of cerebellum in cognition during initial stages of AD continuum. Furthermore, longitudinal studies are warranted to predict long term cognitive outcomes in SCD using cerebellar neuroimaging parameters.

Introduction Punding is a unique stereotypical, repetitive, non‐goal‐directed behavior characterized by an intense fascination with daily objects. This behavior although commonly seen in dementia patients is relatively less studied. In this study, we aimed to assess the effectiveness of combination treatment of escitalopram and risperidone treatment in the punding behavior of dementia patients. Methodology A retrospective study of dementia patients with punding behavior treated inpatient with a combination treatment of escitalopram and risperidone from January 2023 to October 2023. A semi‐structured proforma was used to collect the demographic details, illness information, and outcomes based on standardized rating scales from the records of a tertiary care center in India. The data were analyzed using paired t‐test and McNemar test. Results A total of 29 patients, 17 females and 12 males with a mean age of 74.14 ± 7.18 years were included. A significant decline was found in the Neuropsychiatric Inventory (NPI) motor behavior subscale score and caregiver distress related to motor behavior from Day 0 to Day 7 (p‐value of 0.0002, p = 0.001) on the combination treatment. However, the total NPI Severity Score and total QUIP‐RP Score (for repetitive behavior) exhibited a reduction in scores from Day 0 to Day 7 but the p‐value was non‐significant. Conclusion The study adds valuable insights into the management of punding behavior and its associated distress providing a basis for further research on the neurobiological underpinnings of this distinctive symptom in dementia.

Koro is a culture-bound syndrome prevalent in South-East Asian cultures. It is characterised by acute anxiety due to the fear of genital retraction which is believed to lead to death. While predominantly observed in men, cases involving women at an early age have been reported during Koro outbreaks. This paper describes a sporadic case of Koro-like syndrome in a South Asian woman in her 70s focusing on the psychological underpinnings contributing to its development and the importance of adopting a comprehensive management plan that addresses both psychiatric symptoms and co-occurring somatic issues.