Acute relationships between mental health and cognitive function during the COVID-19 pandemic: Longitudinal evidence from middle-aged and older US adults

Biopsychosocial risk factors for subjective cognitive decline among older adults during the COVID-19 pandemic: a population-based study

OBJECTIVES

There have been concerns that the COVID-19 pandemic and the measures used to contain it impacted the cognitive health of older adults. We therefore examined the prevalence of subjective cognitive decline, and its associated risk factors and health consequencs, among dementia-free older adults 2 years into the pandemic in Switzerland.

STUDY DESIGN

Population-based cohort study.

METHODS

Prevalence of SCD was estimated using the cognitive complaint questionnaire administered to adults aged ≥65 years in June-September 2022 (Specchio-COVID19 cohort, N = 1414), and compared to prepandemic values from 2014 to 2018 (CoLaus|PsyCoLaus cohort, N = 1181). Associated risk factors and health consequences were assessed using logistic and/or linear regression.

RESULTS

Prevalence of SCD in 2022 (18.9% [95% CI, 16.2-21.9]) was comparable to prepandemic levels in 2014-2018 (19.5% [17.2-22.1]). Risk factors included established risks for dementia-namely health issues, health behaviours, and depressive symptoms. Self-reported post-COVID, perceived worsening of mental health since the start of the pandemic, less frequent social club attendance, and increased loneliness were also risk factors for SCD. In turn, SCD was associated with poorer objective cognitive performance, difficulty performing instrumental activities of daily living, greater risk of falls, and lower well-being at one-year follow-up.

CONCLUSIONS

While the overall prevalence of SCD in 2022 was comparable to prepandemic levels, we identified several pandemic-related risk factors for SCD, including perceived worsening of mental health and increased isolation since the start of the pandemic. These findings highlight the importance of mental health promotion strategies in reducing cognitive complaints and preventing cognitive decline.

Milk Fat Globule Membranes for Mental Health across the Human Lifespan

The milk fat globule membrane (MFGM) contains bioactive proteins, carbohydrates, and lipids. Polar lipids found in the MFGM play a critical role in maintaining cell membrane integrity and neuronal signalling capacity, thereby supporting brain health. This review summarises the literature on the MFGM and its phospholipid constituents for improvement of mental health across three key stages of the human lifespan, i.e., infancy, adulthood, and older age. MFGM supplementation may improve mental health by reducing neuroinflammation and supporting neurotransmitter synthesis through the gut-brain axis. Fortification of infant formula with MFGMs is designed to mimic the composition of breastmilk and optimise early gut and central nervous system development. Early behavioural and emotional development sets the stage for future mental health. In adults, promising results suggest that MFGMs can reduce the negative consequences of situational stress. Preclinical models of age-related cognitive decline suggest a role for the MFGM in supporting brain health in older age and reducing depressive symptoms. While there is preclinical and clinical evidence to support the use of MFGM supplementation for improved mental health, human studies with mental health as the primary target outcome are sparce. Further high-quality clinical trials examining the potential of the MFGM for psychological health improvement are important.

Social isolation during the COVID-19 pandemic is associated with the decline in cognitive functioning in young adults

Coronaviruses have caused widespread disease and death worldwide, leading to the implementation of lockdown measures and the closure of educational institutions in various countries. This research aims to investigate the impact of social isolation on the cognitive functioning of young students. The study included 84 subjects, with 48 being socially isolated and 36 non-isolated individuals. The participants' mental health was assessed using the Mini-Mental State Examination (MMSE), while cognitive functions were evaluated through attention-switching tasks (AST), pattern recognition memory (PRM), and choice reaction time (CRT) tests utilizing the Cambridge Neuropsychological Automated Battery (CANTAB) software. The socially isolated group had an average age of 21.3 ± 1.1 years, whereas the non-isolated group had an average age of 22.8 ± 2.0 years. The MMSE scores were 25.8 ± 1.6 for the socially isolated group and 28.6 ± 1.3 for the non-isolated group. In terms of cognitive functioning, there were significant differences (p = 0.000) observed in the values of AST correct latency for non-switching blocks (blocks 3 and 5) between the socially isolated group (608.1 ± 139.2) and the non-isolated group (499.5 ± 67.8). Similarly, the AST mean correct latency for switching blocks (block 7) was significantly different (p = 0.012) between the socially isolated group (784.4 ± 212.5) and the non-isolated group (671.8 ± 175.6). The socially isolated group exhibited significantly higher values in AST correct mean latency, AST congruent mean latency, AST incongruent mean latency, and AST percent mean correct trials compared to the non-isolated group. Additionally, the PRM mean percent correct significantly differed (p = 0.000) between the isolated group (81.3 ± 12.0) and the non-isolated group (91.9 ± 9.2). The isolated group also showed a higher CRT correct mean latency (482.4 ± 128.9) than the non-isolated group (451.0 ± 59.0), however the difference was not significant. In conclusion, social isolation during the COVID-19 pandemic has resulted in a decline in the cognitive functioning of young students.

The impact of loneliness and social isolation during COVID-19 on cognition in older adults: a scoping review

Background

The COVID-19 pandemic required implementation of public health measures to reduce the spread of SARS CoV-2. This resulted in social isolation and loneliness for many older adults. Loneliness and social isolation are associated with cognitive decline, however, the impact of this during COVID-19 has not been fully characterized.

Objective

The aim of this scoping review was to explore the impact of social isolation and loneliness during COVID-19 on cognition in older adults.

Eligibility criteria

Eligible studies occurred during the COVID-19 pandemic, enrolled older adults and reported longitudinal quantitative data on both loneliness (exposure) and cognition (outcome).

Sources of evidence

A comprehensive search was conducted in CINAHL, Medline, PubMed, and Psychinfo databases (updated October 10, 2023).

Charting methods

Studies were screened independently by two reviewers and study characteristics, including participant demographics, loneliness and cognition measurement tools, study objectives, methods and results were extracted.

Results

The search yielded 415 results, and seven were included in the final data synthesis. All studies were conducted between 2019 and 2023. Six studies enrolled community-dwelling individuals while the remaining study was conducted in long-term care. In 6 studies, loneliness and/or social isolation was correlated with poorer cognitive function. In the seventh study, subjective memory worsened, while objective cognitive testing did not.

Conclusion

Loneliness and social isolation during COVID-19 were correlated with cognitive decline in older adults. The long-term effect of these impacts remains to be shown. Future studies may focus on interventions to mitigate the effects of loneliness and social isolation during future pandemics.

The longer-term impact of the COVID-19 pandemic on wellbeing and subjective cognitive functioning of older adults in Belgium

In earlier survey research, we observed a severe impact of the first peak of the COVID-19 pandemic on the subjective wellbeing, sleep and activity of adults aged 65 years or older in Flanders, Belgium. The impact on subjective cognitive functioning, however, was limited. Since then, periods of lockdown and periods with less strict regulations alternated, but social distancing remained, especially for older adults. To study the longer-term impact of the pandemic on wellbeing and subjective cognitive functioning, we re-assessed the older adults from the first measurement moment (May-June 2020) in a second (June-July 2020) and third (December 2020) wave of the survey (n = 371, M = 72 years old, range 65-97 years old). Results indicated that wellbeing fluctuated with the severity of the pandemic. Results for self-reported cognitive functioning were mixed. While participants indicated a slightly better general subjective cognitive functioning at the end of the study, experienced problems with most cognitive subdomains significantly increased over time. The presence of depressive and anxiety symptoms were related to the longer-term impact of the pandemic on wellbeing and subjective cognitive functioning. Our study shows the long-lasting impact of the pandemic on the wellbeing and subjective cognitive functioning of older adults, without full recovery from the first wave.

Changes in Older Adults' Frequency of Going Outside between 2020 and 2021: Associations with Health Status and Environmental Factors

OBJECTIVES

To examine the changes in the frequency of going outside among U.S. older adults between 2020 and 2021 (post-COVID vaccine) and correlates of those changes.

METHODS

We used the 2019-2021 National Health and Aging Trend Study (NHATS) (N = 3,063, age 70+) and multinomial logistic regression to analyze associations of increased and decreased frequencies in going outside with physical, psychosocial, and cognitive health, environmental (COVID concerns and transportation) factors, and social media use as the independent variables.

RESULTS

In 2021 compared to 2020, 13% and 16% of those age 70+ reported increased and decreased frequencies, respectively. Increased frequency was associated with social media use. Decreased frequency was associated with poor physical health, depression/anxiety, and perceived memory decline. COVID concerns and transportation problems, as well as female gender, age 90+, and being non-Hispanic Black, were also significant correlates of decreased frequency.

CONCLUSIONS

Most U.S. adults age 70+ appear to have resumed their 2019 level of frequency of going outside in 2021 after the COVID vaccines became available; however, 16% reported decreased frequency of going outside in 2021 compared to 2020.

CLINICAL IMPLICATIONS

Older adults with physical, mental, and cognitive health challenges need help to increase their frequency of going outside.

Executive Functioning Constructs in Anxiety, Obsessive-Compulsive, Post-Traumatic Stress, and Related Disorders

PURPOSE OF REVIEW

We synthesize theories proposing complex relations between cognitive functioning and anxiety-related concepts. We evaluate vulnerability theories suggesting that deficits in various cognitive functioning domains predict future anxiety-associated concepts. We examine scar theories asserting the opposite direction of effects (i.e., anxiety predicting cognitive dysfunction). Furthermore, we examine more novel frameworks on this topic.

RECENT FINDINGS

Reliable evidence exists for the scar and vulnerability theories. This includes mounting data on diverse anxiety symptoms predicting cognitive dysfunction (and conversely) unfolding at between- and within-person levels (dynamic mutualism theory). It also includes data on the stronger effects or central influence of anxiety (versus non-anxiety) symptoms on executive functioning (EF; i.e., higher-order cognitive control governing myriad thinking and action repertoires) versus non-EF domains and vice versa (network theory). In addition, it reviews emerging evidence that enhanced cognitive control can correlate with higher anxiety among children (overgeneralized control theory). The generally inverse relations between anxiety symptoms and cognitive dysfunction are bidirectional and complex within and between persons. Plausible mediators and moderators merit more attention, including immune, metabolism, and neural markers and the social determinants of health.

Increased risk of transurethral and suprapubic catheter self-extraction in COVID-19 patients: real-life experience

INTRODUCTION

This study evaluated the prevalence of transurethral catheter self-removal in critically-ill COVID-19 non-sedated adult patients compared with non-COVID-19 controls.

METHODS

COVID-19 patients who self-extracted transurethral or suprapubic catheters needing a urological intervention were prospectively included (group A). Demographic data, medical and nursing records, comorbidities and nervous system symptoms were evaluated. Agitation, anxiety and delirium were assessed by the Richmond Agitation and Sedation Scale (RASS). The control group B were non-COVID-19 patients who self-extracted transurethral/suprapubic catheter in a urology unit (subgroup B1) and geriatric unit (subgroup B2), requiring a urological intervention in the same period.

RESULTS

37 men and 11 women were enrolled in group A. Mean RASS score was 3.1 ± 1.8. There were 5 patients in subgroup B1 and 11 in subgroup B2. Chronic comorbidities were more frequent in group B than the COVID-19 group (P<0.01). COVID-19 patients had a significant difference in RASS score (P<0.006) and catheter self-extraction events (P<0.001). Complications caused by traumatic catheter extractions (severe urethrorrhagia, longer hospital stay) were greater in COVID-19 patients.

CONCLUSION

This is the first study focusing on the prevalence and complications of catheter self-removal in COVID-19 patients. An increased prevalence of urological complications due to agitation and delirium related to COVID-19 has been demonstrated-the neurological sequelae of COVID-19 must be considered during hospitalisation.