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Umeda S, Kanemoto H, Suzuki M, Wada T, Suehiro T, Kakeda K, Nakatani Y, Satake Y, Yamakawa M, Koizumi F, Taomoto D, Hikida S, Hirakawa N, Sommerlad A, Livingston G, Hashimoto M, Yoshiyama K, Ikeda M. Validation of the Japanese version of the Social Functioning in Dementia scale and COVID-19 pandemic's impact on social function in mild cognitive impairment and mild dementia. Int Psychogeriatr 2024:1-14. [PMID: 38462968 DOI: 10.1017/s1041610224000401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
OBJECTIVES We aimed to psychometrically evaluate and validate a Japanese version of the Social Functioning in Dementia scale (SF-DEM-J) and investigate changes in social function in people with dementia during the coronavirus disease-19 (COVID-19) pandemic. DESIGN We interviewed people with mild cognitive impairment (MCI) and mild dementia and their caregivers during June 2020-March 2021 to validate patient- and caregiver-rated SF-DEM-J and compared their scores at baseline (April 2020 to May 2020) and at 6-8 months (January 2021 to March 2021) during a time of tighter COVID-19 restrictions. SETTING The neuropsychology clinic in the Department of Psychiatry at Osaka University Hospital and outpatient clinic in the Department of Psychiatry and Neurology at Daini Osaka Police Hospital, Japan. PARTICIPANTS 103 dyads of patients and caregivers. MEASUREMENTS SF-DEM-J, Mini-Mental State Examination, Neuropsychiatric Inventory, UCLA Loneliness Scale, and Apathy Evaluation Scale. RESULTS The scale's interrater reliability was excellent and test-retest reliability was substantial. Content validity was confirmed for the caregiver-rated SF-DEM-J, and convergent validity was moderate. Caregiver-rated SF-DEM-J was associated with apathy, irritability, loneliness, and cognitive impairment. The total score of caregiver-rated SF-DEM-J and the score of Section 2, "communication with others," significantly improved at 6-8 months of follow-up. CONCLUSIONS The SF-DEM-J is acceptable as a measure of social function in MCI and mild dementia. Our results show that the social functioning of people with dementia, especially communicating with others, improved during the COVID-19 pandemic, probably as a result of adaptation to the restrictive life.
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Affiliation(s)
- Sumiyo Umeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- Department of Psychiatry and Neurology, Daini Osaka Police Hospital, Osaka, Japan
- Department of Psychiatry and Mental Health, Sumitomo Hospital, Osaka, Japan
| | - Hideki Kanemoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Maki Suzuki
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- Department of Behavioral Neurology and Neuropsychiatry, Osaka University United Graduate School of Child Development, Suita, Osaka, Japan
| | - Tamiki Wada
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- Department of Psychiatry and Neurology, Daini Osaka Police Hospital, Osaka, Japan
| | - Takashi Suehiro
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kyosuke Kakeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- Department of Psychiatry, Medical Corporation Seiwakai Hanwaizumi Hospital, Izumi, Osaka, Japan
| | - Yoshitaka Nakatani
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- Department of Psychiatry, Osaka Psychiatric Medical Center, Hirakata, Osaka, Japan
| | - Yuto Satake
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Maki Yamakawa
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Fuyuki Koizumi
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Daiki Taomoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Sakura Hikida
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Natsuho Hirakawa
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Andrew Sommerlad
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Mamoru Hashimoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- Department of Neuropsychiatry, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Kenji Yoshiyama
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Manabu Ikeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Ahmed W, Feng J, Zhang Y, Chen L. SARS-CoV-2 and Brain Health: New Challenges in the Era of the Pandemic. Microorganisms 2023; 11:2511. [PMID: 37894169 PMCID: PMC10609574 DOI: 10.3390/microorganisms11102511] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/13/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023] Open
Abstract
Respiratory viral infections have been found to have a negative impact on neurological functions, potentially leading to significant neurological impairment. The SARS-CoV-2 virus has precipitated a worldwide pandemic, posing a substantial threat to human lives. Growing evidence suggests that SARS-CoV-2 may severely affect the CNS and respiratory system. The current prevalence of clinical neurological issues associated with SARS-CoV-2 has raised significant concerns. However, there needs to be a more comprehensive understanding of the specific pathways by which SARS-CoV-2 enters the nervous system. Based on the available evidence, this review focuses on the clinical neurological manifestations of SARS-CoV-2 and the possible mechanisms by which SARS-CoV-2 invades the brain.
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Affiliation(s)
- Waqas Ahmed
- Department of Neurosurgery, Neuroscience Center, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510310, China
- School of Medicine, Southeast University, Nanjing 210009, China
| | - Jia Feng
- Department of Neurosurgery, Neuroscience Center, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510310, China
- Guangdong Second Provincial General Hospital, Guangzhou 510317, China
| | - Yifan Zhang
- Department of Neurosurgery, Neuroscience Center, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510310, China
| | - Lukui Chen
- Department of Neurosurgery, Neuroscience Center, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou 510310, China
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Liang J, Aranda MP. The Use of Telehealth Among People Living With Dementia-Caregiver Dyads During the COVID-19 Pandemic: Scoping Review. J Med Internet Res 2023; 25:e45045. [PMID: 37227755 PMCID: PMC10251224 DOI: 10.2196/45045] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/07/2023] [Accepted: 03/30/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Telehealth has gained substantial attention during the COVID-19 pandemic, and reimbursement policies in health care settings have increased access to remote modes of care delivery. Telehealth has the potential to mitigate care concerns for people living with dementia and their family caregivers. There is a paucity of knowledge on the performance of telehealth services and user experiences, especially among caregiving dyads during the pandemic. OBJECTIVE This study aims to describe the implementation, effectiveness, user experience, and barriers to accessing and using telehealth services for people living with dementia and their caregivers during the COVID-19 pandemic. METHODS Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist, we searched 7 databases (PubMed, PsycINFO, AgeLine, CINAHL, Social Services Abstracts, Web of Science, and Scopus) and a web-based search engine (Google Scholar). The inclusion criteria for peer-reviewed English publications from March 2020 to August 2022 consisted of studies related to telehealth services for people living with dementia and their family caregivers and studies conducted during the COVID-19 pandemic. RESULTS A total of 24 articles (10 quantitative and 14 qualitative studies) from 10 different countries were included. The major findings of the reviewed articles were extracted and organized into the following 4 themes: study design characteristics-strategies were adopted to improve the accessibility and experience of people living with dementia-caregiver dyads; efficacy outcomes of telehealth services-robust evidence is lacking on the comparative effectiveness of in-person services; perceived experiences of people living with dementia and caregivers-most reviewed studies reported positive experiences of using telehealth services and perceived personal and social benefits from their participants; and barriers to accessing and using telehealth services-several barriers related to individuals, infrastructure, and telehealth environments were identified. CONCLUSIONS Although evidence of its effectiveness is still limited, telehealth is widely accepted as a viable alternative to in-person care for high-risk groups, such as people living with dementia and their caregivers. Future research should include expanding digital access for those with limited resources and low technology literacy, adopting randomized controlled trial designs to establish the comparative effectiveness of different modes of service delivery, and increasing the sample diversity.
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Affiliation(s)
- Jiaming Liang
- Edward R Roybal Institute on Aging, Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
| | - Maria P Aranda
- Edward R Roybal Institute on Aging, Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
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Park JM, Woo W, Lee SC, Park S, Yon DK, Lee SW, Smith L, Koyanagi A, Shin JI, Kim YW. Prevalence and Mortality Risk of Neurological Disorders during the COVID-19 Pandemic: An Umbrella Review of the Current Evidence. Neuroepidemiology 2023; 57:129-147. [PMID: 37044073 DOI: 10.1159/000530536] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/22/2023] [Indexed: 04/14/2023] Open
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19), a global pandemic, has infected approximately 10% of the world's population. This comprehensive review aimed to determine the prevalence of various neurological disorders in COVID-19 without overlapping meta-analysis errors. METHODS We searched for meta-analyses on neurological disorders following COVID-19 published up to March 14, 2023. We obtained 1,184 studies, of which 44 meta-analyses involving 9,228,588 COVID-19 patients were finally included. After confirming the forest plot of each study and removing overlapping individual studies, a re-meta-analysis was performed using the random-effects model. RESULTS The summarized combined prevalence of each neurological disorder is as follows: stroke 3.39% (95% confidence interval, 1.50-5.27), dementia 6.41% (1.36-11.46), multiple sclerosis 4.00% (2.50-5.00), epilepsy 5.36% (-0.60-11.32), Parkinson's disease 0.67% (-1.11-2.45), encephalitis 0.66% (-0.44-1.77), and Guillain-Barré syndrome 3.83% (-0.13-7.80). In addition, the mortality risk of patients with comorbidities of COVID-19 is as follows: stroke OR 1.63 (1.23-2.03), epilepsy OR 1.71 (1.00-2.42), dementia OR 1.90 (1.31-2.48), Parkinson's disease OR 3.94 (-2.12-10.01). CONCLUSION Our results show that the prevalence and mortality risk may increase in some neurological diseases during the COVID-19 pandemic. Future studies should elucidate the precise mechanisms for the link between COVID-19 and neurological diseases, determine which patient characteristics predispose them to neurological diseases, and consider potential global patient management.
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Affiliation(s)
- Jong Mi Park
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Wongi Woo
- Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Sang Chul Lee
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seoyeon Park
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Seung Won Lee
- Department of Data Science, Sejong University College of Software Convergence, Seoul, Republic of Korea
- Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Lee Smith
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Deu/CIBERSAM, ISCIII, Universitat de Barcelona, Fundacio Sant Joan de Deu, Sant Boi de Llobregat, Barcelona, Spain
- ICREA, Pg. Lluis Companys 23, Barcelona, Spain
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong Wook Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Beach B, Steel N, Steptoe A, Zaninotto P. Associations of cognitive impairment with self-isolation and access to health and care during the COVID-19 pandemic in England. Sci Rep 2023; 13:5026. [PMID: 36977759 PMCID: PMC10043531 DOI: 10.1038/s41598-023-31241-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 03/08/2023] [Indexed: 03/30/2023] Open
Abstract
This research explored experiences across three cognitive function groups (no impairment, mild impairment, and dementia) with respect to shielding (either self-isolating or staying at home), COVID-19 infection, and access to health/care services during the COVID-19 pandemic. Analyses were conducted using data from the English Longitudinal Study of Ageing (ELSA) COVID-19 sub-study collected in 2020. We report bivariate estimates across our outcomes of interest by cognitive function group along with multivariate regression results adjusting for demographic, socioeconomic, geographic, and health characteristics. Rates of shielding were high across all cognitive function groups and three measured time points (April, June/July, and Nov/Dec 2020), ranging from 74.6% (95% confidence interval 72.9-76.2) for no impairment in Nov/Dec to 96.7% (92.0-98.7) for dementia in April (bivariate analysis). 44.1% (33.5-55.3) of those with dementia experienced disruption in access to community health services by June/July compared to 34.9% (33.2-36.7) for no impairment. A higher proportion of those with mild impairment reported hospital-based cancellations in June/July (23.1% (20.1-26.4)) and Nov/Dec (16.3% (13.4-19.7)) than those with no impairment (18.0% (16.6-19.4) and 11.7% (10.6-12.9)). Multivariate adjusted models found that those with dementia were 2.4 (1.1-5.0) times more likely than those with no impairment to be shielding in June/July. All other multivariate analyses found no statistically significant differences between cognitive function groups. People with dementia were more likely than people with no impairment to be shielding early in the pandemic, but importantly they were no more likely to experience disruption to services or hospital treatment.
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Affiliation(s)
- Brian Beach
- UCL Research Department of Epidemiology & Public Health, University College London, London, UK.
| | - Nicholas Steel
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Andrew Steptoe
- UCL Research Department of Behavioural Science & Health, University College London, London, UK
| | - Paola Zaninotto
- UCL Research Department of Epidemiology & Public Health, University College London, London, UK
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Wei G, Piguet O, Kumfor F. A Psychosocial Intervention for Carers of Individuals Diagnosed with Dementia in Social Isolation. Dement Geriatr Cogn Dis Extra 2023; 13:48-56. [PMID: 38098956 PMCID: PMC10721235 DOI: 10.1159/000535207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/07/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction Growing research has shown the negative impact of social isolation on the health and psychological well-being of individuals with dementia and their carers. This study investigated the effectiveness of a psychosocial intervention for dementia carers during a lockdown period of the COVID-19 pandemic. Methods Twenty-three family carers of individuals diagnosed with dementia living in the community were recruited and provided with an online psychoeducation toolkit that aims to improve health literacy, management of social and behavioural symptoms in dementia, carer social engagement, and coping skills. Carers were divided into "mild" or "moderate" groups based on the disease severity of the person with dementia they cared for. Outcome measures including distress and severity of neuropsychiatric symptoms, carer self-efficacy and burden, social network, and feelings of loneliness were assessed at baseline and 2 weeks later. Results Carers in the moderate group reported higher levels of distress (p = 0.001) and severity (p < 0.001) of neuropsychiatric symptoms and greater carer burden (p = 0.003) than carers in the mild group. Following the intervention, both groups reported increased social networks (p = 0.001). In addition, carers in the moderate group reported significantly reduced distress for neuropsychiatric symptoms (p = 0.013), enhanced carer self-efficacy for controlling upsetting thoughts (p = 0.040), and decreased loneliness (p = 0.023). Conclusions This study demonstrated that psychosocial interventions improve outcomes for carers of individuals with dementia, particularly those caring for individuals with greater disease severity. Findings from this study will inform the development of support services that meet the evolving needs of individuals with dementia and their carers in social isolation, during and in a post-pandemic context.
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Affiliation(s)
- Grace Wei
- The University of Sydney, Brain and Mind Centre, Sydney, NSW, Australia
- The University of Sydney, School of Psychology, Sydney, NSW, Australia
| | - Olivier Piguet
- The University of Sydney, Brain and Mind Centre, Sydney, NSW, Australia
- The University of Sydney, School of Psychology, Sydney, NSW, Australia
| | - Fiona Kumfor
- The University of Sydney, Brain and Mind Centre, Sydney, NSW, Australia
- The University of Sydney, School of Psychology, Sydney, NSW, Australia
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Wong R, Lovier MA. Relationship between dementia, COVID-19 risk, and adherence to COVID-19 mitigation behaviors among older adults in the United States. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5735. [PMID: 35578831 PMCID: PMC9348266 DOI: 10.1002/gps.5735] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/04/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To examine how dementia is associated with COVID-19 risk and adherence to COVID-19 mitigation behaviors, and whether mitigation behaviors mediate the relationship between dementia and COVID-19 risk. METHODS/DESIGN We analyzed 2019 and 2020 data from the National Health and Aging Trends Study, a national prospective cohort study of United States older adults age 65+. Outcomes were COVID-19 diagnosis and adherence to COVID-19 mitigation behaviors (handwashing, mask-wearing, and social distancing). RESULTS Among the 3257 older adults in this study, 485 (14.9%) had dementia in 2019 and 98 (3.1%) were COVID-19 positive in 2020. Dementia significantly increased the odds of COVID-19 by 129% (odds ratio [OR] = 2.29, 95% confidence interval [CI] 1.32-3.97), and remained elevated after adjusting for sociodemographics and health (OR = 1.67, 95% CI 0.90-3.11). Dementia significantly decreased the odds of handwashing by 72% (OR = 0.28, 95% CI 0.17-0.44), which remained lower after adjusting for sociodemographics and health (OR = 0.53, 95% CI 0.23-1.21). Dementia was not significantly associated with mask-wearing and social distancing. The relationship between dementia and COVID-19 was primarily mediated by functional impairment, income, and residential setting. CONCLUSIONS Dementia was associated with an increased COVID-19 risk and lower adherence to handwashing among U.S. older adults. Adherence to COVID-19 mitigation behaviors did not mediate COVID-19 risk by dementia status. For older adults with dementia, COVID-19 risk could be decreased by prioritizing health interventions.
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Affiliation(s)
- Roger Wong
- Department of Public Health and Preventive Medicine, Norton College of MedicineSUNY Upstate Medical UniversitySyracuseNew YorkUSA
| | - Margaret Anne Lovier
- Department of Public Health and Preventive Medicine, Norton College of MedicineSUNY Upstate Medical UniversitySyracuseNew YorkUSA
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Nervous system manifestations related to COVID-19 and their possible mechanisms. Brain Res Bull 2022; 187:63-74. [PMID: 35772604 PMCID: PMC9236920 DOI: 10.1016/j.brainresbull.2022.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 05/23/2022] [Accepted: 06/26/2022] [Indexed: 12/15/2022]
Abstract
In December 2019, the novel coronavirus disease (COVID-19) due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection broke. With the gradual deepening understanding of SARS-CoV-2 and COVID-19, researchers and clinicians noticed that this disease is closely related to the nervous system and has complex effects on the central nervous system (CNS) and peripheral nervous system (PNS). In this review, we summarize the effects and mechanisms of SARS-CoV-2 on the nervous system, including the pathways of invasion, direct and indirect effects, and associated neuropsychiatric diseases, to deepen our knowledge and understanding of the relationship between COVID-19 and the nervous system.
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Chang AY, Babb KN. One-Year Report of COVID-19 Impact on Geriatric Patients: a Bio-Psycho-Social Approach. Can Geriatr J 2022; 25:212-221. [PMID: 35747408 PMCID: PMC9156418 DOI: 10.5770/cgj.25.553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background Since December of 2019, coronavirus 19 (COVID-19) has spread rapidly around the world. Our understanding of the infection has grown over the past year, and its impact on older adults is particularly significant. Apart from the direct impacts of COVID-19 infections, it has also led to lockdowns which, in turn, result in isolation and loneliness. Method We conducted a literature review of publicly available articles of the COVID-19 pandemic impact on the geriatric population between December 2019 and April 2021, a total of 748 articles. Results The review will be presented with the Bio-Psycho-Social model, covering how the biological, psychological, and sociological aspects of health are intertwined and impact older adults. Early studies have also highlighted the prevalence of post-COVID infection symptoms that typically fall under geriatric medicine care. We highlight the bidirectional impact of isolation and COVID-19 infections on geriatric health, as well as discuss pertinent topics such as vaccine efficacy, long-term sequelae of COVID-19 infections, and ageism. Conclusion This review seeks to present a one-year report of what is known about COVID-19 and geriatric medicine, as well as provide guidance to practitioners who care for older adults based on the most up-to-date literature.
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Hicks B, Read S, Hu B, Wittenberg R, Grahamslaw A, Karim A, Martin E, Nuzum E, Reichental J, Russell A, Siddle E, Storey B, Tipping E, Baxter K, Birks Y, Brayne C, Brimblecombe N, Dangoor M, Dixon J, Gridley K, Harris PR, Knapp M, Miles E, Perach R, Robinson L, Rusted J, Stewart R, Thomas AJ, Banerjee S. A cohort study of the impact of COVID-19 on the quality of life of people newly diagnosed with dementia and their family carers. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2022; 8:e12236. [PMID: 35509503 PMCID: PMC9060551 DOI: 10.1002/trc2.12236] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/23/2021] [Accepted: 11/23/2021] [Indexed: 01/10/2023]
Abstract
Introduction COVID-19 has impacted people with dementia and their family carers, yet little is known about effects on overall quality of life. Methods In a UK cohort study, pre- and post-pandemic data were collected from 114 carers and 93 recently diagnosed people with dementia. Latent growth curve modeling examined change in quality of life. Results Carers reported significant decline in quality of life, although no change was demonstrated by people with dementia. In multivariable analyses, higher levels of cognitive impairment, deprivation, study site, and lower number of memory clinic contacts were associated with greater decline in carer quality of life. Discussion Maintaining life quality for people with dementia during the pandemic appears to have come at the expense of their family carers. This inequity has fallen hardest on those caring for people with more severe dementia, in deprived areas, and with least support from memory services. These effects may be prevented or reversed by post-diagnostic care.
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Affiliation(s)
- Ben Hicks
- Brighton and Sussex Medical SchoolUniversity of SussexBrightonUK
| | - Sanna Read
- Care Policy and Evaluation CentreLondon School of Economics and Political ScienceLondonUK
| | - Bo Hu
- Care Policy and Evaluation CentreLondon School of Economics and Political ScienceLondonUK
| | - Raphael Wittenberg
- Care Policy and Evaluation CentreLondon School of Economics and Political ScienceLondonUK
| | | | | | - Evelyn Martin
- South London and Maudsley NHS Foundation TrustLondonUK
| | - Eleanor Nuzum
- South London and Maudsley NHS Foundation TrustLondonUK
| | | | | | | | | | - Eva Tipping
- Sussex Partnership NHS Foundation TrustWorthingUK
| | - Kate Baxter
- Social Policy Research UnitUniversity of YorkYorkUK
| | - Yvonne Birks
- Social Policy Research UnitUniversity of YorkYorkUK
| | - Carol Brayne
- Cambridge Public HealthUniversity of CambridgeCambridgeUK
| | - Nicola Brimblecombe
- Care Policy and Evaluation CentreLondon School of Economics and Political ScienceLondonUK
| | - Margaret Dangoor
- Care Policy and Evaluation CentreLondon School of Economics and Political ScienceLondonUK
| | - Josie Dixon
- Care Policy and Evaluation CentreLondon School of Economics and Political ScienceLondonUK
| | - Kate Gridley
- Social Policy Research UnitUniversity of YorkYorkUK
| | | | - Martin Knapp
- Care Policy and Evaluation CentreLondon School of Economics and Political ScienceLondonUK
| | | | - Rotem Perach
- School of PsychologyUniversity of SussexBrightonUK
| | - Louise Robinson
- Population Health Sciences InstituteNewcastle UniversityNewcastleUK
| | | | - Rob Stewart
- Institute of PsychiatryPsychology and NeuroscienceKing's College LondonLondonUK
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Rajagopalan J, Arshad F, Thomas PT, Varghese F, Hurzuk S, Hoskeri RM, Ramappa RB, Nair VS, Paplikar A, Mekala S, Manae TS, Ramanna DBP, Rakesh G, Ganeshbhai PV, Dhiren SR, Komaravolu S, Kammammettu C, Rao GN, Alladi S. Cognition, Behavior, and Caregiver Stress in Dementia during the COVID-19 Pandemic: An Indian Perspective. Dement Geriatr Cogn Disord 2022; 51:90-100. [PMID: 35184061 PMCID: PMC9059024 DOI: 10.1159/000519616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 09/10/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Little is known regarding the cognitive and behavioral status of patients with dementia and their caregivers in lower middle-income countries during the COVID-19 pandemic. This study aimed to understand the impact of the pandemic on persons with dementia and their caregivers in India. METHODS This was an observational study. A cohort of 66 persons with dementia and their caregivers were evaluated during the COVID-19 pandemic in 2 specialist hospitals in South India. Caregivers were interviewed at 2 distinct time points of the pandemic: during the national lockdown and 5 months after during later periods of the "cluster of cases" transmission phase. Participants were assessed via telephone utilizing validated instruments (Neuropsychiatric Inventory [NPI], Clinical Dementia Rating [CDR] Scale, and Depression, Anxiety and Stress Scale [DASS-21]) and a semi-structured questionnaire. The questionnaire documented sociodemographic information, clinical history, infection measures adopted, changes in caregiving routines, involvement in functional rehabilitation activities, and access to medical and long-term care support services. RESULTS The 2-phase follow-up study found a significant worsening of behavior in dementia patients, demonstrated by a difference in the NPI sub-domain scores for anxiety (mean difference [standard deviation, SD] = -0.552 [1.993], t58 = -2.109, p = 0.039) and eating disturbances (mean difference [SD] = -1.121 [2.493], t59 = -3.424, p = 0.001). A relatively high proportion of patients developed anxiety (cumulative incidence = 24.53%) and eating disturbances (cumulative incidence = 26.92%), without having these symptoms at baseline. There was a trend toward an increase in proportion of persons with severe dementia (19.7% vs. 39.4%) on follow-up. Caregiver distress reported was significantly associated with neuropsychiatric symptoms (r = 0.712, p < 0.001) and dementia severity (ρ = 0.365, p = 0.004). In addition, difficulties in accessing medical care persisted between the 2 assessments, and there were statistically significant differences between functional rehabilitation activities such as indoor activities (p < 0.001), outdoor activities (p = 0.013), and physical exercises (p = 0.003) between baseline and follow-up. CONCLUSION Findings suggest interruption of functional rehabilitation activities and disruption in medical care services are likely to have had an adverse impact on patients with dementia and contributed toward caregiver distress.
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Affiliation(s)
- Jayeeta Rajagopalan
- Strengthening Responses to Dementia in Developing Countries (STRiDE) India, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Faheem Arshad
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India,*Faheem Arshad,
| | - Priya Treesa Thomas
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Feba Varghese
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Saadiya Hurzuk
- Strengthening Responses to Dementia in Developing Countries (STRiDE) India, Alzheimer's and Related Disorders Society of India, Hyderabad, India
| | | | - Renuka Bavikatti Ramappa
- Dementia Science Programme, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Vasundharaa S. Nair
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Avanthi Paplikar
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Shailaja Mekala
- Department of Neurology, Nizam's Institute of Medical Sciences India, Hyderabad, India
| | - Tejaswini S. Manae
- Dementia Science Programme, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Gurrapu Rakesh
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Patel Vishal Ganeshbhai
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Shah Rutul Dhiren
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Shashidhar Komaravolu
- Alzheimer's and Related Disorders Society of India Hyderabad Deccan Chapter, Hyderabad, India
| | | | - Girish N. Rao
- Department of Epidemiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
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12
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The effects of the COVID-19 pandemic on neuropsychiatric symptoms in dementia and carer mental health: an international multicentre study. Sci Rep 2022; 12:2418. [PMID: 35165292 PMCID: PMC8844310 DOI: 10.1038/s41598-022-05687-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 12/28/2021] [Indexed: 01/10/2023] Open
Abstract
As a global health emergency, the rapid spread of the novel coronavirus disease (COVID-19) led to the implementation of widespread restrictions (e.g., quarantine, physical/social distancing measures). However, while these restrictions reduce the viral spread of COVID-19, they may exacerbate behavioural and cognitive symptoms in dementia patients and increase pressure on caregiving. Here, we aimed to assess the impact of COVID-19 and related restrictions on both carers and people living with dementia across the world. We conducted an international survey (Australia, Germany, Spain, and the Netherlands) to assess the impact of COVID-19 on carers and people living with dementia. People with dementia experienced worsened neuropsychiatric symptoms since the outbreak of COVID-19, most commonly, depression, apathy, delusions, anxiety, irritability, and agitation. Regression analyses revealed that limited understanding of the COVID-19 situation and not living with the carer was associated with worsened neuropsychiatric symptoms. Carers also reported a decline in their own mental health, increased stress and reduced social networks as a result of COVID-19 and related restrictions. Regression analyses revealed uncertainty about the future and loneliness were associated with worsened carer mental health. Findings from this study will inform strategies for the development of support services and compassionate protocols that meet the evolving needs of those living with dementia and their carers.
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13
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Cousins E, de Vries K, Harrison Dening K. ' Four walls and a garden': Exploring the experiences of families affected by dementia during the COVID-19 pandemic. DEMENTIA 2021; 21:810-829. [PMID: 34918956 PMCID: PMC8995930 DOI: 10.1177/14713012211059021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Introduction When the first national COVID-19 lockdown came into effect in the UK in March
2020, life changed significantly. Some services and social contacts for
people with dementia and their families stopped, while others, for example,
peer support, moved online. This research explored the experiences of
families affected by dementia during the pandemic, specifically those living
in the community. Aims In partnership with a community dementia charity, this study sought to gain
an understanding of the experiences of people with dementia and family
carers during the COVID-19 pandemic and explore the impact and implications
of lockdown on people with dementia and family carers. Methods This was a qualitative study that used semi-structured interviews to collect
data from people with dementia and family carers. Interviews were conducted
online via video call, individually or within caring dyads. Initially, data
were coded, analysed and themed inductively. Additionally, social disruption
and social division theories were used to deductively identify patterns in
the data to enhance understanding. Findings Six distinct themes were identified from the inductive analysis: Routine:
‘busy life before lockdown’; Isolation: ‘four
walls and a garden’; Living with restrictions:
‘treading on eggshells’; Discovering positives:
‘you are in the same boat’; Easing lockdown:
‘raring to go’; Heightened uncertainty: ‘things
have changed’. Illustrative examples of symptoms of social
disruption and division were identified within the data: frustration,
democratic disconnection, fragmentation, polarisation and escalation. Conclusion Experiences of people with dementia and family carers during the pandemic
were mixed, resulting in hopes and worries for the future. Social disruption
and social division are relevant frameworks for analysing experiences of
COVID-19.
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Affiliation(s)
- Emily Cousins
- Faculty of Health and Life Sciences, School of Nursing and Midwifery, RinggoldID:4487De Montfort University, Leicester, UK
| | - Kay de Vries
- Faculty of Health and Life Sciences, School of Nursing and Midwifery, RinggoldID:4487De Montfort University, Leicester, UK
| | - Karen Harrison Dening
- Faculty of Health and Life Sciences, School of Nursing and Midwifery, 4487De Montfort University, Leicester, UK; Dementia UK, London, UK
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14
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Liu KY, Howard R, Banerjee S, Comas‐Herrera A, Goddard J, Knapp M, Livingston G, Manthorpe J, O'Brien JT, Paterson RW, Robinson L, Rossor M, Rowe JB, Sharp DJ, Sommerlad A, Suárez‐González A, Burns A. Dementia wellbeing and COVID-19: Review and expert consensus on current research and knowledge gaps. Int J Geriatr Psychiatry 2021; 36:1597-1639. [PMID: 34043836 PMCID: PMC8237017 DOI: 10.1002/gps.5567] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/06/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES In response to a commissioned research update on dementia during the COVID-19 pandemic, a UK-based working group, comprising dementia researchers from a range of fields and disciplines, aimed to describe the impact of the pandemic on dementia wellbeing and identify priorities for future research. METHODS We supplemented a rapid literature search (including unpublished, non-peer reviewed and ongoing studies/reports) on dementia wellbeing in the context of COVID-19 with expert group members' consensus about future research needs. From this we generated potential research questions the group judged to be relevant that were not covered by the existing literature. RESULTS Themes emerged from 141 studies within the six domains of the NHS England COVID-19 Dementia Wellbeing Pathway: Preventing Well, Diagnosing Well, Treating Well, Supporting Well, Living Well and Dying Well. We describe current research findings and knowledge gaps relating to the impact on people affected by dementia (individuals with a diagnosis, their carers and social contacts, health and social care practitioners and volunteers), services, research activities and organisations. Broad themes included the potential benefits and risks of new models of working including remote healthcare, the need for population-representative longitudinal studies to monitor longer-term impacts, and the importance of reporting dementia-related findings within broader health and care studies. CONCLUSIONS The COVID-19 pandemic has had a disproportionately negative impact on people affected by dementia. Researchers and funding organisations have responded rapidly to try to understand the impacts. Future research should highlight and resolve outstanding questions to develop evidence-based measures to improve the quality of life of people affected by dementia.
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Affiliation(s)
- Kathy Y. Liu
- Division of PsychiatryUniversity College LondonLondonUK
| | - Robert Howard
- Division of PsychiatryUniversity College LondonLondonUK
| | | | - Adelina Comas‐Herrera
- Department of Health PolicyLondon School of Economics and Political ScienceCare Policy and Evaluation CentreLondonUK
| | - Joanne Goddard
- Economic and Social Research CouncilUK Research and InnovationSwindonUK
| | - Martin Knapp
- Department of Health PolicyLondon School of Economics and Political ScienceCare Policy and Evaluation CentreLondonUK
| | | | - Jill Manthorpe
- NIHR Policy Research Unit in Health and Social Care WorkforceKing's College LondonLondonUK
| | - John T. O'Brien
- Department of PsychiatryUniversity of Cambridge School of Clinical MedicineCambridgeUK
| | - Ross W. Paterson
- Dementia Research CentreQueen Square UCL Institute of NeurologyUniversity College LondonLondonUK
| | - Louise Robinson
- Population Health Sciences InstituteFaculty of Medical SciencesNewcastle UniversityNewcastleUK
| | - Martin Rossor
- Dementia Research CentreQueen Square UCL Institute of NeurologyUniversity College LondonLondonUK
| | - James B. Rowe
- Medical Research Council Cognition and Brain Sciences UnitUniversity of CambridgeCambridgeUK,Department of Clinical NeurosciencesUniversity of CambridgeCambridgeUK
| | - David J. Sharp
- Department of Brain SciencesImperial College LondonLondonUK,UK Dementia Research InstituteCare Research and Technology Centre, Imperial College LondonLondonUK
| | | | - Aida Suárez‐González
- Dementia Research CentreQueen Square UCL Institute of NeurologyUniversity College LondonLondonUK
| | - Alistair Burns
- Division of Neuroscience and Experimental PsychologyThe University of ManchesterManchesterUK
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15
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Okamura T, Ura C, Sugiyama M, Kugimiya Y, Okamura M, Awata S. Everyday lives of community-dwelling older people with dementia during the COVID-19 pandemic in Japan. Int J Geriatr Psychiatry 2021; 36:1465-1467. [PMID: 33848362 PMCID: PMC8250268 DOI: 10.1002/gps.5553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/30/2021] [Indexed: 11/15/2022]
Affiliation(s)
| | - Chiaki Ura
- Tokyo Metropolitan Institute of GerontologyTokyoJapan
| | - Mika Sugiyama
- Tokyo Metropolitan Institute of GerontologyTokyoJapan
| | | | | | - Shuichi Awata
- Tokyo Metropolitan Institute of GerontologyTokyoJapan
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16
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Suárez-González A, Rajagopalan J, Livingston G, Alladi S. The effect of COVID-19 isolation measures on the cognition and mental health of people living with dementia: A rapid systematic review of one year of quantitative evidence. EClinicalMedicine 2021; 39:101047. [PMID: 34386758 PMCID: PMC8342894 DOI: 10.1016/j.eclinm.2021.101047] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 07/06/2021] [Accepted: 07/14/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND COVID-19 prevention and control policies have entailed lockdowns and confinement. This study aimed to summarize the global research evidence describing the effect of COVID-19 isolation measures on the health of people living with dementia. METHODS We searched Pubmed, PsycINFO and CINAHL up to 27th of February 2021 for peer-reviewed quantitative studies about the effects of isolation during COVID-19 on the cognitive, psychological and functional symptoms of people with dementia or mild cognitive impairment. The Joanna Briggs Institute critical appraisal tool was used to conduct the quality assessment. PROSPERO registration: CRD42021229259. FINDINGS 15 eligible papers were identified, examining a total of 6442 people with dementia. 13/15 studies investigated people living in the community and 2 in care homes. Out of 15 studies, 9 (60%) reported changes in cognition and 14 (93%) worsening or new onset of behavioral and psychological symptoms. Six studies (46%) reported a functional decline in daily activities in a variable proportion of the population analyzed. INTERPRETATION COVID-19 isolation measures have damaged the cognitive and mental health of people with dementia across the world. It is urgent to issue guidance that balances infection control measures against the principles of non-maleficence to guarantee fair and appropriate care during pandemic times for this population.
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Affiliation(s)
- Aida Suárez-González
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, box 16, 8-11 Queen Square, London WC1N 3BG, United Kingdom
| | - Jayeeta Rajagopalan
- Strengthening Responses to Dementia in Developing Countries (STRiDE) India, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Gill Livingston
- Division of Psychiatry, Maple House, University College London, United Kingdom
| | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
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17
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Toniolo S, Scarioni M, Di Lorenzo F, Hort J, Georges J, Tomic S, Nobili F, Frederiksen KS. Dementia and COVID-19, a Bidirectional Liaison: Risk Factors, Biomarkers, and Optimal Health Care. J Alzheimers Dis 2021; 82:883-898. [PMID: 34092646 DOI: 10.3233/jad-210335] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cognitive impairment following SARS-CoV-2 infection is being increasingly recognized as an acute and possibly also long-term sequela of the disease. Direct viral entry as well as systemic mechanisms such as cytokine storm are thought to contribute to neuroinflammation in these patients. Biomarkers of COVID-19-induced cognitive impairment are currently lacking, but there is some limited evidence that SARS-CoV-2 could preferentially target the frontal lobes, as suggested by behavioral and dysexecutive symptoms, fronto-temporal hypoperfusion on MRI, EEG slowing in frontal regions, and frontal hypometabolism on 18F-FDG-PET. Possible confounders include cognitive impairment due to hypoxia and mechanical ventilation and post-traumatic stress disorder. Conversely, patients already suffering from dementia, as well as their caregivers, have been greatly impacted by the disruption of their care caused by COVID-19. Patients with dementia have experienced worsening of cognitive, behavioral, and psychological symptoms, and the rate of COVID-19-related deaths is disproportionately high among cognitively impaired people. Multiple factors, such as difficulties in remembering and executing safeguarding procedures, age, comorbidities, residing in care homes, and poorer access to hospital standard of care play a role in the increased morbidity and mortality. Non-pharmacological interventions and new technologies have shown a potential for the management of patients with dementia, and for the support of their caregivers.
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Affiliation(s)
- Sofia Toniolo
- Cognitive Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Marta Scarioni
- Department of Neurology, Amsterdam University Medical Centers, Location VUmc, Alzheimer Center, Amsterdam, The Netherlands.,Department of Pathology, Amsterdam University Medical Centers, Location VUmc, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Francesco Di Lorenzo
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, Brighton, UK.,Non-invasive Brain Stimulation Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Jakub Hort
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | | | - Svetlana Tomic
- Department of Neurology, Osijek University Hospital Center, Osijek, Croatia.,Faculty of Medicine, University Josip Juraj Strossmayer of Osijek, Osijek, Croatia
| | - Flavio Nobili
- Neurology Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy
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18
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Rajagopalan J, Arshad F, Hoskeri RM, Nair VS, Hurzuk S, Annam H, Varghese F, Br R, Dhiren SR, Ganeshbhai PV, Kammammettu C, Komaravolu S, Thomas PT, Comas-Herrera A, Alladi S. Experiences of people with dementia and their caregivers during the COVID-19 pandemic in India: A mixed-methods study. DEMENTIA 2021; 21:214-235. [PMID: 34346238 PMCID: PMC8685595 DOI: 10.1177/14713012211035371] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background The COVID-19 pandemic has unprecedented consequences for the management of chronic diseases such as dementia. However, limited evidence exists on the condition of persons with dementia and their caregivers during the pandemic in lower-middle-income countries (LMICs). The study aimed to provide insights into the experiences of persons with dementia and their families during the early phases of the pandemic in India. Methods This study adopted a mixed-method approach. One hundred and four persons with dementia and their caregivers were evaluated via telephone using validated instruments and a semi-structured interview guide. We used the quantitative data collected to establish a baseline, whereas qualitative data were analysed thematically. Results The study revealed that persons with dementia and their caregivers experienced difficulties during the pandemic, which included worsening of behaviour, problems in accessing care, disruptions in functional activities and struggles in enforcing infection prevention contributing to caregiver distress. An important finding that emerged was the unchanging reality of caregiving for families. The relative success of the public health response to the COVID-19 pandemic contrasted with the lack of awareness and formal support for dementia. Conclusions The COVID-19 pandemic has exposed the vulnerabilities of persons with dementia and their caregivers. This calls for a collaborative reframing of medical care and public health policies to address dementia care.
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Affiliation(s)
- Jayeeta Rajagopalan
- Strengthening Responses to Dementia in Developing Countries (STRiDE) India, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Faheem Arshad
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Vasundharaa S Nair
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Saadiya Hurzuk
- Strengthening Responses to Dementia in Developing Countries (STRiDE) India, Alzheimer's and Related Disorders Society of India, Hyderabad, India
| | - Harikrishna Annam
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Feba Varghese
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Renuka Br
- Dementia Science Programme, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Shah R Dhiren
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Patel V Ganeshbhai
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Shashidhar Komaravolu
- Alzheimer's and Related Disorders Society of India Hyderabad Deccan Chapter, Hyderabad, India
| | - Priya T Thomas
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Adelina Comas-Herrera
- Care Policy and Evaluation Centre, 4905London School of Economics and Political Science (LSE), London, UK
| | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
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19
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Manini A, Brambilla M, Maggiore L, Pomati S, Pantoni L. The impact of lockdown during SARS-CoV-2 outbreak on behavioral and psychological symptoms of dementia. Neurol Sci 2021; 42:825-833. [PMID: 33442845 PMCID: PMC7806279 DOI: 10.1007/s10072-020-05035-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 12/31/2020] [Indexed: 01/10/2023]
Abstract
Background During Covid-19 pandemic, the Italian government adopted restrictive limitations and declared a national lockdown on March 9, which lasted until May 4 and produced dramatic consequences on people’s lives. The aim of our study was to assess the impact of prolonged lockdown on behavioral and psychological symptoms of dementia (BPSD). Methods Between April 30 and June 8, 2020, we interviewed with a telephone-based questionnaire the caregivers of the community-dwelling patients with dementia who had their follow-up visit scheduled from March 9 to May 15 and canceled due to lockdown. Among the information collected, patients’ BPSDs were assessed by the Neuropsychiatric Inventory (NPI). Non-parametric tests to compare differences between NPI scores over time and logistic regression models to explore the impact of different factors on BPSD worsening were performed. Results A total of 109 visits were canceled and 94/109 caregivers completed the interview. Apathy, irritability, agitation and aggression, and depression were the most common neuropsychiatric symptoms experienced by patients both at baseline and during Covid-19 pandemic. Changes in total NPI and caregiver distress scores between baseline and during lockdown, although statistically significant, were overall modest. The logistic regression model failed to determine predictors of BPSD worsening during lockdown. Conclusion This is one of the first studies to investigate the presence of BPSD during SARS-CoV-2 outbreak and related nationwide lockdown, showing only slight, likely not clinically relevant, differences in BPSD burden, concerning mostly agitation and aggression, anxiety, apathy and indifference, and irritability. Supplementary Information The online version contains supplementary material available at 10.1007/s10072-020-05035-8.
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Affiliation(s)
- Arianna Manini
- Stroke and Dementia Lab, "Luigi Sacco" Department of Biomedical and Clinical Sciences, University of Milan, Via Giovanni Battista Grassi 74, 20157, Milan, Italy
| | - Michela Brambilla
- Center for Cognitive Disorders and Dementias (CDCD), Neurology Unit, Ospedale Luigi Sacco, Milan, Italy
| | - Laura Maggiore
- Center for Cognitive Disorders and Dementias (CDCD), Neurology Unit, Ospedale Luigi Sacco, Milan, Italy
| | - Simone Pomati
- Center for Cognitive Disorders and Dementias (CDCD), Neurology Unit, Ospedale Luigi Sacco, Milan, Italy
| | - Leonardo Pantoni
- Stroke and Dementia Lab, "Luigi Sacco" Department of Biomedical and Clinical Sciences, University of Milan, Via Giovanni Battista Grassi 74, 20157, Milan, Italy.
- Center for Cognitive Disorders and Dementias (CDCD), Neurology Unit, Ospedale Luigi Sacco, Milan, Italy.
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20
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Custodio N, Castro-Suárez S, Montesinos R, Failoc-Rojas VE, Cruz del Castillo R, Herrera-Perez E. Neuropsychiatric Symptoms in Patients With Alzheimer's Disease During SARS-COV-2 Pandemic in Peru. Am J Alzheimers Dis Other Demen 2021; 36:15333175211039089. [PMID: 34416114 PMCID: PMC10581147 DOI: 10.1177/15333175211039089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
To evaluate neuropsychiatric symptoms in patients with Alzheimer's disease (AD) and their association with cognition and functionality during lockdown of the COVID-19's first wave. We included 91 patients and caregivers of people with AD from a memory clinic. The RUDAS, M@T, and CDR were administered to patients and NPI/ADCS-ADL to caregivers. Baseline and lockdown measurements scales were analyzed to compare the frequencies at baseline versus lockdown and conditional Odds Ratio (ORc) was calculated for the neuropsychiatric symptoms. During the pandemic, significant increase in the number of cases was observed in depression (23%), agitation (36.8%), aberrant motor activity (12%), sleep disorders (26.3%), and appetite change (12.1%). In worsening of pre-existing symptoms, the most frequent were delusions (75%), followed by sleep disorders (71.7%). Lockdown induces a rapid increase of neuropsychiatric symptoms affecting cognitive symptoms and functionality of Peruvian patients with AD.
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Affiliation(s)
- Nilton Custodio
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Departamento de Investigación y docencia, Instituto Peruano de Neurociencias, Lima, Perú
| | - Sheila Castro-Suárez
- Departamento de Investigación y docencia, Instituto Peruano de Neurociencias, Lima, Perú
- CBI en Demencias y Enfermedades Desmielinizantes del Sistema Nervioso, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
- Atlantic Senior Fellow of Global Brain Health Institute, University of California, San Francisco, CA. USA
| | - Rosa Montesinos
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Departamento de Investigación y docencia, Instituto Peruano de Neurociencias, Lima, Perú
- Servicio de Rehabilitación, Instituto Peruano de Neurociencias, Lima, Perú
| | - Virgilio E. Failoc-Rojas
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Departamento de Investigación y docencia, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Lima, Perú
| | - Rossana Cruz del Castillo
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Departamento de Investigación y docencia, Instituto Peruano de Neurociencias, Lima, Perú
- Servicio de Geriatría, Programa de Atención Domiciliaria-PADOMI, EsSalud, Lima, Perú
| | - Eder Herrera-Perez
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Departamento de Investigación y docencia, Instituto Peruano de Neurociencias, Lima, Perú
- CBI en Demencias y Enfermedades Desmielinizantes del Sistema Nervioso, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
- Grupo de investigación Molident, Universidad San Ignacio de Loyola, Lima, Perú
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21
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Matias-Guiu JA, Pytel V, Matías-Guiu J. Death Rate Due to COVID-19 in Alzheimer’s Disease and Frontotemporal Dementia. J Alzheimers Dis 2020; 78:537-541. [DOI: 10.3233/jad-200940] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We aimed to evaluate the frequency and mortality of COVID-19 in patients with Alzheimer’s disease (AD) and frontotemporal dementia (FTD). We conducted an observational case series. We enrolled 204 patients, 15.2% of whom were diagnosed with COVID-19, and 41.9% of patients with the infection died. Patients with AD were older than patients with FTD (80.36±8.77 versus 72.00±8.35 years old) and had a higher prevalence of arterial hypertension (55.8% versus 26.3%). COVID-19 occurred in 7.3% of patients living at home, but 72.0% of those living at care homes. Living in care facilities and diagnosis of AD were independently associated with a higher probability of death. We found that living in care homes is the most relevant factor for an increased risk of COVID-19 infection and death, with AD patients exhibiting a higher risk than those with FTD.
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Affiliation(s)
- Jordi A. Matias-Guiu
- Department of Neurology, Institute of Neurosciences, Hospital Clínico San Carlos, San Carlos Health Research Institute (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Vanesa Pytel
- Department of Neurology, Institute of Neurosciences, Hospital Clínico San Carlos, San Carlos Health Research Institute (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Jorge Matías-Guiu
- Department of Neurology, Institute of Neurosciences, Hospital Clínico San Carlos, San Carlos Health Research Institute (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
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22
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Alonso-Lana S, Marquié M, Ruiz A, Boada M. Cognitive and Neuropsychiatric Manifestations of COVID-19 and Effects on Elderly Individuals With Dementia. Front Aging Neurosci 2020; 12:588872. [PMID: 33192483 PMCID: PMC7649130 DOI: 10.3389/fnagi.2020.588872] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/05/2020] [Indexed: 12/13/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread worldwide and has had unprecedented effects in healthcare systems, economies and society. COVID-19 clinical presentation primarily affects the respiratory system causing bilateral pneumonia, but it is increasingly being recognized as a systemic disease, with neurologic manifestations reported in patients with mild symptoms but, most frequently, in those in a severe condition. Elderly individuals are at high risk of developing severe forms of COVID-19 due to factors associated with aging and a higher prevalence of medical comorbidities and, therefore, they are more vulnerable to possible lasting neuropsychiatric and cognitive impairments. Several reports have described insomnia, depressed mood, anxiety, post-traumatic stress disorder and cognitive impairment in a proportion of patients after discharge from the hospital. The potential mechanisms underlying these symptoms are not fully understood but are probably multifactorial, involving direct neurotrophic effect of SARS-CoV-2, consequences of long intensive care unit stays, the use of mechanical ventilation and sedative drugs, brain hypoxia, systemic inflammation, secondary effects of medications used to treat COVID-19 and dysfunction of peripheral organs. Chronic diseases such as dementia are a particular concern not only because they are associated with higher rates of hospitalization and mortality but also because COVID-19 further exacerbates the vulnerability of those with cognitive impairment. In patients with dementia, COVID-19 frequently has an atypical presentation with mental status changes complicating the early identification of cases. COVID-19 has had a dramatical impact in long-term care facilities, where rates of infection and mortality have been very high. Community measures implemented to slow the spread of the virus have forced to social distancing and cancelation of cognitive stimulation programs, which may have contributed to generate loneliness, behavioral symptoms and worsening of cognition in patients with dementia. COVID-19 has impacted the functioning of Memory Clinics, research programs and clinical trials in the Alzheimer’s field, triggering the implementation of telemedicine. COVID-19 survivors should be periodically evaluated with comprehensive cognitive and neuropsychiatric assessments, and specific mental health and cognitive rehabilitation programs should be provided for those suffering long-term cognitive and psychiatric sequelae.
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Affiliation(s)
- Silvia Alonso-Lana
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Marta Marquié
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Agustín Ruiz
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Mercè Boada
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain.,Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
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23
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Hashimoto M, Suzuki M, Hotta M, Nagase A, Yamamoto Y, Hirakawa N, Nagata Y, Satake Y, Suehiro T, Kanemoto H, Yoshiyama K, Mori E, Ikeda M. The Influence of the COVID-19 Outbreak on the Lifestyle of Older Patients With Dementia or Mild Cognitive Impairment Who Live Alone. Front Psychiatry 2020; 11:570580. [PMID: 33192695 PMCID: PMC7661779 DOI: 10.3389/fpsyt.2020.570580] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/08/2020] [Indexed: 01/25/2023] Open
Abstract
Background: Under the COVID-19 outbreak, the Japanese government has strongly encouraged individuals to stay at home. The aim of the current study was to clarify the effects of the COVID-19 outbreak on the lifestyle of older adults with dementia or mild cognitive impairment (MCI) who live alone. Methods: Seventy-four patients with dementia or MCI aged ≥65 years, who regularly visited the dementia clinic of the Department of Psychiatry, Osaka University Hospital, were recruited in this study. The patients were divided into two groups according to their living situation: living alone group (n = 12) and living together group (n = 62). Additionally, the spouses of patients aged ≥65 years were assigned to the healthy control group (n = 37). Subjects' lifestyle changes were evaluated between April 8 and 28, 2020. Results: No subjects with acquaintances or relatives were infected with COVID-19 within the study period. The proportion of subjects who reduced going out in the living alone group, living together group and healthy control group was 18.2, 52.5, and 78.4%, respectively. The proportion of subjects who went out less frequently was significantly lower in both the living alone (p < 0.01) and living together (p < 0.05) groups than in the healthy control group. Conclusion: Most patients with dementia or MCI who live alone did not limit their outings or activities during the COVID-19 outbreak. Regular monitoring for potential COVID-19 infection in people living alone with dementia is vital for their safety and well-being.
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Affiliation(s)
- Mamoru Hashimoto
- Department of Psychiatry, Course of Integrated Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Maki Suzuki
- Department of Behavioral Neurology and Neuropsychiatry, Osaka University United Graduate School of Child Development, Osaka, Japan
| | - Maki Hotta
- Department of Psychiatry, Course of Integrated Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Aki Nagase
- Department of Behavioral Neurology and Neuropsychiatry, Osaka University United Graduate School of Child Development, Osaka, Japan
| | - Yuki Yamamoto
- Department of Psychiatry, Course of Integrated Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Natsuho Hirakawa
- Department of Psychiatry, Course of Integrated Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuma Nagata
- Department of Psychiatry, Course of Integrated Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuto Satake
- Department of Psychiatry, Course of Integrated Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takashi Suehiro
- Department of Psychiatry, Course of Integrated Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hideki Kanemoto
- Department of Psychiatry, Course of Integrated Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kenji Yoshiyama
- Department of Psychiatry, Course of Integrated Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Etsuro Mori
- Department of Behavioral Neurology and Neuropsychiatry, Osaka University United Graduate School of Child Development, Osaka, Japan
| | - Manabu Ikeda
- Department of Psychiatry, Course of Integrated Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
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24
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Manca R, De Marco M, Venneri A. The Impact of COVID-19 Infection and Enforced Prolonged Social Isolation on Neuropsychiatric Symptoms in Older Adults With and Without Dementia: A Review. Front Psychiatry 2020; 11:585540. [PMID: 33192732 PMCID: PMC7649825 DOI: 10.3389/fpsyt.2020.585540] [Citation(s) in RCA: 117] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/22/2020] [Indexed: 12/21/2022] Open
Abstract
Background: The sudden and drastic changes due to the Coronavirus Disease 19 (COVID-19) pandemic have impacted people's physical and mental health. Clinically-vulnerable older people are more susceptible to severe effects either directly by the COVID-19 infection or indirectly due to stringent social isolation measures. Social isolation and loneliness negatively impact mental health in older adults and may predispose to cognitive decline. People with cognitive impairments may also be at high risk of worsening cognitive and mental health due to the current pandemic. This review provides a summary of the recent literature on the consequences of COVID-19, due to either viral infection or social isolation, on neuropsychiatric symptoms in older adults with and without dementia. Methods: A search was conducted in PubMed and Web of Science to identify all relevant papers published up to the 7th July 2020. Two independent assessors screened and selected the papers suitable for inclusion. Additional suitable papers not detected by literature search were manually added. Results: Fifteen articles were included: 8 focussed on the psychiatric symptoms caused by the COVID-19 infection and 7 investigated the impact of social isolation on older adults' neuropsychiatric symptoms. Four studies included older adults without dementia and 11 included patients with cognitive impairment mainly due to Alzheimer's disease. All studies found that different neuropsychiatric symptoms emerged and/or worsened in older adults with and without dementia. These changes were observed as the consequence of both COVID-19 infection and of the enforced prolonged conditions of social isolation. Cases were reported of viral infection manifesting with delirium at onset in the absence of other symptoms. Delirium, agitation and apathy were the symptoms most commonly detected, especially in people with dementia. Conclusion: The available evidence suggests that the COVID-19 pandemic has a wide negative impact on the mental well-being of older adults with and without dementia. Viral infection and the consequent social isolation to limit its spreading have a range of neuropsychiatric consequences. Larger and more robustly designed studies are needed to clarify such effects and to assess the long-term implications for the mental health of older adults, and to test possible mitigating strategies.
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Affiliation(s)
- Riccardo Manca
- Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Matteo De Marco
- Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Annalena Venneri
- Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom
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