Effects of COVID-19 Pandemic Confinement in Patients With Cognitive Impairment

Abstract

Introduction: State of emergency caused by COVID-19 pandemic and subsequent lockdown hit Spain on 14th March 2020 and lasted until 21st June 2020. Social isolation measures were applied. Medical attention was focused on COVID-19. Primary and social care were mainly performed by telephone. This exceptional situation may affect especially vulnerable patients such as people living with dementia. Our aim was to describe the influence of restrictive measures on patients living with mild cognitive decline and dementia evaluating SARS-CoV2 infection, changes in routines, cognitive decline stage, neuropsychiatric symptoms, delirium, falls, caregiver stress, and access to sanitary care.Materials and Methods: We gathered MCI and dementia patients with clinical follow-up before and after confinement from DegMar registry (Hospital del Mar). A telephone ad-hoc questionnaire was administered. Global status was assessed using CDR scale. Changes in neuropsychiatric symptoms were assessed by Neuropsychiatric Inventory (NPI) and retrospective interview for pre-confinement base characteristics.Results: We contacted a total of 60 patients, age 75.4 years ± 5,192. 53.3% were women. Alzheimer's Disease (41.7%) and Mild Cognitive Impairment (25%) were the most prevalent diagnosis. Remaining cases included different dementia disorders. A total of 10% of patients had been diagnosed with SARS-CoV-2. During confinement 70% of patients abandoned previous daily activities, 60% had cognitive worsening reported by relatives/caretakers, 15% presented delirium episodes, and 13% suffered increased incidence of falls. Caregivers reported an increased burden in 41% cases and burnout in 11% cases. 16% reported difficulties accessing medical care, 33% received medical phone assistance, 20% needed emergency care and 21% had changes in psychopharmacological therapies. Neuropsychiatric profile globally worsened (p < 0.000), also in particular items like agitation (p = 0.003), depression (p < 0.000), anxiety (p < 0.000) and changes in appetite (p = 0.004).Conclusion: SARS-CoV2-related lockdown resulted in an important effect over social and cognitive spheres and worsening of neuropsychiatric traits in patients living with mild cognitive decline and dementia. Although the uncertainty regarding the evolution of the pandemic makes strategy difficult, we need to reach patients and caregivers and develop adequate strategies to reinforce and adapt social and health care.

The Impact of the COVID-19 Pandemic on Alzheimer's Disease and Other Dementias

“…When comparing the two groups with neuropsychiatric symptoms at follow-up, the point proportion at baseline and the follow-up was not significantly different regardless of the group, except for sleep disturbances in the AD group during the pandemic. This is roughly the same as the follow-up results for 60 CI patients in Spain (27) and suggests that the neuropsychiatric profile worsened globally (p < 0.000), as well as appetite (p = 0.004). However, not all of the results have been consistent, and some studies that followed up patients with AD during confinement have reported an increase in the occurrence of psychiatric symptoms (28), particularly depression and anxiety (29).…”

“…Thus, the cognitive differences between the two groups appeared to be intrinsic and not to have been influenced by confinement. Although no significant cognitive changes were observed in Barguilla's study of AD caregivers (27), 60% of CI caregivers perceived worsening cognition during COVID-19 confinement. This may have resulted from more intense observations provided by the caregivers and was affected by caregiver anxiety.…”

The Impact of the COVID-19 Pandemic on the Cognition of People with Dementia

“…Consequently, caregivers of people with dementia also experienced an increased rate of psychological symptoms, including anxiety and depression [17,37]. In addition to neuropsychiatric disorders, a high rate of delirium episodes and falls has been reported in those with cognitive impairment [38], and these events are known to be associated with the worsening of cognitive performance [39][40][41]. The healthcare system struggled to copy with the health needs of people with dementia living in the community and in a protected environment.…”

COVID-19 lockdown and lifestyles: A narrative review

“…In total, 65% of 432 respondents in another study from Hong Kong reported clinical levels of depression, anxiety, and/or stress. Older adults, especially those in isolation and with cognitive decline 147,148 , and their caregivers 149 were identified to be more prone to anxiety, stress, and depression 9,139 . A high prevalence of stress and post-traumatic stress disorders was documented among Nepalese 150 , Lebanese 151 , Saudi Arabian 152 , Vietnamese 153 , and Philippine nationals 154 at the height of lockdown.…”