Neuropsychiatric Symptoms in Elderly With Dementia During COVID-19 Pandemic: Definition, Treatment, and Future Directions

Abstract

Background Neuropsychiatric symptoms (NPS) of dementia, such as anxiety, depression, agitation, and apathy, are complex, stressful, and costly aspects of care, and are associated to poor health outcomes and caregiver burden. A steep worsening of such symptoms has been reported during Coronavirus Disease 2019 (COVID-19) pandemic. However, their causes, their impact on everyday life, and treatment strategies have not been systematically assessed. Therefore, the aim of this review is to provide a detailed description of behavioral and psychopathological alterations in subjects with dementia during COVID-19 pandemic and the associated management challenges. Methods A PubMed search was performed focusing on studies reporting alterations in behavior and mood and treatment strategies for elderly patients with dementia, in accordance with PRISMA guidelines. The following search strategy was utilized: (COVID* OR coronavirus OR “corona vir*” OR SARS-CoV-2) AND (dementia OR demented OR dement* OR alzheimer* OR “pick’s disease” OR “lewy body” OR “mild cognitive” OR mild cognitive impairment OR MCI). Results Apathy, anxiety and agitation are the most frequently NPS during the COVID-19 pandemic and are mainly triggered by protracted isolation. Most treatment strategies rely on pharmacotherapy; technology is increasingly utilized with mixed results. Conclusions NPS of dementia during COVID-19 appear to arise from social restrictions occurring as a consequence of the pandemic. Implementation of caregiver support and the presence of skilled nursing home staff are required to restore social interaction and adjust technological support to the patients’ needs.

Effects of COVID-19 Infection Control Measures on Appointment Cancelation in an Italian Outpatient Memory Clinic

“…Moreover, the social restrictions and increased isolation may lead to increased negative effects on memory disorders and neuropsychiatric symptoms of older people with NCD (18,19). In fact, recent data on this topic reported an increase of behavioral symptoms in elderly with dementia (8)(9)(10). It is also possible that there may be an increased need for assessment of new patients in geriatric psychiatry settings as a result of the negative consequence of quarantine and social distancing measures.…”

“…Many countries have employed similar restrictive measures (2-4) and have made changes to the routine management of patients with non-communicable diseases [e.g., canceling "so-called" non-urgent appointments, which have important implications for the identification and treatment, and therefore for the progression of these chronic conditions (5)]. Although the focus on procedures to urgently slow SARS-CoV-2 infection rates and minimize the number of infected individuals has extreme importance, it has short-and long-term negative consequences on health and well-being of patients with non-communicable diseases, including neurocognitive disorders (NCD) (6)(7)(8)(9)(10).…”

Subjective experience of time in dementia with Lewy bodies during COVID-19 lockdown

“…We argue that this subjective experience may be the consequence of a cognitive-emotional slowdown resulting from the joint effect of the clinical features of the disease and the adverse in uence of the experience of lockdown on the cognitive and behavioral pro le of the patients. Indeed, the literature (Brooks, 2020) reports how social isolation from quarantine or lockdown is frequently associated with negative psychological outcomes including stress, fear, anxiety, mood disorders, apathy and insomnia which, in fragile people such as patients with dementia, can easily lead to an exacerbation of the symptomatology (Cagnin et al, 2020;Simonetti et al, 2020), likely affecting their cognition of time as well. In the speci c case of the patients recruited in this study, it would seem that they tend to live the passage of time during the lockdown with detachment, nding refuge in a personal temporal dimension.…”

“…It has been shown that patients with DLB, given their signi cantly disabling clinical pro le, might be particularly vulnerable to the psychological outcomes of the pandemic, leading to a worsening of their symptoms and of their caregivers' burden (Cagnin et al, 2020;Migliaccio & Bouzigues, 2020). In general, apathy, agitation and anxiety are the most frequently reported worsening symptoms during quarantine in patients with dementia (Simonetti et al, 2020), while in the speci c case of DLB patients an increased risk of worsening hallucinations and sleep disorder has been observed (Cagnin et al, 2020). Lockdown and quarantine may be indeed considered as ecological models of the effects of deprivation of multidimensional stimulation, leading to a global down-regulation of cognitive, physical and emotional domains, with increased apathy as one of its main manifestations (Cagnin et al, 2020;Simonetti et al, 2020).…”

Folgen der COVID-19-Pandemie für Menschen mit Schizophrenie, Demenz und Abhängigkeitserkrankungen

“…Diese soziale Deprivation bedingt häufig eine Verschlechterung des kognitiven Funktionsniveaus und eine Neumanifestation oder Zunahme neuropsychiatrischer Symptome [ 13 ]. Neuropsychiatrische Symptome von Demenzpatienten während COVID-19-Pandemie-bedingter Restriktionen sind detailliert beschrieben worden [ 17 ]. Relevant sind hier Symptome wie Agitation, Ängstlichkeit, Apathie, Depressivität und Irritabilität [ 18 , 19 ], wobei die Apathie das häufigste neuropsychiatrische Symptom darstellt [ 20 ].…”