Influence of COVID-19 quarantine on the health of adults with mild cognitive impairment

ABSTRACT. COVID-19 is an infectious disease declared by the World Health Organization as a public health emergency of international concern. Objective: The objective of this article was to determine the physical, psychological, and social health conditions and mood of COVID-19 quarantine in adults with mild cognitive impairment. Methods: The sample consisted of 129 participants, most of them were healthy, but some have mild cognitive impairment. The data were collected with a questionnaire and the Yesavage Geriatric Depression Scale applied through phone calls from April to June 2020. Results: Statistically significant differences were found in the changes in sleep habits of the healthy participants (p=0.018). Intragroup comparisons of the Yesavage Geriatric Depression Scale in healthy participants were significant (p=0.010) and at the intergroup level before and after quarantine showed significant differences in pretest scores (p=0.003). Conclusions: Social isolation had a negative psychological effect on sleep habits, depressed mood, and physical health, mainly in healthy participants.

, which causes physical and the American continent 2 . According to the Ministry of Health, Colombia reported 49% of the deaths 3 .
During the global health crisis, physical health consequences and medical complications have received more attention than the pandemic effects on mental health of adults above 60 years 4 ; those who have comorbidities with chronic diseases have a higher risk of experiencing mental, cognitive, behavioral, emotional, (e.g., stress, anxiety, or depression) and social deterioration, as well as disturbances in sleep habits 5,6 , therby having negative consequences in everyday functioning. WHO 7 has recommended to set social restrictions and self-care measures to guarantee the physical and mental health of the older adult population. However, these restrictions limit contact with family and friends and daily activities such as walking, talking, or attending volunteer work in groups, which have negative consequences on psychological Personal satisfaction and physical health conditions [8][9][10][11][12][13] .
This study aimed to evaluate the physical, psychological, and social Personal satisfaction conditions in adults with mild cognitive impairment (MCI) in a South Colombian study group, in the quarantine for the COVID-19 pandemic.

Study design and description
This transversal descriptive study included 129 adults (54 healthy and 75 with MCI participants in the "Longitudinal Measurement of the integration function in short-term memory in patients with Mild Cognitive Impairment" project). Three measurement sessions were scheduled during of 3 years, but with the temporary suspension of the activities due to the restrictions due to COVID-19, the physical, social, and psychological well-being of the participants was assessed. For the data collection, clinical psychologists contacted the participants of the study by phone, from April to June of 2020. For the eligibility criteria, the following points were considered: (1) age ≥50 years, (2) having a landline or mobile phone, (3)

Instruments
The questionnaire "Conditions of Personal satisfaction during COVID-19 pandemic quarantine: ages 50 and up" was created using Google Forms, and it took 20 min to answer. The questionnaire was made to identify the current situation in adults in three dimensions: physical Personal satisfaction (17 items), psychological Personal satisfaction (27 items), and social Personal satisfaction (8 items). The content validity was performed by consensus among experts (five researchers from the areas of psychology, neuropsychology, neuroscience, and epidemiology). The level of concordance of the expert's evaluations was analyzed with the Kappa statistical index. A coefficient of 0.60 was obtained (p=0.000). This interpreted as adequate agreement by the evaluators according to the Kappa classification 14 .
Geriatric Depression Scale was developed by Yesavage in 1982. The purpose of this instrument is to identify depressive symptoms in adults above 60 years of age in the past 7 days. It has 15 dichotomous items (Yes/No) and a duration of 5-10 min for its application. This study used the scale to assess adults below 60 years of age because this scale has been shown to have adequate precision in identifying symptoms of depression in young adults aged 18-59 years. It has sensitivity of 72% and specificity of 97% in young adults, and a sensitivity of 86% and specificity of 91% in older adults 15 . The 15-item version has been shown to have better diagnostic accuracy and clinical utility than the 30-item version 16 .

Statistical analysis
Data were collected and tabulated in a Google spreadsheet file and subsequently analyzed using the Statistical Package for the Social Sciences (SPSS) version 23. First, a description of the characteristics of the sample is presented in absolute frequencies and percentages for the categorical variables. The comparison of nominal categorical variables in the two groups was done using the chi-square statistical test, and the normality of the numerical data was evaluated using the Kolmogorov-Smirnov test, which showed nonparametric behavior. Therefore, for the intragroup comparison of the Yesavage test in the healthy group and with MCI, the nonparametric Wilcoxon signed-rank test was used. In the intergroup comparison before and after the pandemic, the nonparametric Mann-Whitney U statistic was used.

Ethical aspects
The research complied with the ethical standards at the international and national levels for the study with human beings, such as the Declaration of Helsinki

RESULTS
A total of 129 people were surveyed, the mean age was 66.4 (SD=8.1), 78% were identified as female, 28% of the participants were below 60 years old, and 72% were above 61 years old. According to a previous neuropsychological evaluation, 41.9% were considered healthy and, therefore, were part of the "healthy group" and 58.1% showed symptoms of MCI. The mean age of the healthy group was 63.6 (SD=7.2) and that of the "MCI group" was 68.4 (SD=8.2). All the results obtained from the survey show the physical, psychological, and social state perceived by the participants of the two groups in the quarantine. Table 1 shows a summary of the survey responses, including a comparison between the groups (healthy and with MCI).
As for the physical health state, 37% of healthy participants and 48% with MCI reported chronic health conditions prior to COVID-19. When asked about individual perception regarding the physical health state, 22.5% of the participants in the MCI group and 22% of healthy members stated that they did not feel completely well. Regarding the time spent per week doing physical activity, 37% of the healthy group did not do physical activity, 27.8% dedicated less than an hour, and 35.2% did exercise for more than an hour. Meanwhile, 40% of participants with MCI did not perform physical activity, 37.3% dedicated less than an hour, and 22% did exercise for more than an hour. Among healthy participants, 5.6% stated that they had consumed alcohol and 5.6% were smokers, and among the participants with MCI, 9.3% consumed alcohol and 4% were smokers.
Regarding the psychological Personal satisfaction, the healthy participants stated that they experienced emotional changes during quarantine: 59.3% never felt discouraged, 29.6% sometimes bored, 25.9 always relaxed, 25.9 always optimistic, 24.1% nervous sometimes, and 9.3% always irritated. In the group of participants with MCI, 26.7% reported that they felt nervous at times, 4.7% almost always irritated, 41.3% sometimes bored, 54.7% never felt discouraged, 32% always relaxed, and 28% always optimistic. Statistically significant differences were found in changes in sleep habits of healthy participants (p=0.018).
In the evaluation with the Yesavage Geriatric Depression Scale, statistically significant differences were found in the intragroup comparisons in the healthy participants (p=0.010) using the Wilcoxon rank-sum test (Table 2). In contrast, when making an intergroup comparison of the Yesavage scale before and after quarantine in healthy participants and those with MCI, statistically significant differences were obtained in the pretest scores (p=0.003) using the Mann-Whitney U test (Table 3).
In the social domain, 109 participants (46 healthy and 63 MCI) reported to live with a relative, friend, or acquittance; 44.2% considered that they received good care or attention at home; and 85.3% mentioned not having changes in their relationships with their families as a result of quarantine. In the sample (n=129), around 37.2% responded that they did not have financial resources for household expenses, and 42.6% were concerned about the economic situation of the family.

DISCUSSION
The primary purpose of this study was to determine the physical, psychological, and social health conditions and mood of COVID-19 quarantine in adults with MCI, who are part of the project "Longitudinal Measurement of the integration function in short-term memory in patients with Mild Cognitive Impairment (MCI)." The results suggested that the quarantine had a negative psychological impact on sleep habits, both in the healthy group and the MCI group. Social distancing and the association of it with loneliness, worries, and low resilience can cause an increase 17 or decrease in sleep time 18 . People with dementia and insomnia can experience emotional changes (aggressiveness and irritability) as well as symptoms of anxiety and depression 19,20 . In fact, this information corroborated by the results. In the Yesavage scale, the intragroup comparisons of healthy participants were significant (p=0.010) and at the intergroup level the Yesavage scale before and after quarantine showed significant differences in the pretest scores (p=0.003). The emotional state was mainly affected by quarantine and loneliness. In this study, the participants showed boredom and nervousness as an emotional state, and these are predictors highly related to depression and progression of dementia 20 . However, a tendency to be optimistic was identified, regarding the health crisis caused by the COVID-19 pandemic in more than 50% of the participants in both groups.
Physical health is another condition affected by the restrictions due to the pandemic. About 37% of healthy participants reported not doing physical activities, and they also perceived an increase in symptoms of sickness during quarantine (p=0.043). These findings suggest that physical activity is related to the state of psychological Personal satisfaction 21 . Therefore, involving older people in physical activities could be a protective measure for the older adult population during quarantine 22 .
Social Personal satisfaction is another aspect affected by quarantine, because social interaction is a fundamental factor that helps a person to face an adverse situation. In this research, 109 participants (46 healthy and 63 MCI) reported that they live with the first-degree relatives and stated that they receive good care or assistance from them; results are similar to other research in which it was found that the majority of people live with their family members 17,23,24 and, to a lesser extent, with a friend or caregiver 25 .
The quarantine due to COVID-19 had a negative psychological effect on both physical and mental health of the participants, mainly affecting the physical domain (physical activity, increased symptoms of physical illnesses), psychological domain (sleep habits, mood, depression), and social domain (tendency to be interested in news related to . Statistically significant differences were found at the intergroup and intragroup levels when applying the Yesavage Geriatric Depression Scale before and after quarantine. These results suggest that physical distancing measures and visiting restrictions can reduce the risk of transmission and physical affectations, but it could increase mental distress.  Table 3. Mann-Whitney test for intragroup comparisons.