Dementia and COVID-19: complications of managing a pandemic during another pandemic

Saeed Sadigh-Eteghad Sepideh Seyedi Sahebari Amirreza Naseri About the authors

Dear Editor,

Dementia is a pandemic condition in aging societies, affecting about 50 million people.11. Fox NC, Petersen RC. The G8 Dementia Research Summit––a starter for eight? Lancet (London, England). 2013;382(9909):1968-9. https://doi.org/10.1016/s0140-6736(13)62426-5
https://doi.org/10.1016/s0140-6736(13)62...
As the world faces the coronavirus disease 2019 (COVID-19) pandemic, dealing with a pandemic during another pandemic is a challenge. It is especially important when we know that aging is a well-established risk factor for dementia and also a risk factor for COVID-19 mortality.22. Li J, Huang DQ, Zou B, Yang H, Hui WZ, Rui F, et al. Epidemiology of COVID-19: a systematic review and meta-analysis of clinical characteristics, risk factors, and outcomes. J Med Virol. 2020. https://doi.org/10.1002/jmv.26424
https://doi.org/10.1002/jmv.26424...

People with dementia may not be able to follow health recommendations such as keeping social distancing, covering their mouth and nose when coughing, and hand hygiene,33. Brown EE, Kumar S, Rajji TK, Pollock BG, Mulsant BH. Anticipating and mitigating the impact of the COVID-19 pandemic on Alzheimer's disease and related dementias. Am J Geriatr Psychiatry. 2020;28(7):712-21. https://doi.org/10.1016/j.jagp.2020.04.010
https://doi.org/10.1016/j.jagp.2020.04.0...
which makes them more susceptible to getting infected. The clinical manifestation of COVID-19 may be different in people with dementia. A study consisted of 82 dementia patients reports a 67.1% rate of delirium as the most common symptom for COVID-19 infection, which was more than fever and dyspnea.44. Bianchetti A, Rozzini R, Guerini F, Boffelli S, Ranieri P, Minelli G, et al. Clinical Presentation of COVID19 in Dementia Patients. J Nutr Health Aging. 2020;24(6):560-2. https://doi.org/10.1007/s12603-020-1389-1
https://doi.org/10.1007/s12603-020-1389-...
As the management of patients with COVID-19 is mainly focused on preventing transmission, the lack of diagnosis in a huge number of infected people who cannot follow health recommendations can lead to further spreading of the virus. It can be more worrying when we know that a significant number of infected people are asymptomatic.55. World Health Organization [Internet]. Transmission of COVID-19 by asymptomatic cases [accessed on Jun. 11, 2020]. Available at: http://wwwemrowhoint/health-topics/corona-virus/transmission-of-covid-19-by-asymptomatic-caseshtml
http://wwwemrowhoint/health-topics/coron...

Taking care of dementia patients is more probable to get a poor outcome.66. Fotuhi M, Mian A, Meysami S, Raji CA. Neurobiology of COVID-19. J Alzheimers Dis. 2020;76(1):3-19. https://doi.org/10.3233/jad-200581
https://doi.org/10.3233/jad-200581...
Recent studies found that individuals with dementia are more likely to have other COVID-19 risk factors such as diabetes and cardiovascular disease.77. Bauer K, Schwarzkopf L, Graessel E, Holle R. A claims data-based comparison of comorbidity in individuals with and without dementia. BMC Geriatr. 2014;14:10. https://doi.org/10.1186/1471-2318-14-10
https://doi.org/10.1186/1471-2318-14-10...
Besides, a systematic review of literature found a twice as high pneumonia mortality rate in patients with dementia.88. Foley NC, Affoo RH, Martin RE. A systematic review and meta-analysis examining pneumonia-associated mortality in dementia. Dement Geriatr Cogn Disord. 2015;39(1-2):52-67. https://doi.org/10.1159/000367783
https://doi.org/10.1159/000367783...

During this pandemic, individuals with dementia showed higher mortality rate compared to patients without dementia which makes severe dementia independent risk factors for death due to COVID-19.44. Bianchetti A, Rozzini R, Guerini F, Boffelli S, Ranieri P, Minelli G, et al. Clinical Presentation of COVID19 in Dementia Patients. J Nutr Health Aging. 2020;24(6):560-2. https://doi.org/10.1007/s12603-020-1389-1
https://doi.org/10.1007/s12603-020-1389-...
,99. Covino M, De Matteis G, Santoro M, Sabia L, Simeoni B, Candelli M, et al. Clinical characteristics and prognostic factors in COVID-19 patients aged ≥ 80 years. Geriatr Gerontol Int. 2020;20(7):704-8. https://doi.org/10.1111/ggi.13960
https://doi.org/10.1111/ggi.13960...

According to statistics from the World Health Organization (WHO), 60–70% of dementia cases are in the form of Alzheimer disease (AD).1010. World Health Organization [Internet]. Dementia [accessed on Sep. 19, 2019]. Available at: https://wwwwhoint/news-room/fact-sheets/detail/dementia
https://wwwwhoint/news-room/fact-sheets/...
The neuropsychiatric symptoms of AD, including depression, anxiety, apathy, agitation, and hallucinations, seem to worsen in COVID-19 confinement. Especially during prolonged hospitalization, when being away from the family, the familiar environment, and social and exercise groups may deteriorate patients’ dementia condition. In line with this, as the result of a study, among 38 AD patients with COVID-19 infection who were kept at home for nearly 2 months, 10 of them showed worsening of neuropsychiatric symptoms changes after confinement.1111. Boutoleau-Bretonnière C, Pouclet-Courtemanche H, Gillet A, Bernard A, Deruet AL, Gouraud I, et al. The effects of confinement on neuropsychiatric symptoms in Alzheimer's Disease during the COVID-19 crisis. J Alzheimers Dis. 2020;76(1):41-7. https://doi.org/10.3233/jad-200604
https://doi.org/10.3233/jad-200604...

The long-term effects of SARS-CoV2 infection on neurodegeneration are still unknown.

The direct neuroinvasive capacity of coronavirus to infect the central nervous system is not well known, but there are multiple possible mechanisms suggested for indirectly mediated inflammation.1212. Yachou Y, El Idrissi A, Belapasov V, Ait Benali S. Neuroinvasion, neuro-tropic, and neuroinflammatory events of SARS-CoV-2: understanding the neurological manifestations in COVID-19 patients. Neurol Sci. 2020:1-13. [Epub ahead of print]. https://doi.org/10.1007/s10072-020-04575-3
https://doi.org/10.1007/s10072-020-04575...
The cytokines produced in COVID-19 infection such as interleukin-1 (IL-1) and interleukin-6 (IL-6) may synergize with amyloid-stimulated type I interferon (IFN) in AD patients and play a role in the presentation of symptoms. This may be a silent impact of SARS-CoV2 on the deterioration of AD. It may also be a reason for facing severe COVID-19 symptoms earlier, after the onset of the infection in AD patients.1313. Naughton SX, Raval U, Pasinetti GM. Potential novel role of COVID-19 in Alzheimer's disease and preventative mitigation strategies. J Alzheimers Dis. 2020;76(1):21-5. https://doi.org/10.3233/jad-200537
https://doi.org/10.3233/jad-200537...
,1414. Ferini-Strambi L, Salsone M. COVID-19 and neurological disorders: are neurodegenerative or neuroimmunological diseases more vulnerable? J Neurol. 2020:1-11. [Epub ahead of print]. https://doi.org/10.1007/s00415-020-10070-8
https://doi.org/10.1007/s00415-020-10070...
Also, stress due to such a pandemic can accelerate cognitive decline.1515. Tsolaki M, Papaliagkas V, Kounti F, Messini C, Boziki M, Anogianakis G, et al. Severely stressful events and dementia: a study of an elderly Greek demented population. Psychiatry Res. 2010;176(1):51-4. https://doi.org/10.1016/j.psychres.2009.06.001
https://doi.org/10.1016/j.psychres.2009....

These findings may lead to an even higher rate of dementia in the long run after the COVID-19 pandemic.

Disruption in routine medical visits, diagnosis, and follow-up results in a rapid increase of severe cases of dementia in the future. We are not sure when the world society condition will become stable again; but we are sure that the mental and physical health of patients with dementia should not be neglected during this pandemic and COVID-19 should not overshadow dementia treatment.

  • Funding: none.

ACKNOWLEDGMENTS

We thank the Neuroscience Research Center and the Student Research Committee of Tabriz University of Medical Sciences for their kind supports.

REFERENCES

  • 1
    Fox NC, Petersen RC. The G8 Dementia Research Summit––a starter for eight? Lancet (London, England). 2013;382(9909):1968-9. https://doi.org/10.1016/s0140-6736(13)62426-5
    » https://doi.org/10.1016/s0140-6736(13)62426-5
  • 2
    Li J, Huang DQ, Zou B, Yang H, Hui WZ, Rui F, et al. Epidemiology of COVID-19: a systematic review and meta-analysis of clinical characteristics, risk factors, and outcomes. J Med Virol. 2020. https://doi.org/10.1002/jmv.26424
    » https://doi.org/10.1002/jmv.26424
  • 3
    Brown EE, Kumar S, Rajji TK, Pollock BG, Mulsant BH. Anticipating and mitigating the impact of the COVID-19 pandemic on Alzheimer's disease and related dementias. Am J Geriatr Psychiatry. 2020;28(7):712-21. https://doi.org/10.1016/j.jagp.2020.04.010
    » https://doi.org/10.1016/j.jagp.2020.04.010
  • 4
    Bianchetti A, Rozzini R, Guerini F, Boffelli S, Ranieri P, Minelli G, et al. Clinical Presentation of COVID19 in Dementia Patients. J Nutr Health Aging. 2020;24(6):560-2. https://doi.org/10.1007/s12603-020-1389-1
    » https://doi.org/10.1007/s12603-020-1389-1
  • 5
    World Health Organization [Internet]. Transmission of COVID-19 by asymptomatic cases [accessed on Jun. 11, 2020]. Available at: http://wwwemrowhoint/health-topics/corona-virus/transmission-of-covid-19-by-asymptomatic-caseshtml
    » http://wwwemrowhoint/health-topics/corona-virus/transmission-of-covid-19-by-asymptomatic-caseshtml
  • 6
    Fotuhi M, Mian A, Meysami S, Raji CA. Neurobiology of COVID-19. J Alzheimers Dis. 2020;76(1):3-19. https://doi.org/10.3233/jad-200581
    » https://doi.org/10.3233/jad-200581
  • 7
    Bauer K, Schwarzkopf L, Graessel E, Holle R. A claims data-based comparison of comorbidity in individuals with and without dementia. BMC Geriatr. 2014;14:10. https://doi.org/10.1186/1471-2318-14-10
    » https://doi.org/10.1186/1471-2318-14-10
  • 8
    Foley NC, Affoo RH, Martin RE. A systematic review and meta-analysis examining pneumonia-associated mortality in dementia. Dement Geriatr Cogn Disord. 2015;39(1-2):52-67. https://doi.org/10.1159/000367783
    » https://doi.org/10.1159/000367783
  • 9
    Covino M, De Matteis G, Santoro M, Sabia L, Simeoni B, Candelli M, et al. Clinical characteristics and prognostic factors in COVID-19 patients aged ≥ 80 years. Geriatr Gerontol Int. 2020;20(7):704-8. https://doi.org/10.1111/ggi.13960
    » https://doi.org/10.1111/ggi.13960
  • 10
    World Health Organization [Internet]. Dementia [accessed on Sep. 19, 2019]. Available at: https://wwwwhoint/news-room/fact-sheets/detail/dementia
    » https://wwwwhoint/news-room/fact-sheets/detail/dementia
  • 11
    Boutoleau-Bretonnière C, Pouclet-Courtemanche H, Gillet A, Bernard A, Deruet AL, Gouraud I, et al. The effects of confinement on neuropsychiatric symptoms in Alzheimer's Disease during the COVID-19 crisis. J Alzheimers Dis. 2020;76(1):41-7. https://doi.org/10.3233/jad-200604
    » https://doi.org/10.3233/jad-200604
  • 12
    Yachou Y, El Idrissi A, Belapasov V, Ait Benali S. Neuroinvasion, neuro-tropic, and neuroinflammatory events of SARS-CoV-2: understanding the neurological manifestations in COVID-19 patients. Neurol Sci. 2020:1-13. [Epub ahead of print]. https://doi.org/10.1007/s10072-020-04575-3
    » https://doi.org/10.1007/s10072-020-04575-3
  • 13
    Naughton SX, Raval U, Pasinetti GM. Potential novel role of COVID-19 in Alzheimer's disease and preventative mitigation strategies. J Alzheimers Dis. 2020;76(1):21-5. https://doi.org/10.3233/jad-200537
    » https://doi.org/10.3233/jad-200537
  • 14
    Ferini-Strambi L, Salsone M. COVID-19 and neurological disorders: are neurodegenerative or neuroimmunological diseases more vulnerable? J Neurol. 2020:1-11. [Epub ahead of print]. https://doi.org/10.1007/s00415-020-10070-8
    » https://doi.org/10.1007/s00415-020-10070-8
  • 15
    Tsolaki M, Papaliagkas V, Kounti F, Messini C, Boziki M, Anogianakis G, et al. Severely stressful events and dementia: a study of an elderly Greek demented population. Psychiatry Res. 2010;176(1):51-4. https://doi.org/10.1016/j.psychres.2009.06.001
    » https://doi.org/10.1016/j.psychres.2009.06.001

Publication Dates

  • Publication in this collection
    11 Dec 2020
  • Date of issue
    Dec 2020

History

  • Received
    27 Aug 2020
  • Accepted
    29 Sept 2020
Academia Brasileira de Neurologia, Departamento de Neurologia Cognitiva e Envelhecimento R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices, Torre Norte, São Paulo, SP, Brazil, CEP 04101-000, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revistadementia@abneuro.org.br | demneuropsy@uol.com.br