Coping with Dementia in the Middle of the COVID-19 Pandemic

Guillain-Barré Syndrome After COVID-19 Infection in Korea: A Case Series

Guillain-Barré syndrome (GBS) is an autoimmune-driven condition characterized by acute polyneuropathy, often emerging as a sequel to prior infections or vaccinations. This study presents the first reported cases of GBS emerging after the full recovery from coronavirus disease 2019 (COVID-19) infection in Korea. Despite experiencing mild acute COVID-19 symptoms, these patients faced substantial weakness attributed to GBS, significantly affecting their daily lives. The timely administration of intravenous immunoglobulin treatment halted the progression of symptoms, underscoring the critical importance of early intervention. These cases highlight the potential for neurological complications associated with COVID-19 and underscore the necessity for continuous monitoring and timely medical care.

Long-term cognitive dysfunction after the COVID-19 pandemic: a narrative review

Introduction

SARS-CoV-2, the virus responsible for the COVID-19 pandemic, has brought a conglomerate of novel chronic disabling conditions described as 'Long COVID/Post-COVID-19 Syndrome'. Recent evidence suggests that the multifaceted nature of this syndrome results in both pulmonary and extrapulmonary sequelae,chronic dyspnoea, persistent fatigue, and cognitive dysfunction being the most common, debilitating symptoms. Several mechanisms engender or exacerbate cognitive impairment, including central nervous system and extra-central nervous system causes, although the exact mechanism remains unclear. Both hospitalized and non-hospitalized patients may suffer varying degrees of cognitive impairment, ranging from fatigue and brain fog to prolonged deficits in memory and attention, detrimental to the quality-of-life years post-recovery. The aim of this review is to understand the underlying mechanisms, associations, and attempts for prevention with early intervention of long-term cognitive impairment post-COVID-19.

Methodology

A systematic search was conducted through multiple databases such as Medline, National Library of Medicine, Ovid, Scopus database to retrieve all the articles on the long-term sequalae of cognitive dysfunction after SARS-CoV-2 infection. The inclusion criteria included all articles pertinent to this specific topic and exclusion criteria subtracted studies pertaining to other aetiologies of cognitive dysfunction. This search was carefully screened for duplicates and the relevant information was extracted and analysed.

Results/discussion

To date, the exact pathogenesis, and underlying mechanisms behind cognitive dysfunction in COVID-19, remain unclear, hindering the development of adequate management strategies. However, the proposed mechanisms suggested by various studies include direct damage to the blood-brain barrier, systemic inflammation, prolonged hypoxia, and extended intensive care admissions. However, no clear-cut guidelines for management are apparent.

Conclusion

This review of the COVID-19 pandemic has elucidated a new global challenge which is affecting individuals' quality of life by inducing long-term impaired cognitive function. The authors have found that comprehensive evaluations and interventions are crucial to address the cognitive sequelae in all COVID-19 patients, especially in patients with pre-existing cognitive impairment. Nevertheless, the authors recommend further research for the development of relevant, timely neurocognitive assessments and treatment plans.

Emotions, action strategies and expectations of health professionals and people with dementia regarding COVID-19 in different care settings in Switzerland: a mixed methods study

BACKGROUND

More than 55 million people are currently affected by dementia worldwide and over 144 thousand in Switzerland. In Swiss nursing homes, 47.6% of the residents had a medical diagnosis of dementia in 2014. Due to cognitive impairment, they have difficulties remembering hygiene measures or placing them in the epidemic context. This results in a higher infection risk. There are COVID-19-associated recommendations focused on dementia care management but studies simultaneously surveying and correlating perspectives of health professionals as well as people with dementia across care settings are largely lacking. This study is focused on COVID-19-associated perspectives and needs of health professionals and people with dementia across different care settings. Lessons learned from the pandemic shall be pointed out.

METHODS

We conducted a mixed-methods approach based on an exploratory sequential design. Two qualitative interview rounds (n = 15 participants) and a quantitative online survey (n = 148 participants) with people with dementia, caring relatives, Advanced Practice Nurses and nursing home managers (health professionals) were performed. Data collected was performed in nursing home and home-care settings. The SQRQ checklist was used.

RESULTS

Fear and uncertainty were highest at the beginning of the pandemic among the interviewed nursing professionals and nursing home managers. As a positive side effect of the pandemic, increased cohesion in care teams was reported. Some people with dementia experienced the decelerated outside world as pleasant and less challenging to master. Particularly during the first wave, nursing home managers rated political decision-making processes as being too slow, partly non-transparent, inconsistent, and sometimes inappropriate for people with dementia.

CONCLUSIONS

Although the identified emotional and physical consequences of the COVID-19 pandemic are mostly negative for health professionals and people with dementia, research should also investigate potential positive side effects. Furthermore, political decisions should be passed on to care institutions as promptly, transparently, and comprehensibly as possible. The results provide guidance on dementia-focused COVID-19 management interventions incorporating lessons learned and considering the emotional impact of the pandemic in Switzerland and beyond.

Consequences and Perception of the COVID-19 Pandemic on Patients and Caregivers in an Austrian Memory Clinic Population One Year After Pandemic Onset

BACKGROUND

The COVID-19 pandemic was associated with high mortality and negative consequences for patients with Alzheimer's disease or dementia and their caregivers. Memory clinics play an important role in enabling early dementia diagnosis and providing support for patients and their caregivers.

OBJECTIVE

This study investigates the impact of the COVID-19 pandemic and its restrictions on patients of a memory clinic and their caregivers between March 2020 and March 2021.

METHODS

We conducted a prospective, single-center, questionnaire-based, observational study to assess consequences and perception of the COVID-19 pandemic on emotion, cognitive function, social living, areas of care, and information retrieval.

RESULTS

Results of 255 participants' (mean age 76.78, SD 8.9; 12% cognitively intact, 33% mild cognitive impairment, 55% dementia) and 203 caregivers' COVID-19 questionnaires (valid response rate 71%) could be included in the study. Participants reported a prevalence of psychological symptoms associated with the pandemic between 3-20%. Caregivers living outside compared to those living with the participant reported higher rates of new onset or worsening of neuropsychiatric symptoms in participants since pandemic onset. Patients with dementia showed the lowest use of digital communication before (15.7%) and after (17.1%) pandemic onset in the diagnostic groups.

CONCLUSION

The COVID-19 pandemic frequently led to social isolation and reduced cognitive stimulation due to restrictions in elderly persons with cognitive deficits resulting in negative effects on emotional and social levels. We hypothesize that the implementation and sensitization with digital communication in clinical routine could provide a useful tool to counteract these negative effects.

Challenges, strategies and consequences from the perspective of German nursing home managers during the first wave of the COVID-19 pandemic - a qualitative interview study

Background

The first wave of the COVID-19 pandemic reached Germany between March and May 2020. In order to contain the spread of the virus and particularly protect vulnerable people, the government imposed a lockdown in March 2020. In addition to infection control measures, such as hygiene and social distancing requirements, a general ban on access to nursing homes for relatives and external service providers was issued.

Methods

To investigate the challenges and consequences of the enacted infection prevention measures and specific strategies for nursing homes in Germany, a multicentre cross-sectional qualitative interview study with nursing home managers and ward managers was conducted. Recorded audio data were transcribed, analysed using thematic framework analysis and reflected in peer debriefings.

Results

Seventy-eight interviews with 40 nursing home managers and 38 ward managers from 43 German nursing homes were conducted. At organisational level, the following six themes were identified: Appointing a multi-professional crisis task force, reorganizing the use of building and spatial structures, continuous adaption and implementation of hygiene plans, adapting staff deployment to dynamically changing demands, managing additional communicative demands and relying on and resorting to informal networks. To deal with the pandemic challenges also six themes can be described for the direct care level: Changed routines, taking over non-nursing tasks, increased medical responsibility, increased documentation demands, promoting social participation and increased communication demands. Also various negative consequences were identified (four themes): Psychological stress, negative emotional consequences, permanent feeling of responsibility and increased potential for conflicts. Positive emotional consequences were also reported (two themes): resources for the challenges and positive emotional consequences for home managers and staff.

Conclusions

The results of the described challenges, strategies and consequences allow recommendations as basis for possible approaches and successful adaptation processes in nursing home care in the future. In particular, there is a need for local networks to act in a coordinated way and a need for quantitative and qualitative support for nurses, such as staff support as well as advanced nursing practice, to cope with the challenges of the pandemic.

Characteristics of Cognitive Function Changes and Related Factors in Individuals With Cognitive Impairment During the Pandemic of COVID-19: A Retrospective Chart Review Study

OBJECTIVE

This study aimed to explore the characteristics and factors related to changes in cognitive function in vulnerable individuals with cognitive impairment during the coronavirus disease 2019 (COVID-19) pandemic.

METHODS

Among patients who visited a local university hospital with subjective cognitive complaints, those who had been tested for cognitive function at least once after the onset of COVID-19 and tested regularly at least three times within the last 5 years were included (1st, the initial screening; 2nd, the test immediately before the COVID-19 pandemic; 3rd, the most recent test after the pandemic). Finally, 108 patients were included in this study. They were divided into groups according to whether the Clinical Dementia Rating (CDR) was maintained/improved and deteriorated. We investigated the characteristics of the changes in cognitive function and related factors during COVID-19.

RESULTS

When comparing CDR changes before and after COVID-19, there was no significant difference between the two groups (p=0.317). Alternatively, the main effect of the time when the test was conducted was significant (p<0.001). There was also a significant difference in the interaction between the groups and time. When the effect of the interaction was analyzed, the CDR score of the maintained/ improved group significantly decreased before COVID-19 (1st-2nd) (p=0.045). After COVID-19 (2nd-3rd), the CDR score of the deteriorated group was significantly higher than that of the maintained/improved group (p<0.001). Mini-Mental State Examination recall memory and changes in activity during COVID-19 were significantly associated with CDR deterioration.

CONCLUSION

Memory dysfunction and decreased activity during the COVID-19 pandemic are strongly related to the deterioration of cognitive impairment.

Direct, indirect, post-infection damages induced by coronavirus in the human body: an overview

Background

Severe acute respiratory syndrome Coronavirus-2 invades the cells via ACE2 receptor and damages multiple organs of the human body. Understanding the pathological manifestation is mandatory to endure the rising post-infection sequel reported in patients with or without comorbidities.

Materials and methods

Our descriptive review emphasises the direct, indirect and post-infection damages due to COVID-19. We have performed an electronic database search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines with selective inclusion and exclusion criteria.

Results

The included studies substantiated the extensive damages in the multiple organs due to direct and indirect consequences of COVID-19. After an apparent recovery, the prolonged presentation of the symptoms manifests as post-COVID that can be related with persisting viral antigens and dysregulated immune response.

Conclusion

A few of the symptoms of respiratory, cardiovascular, and neuropsychiatric systems that persist or reappear as post-COVID manifestations. Vaccination and preventive programs will effectively reduce the prevalence but, the post-COVID, a multisystem manifestation, will be a significant tribulation to the medical profession. However, the issue can be managed by implementing public health programs, rehabilitation services, and telemedicine virtual supports to raise awareness and reduce panic.

Communication challenges in social isolation, subjective cognitive decline, and mental health status in older adults: A scoping review (2019-2021)

PURPOSE

Through an evolutionary concept analysis, social isolation (SI) was defined as lack of social belonging and engagement with others, minimal number of social contacts, and insufficient quality relationships. This definition represents broader understanding of most contributing factors to SI and supports the concepts of reduced communication and socialization experienced during the COVID-19 pandemic. The COVID-19 pandemic served to heighten this problem, including communication challenges, and brought negative outcomes of SI to light. The overall research question examined the impact of communication challenges and SI on OAs with Alzheimer's disease, related dementias, and subjective cognitive changes (2020-2021). This scoping literature review was developed to compare the psychosocial and mental health of older adults between prepandemic and pandemic lockdown of 2020-2021.

DESIGN AND METHODS

This review followed the procedures for scoping review reporting as stated by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews (PRISMA-ScR). In collaboration with an expert scientific information specialist assigned to the college of nursing, the literature was queried through MEDLINE(R) and Epub Ahead of Print, In-Process, In-Data-Review & Other Non-Indexed Citations and Daily 1946 to September 02, 2021; APA PsycInfo 1806 to August Week 5 2021; and Embase Classic+Embase 1947 to 2021 September 02. Search terms included social isolation; nursing home; home for the aged; long-term care; old age homes or convalescent home or nursing home; long-term care, or long-term care; aged or elders or seniors, dementia, Alzheimer's or dementia; osteoporosis; and fragility fracture.

FINDINGS

Quantitative data informed outcomes through increased depression and anxiety, higher rates of depression during the pandemic than prepandemic, and increased symptomology in neuropsychiatric profiles. Further, COVID19-related restrictions, including impaired communication streams, seemed to be the origin of stress-related cognitive changes and symptomology. Communication challenges in residents with dementia may lead to feelings of social isolation. Qualitative evidence supports that dementia has a social, psychological, material, and socio-demographic impact. Further, the lockdown disrupted the existing flow of communication between all stakeholders and residents, resulting in heightened perceptions of SI and a profound sense of loss.

PRACTICE IMPLICATIONS

The results include a diverse and complex characterization of negative outcomes. Further, strong evidence indicates that communication and human contact can ameliorate negative outcomes.

Expansion of a House Calls Program for Patients With Dementia During COVID-19

Homebound older adults with dementia have increased health care use, hospitalization rates, and mortality risk, which are associated with considerable health care costs. A large, unmet need for individuals with dementia is home-based medical care. Although our institution has had a primary care program for homebound patients since 2019, we did not have an analogous program for patients with dementia before the coronavirus disease 2019 (COVID-19) pandemic. However, with increased health risks and challenges associated with the pandemic, we rapidly expanded the program to include facility-based older adults with dementia. We incorporated telemedicine and home-based visits to effectively provide patient-centered care that was aligned with their goals and preferences, and we describe a program example of how we provided care during a COVID-19 outbreak in a large facility. Further research is needed to capture potential cost savings and hospitalization rates for persons with dementia who receive home-based medical care. [Journal of Gerontological Nursing, 48(10), 21-25.].

The Relationship between Mental Disorders and the COVID-19 Pandemic—Course, Risk Factors, and Potential Consequences

In this review the authors discuss that COVID-19 has already had a direct impact on the physical health of many people and that it appears to have put at risk the mental health of large populations. In this review, we also discuss the relationship between mental disorders and the SARS-CoV-2 infection. We convey the disorders’ risk factors and the more serious mental disorder consequences of COVID-19. People with mental health disorders could be more susceptible to the emotional responses brought on by the COVID-19 epidemic. The COVID-19 pandemic may adversely influence the mental health of patients with already diagnosed mental disorders. For the aim of dealing better with the psychological problems of people afflicted by the COVID-19 pandemic, new psychological procedures are required.

Impact of the COVID-19 Pandemic on Utilization of Inpatient Mental Health Services in Shanghai, China

(1) Purpose: The ongoing COVID-19 pandemic has had an impact on mental health and the utilization of hospital-based inpatient mental health care worldwide. The aim of this study was to determine the impact of this pandemic on the utilization of this service in Shanghai by comparison with hospital-based health care records during the preceding 4 years. (2) Methods: The medical records were provided by the Shanghai Municipal Health Insurance Bureau. Diagnostic coding was based on International Classification of Diseases-10th revision (ICD-10), and inpatients with codes from F00 to F99 were examined. (3) Results: Inpatients were compared according to gender, age, pandemic stage, and type of mental disease. Utilization of psychiatric inpatient care in Shanghai during each of the four stages of the pandemic (1 January 2016 to 21 January 2020; 22 January 2020 to 9 February 2020; 10 February 2020 to 1 March 2020; 2 March 2020 to 31 July 2020) was analyzed. Before the lockdown, the utilization of psychiatric inpatient care had an overall upward trend; after the lockdown, the number of inpatients dropped sharply; as of 31 July 2020, it has not been restored. The utilization of this service for most types of mental disease declined rapidly during the pandemic; for vascular dementia (VAD, F01), it was relatively steady. The observed number of inpatient patients was about 51.07% lower than the predicted number in 2020. (4) Conclusions: The COVID-19 pandemic led to the implementation of prevention and control measures that reduced the utilization of psychiatric inpatient care in Shanghai. The use of inpatient services for categories F20–F29 had the greatest decline, and VAD (F01) had the smallest change during the pandemic. This service consequence of COVID-19 is apparent; to assure access to adequate service during a pandemic, health care professionals should pay close attention to changes in the utilization of different mental health services.

The Development of Videoconference-Based Support for People Living With Rare Dementias and Their Carers: Protocol for a 3-Phase Support Group Evaluation

Background

People living with rarer dementias face considerable difficulty accessing tailored information, advice, and peer and professional support. Web-based meeting platforms offer a critical opportunity to connect with others through shared lived experiences, even if they are geographically dispersed, particularly during the COVID-19 pandemic.

Objective

We aim to develop facilitated videoconferencing support groups (VSGs) tailored to people living with or caring for someone with familial or sporadic frontotemporal dementia or young-onset Alzheimer disease, primary progressive aphasia, posterior cortical atrophy, or Lewy body dementia. This paper describes the development, coproduction, field testing, and evaluation plan for these groups.

Methods

We describe a 3-phase approach to development. First, information and knowledge were gathered as part of a coproduction process with members of the Rare Dementia Support service. This information, together with literature searches and consultation with experts by experience, clinicians, and academics, shaped the design of the VSGs and session themes. Second, field testing involved 154 Rare Dementia Support members (people living with dementia and carers) participating in 2 rounds of facilitated sessions across 7 themes (health and social care professionals, advance care planning, independence and identity, grief and loss, empowering your identity, couples, and hope and dementia). Third, a detailed evaluation plan for future rounds of VSGs was developed.

Results

The development of the small groups program yielded content and structure for 9 themed VSGs (the 7 piloted themes plus a later stages program and creativity club for implementation in rounds 3 and beyond) to be delivered over 4 to 8 sessions. The evaluation plan incorporated a range of quantitative (attendance, demographics, and geography; pre-post well-being ratings and surveys; psycholinguistic analysis of conversation; facial emotion recognition; facilitator ratings; and economic analysis of program delivery) and qualitative (content and thematic analysis) approaches. Pilot data from round 2 groups on the pre-post 3-word surveys indicated an increase in the emotional valence of words selected after the sessions.

Conclusions

The involvement of people with lived experience of a rare dementia was critical to the design, development, and delivery of the small virtual support group program, and evaluation of this program will yield convergent data about the impact of tailored support delivered to geographically dispersed communities. This is the first study to design and plan an evaluation of VSGs specifically for people affected by rare dementias, including both people living with a rare dementia and their carers, and the outcome of the evaluation will be hugely beneficial in shaping specific and targeted support, which is often lacking in this population.

International Registered Report Identifier (IRRID)

DERR1-10.2196/35376

Long COVID, neuropsychiatric disorders, psychotropics, present and future

Long COVID refers to the lingering symptoms which persist or appear after the acute illness. The dominant long COVID symptoms in the two years since the pandemic began (2020-2021) have been depression, anxiety, fatigue, concentration and cognitive impairments with few reports of psychosis. Whether other symptoms will appear later on is not yet known. For example, dopamine-dependent movement disorders generally take many years before first symptoms are seen. Post-stroke depression and anxiety may explain many of the early long COVID cases. Hemorrhagic, hypoxic and inflammatory damages of the central nervous system, unresolved systematic inflammation, metabolic impairment, cerebral vascular accidents such as stroke, hypoxia from pulmonary damages and fibrotic changes are among the major causes of long COVID. Glucose metabolic and hypoxic brain issues likely predispose subjects with pre-existing diabetes, cardiovascular or lung problems to long COVID as well. Preliminary data suggest that psychotropic medications may not be a danger but could instead be beneficial in combating COVID-19 infection. The same is true for diabetes medications such as metformin. Thus, a focus on sigma-1 receptor ligands and glucose metabolism is expected to be useful for new drug development as well as the repurposing of current drugs. The reported protective effects of psychotropics and antihistamines against COVID-19, the earlier reports of reduced number of sigma-1 receptors in post-mortem schizophrenic brains, with many antidepressant and antipsychotic drugs being antihistamines with significant affinity for the sigma-1 receptor, support the role of sigma and histamine receptors in neuroinflammation and viral infections. Literature and data in all these areas are accumulating at a fast rate. We reviewed and discussed the relevant and important literature.

Relationship between dementia, COVID-19 risk, and adherence to COVID-19 mitigation behaviors among older adults in the United States

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.

A foundational theoreticalAl12E12(E = N, P) adsorption and quinolone docking study: cage–quinolone pairs, optics and possible therapeutic and diagnostic applications

This combined Al₁₂E₁₂ (E = N, P) surface adsorption and docking study describes the new possibility of prospective potential probing(photophysical/optical) and therapy(medicinal/biochemical) with these adsorbent conjugates. DFT investigations were undertaken herein to help generate geometrical models and better understand the possible favorable adsorption energetics. We attempt to explain their adsorption behaviors and docking involving SARS-CoV-2 viruses (PDB)to assess their possible pharmaceutical potential against the pandemic virus (COVID-19). The adsorption behavior of 8-hydroxy-2-methylquinoline (MQ) and its halogenated derivatives, 5,7-diiodo-8-hydroxy-2-methylquinoline (MQI), 5,7-dichloro-8-hydroxy-2-methylquinoline (MQCl), and 5,7-dibromo-8-hydroxy-2-methylquinoline (MQBr), with aluminum-nitrogen (AlN), and aluminum-phosphorous (AlP) fullerene-like nanocages is reported. A decrease in the hardness of the nanoclusters when adsorbed with drug molecules resulted in an incrementally improved chemical softness (see e.g., Hard-Soft Acid Base theory) indicating that reactivity of the drug molecule in the resulting complex increases upon cluster chemical adsorption. The energy gap is found to be maximized for AlN-MQ and minimized for AlP-MQI; the reduced density gradient (RDG) iso-surfaces and AIM studies also corroborated this. Therefore, these two were found, respectively, to be the least and most electrically conductive of the species under study. We selected a simple medicinal building block (chelator)in addition to selecting the cluster based on previous literature reports. Important parameters such as gap energies and global indices were determined. We assessed NLO properties. The SARS-CoV-2 virus PDB docking data for 6VW1, 6VYO, 6WKQ, 7AD1, 7AOL, 7B3C, were enlisted as ligand targets for studies of docking (PatchDock Server) using the requisite PDB geometries (For the structure of 6VW1, kindly see reference, 2020; For the structure of 6VYO kindly see reference, 2020; For the structure of 6WKQ kindly see reference, 2020; For the structure of 7AD1 kindly see reference, 2021; For the structure of 7AOL kindly see reference, 2021; For the structure of 7B3C kindly see reference, 2021). Such findings indicate that the AlN-drug conjugation have inhibitory effect against these selected receptors.Communicated by Ramaswamy H. Sarma.

COVID-19 and cognitive impairment: A cross-sectional clinic-based study

BACKGROUND

Patients with dementia are more prone to acquire COVID-19 infection. Patients with COVID-19 showed a tendency to develop cognitive impairment.

OBJECTIVES

We aimed to study the clinical manifestations of COVID-19 infection among adult Sudanese demented patients and the prevalence of cognitive impairment among adult Sudanese nondemented patients.

METHODOLOGY

This is a descriptive cross-sectional study that took place in Sudan, Khartoum state in the period (September to December 2021) in a private neurology/psychiatry clinic. A total of 135 adult Sudanese patients were included in this study and were divided into two groups. The first group consists of 100 patients with a known history of dementia that got infected recently with COVID-19, while the second group consists of 35 patients who developed some sort of cognitive impairment after recovering from COVID-19 infection. Regarding the second group, cognitive functions were assessed by senior consultant neurologist and senior consultant psychiatrist using a well validated neuropsychological measure.

RESULTS

Out of 100 patients in the first group, females were 60 and males were 40. Age distribution is between 63 and 98. The common presenting symptoms of COVID-19 among this group were cough and fever (90 patients), diarrhea and vomiting (5 patients), breathlessness (4 patients), coughing of blood (5 patients), convulsions (1 patient), paraplegia (1 patient), and hemiplegia (1 patient). Regarding the second group, age distribution varied from 30 to 80 years. Cognitive functions impairment was noticed as follows: memory recall (22%), memory recognition (23%), memory encoding (24%), processing speed (16%), executive functioning (19%), phonemic fluency (17%), and category fluency (17%).

CONCLUSION

Patients with dementia are more susceptible to develop COVID-19 infection. Patients with COVID-19 Infection are at risk of developing some sort of cognitive impairment after recovery.

A Cohort Study to Assess Cognitive Impairment and Its Effects on Older Patients in the Orthopedic Rehabilitation

Background

The cognitive role of older patients is regularly not investigated in orthopedic rehabilitation, after the elective as well as the nonelective operation. The objective of this research is to investigate the cognitive disorder and its influence over the duration of stay along with the functional consequences of the older patients who were admitted to orthopedic rehabilitation. Material and Methods. The inclusion criteria for this study were the patients with age above 50 years; who were admitted with the detection of orthopedic impairment and the surgery both elective and nonelective, investigated utilizing the MoCA (Montreal Cognitive Assessment) over admission, MBI (Modified Barthel Index), and FIM (Function Independent Measure) over admission and discharge status; and were discharged from the hospital. The demography, as well as the clinical data, comprising of the duration of stay, age and the detection was also reported.

Result

Of the 109 admitted patients, 80 patients were included in the study where n = 47 (58.75%) patients were females and n = 33 (41.25%) were males. The age group range was 50 to 94 years with a mean age of 78.5 years (SD = 8.27). The diagnostic groups included for the study were fractured neck of femur (n = 34; 42.5%), orthopedic surgery (n = 22; 27.5%), and other orthopedic surgery (n = 24; 30%). The mean duration of rehabilitation stay was reported as 34 (4.39), where the MoCA was reported as 22.17 (2.44); functional independence measures were as follows: motor admission as 53.97 (7.55), motor discharge as 76.27 (5.35), cognitive admission as 30.71 (1.99), and cognitive discharge as 31.85 (1.94). Here, the diagnosis was done over the fractured neck of the femur (i.e., NOF being 34 (42.5%), elective surgeries 22 (27.5%), and other orthopedic as 24 (30%)).

Conclusion

An excessive percentage of older-age patients in a rehabilitation unit with elective as well as nonelective diagnoses comprises the cognitive disorder. The cognitive screening was advised for all the older age patients in the rehabilitation units to report a specific rehabilitation plan to enhance the consequences along with the duration of stay. There is further study required to explore different cognitive strategies to enhance the rehabilitation consequences among older-age orthopedic patients.

The Revised Memory and Behavior Problems Checklist for Nursing Homes: Validation among Different Spanish Territories

Memory and behavioral difficulties among older people living in nursing homes can cause burden and other consequences in professional caregivers. There is a lack of instruments that evaluate these behaviors and their influence in formal caregivers. The aim of this study is to develop and psychometrically test—the Revised Memory and Behavior Problems Checklist for Nursing Homes (RMBPC-NH). A cross-sectional study was carried out. The sample was made up of 312 formal caregivers working in nursing homes from different territories in Spain, 87.5% were women and 12.5% were men. The average age of participants was 39 years (SD = 12.2). The sample was recruited from January 2019 to March 2020. Participants completed a self-administered questionnaire, which included sociodemographic information, and assessed quality of technical equipment, level of training, experience of working with older people, job satisfaction, professional quality of life, burnout, and conception of negative stereotypes held towards aging. The four-factor structure of the RMBPC-NH showed a good fit, namely in relation to memory, functional, and emotional factors, and other problems. It has shown adequate psychometric properties, internal consistency, and validity (correlations with professional quality of life, job satisfaction, burnout, and negative stereotypes). The RMBPC-NH is a useful instrument to evaluate the frequency of older people’s memory and behavior problems and professional caregivers’ burden. The practical application in nursing homes is discussed.

Psychosocial Effects of COVID-19 Measures on (Pre-)Dementia Patients During Second Lockdown

BACKGROUND

The COVID-19 pandemic poses enormous social challenges, especially during lockdown. People with cognitive decline and their caregivers are particularly at risk of lockdown consequences.

OBJECTIVE

To investigate psychosocial effects in (pre-)dementia patients and caregivers during second lockdown and compare effects between first and second lockdown.

METHODS

We included n = 511 (pre-)dementia patients and n = 826 caregivers from the Amsterdam Dementia Cohort and via Alzheimer Nederland. All respondents completed a self-designed survey on psychosocial effects of COVID-19. We examined relations between experienced support and psychosocial and behavioral symptoms using logistic regression. In a subset of patients and caregivers we compared responses between first and second lockdown using generalized estimating equation.

RESULTS

The majority of patients (≥58%) and caregivers (≥60%) reported that family and friends, hobbies, and music helped them cope. Support from family and friends was strongly related to less negative feelings in patients (loneliness: OR = 0.3[0.1-0.6]) and caregivers (loneliness: OR = 0.2[0.1-0.3]; depression: OR = 0.4[0.2-0.5]; anxiety: OR = 0.4[0.3-0.6]; uncertainty: OR = 0.3[0.2-0.5]; fatigue: OR = 0.3[0.2-0.4]; stress: OR = 0.3[0.2-0.5]). In second lockdown, less psychosocial and behavioral symptoms were reported compared to first lockdown (patients; e.g., anxiety: 22% versus 13%, p = 0.007; apathy: 27% versus 8%, p < 0.001, caregivers; e.g., anxiety: 23% versus 16%, p = 0.033; patient's behavioral problems: 50% versus 35%, p < 0.001). Patients experienced more support (e.g., family and friends: 52% versus 93%, p < 0.001; neighbors: 28% versus 66%, p < 0.001).

CONCLUSION

During second lockdown, patients and caregivers adapted to challenges posed by lockdown, as psychosocial and behavioral effects decreased, while patients experienced more social support compared to first lockdown. Support from family and friends is a major protective factor for negative outcomes in patients and caregivers.

Impact of Dementia on Mortality Due to Coronavirus Disease 2019: Propensity-Score-Matching Study

BACKGROUND AND PURPOSE

Patients with dementia are particularly vulnerable to coronavirus disease 2019 (COVID-19) because they tend to be older and often have concomitant diseases. Previous studies have investigated the impact of dementia on COVID-19 outcomes, but the evidence is not robust for Asian populations. We aimed to determine the relationship between dementia and COVID-19 outcomes using data from a large-scale nationwide public database.

METHODS

Data on patients with COVID-19 who were released from quarantine between January 1, 2020 and April 30, 2020, published by the Korea Disease Control and Prevention Agency, were divided into two groups based on the dementia status. Propensity-score matching was used to adjust for multiple confounders between the dementia and no-dementia groups. Binary, ordinal logistic regression and multivariate Cox proportional-hazards models were used to compare mortality, quarantine duration, and clinical deterioration according to the dementia status in the two groups.

RESULTS

Males and older individuals (age ≥60 years) constituted 41.5% and 32.9%, respectively, of the 5,299 patients. The prevalence of dementia was 4.2%, and 4.5% of the participants died during hospitalization. In multivariate analysis, dementia was significantly associated with increased mortality (odds ratio [OR]=2.80, 95% confidence interval [CI]=1.60-4.60), longer duration of quarantine (hazard ratio=1.69, 95% CI=1.16-2.45), and larger shift to a worse clinical severity (common OR=1.74, 95% CI=1.18-2.61).

CONCLUSIONS

After adjusting for important clinical predictors, dementia was associated with increased in-hospital mortality, duration of quarantine, and clinical deterioration during hospitalization in COVID-19 patients.

COVID-19 and Dementia; Hard to Forget Yet Haunting Forgetfulness!

The current pandemic has affected almost everyone worldwide. Although the majority of people survive the illness, bad cognitive repercussions might last a long time, resulting in a lower quality of life and disability, particularly in severe cases. We tried to understand and bring together the various possible mechanisms leading to dementia in COVID-19. The link between COVID-19 and dementia will help public health workers plan and allocate resources to provide better care for a community suffering from sickness and improve quality of life. A conceptual framework for care of infected people in the older age group and care of dementia people is proposed.

Considering People with Dementia and Their Caregivers in Covid-19 Lockdowns

Recent outbreaks in Australia and the detection of more virulent SARS-CoV-2 strains suggest that Covid-19 is not yet over. In July 2021, three states in Australia were in lockdown as a result of community transmission of the Delta variant. Despite being effective at mitigating outbreaks, lockdowns could have adverse effects on the elderly and people with dementia. This commentary reviews general lockdown and aged-care lockdown policies in Victoria, New South Wales, and South Australia and highlights how these could affect the well-being of people with dementia and their caregivers. Drawing from literature on Covid-19 and dementia, this commentary provides pragmatic recommendations on how to consider the well-being of people with dementia and their care providers in Covid-19 management policies.

Experts' perception of support for people with dementia and their families during the COVID-19 pandemic

Aim

This study aimed to explore the perceptions of dementia experts on support for people with dementia (PWD) and their families, considering PWD's vulnerability regarding COVID‐19 prevention.

Methods

A collaborative qualitative study was conducted, involving Hiroshima University, the Japan Geriatrics Society, the Japan Society for Dementia Research, and the Japanese Psychogeriatric Society. An anonymous, self‐reported questionnaire survey was sent to dementia experts from 456 medical centers for dementia in Japan. The responses were categorized in a qualitative inductive manner.

Results

A total of 214 experts from 119 centers responded (facility recovery rate: 26.1%). Four core themes emerged from the data analysis. Of these themes, three were related to support for infection prevention and related issues and response to infection: (i) support for continuation of daily life while preventing infection; (ii) support to mitigate the unfavorable effects of infection prevention measures; and (iii) decision‐making support and treatment for infected PWD. The remaining theme, (iv) community building for PWD living together, was extracted as a basis for facilitating themes (i) to (iii). Furthermore, in each theme, the roles of medical and long‐term care facilities, administration, and the need for community collaboration were identified.

Conclusions

Dementia experts strongly felt the need not only for short‐term support to prevent the spread of infection to PWD and their families during the pandemic, but also for long‐term support to enable them to maintain their daily lives and mitigate the impact of infection prevention measures. Geriatr Gerontol Int 2022; 22: 26–31.

Risk factors of mortality among patients hospitalised with COVID-19 in a critical care or hospital care unit: analysis of the French national medicoadministrative database

Objective

To explore mortality risk factors for patients hospitalised with COVID-19 in a critical care unit (CCU) or a hospital care unit (HCU).

Design

Retrospective cohort analysis using the French national (Programme de médicalisation des systèmes d’information) database.

Setting

Any public or private hospital in France.

Participants

98 366 patients admitted with COVID-19 for more than 1 day during the first semester of 2020 were included. The underlying conditions were retrieved for all contiguous stays.

Main outcome measures

In-hospital mortality and associated risk factors were assessed using frailty Cox models.

Results

Among the 98 366 patients included, 25 765 (26%) were admitted to a CCU. The median age was 66 (IQR: 55–76) years in CCUs and 74 (IQR: 57–85) years in HCUs. Age was the main risk factor of death in both CCUs and HCUs, with adjusted HRs (aHRs) in CCUs increasing from 1.60 (95% CI 1.35 to 1.88) for 46 to 65 years to 8.17 (95% CI 6.86 to 9.72) for ≥85 years. In HCUs, the aHR associated with age was more than two times higher. The gender was not significantly associated with death, aHR 1.03 (95% CI 0.98 to 1.09, p=0.2693) in CCUs. Most of the underlying chronic conditions were risk factors for death, including malignant neoplasm (CCU: 1.34 (95% CI 1.25 to 1.43); HCU: 1.41 (95% CI 1.35 to 1.47)), cirrhosis without transplant (1.41 (95% CI 1.22 to 1.64); 1.27 (95% CI 1.12 to 1.45)) and dementia (1.30 (95% CI 1.16 to 1.46); 1.07 (95% CI 1.03 to 1.12)).

Conclusion

This analysis confirms the role of age as the major risk factor of death in patients with COVID-19 irrespective to admission to critical care and therefore supports the current vaccination policies targeting older individuals.

Dementia and COVID-19, a Bidirectional Liaison: Risk Factors, Biomarkers, and Optimal Health Care

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.

The effect of the March 2020 COVID-19 lockdown on national psychiatric contacts in Denmark: An interrupted time series analysis

The COVID-19 pandemic resulted in national lockdowns in several countries. Previous global epidemics led to an increase in the number of psychiatric patients presenting symptoms of anxiety or depression. Knowledge about the impact of early lockdown initiatives during the COVID-19 pandemic on the number of healthcare interactions is sparse. Contacts in this study include all recorded face-to-face (FTF) and virtual treatment interactions between patients and healthcare systems.

AIM

To investigate both the impact of the Danish lockdown event on psychiatric patients' contact with the healthcare system, stratified by type of contact (FTF or virtual) and ICD-10 diagnosis, and how acute contacts were impacted in the five regions in Denmark.

METHODS

An interrupted time series analysis was applied to determine the effect of the COVID-19 lockdown event on the number of contacts with psychiatric hospitals in Denmark, from February 25, 2019 to May 3, 2020. The analyses took a Box-Jenkins approach to fit an autoregressive integrated moving average (ARIMA) model.

RESULTS

Virtual contacts replaced most FTF contacts during the lockdown. For most patient groups, the total number of contacts did not decrease significantly. However, for adult patients diagnosed with ICD-10 F 0-10, 10-19, and 60-69 and child and adolescent patients diagnosed with F 10-19, 70-79, and 80-89, the number of contacts decreased during lockdown. The number of acute contacts with the psychiatric system decreased significantly in all regions in Denmark during lockdown.

DISCUSSION

The Danish healthcare system was forced to introduce innovative tele-psychiatry to mental health care during the lockdown. Disruption to service delivery was minimized because the resources were in place to sustain the transition from FTF to virtual contacts.

Nursing homes during the COVID-19 pandemic: a scoping review of challenges and responses

Aim

To describe factors that contributed to the spread and mortality of COVID-19 in nursing homes and provide an overview of responses that were implemented.

Findings

COVID-19 exerted severe challenges on the nursing home population and its staff. Both internal and external factors predisposed nursing homes to an increased propensity of spread.

Message

Substantial learning occurred that will lead to better pandemic preparedness and improve quality of care for nursing home residents at all times.

Introduction

COVID-19 has caused unprecedented challenges in nursing homes. In this scoping review, we aimed to describe factors that contributed to the spread and mortality of COVID-19 in nursing homes and provide an overview of responses that were implemented to try to overcome such challenges.

Methods

The MeSH terms “Nursing homes” and “COVID-19” were searched in MEDLINE Ovid, and English language articles were retrieved that were published between 1 March 2020 and 31 January 2021. Article titles and abstracts were screened by two reviewers, and the results of included articles were grouped by themes.

Results

The search retrieved 348 articles, of which 76 were included in the thematic review. 8 articles related to COVID-19 disease characteristics (e.g. asymptomatic transmission), 24 to resident-related factors (e.g. comorbidities, nutrition, cognition), 13 to facility characteristics (e.g. physical space, occupancy, for-profit status), 21 to staffing (e.g. staffing levels, staff-to-resident ratio, staff multi-employment), and 10 to external factors (e.g. availability of personal protective equipment, prevailing health and social care policies). In terms of responses, identified themes included widespread testing, isolation and cohorting of residents, staff protection and support, promotion of residents’ well-being, and technological innovations.

Conclusion

COVID-19 exerted severe challenges on the nursing home population and its staff. Both internal and external factors predisposed nursing homes to an increased propensity of spread. Numerous strategies were employed to attempt to mitigate the negative impacts. Substantial learning occurred that may not only aid future pandemic preparedness but improve quality of care for nursing home residents at all times.

Neuropsychiatric Symptoms in Patients with Dementia Associated with Increased Psychological Distress in Caregivers During the COVID-19 Pandemic

BACKGROUND

The social isolation imposed by COVID-19 pandemic can have a major impact on the mental health of dementia patients and their caregivers.

OBJECTIVE

We aim to evaluate the neurological decline of patients with dementia and the caregivers' burden during the pandemic.

METHODS

We performed a cross-sectional study. Caregivers of dementia patients following in the outpatient clinic were included. A structured telephone interview composed of the Neuropsychiatric Inventory Questionnaire (NPI-Q), Zarit Burden Interview (ZBI), Beck Depression (BDI) and Anxiety (BAI) Inventories to address cognitive, behavioral, and functional changes associated with social distancing during the Sars-Cov-2 outbreak. Patients were divided in two groups according to caregivers' report: with perceived Altered Cognition (AC) and Stable Cognition (SC).

RESULTS

A total of 58 patients (median age: 57 years [21-87], 58.6%females) and caregivers (median age: 76.5 years [55-89], 79.3%females) were included. Cognitive decline was shown by most patients (53.4%), as well as behavioral symptoms (48.3%), especially apathy/depression (24.1%), and functional decline (34.5%). The AC group (n = 31) presented increased behavioral (67.7%versus 25.9%, p = 0.002) and functional (61.3%versus 3.7%, p < 0.001) changes when compared to the SC group. In the AC group, ZBI, BDI, NPI-Q caregiver distress, and NPI-Q patient's severity of symptoms scores were worse than the SC group (p < 0.005 for all).

CONCLUSION

Patients' neuropsychiatric worsening and caregiver burden were frequent during the pandemic. Worsening of cognition was associated with increased caregivers' psychological distress.

Geographic Factors Associated with Poorer Outcomes in Patients Diagnosed with COVID-19 in Primary Health Care

Background: The prognosis of older age COVID-19 patients with comorbidities is associated with a more severe course and higher fatality rates but no analysis has yet included factors related to the geographical area/municipality in which the affected patients live, so the objective of this study was to analyse the prognosis of patients with COVID-19 in terms of sex, age, comorbidities, and geographic variables. Methods: A retrospective cohort of 6286 patients diagnosed with COVID-19 was analysed, considering demographic data, previous comorbidities and geographic variables. The main study variables were hospital admission, intensive care unit (ICU) admission and death due to worsening symptoms; and the secondary variables were sex, age, comorbidities and geographic variables (size of the area of residence, distance to the hospital and the driving time to the hospital). A comparison analysis and a multivariate Cox model were performed. Results: The multivariate Cox model showed that women had a better prognosis in any type of analysed prognosis. Most of the comorbidities studied were related to a poorer prognosis except for dementia, which is related to lower admissions and higher mortality. Suburban areas were associated with greater mortality and with less hospital or ICU admission. Distance to the hospital was also associated with hospital admission. Conclusions: Factors such as type of municipality and distance to hospital act as social health determinants. This fact must be taken account in order to stablish specifics prevention measures and treatment protocols.

Dementia and Major Neurocognitive Disorders: Some Lessons Learned One Century after the first Alois Alzheimer's Clinical Notes

Over 100 years ago, Alois Alzheimer presented the clinical signs and symptoms of what has been later called "Alzheimer Dementia" in a young woman whose name was Augustine Deter [...].