J Korean Med Sci.  2020 Nov;35(42):e383. 10.3346/jkms.2020.35.e383.

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

• Ryoo Ny
• Pyun JM
• Baek MJ
• Suh Jw
• Kang MJ
• Wang MJ
• Youn YC
• Yang DW
• Kim SY
• Park YH
• Kim SY

• KMID: 2508433
• DOI: http://doi.org/10.3346/jkms.2020.35.e383

Abstract

Multiple neurological complications have been associated with the coronavirus disease-19 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2. This is a narrative review to gather information on all aspects of COVID-19 in elderly patients with cognitive impairment. First, the following three mechanisms have been proposed to underlie the neurological complications associated with COVID-19: 1) direct invasion, 2) immune and inflammatory reaction, and 3) hypoxic brain damage by COVID-19. Next, because the elderly dementia patient population is particularly vulnerable to COVID-19, we discussed risk factors and difficulties associated with cognitive disorders in this vulnerable population. We also reviewed the effects of the patient living environment in COVID-19 cases that required intensive care unit (ICU) care. Furthermore, we analyzed the impact of stringent social restrictions and COVID-19 pandemic-mediated policies on dementia patients and care providers. Finally, we provided the following strategies for working with elderly dementia patients: general preventive methods; dementia care at home and nursing facilities according to the activities of daily living and dementia characteristics; ICU care after COVID-19 infection; and public health care system and government response. We propose that longitudinal follow-up studies are needed to fully examine COVID-19 associated neurological complications, such as dementia, and the efficacy of telemedicine/telehealth care programs.

Keyword

COVID-19; SARS-CoV-2; Neurology; CNS Complications; Dementia Care; Dementia Prevention

Reference

1. World Health Organization. Coronavirus disease (COVID-19) situation reports. Updated 2020. Accessed October 15, 2020. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports.

2. Kim JY, Choe PG, Oh Y, Oh KJ, Kim J, Park SJ, et al. The first case of 2019 novel coronavirus pneumonia imported into Korea from Wuhan, China: implication for infection prevention and control measures. J Korean Med Sci. 2020; 35(5):e61. PMID: 32030925.

3. CoronaBoard. Billboard of COVID-19. Updated 2020. Accessed October 15, 2020. https://coronaboard.kr/.

4. Kwon KT, Ko JH, Shin H, Sung M, Kim JY. Drive-through screening center for COVID-19: a safe and efficient screening system against massive community outbreak. J Korean Med Sci. 2020; 35(11):e123. PMID: 32193904.

5. Her M. How is COVID-19 affecting South Korea? What is our current strategy? Disaster Med Public Health Prep. 2020; 1–3.

6. Kraemer MUG, Yang CH, Gutierrez B, Wu CH, Klein B, Pigott DM, et al. The effect of human mobility and control measures on the COVID-19 epidemic in China. Science. 2020; 368(6490):493–497. PMID: 32213647.

7. Wu Y, Xu X, Chen Z, Duan J, Hashimoto K, Yang L, et al. Nervous system involvement after infection with COVID-19 and other coronaviruses. Brain Behav Immun. 2020; 87(March):18–22. PMID: 32240762.

8. Su S, Wong G, Shi W, Liu J, Lai ACK, Zhou J, et al. Epidemiology, genetic recombination, and pathogenesis of coronaviruses. Trends Microbiol. 2016; 24(6):490–502. PMID: 27012512.

9. Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020; 395(10224):565–574. PMID: 32007145.

10. Cui J, Li F, Shi ZL. Origin and evolution of pathogenic coronaviruses. Nat Rev Microbiol. 2019; 17(3):181–192. PMID: 30531947.

11. Pleasure SJ, Green AJ, Josephson SA. The spectrum of neurologic disease in the severe acute respiratory syndrome coronavirus 2 pandemic infection. JAMA Neurol. 2020; 77(6):679–680. PMID: 32275291.

12. Ogier M, Andéol G, Sagui E, Dal Bo G. How to detect and track chronic neurologic sequelae of COVID-19? Use of auditory brainstem responses and neuroimaging for long-term patient follow-up. Brain Behav Immun Health. 2020; 5:100081. PMID: 32427134.

13. Fotuhi M, Mian A, Meysami S, Raji CA. Neurobiology of COVID-19. J Alzheimers Dis. 2020; 76(1):3–19. PMID: 32538857.

14. Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020; 77(6):683–690. PMID: 32275288.

15. Moriguchi T, Harii N, Goto J, Harada D, Sugawara H, Takamino J, et al. A first case of meningitis/encephalitis associated with SARS-coronavirus-2. Int J Infect Dis. 2020; 94(March):55–58. PMID: 32251791.

16. Li MY, Li L, Zhang Y, Wang XS. Expression of the SARS-CoV-2 cell receptor gene ACE2 in a wide variety of human tissues. Infect Dis Poverty. 2020; 9(1):45. PMID: 32345362.

17. Sepehrinezhad A, Shahbazi A, Negah SS. COVID-19 virus may have neuroinvasive potential and cause neurological complications: a perspective review. J Neurovirol. 2020; 26(3):324–329. PMID: 32418055.

18. Xydakis MS, Dehgani-Mobaraki P, Holbrook EH, Geisthoff UW, Bauer C, Hautefort C, et al. Smell and taste dysfunction in patients with COVID-19. Lancet Infect Dis. 2020; 20(9):1015–1016. PMID: 32304629.

19. Lee Y, Min P, Lee S, Kim SW. Prevalence and duration of acute loss of smell or taste in COVID-19 patients. J Korean Med Sci. 2020; 35(18):e174. PMID: 32383370.

20. Lee JM, Lee SJ. Olfactory and gustatory dysfunction in a COVID-19 patient with ankylosing spondylitis treated with etanercept: case report. J Korean Med Sci. 2020; 35(21):e201. PMID: 32476306.

21. Vaira LA, Salzano G, Deiana G, De Riu G. Anosmia and ageusia: common findings in COVID-19 patients. Laryngoscope. 2020; 130(7):1787. PMID: 32237238.

22. Lechien JR, Chiesa-Estomba CM, De Siati DR, Horoi M, Le Bon SD, Rodriguez A, et al. Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study. Eur Arch Otorhinolaryngol. 2020; 277(8):2251–2261. PMID: 32253535.

23. Giacomelli A, Pezzati L, Conti F, Bernacchia D, Siano M, Oreni L, et al. Self-reported olfactory and taste disorders in patients with severe acute respiratory coronavirus 2 infection: a cross-sectional study. Clin Infect Dis. 2020; 71(15):889–890. PMID: 32215618.

24. Netland J, Meyerholz DK, Moore S, Cassell M, Perlman S. Severe acute respiratory syndrome coronavirus infection causes neuronal death in the absence of encephalitis in mice transgenic for human ACE2. J Virol. 2008; 82(15):7264–7275. PMID: 18495771.

25. Dubé M, Le Coupanec A, Wong AHM, Rini JM, Desforges M, Talbot PJ. Axonal transport enables neuron-to-neuron propagation of human coronavirus OC43. J Virol. 2018; 92(17):e00404–18. PMID: 29925652.

26. Jose RJ, Manuel A. COVID-19 cytokine storm: the interplay between inflammation and coagulation. Lancet Respir Med. 2020; 8(6):e46–7. PMID: 32353251.

27. 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):21–25. PMID: 32538855.

28. Li Y, Li M, Wang M, Zhou Y, Chang J, Xian Y, et al. Acute cerebrovascular disease following COVID-19: a single center, retrospective, observational study. Stroke Vasc Neurol. 2020; 5(3):279–284. PMID: 32616524.

29. Lodigiani C, Iapichino G, Carenzo L, Cecconi M, Ferrazzi P, Sebastian T, et al. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thromb Res. 2020; 191:9–14. PMID: 32353746.

30. Oxley TJ, Mocco J, Majidi S, Kellner CP, Shoirah H, Singh IP, et al. Large-vessel stroke as a presenting feature of COVID-19 in the young. N Engl J Med. 2020; 382(20):e60. PMID: 32343504.

31. Zhou B, She J, Wang Y, Ma X. A case of coronavirus disease 2019 with concomitant acute cerebral infarction and deep vein thrombosis. Front Neurol. 2020; 11:296. PMID: 32390931.

32. Row BW. Intermittent hypoxia and cognitive function: implications from chronic animal models. Adv Exp Med Biol. 2007; 618:51–67. PMID: 18269188.

33. Solomon IH, Normandin E, Bhattacharyya S, Mukerji SS, Keller K, Ali AS, et al. Neuropathological features of COVID-19. N Engl J Med. 2020; 383(10):989–992. PMID: 32530583.

34. Coolen T, Lolli V, Sadeghi N, Rovaï A, Trotta N, Taccone FS, et al. Early postmortem brain MRI findings in COVID-19 non-survivors. Neurology. 2020; 95(14):e2016–27. PMID: 32546654.

35. Lippi A, Domingues R, Setz C, Outeiro TF, Krisko A. SARS-CoV-2: at the crossroad between aging and neurodegeneration. Mov Disord. 2020; 35(5):716–720. PMID: 32291797.

36. Helms J, Kremer S, Merdji H, Clere-Jehl R, Schenck M, Kummerlen C, et al. Neurologic features in severe SARS-CoV-2 infection. N Engl J Med. 2020; 382(23):2268–2270. PMID: 32294339.

37. Ji W, Huh K, Kang M, Hong J, Bae GH, Lee R, et al. Effect of underlying comorbidities on the infection and severity of COVID-19 in Korea: a nationwide case-control study. J Korean Med Sci. 2020; 35(25):e237. PMID: 32597048.

38. Lee JY, Kim HA, Huh K, Hyun M, Rhee JY, Jang S, et al. Risk factors for mortality and respiratory support in elderly patients hospitalized with COVID-19 in Korea. J Korean Med Sci. 2020; 35(23):e223. PMID: 32537957.

39. Bonafè M, Prattichizzo F, Giuliani A, Storci G, Sabbatinelli J, Olivieri F. Inflamm-aging: Why older men are the most susceptible to SARS-CoV-2 complicated outcomes. Cytokine Growth Factor Rev. 2020; 53:33–37. PMID: 32389499.

40. Wang L, He W, Yu X, Hu D, Bao M, Liu H, et al. Coronavirus disease 2019 in elderly patients: characteristics and prognostic factors based on 4-week follow-up. J Infect. 2020; 80(6):639–645. PMID: 32240670.

41. Rosenbaum L. Facing COVID-19 in Italy - ethics, logistics, and therapeutics on the epidemic's front line. N Engl J Med. 2020; 382(20):1873–1875. PMID: 32187459.

42. Atkins JL, Masoli JAH, Delgado J, Pilling LC, Kuo CL, Kuchel GA, et al. Preexisting comorbidities predicting severe COVID-19 in older adults in the UK biobank community cohort. Updated 2020. Accessed July 7, 2020. https://www.medrxiv.org/content/10.1101/2020.05.06.20092700v1.article-info.

43. Perrotta F, Corbi G, Mazzeo G, Boccia M, Aronne L, D'Agnano V, et al. COVID-19 and the elderly: insights into pathogenesis and clinical decision-making. Aging Clin Exp Res. 2020; 32(8):1599–1608. PMID: 32557332.

44. Onder G, Rezza G, Brusaferro S. Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA. 2020; 323(18):1775–1776. PMID: 32203977.

45. Perry G. Alzheimer's disease patients in the crosshairs of COVID-19. J Alzheimers Dis. 2020; 76(1):1. PMID: 32623403.

46. 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(1):10. PMID: 24472217.

47. Yamazaki Y, Zhao N, Caulfield TR, Liu CC, Bu G. Apolipoprotein E and Alzheimer disease: pathobiology and targeting strategies. Nat Rev Neurol. 2019; 15(9):501–518. PMID: 31367008.

48. Shi Y, Manis M, Long J, Wang K, Sullivan PM, Remolina Serrano J, et al. Microglia drive APOE-dependent neurodegeneration in a tauopathy mouse model. J Exp Med. 2019; 216(11):2546–2561. PMID: 31601677.

49. Atkins JL, Masoli JAH, Delgado J, Pilling LC, Kuo CL, Kuchel GA, et al. APOE e4 genotype predicts severe COVID-19 in the UK biobank community cohort. Updated 2020. Accessed July 7, 2020. https://www.medrxiv.org/content/10.1101/2020.05.07.20094409v2.

50. World Health Organization. Risk Communication and Community Engagement Readiness and Response to Coronavirus Disease (COVID-19): Interim Guidance. Geneva: World Health Organization;2020.

51. McKeith IG. Dementia with Lewy bodies. Br J Psychiatry. 2002; 180:144–147. PMID: 11823325.

52. Arvanitakis Z. Update on frontotemporal dementia. Neurologist. 2010; 16(1):16–22. PMID: 20065792.

53. Simard M, Hudon C, van Reekum R. Psychological distress and risk for dementia. Curr Psychiatry Rep. 2009; 11(1):41–47. PMID: 19187707.

54. Rogers JP, Chesney E, Oliver D, Pollak TA, McGuire P, Fusar-Poli P, et al. Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic. Lancet Psychiatry. 2020; 7(7):611–627. PMID: 32437679.

55. 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):41–47. PMID: 32568211.

56. Meyer JS, Xu G, Thornby J, Chowdhury MH, Quach M. Is mild cognitive impairment prodromal for vascular dementia like Alzheimer's disease? Stroke. 2002; 33(8):1981–1985. PMID: 12154249.

57. McKeith IG, Boeve BF, Dickson DW, Halliday G, Taylor JP, Weintraub D, et al. Diagnosis and management of dementia with Lewy bodies: fourth consensus report of the DLB consortium. Neurology. 2017; 89(1):88–100. PMID: 28592453.

58. Gore RL, Vardy ER, O'Brien JT. Delirium and dementia with Lewy bodies: distinct diagnoses or part of the same spectrum? J Neurol Neurosurg Psychiatry. 2015; 86(1):50–59. PMID: 24860139.

59. Boot BP, McDade EM, McGinnis SM, Boeve BF. Treatment of dementia with Lewy bodies. Curr Treat Options Neurol. 2013; 15(6):738–764. PMID: 24222315.

60. Bang J, Spina S, Miller BL. Frontotemporal dementia. Lancet. 2015; 386(10004):1672–1682. PMID: 26595641.

61. Rada AG. COVID-19: the precarious position of Spain's nursing homes. BMJ. 2020; 369:m1554. PMID: 32312710.

62. Yourish K, Lai KKR, Ivory D, Smith M. One-third of all U.S. coronavirus deaths are nursing home residents or workers. Updated 2020. Accessed May 11, 2020. https://www.nytimes.com/interactive/2020/05/09/us/coronavirus-cases-nursing-homes-us.html.

63. Trabucchi M, De Leo D. Nursing homes or besieged castles: COVID-19 in northern Italy. Lancet Psychiatry. 2020; 7(5):387–388. PMID: 32353267.

64. Wang H, Li T, Barbarino P, Gauthier S, Brodaty H, Molinuevo JL, et al. Dementia care during COVID-19. Lancet. 2020; 395(10231):1190–1191. PMID: 32240625.

65. Morandi A, Lucchi E, Turco R, Morghen S, Guerini F, Santi R, et al. Delirium superimposed on dementia: a quantitative and qualitative evaluation of patient experience. J Psychosom Res. 2015; 79(4):281–287. PMID: 26282373.

66. Brown EE, Kumar S, Rajji TK, Pollock BG, Mulsant BH. Anticipating and mitigating the impact of COVID-19 pandemic on Alzheimer's disease and related dementias. Am J Geriatr Psychiatry. 2020; 28(7):712–721. PMID: 32331845.

67. The Alzheimer's Association. Coronavirus (COVID-19): tips for dementia caregivers. Updated 2020. Accessed June 20, 2020. https://www.alz.org/help-support/caregiving/coronavirus-(covid-19)-tips-for-dementia-care.

68. UK Alzheimer's Society. 5 great ways to keep moving at home - tips for people with dementia. Updated 2020. Accessed June 23, 2020. https://www.alzheimers.org.uk/blog/5-exercise-activities-dementia-coronavirus.

69. Alzheimer's Disease International (ADI). ADI offers advice and support during COVID-19. Updated 2020. Accessed June 17, 2020. https://www.alz.co.uk/news/adi-offers-advice-and-support-during-covid-19.

70. Understand Together Campaign. At home activities: meaningful activities for PWD, families and carers. Updated 2020. Accessed June 12, 2020. https://www.understandtogether.ie/Training-resources/Helpful-Resources/Publications/At%20Home%20Activities.pdf.

71. Alzheimer Scotland. Coronavirus: guidance for people with dementia and carers. Updated 2020. Accessed March 22, 2020. https://www.alzscot.org/sites/default/files/2020-03/Coronavirus%20toptips.pdf.

72. IDEAL. How to stay well during the COVID-19 pandemic: 5 key messages for people living with dementia. Updated 2020. Accessed April 24, 2020. http://www.idealproject.org.uk/media/universityofexeter/schoolofpsychology/ideal/covid-19/Dementia_leaflet_Coronavirus.pdf.

73. The Alzehimer Society of Ireland. Tips for vulnerable people living alone/self-isolating. Updated 2020. Accessed March 13, 2020. https://alzheimer.ie/wp-content/uploads/2020/03/Tips-for-vulnerable-adultsv4.pdf.

74. Korczyn AD. Dementia in the COVID-19 period. J Alzheimers Dis. 2020; 75(4):1071–1072. PMID: 32538858.

75. Jung SJ, Jun JY. Mental health and psychological intervention amid COVID-19 outbreak: perspectives from South Korea. Yonsei Med J. 2020; 61(4):271–272. PMID: 32233168.

76. Jin H, Hong C, Chen S, Zhou Y, Wang Y, Mao L, et al. Consensus for prevention and management of coronavirus disease 2019 (COVID-19) for neurologists. Stroke Vasc Neurol. 2020; 5(2):146–151. PMID: 32385132.

77. Tible OP, Riese F, Savaskan E, von Gunten A. Best practice in the management of behavioural and psychological symptoms of dementia. Ther Adv Neurol Disorder. 2017; 10(8):297–309.

78. Bloem BR, Dorsey ER, Okun MS. The coronavirus disease 2019 crisis as catalyst for telemedicine for chronic neurological disorders. JAMA Neurol. 2020; 77(8):927–928. PMID: 32329796.

79. Gerlach LB, Kales HC. Managing behavioral and psychological symptoms of dementia. Psychiatr Clin North Am. 2018; 41(1):127–139. PMID: 29412841.

80. US Centers for Disease Control and Prevention. CDC's recommendations for the next 30 days of mitigation strategies for Seattle-King, Pierce, and Snohomish Counties based on current situation with widespread COVID-19 transmission and affected health care facilities. Updated 2020. Accessed March 26, 2020. https://www.cdc.gov/coronavirus/2019-ncov/downloads/Seattle_Community_Mitigation.pdf.

81. Andrews LJ, Benken ST. COVID-19: ICU delirium management during SARS-CoV-2 pandemic-pharmacological considerations. Crit Care. 2020; 24(1):375. PMID: 32576234.

82. Suzuki T. Does the combination use of two pain assessment tools have a synergistic effect? J Intensive Care. 2017; 5:1. PMID: 28066556.

83. Pyun JM, Park YH, Yang J, Ryoo N, Kim S. Hypersensitivity to atypical antipsychotics in dementia with Lewy bodies: is it common or rare? Parkinsonism Relat Disord. 2020; 76:44–45. PMID: 32563050.

84. Udeh C, Udeh B, Rahman N, Canfield C, Campbell J, Hata JS. Telemedicine/virtual ICU: where are we and where are we going? Methodist DeBakey Cardiovasc J. 2018; 14(2):126–133. PMID: 29977469.

85. Adams JG, Walls RM. Supporting the health care workforce during the COVID-19 global epidemic. JAMA. 2020; 323(15):1439–1440. PMID: 32163102.

86. World Health Organization. Infection prevention and control guidance for long-term care facilities in the context of COVID-19: interim guidance. Updated 2020. Accessed August 10, 2020. https://apps.who.int/iris/handle/10665/331508.

87. The Government of the Republic of Korea. Flattening the curve on COVID-19: how Korea responded to a pandemic using ICT. Updated 2020. Accessed April 27, 2020. http://overseas.mofa.go.kr/gr-en/brd/m_6940/view.do?seq=761548&srchFr=&srchTo=&srchWord=&srchTp=&multi_itm_seq=0&itm_seq_1=0&itm_seq_2=0&company_cd=&company_nm=&page=1.

88. Lee J, Lee AY. Daejeon Metropolitan Dementia Center. Home-visiting cognitive intervention for the community-dwelling elderly living alone. Dement Neurocogn Disord. 2020; 19(2):65–73. PMID: 32602281.

89. Chan EY, Gobat N, Kim JH, Newnham EA, Huang Z, Hung H, et al. Informal home care providers: the forgotten health-care workers during the COVID-19 pandemic. Lancet. 2020; 395(10242):1957–1959. PMID: 32497509.

90. Brodaty H, Donkin M. Family caregivers of people with dementia. Dialogues Clin Neurosci. 2009; 11(2):217–228. PMID: 19585957.

91. Yum HK. Suggestions to prepare for the second epidemic of COVID-19 in Korea. J Korean Med Sci. 2020; 35(19):e191. PMID: 32419402.

92. Benaque A, Gurruchaga MJ, Abdelnour C, Hernández I, Cañabate P, Alegret M, et al. Dementia care in times of COVID-19: experience at Fundació ACE in Barcelona, Spain. J Alzheimers Dis. 2020; 76(1):33–40. PMID: 32538856.