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

Dementia with Lewy bodies (DLB) is a neurodegenerative disease characterized by cognitive, behavioral and motor symptoms and has a more challenging clinical management and poorer prognosis compared to other forms of dementia. The experience of lockdown leads to negative psychological outcomes for fragile people such as elderly with dementia, particularly for DLB, causing a worsening of cognitive and neuropsychiatric symptoms. Since an individual's feeling of time passage is strongly related to their cognitive and emotional state, it is conceivable to expect alterations of this construct in people with DLB during such a difficult period. We therefore assessed the subjective experience of the passage of time for present and past time intervals (Subjective Time Questionnaire, STQ) during the lockdown due to coronavirus disease (COVID-19) in 22 patients with DLB (17 of which were re-tested in a post-lockdown period) and compared their experience with that of 14 caregivers with similar age. Patients showed a significantly slower perception of present and past time spent under lockdown restrictions. We argue that these alterations might be related to the distinctive features of DLB and their exacerbation recorded by the patients' caregivers during the period of lockdown, though our results show that the patients' experience of time passage in a post-lockdown period remained similarly slow. Overall, we show an impairment of the subjective perception of time passage in DLB tested during the COVID-19 lockdown. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12144-021-01811-7.

Depression, Anxiety and Sleep Alterations in Caregivers of Persons With Dementia After 1-Year of COVID-19 Pandemic.

BACKGROUND: Social isolation due to COVID-19 pandemic has an important psychological impact particularly in persons with dementia and their informal caregivers. AIM: To assess frequency and severity of long-term stress-related symptoms in caregivers of patients with dementia 1-year after the beginning of COVID-19 pandemic and to identify predictors of psychological outcomes. METHODS: Eighty-five caregivers were involved in a longitudinal study with 1-year follow-up during pandemic in Italy. At baseline in April 2020 a telephone interview assessed socio-demographic characteristics of caregivers and self-perception of distress symptoms. After 1 year, between March and April 2021, the same standardized interview was delivered to the caregivers' sample. In addition, scales assessing levels of depression and anxiety (DASS-21), sleep disturbances (PSQI) and coping strategies (COPE-NVI) were administered to the caregivers and to 50 age and sex-matched non-caregivers subjects. Linear regression analysis was performed to investigate the power of baseline variables to predict long-term psychological outcomes. RESULTS: After 1 year of pandemic frequency of caregivers' stress-related symptoms increased respect to baseline: depression (60 vs. 5, 9%; p < 0.001), anxiety (45, 9 vs. 29, 4%; p = 0.035), irritability (49, 4 vs. 24, 7%; p < 0.001), and anguish (31, 7 vs. 10, 6%; p < 0.001). Frequency of severe depression was higher in caregivers than in non-caregivers (p = 0.002) although mean levels of depression were comparable in the two groups. Long-term higher depression was predicted by a model built on baseline information (r2 = 0.53, p < 0.001) where being female (t = -3.61, p < 0.001), having lower education (t = -2.15, p = 0.04), presence of feelings of overwhelm (t = 2.29, p = 0.02) and isolation (t = 2.12, p = 0.04) were significant predictors. Female sex was also predictive of anxiety (t = -2.7, p = 0.01) and poor sleep quality (t = -2.17, p = 0.03). DISCUSSION: At 1 year follow-up caregivers of patients with dementia reported higher prevalence of all stress-related symptoms respect to the acute phase of lockdown, particularly depression. Long-lasting stressful conditions may cause exhaustion of resilience factors and increased depression. Planning interventions should support caregivers to enable them to continue with their role during pandemic.

The Impact of COVID-19 Quarantine on Patients With Dementia and Family Caregivers: A Nation-Wide Survey.

INTRODUCTION: Previous studies showed that quarantine for pandemic diseases is associated with several psychological and medical effects. The consequences of quarantine for COVID-19 pandemic in patients with dementia are unknown. We investigated the clinical changes in patients with Alzheimer's disease and other dementias, and evaluated caregivers' distress during COVID-19 quarantine. METHODS: The study involved 87 Italian Dementia Centers. Patients with Alzheimer's Disease (AD), Dementia with Lewy Bodies (DLB), Frontotemporal Dementia (FTD), and Vascular Dementia (VD) were eligible for the study. Family caregivers of patients with dementia were interviewed by phone in April 2020, 45 days after quarantine declaration. Main outcomes were patients' changes in cognitive, behavioral, and motor symptoms. Secondary outcomes were effects on caregivers' psychological features. RESULTS: 4913 patients (2934 females, 1979 males) fulfilled the inclusion criteria. Caregivers reported a worsening in cognitive functions in 55.1% of patients, mainly in subjects with DLB and AD. Aggravation of behavioral symptoms was observed in 51.9% of patients. In logistic regression analysis, previous physical independence was associated with both cognitive and behavioral worsening (odds ratio 1.85 [95% CI 1.42-2.39], 1.84 [95% CI 1.43-2.38], respectively). On the contrary, pandemic awareness was a protective factor for the worsening of cognitive and behavioral symptoms (odds ratio 0.74 [95% CI 0.65-0.85]; and 0.72 [95% CI 0.63-0.82], respectively). Approximately 25.9% of patients showed the onset of new behavioral symptoms. A worsening in motor function was reported by 36.7% of patients. Finally, caregivers reported a high increase in anxiety, depression, and distress. CONCLUSION: Our study shows that quarantine for COVID-19 is associated with an acute worsening of clinical symptoms in patients with dementia as well as increase of caregivers' burden. Our findings emphasize the importance to implement new strategies to mitigate the effects of quarantine in patients with dementia.