Steeper memory decline after COVID-19 lockdown measures.

BACKGROUND: During COVID-19 lockdown measures, memory clinic patients reported worries for faster cognitive decline, due to loss of structure and feelings of loneliness and depression. We aimed to investigate the impact of the COVID-19 lockdown on rate of cognitive decline in a mixed memory clinic population, compared to matched historical controls. METHODS: We included patients who visited Alzheimer Center Amsterdam 6 months to 1 week before the first Dutch COVID-19 lockdown, and had a second visit 1 year later, after this lockdown period (n = 113; 66 ± 7 years old; 30% female; n = 55 dementia, n = 31 mild cognitive impairment (MCI), n = 18 subjective cognitive decline (SCD), n = 9 postponed diagnosis). Historical controls (visit in 2016/2017 and second visit 1 year later (n = 640)) were matched 1:1 to lockdown patients by optimal Mahalanobis distance matching (both groups n = 113). Groups were well matched. Differences between lockdown patients and historical controls over time in Mini-Mental State Examination, Trail Making Test part A and B, Rey-Auditory Verbal Learning Test (RAVLT) immediate and delayed recall, and category fluency scores were analyzed using linear mixed effect models with random intercepts. We examined differences in rate of cognitive decline between whole groups, and after stratification in SCD, MCI, and dementia separately. RESULTS: Lockdown patients had a faster rate of memory decline compared to controls on both RAVLT immediate [B(SE) = - 2.62 (1.07), p = 0.015] and delayed recall [B(SE) = - 1.07 (0.34), p = 0.002]. Stratification by syndrome diagnosis showed that this effect was largely attributable to non-demented participants, as we observed faster memory decline during lockdown in SCD and MCI (RAVLT immediate [SCD: B(SE) = - 6.85 (2.97), p = 0.027; MCI: B(SE) = - 6.14 (1.78), p = 0.001] and delayed recall [SCD: B(SE) = - 2.45 (1.11), p = 0.035; MCI: B(SE) = - 1.50 (0.51), p = 0.005]), but not in dementia. CONCLUSION: Memory clinic patients, specifically in pre-dementia stages, showed faster memory decline during COVID-19 lockdown, providing evidence that lockdown regulations had a deleterious effect on brain health. In individuals that may have been able to deal with accumulating, subclinical neuropathology under normal and structured circumstances, the additional stress of lockdown regulations may have acted as a "second hit," resulting in less beneficial disease trajectory.

The impact of COVID‐19 restrictions after one year on modifiable risk factors related to brain health in older adults in The Netherlands

Background COVID‐19‐restrictions impact the lifestyle and mental health of people, which then might affect brain health and increase risk of cognitive decline particularly in older adults. Thereby, COVID‐19 might indirectly contribute to cognitive decline. We aimed to investigate changes in modifiable risk factors related to brain health in older adults after one year of COVID‐19‐restrictions. Method An online questionnaire was disseminated between February and March 2021 to registrants of the Dutch Brain Research Registry, aged ≥50, without a self‐reported diagnosis of mild cognitive impairment or dementia. Participants reported potential changes in behaviors during COVID‐19 pandemic concerning modifiable risk factors in eight domains (physical activity, sleep, memory, stress, feeling of loneliness, diet, alcohol consumption and smoking) compared to before the COVID‐19‐outbreak. We counted the number of reported detrimental and beneficial changes, and used multiple regression analyses to relate (socio)demographics, subjective memory complaints and COVID‐19 related aspects to increasing number of reported detrimental and beneficial changes, separately. Result 3943 participants (66±8 years old, 76% female) completed the questionnaire. After one year of COVID‐19‐restrictions, 74% reported one or more detrimental changes and 60% reported at least on beneficial change. More specifically, participants reported more often detrimental changes for loneliness, sleep, physical activities, stress, memory complaints and smoking, while beneficial changes were more often reported for diet and alcohol consumption. More detrimental changes was associated lower age, (B = 0.02;95%confidence interval = ‐0.03‐ ‐0.01), female sex (0.28;0.15–0.41), living alone (0.35;0.22–0.48), the presence of subjective memory complaints (0.69;0.54–0.84), a current or past COVID‐19 infection (0.35;0.14–0.56) and a fear of a COVID‐infection (0.54;0.42–0.65). In addition, those who were less satisfied with their income were more likely to report more detrimental changes (0.66;0.34‐1.00). More beneficial changes were only associated with female sex (0.16;0.06‐0.27). Conclusion The COVID‐19 pandemic appears to have a differentially impact on older adults in the Netherlands, with people who are relatively younger, female, living alone, experiencing subjective memory complaints and those with a past or current or fear of a COVID‐19‐infection seem more vulnerable for more detrimental changes in modifiable risk factors related to brain health. Thus providing an opportunity for targeted prevention and health education.

The impact of COVID‐19 lockdown on cognitive decline over time

Background During the COVID‐19 pandemic, memory clinic patients reported worries for faster cognitive decline as a consequence of lockdown measures, e.g. loss of structure and feelings of loneliness and depression. We aimed to investigate the impact of the COVID‐19 lockdown on cognitive decline over time in a mixed memory clinic population, compared to historical controls. Method We included patients who visited Alzheimer Center Amsterdam six months to a week before the first COVID‐19 lockdown in the Netherlands (mid‐March 2020), and a second visit one year later, after this lockdown period (n = 114;67±7 years old;30% female;Mini‐Mental State Examination (MMSE): 25±3;diagnosis: n = 55 dementia, n = 32 mild cognitive impairment, n = 18 subjective cognitive decline, n = 9 postponed diagnosis). We selected historical controls with a visit in 2016 or 2017 and a second visit one year later (n = 641). Historical controls were matched 1:1 to patients during COVID‐19 lockdown by optimal Mahalanobis distance matching based on age, sex, diagnosis, MMSE, type of visit (baseline/follow‐up) and time between the first and second visit. Matching was successful and led to balanced groups (both n = 114) on all matching variables (table 1). We used linear mixed models with terms for time, group (i.e. lockdown patients vs. historical controls) and the interaction between time and group. Outcome measures were MMSE, Trail Making Test part A and B, Rey‐Auditory Verbal Learning Test (RAVLT) immediate and delayed recall and category fluency. Result As expected, there was no effect of group on baseline test performance for any of the tests. We found significant interactions between time and group for RAVLT immediate recall [B(SE) = ‐2.74(1.07), p = 0.011] and delayed recall [B(SE) = ‐1.07(0.34), p = 0.002], indicating steeper cognitive decline during lockdown. In non‐matched historical controls, we found similar results;significant interactions between group and time for RAVLT immediate recall [B(SE) = ‐3.34(0.80), p<0.001] and delayed recall [B(SE) = ‐0.94(0.23), p<0.001], and additionally steeper decline on category fluency [B(SE) = ‐1.42(0.51), p = 0.005]. Conclusion Memory clinic patients during COVID‐19 lockdown show steeper decline in memory than matched historical controls, providing evidence that lockdown regulations contributed to faster cognitive decline.

Changes in Brain-Health Related Modifiable Risk Factors in Older Adults After One Year of COVID-19-Restrictions.

Background: The COVID-19 pandemic has major influence on lifestyle and mental health, which might affect brain-health and increase the risk of cognitive decline, particularly in older adults. We aimed to describe changes in modifiable risk factors related to brain-health in older adults after one year of COVID-19 restrictions. Methods: An online survey was disseminated between February and March 2021 to 17,773 registrants of the Dutch Brain Research Registry, aged ≥50, without a self-reported diagnosis of mild cognitive impairment or dementia. Participants were asked to report potential changes in behaviors during the COVID-19 pandemic, compared to pre-pandemic, in eight domains related to brain health: physical activity, sleep, feeling of memory decline, perceived stress, feeling of loneliness, diet, alcohol consumption, and smoking. We used negative binomial regression analyses to relate (socio)demographics, subjective memory complaints and COVID-19 related aspects (fear of, or current/past COVID-19 infection) to the number of reported detrimental and beneficial changes as dependent variable. Results: 3,943 participants (66 ± 8 years old; 76% female; 71% highly educated) completed the survey. After one year of COVID-19-restrictions, 74% reported at least one detrimental lifestyle change unfavorable for their brain health, most frequently reported were feelings of loneliness, sleep problems, and less physical activity. 60% of participants reported at least one beneficial change, which were most often more physical activity, healthier dietary habits, and less alcohol consumption. Individuals who are younger [incidence rate ratio (IRR) = 0.99, 95% CI = 0.98-0.99], female (1.20, 1.11-1.30), living alone (1.20, 1.11-1.28) and in urban environments (1.18, 1.08-1.29), who are less satisfied with their income (1.38, 1.17-1.62), experiencing subjective memory complaints (1.40, 1.28-1.52) and those with a past or current (1.19, 1.06-1.34) or fear of a COVID-19 infection (1.33, 1.25-1.42) reported higher numbers of detrimental changes. Discussion: The COVID-19 pandemic has influenced lifestyle in both positive and negative ways. We identified (socio)demographic factors associated with more detrimental changes in modifiable risk factors related to brain health, suggesting that some individuals are more vulnerable for the impact of the COVID-19 pandemic. These findings provide an opportunity for targeted prevention and education to promote a healthy lifestyle during and after the pandemic.

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 (GEE). 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.

Psychosocial effects of Corona virus measures on (pre-)dementia patients during 2nd lockdown

Background The COVID-19 pandemic poses enormous social challenges, especially during lockdown. Recently, the second lockdown started in the Netherlands. We aimed to investigate and compare the psychosocial effects of corona measures during lockdown in memory clinic (pre-)dementia patients and their caregivers. Method During second lockdown, n=137 symptomatic patients (age=67.7±6.54, 36.5%F, MMSE = 24.4±4.7;n=82 dementia, n=55 MCI), n=244 cognitively normal (age=63.6±7.56, 38.9%F, MMSE = 28.8±1.18;SCD) and n=198 caregivers of Alzheimer Center Amsterdam completed a survey on psychosocial effects of corona. Questions related to loneliness, worries for faster cognitive decline, psychological and behavioral problems. In a subset of patients (n=169) and caregivers (n=38) we were able to compare their answers to answers on a similar survey completed during first lockdown (May 2020). Result In total, n=17 (4.5%) patients [n=3 (2.2%) symptomatic, n=14 (5.7%) cognitively normal] and n=8 (4%) caregivers reported a positive test result for COVID-19. Over one-third of caregivers reported worries for faster cognitive decline [n=76 (38%)] and behavioral problems [n=70 (35%)] in patients. Feelings of loneliness were experienced by n=23 (17%) symptomatic patients, n=44 (18%) cognitively normal and n=50 (25%) caregivers. One quarter of patients [n=78 (25%)] reported more depressive feelings during lockdown [n=27 (20%) symptomatic, n=51 (21%) cognitively normal]. More feelings of fatigue were reported by n=23 (17%) symptomatic patients, n=46 (19%) cognitively normal, and n=67 (34%) caregivers. Comparing results to those obtained during the first lockdown, feelings of loneliness [?2=26.4, p<.001 in patients, ?2=10.3, p<.001 in caregivers] and anxiety [?2=25.9, p<.001 in patients, ?2=6.69, p=.010 in caregivers] increased. During second lockdown, less feelings of apathy [?2=13.0, p<.001], but more depressive feelings [?2=27.6, p<.001] were reported in patients compared to first lockdown. Caregivers were more worried for memory decline in patients during second lockdown [?2=4.09, p=.043]. Conclusion Compared to first lockdown, feelings of loneliness, anxiety, worries for faster cognitive decline and depressive feelings increased in second lockdown. A noticeable part of (pre-)dementia patients and caregivers report feelings of loneliness, worries for faster cognitive decline, psychological and behavioral problems in second lockdown. These psychosocial effects are more frequently reported by caregivers than patients.

Psychosocial Effects of Corona Measures on Patients With Dementia, Mild Cognitive Impairment and Subjective Cognitive Decline.

Background: The recent COVID-19 pandemic is not only a major healthcare problem in itself, but also poses enormous social challenges. Though nursing homes increasingly receive attention, the majority of people with cognitive decline and dementia live at home. We aimed to explore the psychosocial effects of corona measures in memory clinic (pre-)dementia patients and their caregivers. Methods: Between April 28th and July 13th 2020, n = 389 patients of Alzheimer center Amsterdam [n = 121 symptomatic (age = 69 ± 6, 33%F, MMSE = 23 ± 5), n = 268 cognitively normal (age = 66 ± 8, 40% F, MMSE = 29 ± 1)] completed a survey on psychosocial effects of the corona measures. Questions related to social isolation, worries for faster cognitive decline, behavioral problems and discontinuation of care. In addition, n = 147 caregivers of symptomatic patients completed a similar survey with additional questions on caregiver burden. Results: Social isolation was experienced by n = 42 (35%) symptomatic and n = 67 (25%) cognitively normal patients and two third of patients [n = 129 (66%); n = 58 (75%) symptomatic, n = 71 (61%) cognitively normal] reported that care was discontinued. Worries for faster cognitive decline were existed in symptomatic patients [n = 44 (44%)] and caregivers [n = 73 (53%)], but were also reported by a subgroup of cognitively normal patients [n = 27 (14%)]. Both patients [n = 56 (46%) symptomatic, n = 102 (38%) cognitively normal] and caregivers [n = 72 (48%)] reported an increase in psychological symptoms. More than three quarter of caregivers [n = 111(76%)] reported an increase in patients' behavioral problems. A higher caregiver burden was experienced by n = 69 (56%) of caregivers and n = 43 (29%) of them reported that a need for more support. Discontinuation of care (OR = 3.3 [1.3-7.9]), psychological (OR = 4.0 [1.6-9.9]) and behavioral problems (OR = 3.0 [1.0-9.0]) strongly related to experiencing a higher caregiver burden. Lastly, social isolation (OR = 3.2 [1.2-8.1]) and psychological symptoms (OR = 8.1 [2.8-23.7]) were red flags for worries for faster cognitive decline. Conclusion: Not only symptomatic patients, but also cognitively normal patients express worries for faster cognitive decline and psychological symptoms. Moreover, we identified patients who are at risk of adverse outcomes of the corona measures, i.e., discontinued care, social isolation, psychological and behavioral problems. This underlines the need for health care professionals to provide ways to warrant the continuation of care and support (informal) networks surrounding patients and caregivers to mitigate the higher risk of negative psychosocial effects.

Tackling challenges in care of Alzheimer's disease and other dementias amid the COVID-19 pandemic, now and in the future.

We have provided an overview on the profound impact of COVID-19 upon older people with Alzheimer's disease and other dementias and the challenges encountered in our management of dementia in different health-care settings, including hospital, out-patient, care homes, and the community during the COVID-19 pandemic. We have also proposed a conceptual framework and practical suggestions for health-care providers in tackling these challenges, which can also apply to the care of older people in general, with or without other neurological diseases, such as stroke or parkinsonism. We believe this review will provide strategic directions and set standards for health-care leaders in dementia, including governmental bodies around the world in coordinating emergency response plans for protecting and caring for older people with dementia amid the COIVD-19 outbreak, which is likely to continue at varying severity in different regions around the world in the medium term.