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.

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.