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1.
Front Psychiatry ; 13: 877460, 2022.
Article in English | MEDLINE | ID: covidwho-1903184

ABSTRACT

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.

2.
PLoS ONE Vol 16(10), 2021, ArtID e0258559 ; 16(10), 2021.
Article in English | APA PsycInfo | ID: covidwho-1898196

ABSTRACT

Background: Executive functions underlie self-regulation and are thus important for physical activity and adaptation to new situations. The aim was to investigate, if yearlong physical and cognitive training (PTCT) had greater effects on physical activity among older adults than physical training (PT) alone, and if executive functions predicted physical activity at baseline, after six (6m) and twelve months (12m) of the interventions, one-year post-intervention follow-up and an extended follow-up during COVID-19 lockdown. Methods: Data from a single-blinded, parallel-group randomized controlled trial (PASSWORD-study, ISRCTN52388040) were utilized. Participants were 70-85 years old community-dwelling men and women from Jyvaskyla, Finland. PT (n = 159) included supervised resistance, walking and balance training, home-exercises and self-administered moderate activity. PTCT (n = 155) included PT and cognitive training targeting executive functions on a computer program. Physical activity was assessed with a one-item, seven-scale question. Executive functions were assessed with color-word Stroop, Trail Making Test (TMT) B-A and Letter Fluency. Changes in physical activity were modeled with multinomial logistic models and the impact of executive functions on physical activity with latent change score models. Results: No significant group-by-time interaction was observed for physical activity (p>0.1). The subjects were likely to select an activity category higher than baseline throughout the study (pooled data: B = 0.720-1.614, p<0.001-0.046). Higher baseline Stroop predicted higher physical activity through all subsequent time-points (pooled data: B = 0.011-0.013, p = 0.015-0.030). Higher baseline TMT B-A predicted higher physical activity at 6m (pooled data: B = 0.007, p = 0.006) and during COVID-19 (B = 0.005, p = 0.030). In the PT group, higher baseline Letter Fluency predicted higher physical activity at 12m (B = -0.028, p = 0.030) and follow-up (B = -0.042, p = 0.002). Conclusions: Cognitive training did not have additive effects over physical training alone on physical activity, but multicomponent training and higher executive function at baseline may support adaptation to and maintenance of a physically active lifestyle among older adults. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

3.
Curr Opin Psychiatry ; 35(4): 285-292, 2022 07 01.
Article in English | MEDLINE | ID: covidwho-1891249

ABSTRACT

PURPOSE OF REVIEW: The potential for dementia prevention is deemed substantial if modifiable risk factors were addressed. First large-scale multidomain lifestyle interventions aiming at reducing risk of cognitive decline and dementia have yielded mixed but promising evidence. RECENT FINDINGS: Despite the impact of the COVID-19 pandemic on trials conduction, causing interruptions and delays, the research landscape on multidomain interventions is growing rapidly. The successful Finish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) has led to an adaptation of the FINGER model in trials underway or being planned in over 40 countries. Recent studies identified barriers and facilitators of and adherence to multidomain interventions, showed the suitability of dementia risk scores as surrogate outcomes, and suggested mechanisms. Multidomain interventions are increasingly conducted in the Global South, and study protocols are increasingly testing expanded FINGER models, for example, with pharmacological components, in digital/remote settings and co-designed personalized interventions. SUMMARY: Though results remain mixed, the many ongoing trials will provide more conclusive evidence within the next few years and help to optimize interventions. Continued international collaboration is pivotal to scale and accelerate the development and implementation of effective multidomain interventions as part of larger public health strategies to counteract the global dementia increase.


Subject(s)
COVID-19 , Cognitive Dysfunction , Dementia , Aged , COVID-19/prevention & control , Cognitive Dysfunction/prevention & control , Dementia/prevention & control , Humans , Pandemics , Risk Reduction Behavior
4.
Acta Anaesthesiol Scand ; 66(6): 759-766, 2022 07.
Article in English | MEDLINE | ID: covidwho-1764861

ABSTRACT

BACKGROUND: This is the study plan of the Karolinska NeuroCOVID study, a study of neurocognitive impairment after severe COVID-19, relating post-intensive care unit (ICU) cognitive and neurological deficits to biofluid markers and MRI. The COVID-19 pandemic has posed enormous health challenges to individuals and health-care systems worldwide. An emerging feature of severe COVID-19 is that of temporary and extended neurocognitive impairment, exhibiting a myriad of symptoms and signs. The causes of this symptomatology have not yet been fully elucidated. METHODS: In this study, we aim to investigate patients treated for severe COVID-19 in the ICU, as to describe and relate serum-, plasma- and cerebrospinal fluid-borne molecular and cellular biomarkers of immune activity, coagulopathy, cerebral damage, neuronal inflammation, and degeneration, to the temporal development of structural and functional changes within the brain as evident by serial MRI and extensive cognitive assessments at 3-12 months after ICU discharge. RESULTS: To date, we have performed 51 3-month follow-up MRIs in the ICU survivors. Of these, two patients (~4%) have had incidental findings on brain MRI findings requiring activation of the Incidental Findings Management Plan. Furthermore, the neuropsychological and neurological examinations have so far revealed varying and mixed patterns. Several patients expressed cognitive and/or mental concerns and fatigue, complaints closely related to brain fog. CONCLUSION: The study goal is to gain a better understanding of the pathological mechanisms and neurological consequences of this new disease, with a special emphasis on neurodegenerative and neuroinflammatory processes, in order to identify targets of intervention and rehabilitation.


Subject(s)
COVID-19 , Pandemics , Biomarkers , Critical Care , Humans , Survivors/psychology
5.
The Wiley‐Blackwell Handbook of Childhood Social Development ; n/a(n/a):224-238, 2022.
Article in English | Wiley | ID: covidwho-1750284

ABSTRACT

Summary In this chapter, the authors focus on disruptions to children's lives at home and at school (including early childhood care and education programs [ECCE] and primary schooling) as critical settings for healthy development. The Covid-19 pandemic has upended children's lives in myriad ways, including disruptions in the family system due to illness or death, financial instability tied to job loss, and educational disruptions as a result of closures of child care facilities and schools. In considering how the Covid-19 pandemic is shaping children's social development, the authors attend to how interactions with others and socialization processes within families and schools may buffer or exacerbate the pandemic's negative impact. Developmental scientists are well positioned to research how macro-level shocks such as the coronavirus pandemic affect children's developmental trajectories, and the life-course perspective can guide and inform that investigation. Introduction We conducted a systematic review and meta-analysis of the cognitive effects of coronavirus disease 2019 (COVID-19) in adults with no prior history of cognitive impairment. Methods Searches in Medline/Web of Science/Embase from January 1, 2020, to December 13, 2021, were performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.  A meta-analysis of the Montreal Cognitive Assessment (MoCA) total score comparing recovered COVID-19 and healthy controls was performed. Results Oof 6202 articles, 27 studies with 2049 individuals were included (mean age = 56.05 years, evaluation time ranged from the acute phase to 7 months post-infection). Impairment in executive functions, attention, and memory were found in post-COVID-19 patients.  The meta-analysis was performed with a subgroup of 290 individuals and showed a difference in MoCA score between post-COVID-19 patients versus controls (mean difference = ?0.94, 95% confidence interval [CI] ?1.59, ?0.29;P = .0049). Discussion Patients recovered from COVID-19 have lower general cognition compared to healthy controls up to 7 months post-infection.

6.
Alzheimers Dement ; 18(5): 1047-1066, 2022 05.
Article in English | MEDLINE | ID: covidwho-1748787

ABSTRACT

INTRODUCTION: We conducted a systematic review and meta-analysis of the cognitive effects of coronavirus disease 2019 (COVID-19) in adults with no prior history of cognitive impairment. METHODS: Searches in Medline/Web of Science/Embase from January 1, 2020, to December 13, 2021, were performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.  A meta-analysis of the Montreal Cognitive Assessment (MoCA) total score comparing recovered COVID-19 and healthy controls was performed. RESULTS: Oof 6202 articles, 27 studies with 2049 individuals were included (mean age = 56.05 years, evaluation time ranged from the acute phase to 7 months post-infection). Impairment in executive functions, attention, and memory were found in post-COVID-19 patients.  The meta-analysis was performed with a subgroup of 290 individuals and showed a difference in MoCA score between post-COVID-19 patients versus controls (mean difference = -0.94, 95% confidence interval [CI] -1.59, -0.29; P = .0049). DISCUSSION: Patients recovered from COVID-19 have lower general cognition compared to healthy controls up to 7 months post-infection.


Subject(s)
COVID-19 , Cognitive Dysfunction , Adult , Cognition , Cognitive Dysfunction/etiology , Executive Function , Humans , Infant
7.
Eur Geriatr Med ; 13(3): 705-709, 2022 06.
Article in English | MEDLINE | ID: covidwho-1748360

ABSTRACT

PURPOSE: We compared the prevalence of COVID-19 and related mortality in nursing homes (NHs) in 14 countries until October 2021. We explored the relationship between COVID-19 mortality in NHs with the average size of NHs and with the COVID-19 deaths at a population level. METHODS: The total number of COVID-19 cases and COVID-19-related deaths in all NHs as well as the total number of NHs and NH beds were provided by representatives of 14 countries. The population level respective figures in each country were provided up to October 2021. RESULTS: There was a wide variation in prevalence of COVID-19 cases and deaths between countries. We observed a significant correlation between COVID-19 deaths in NHs and that of the total population and between the mean size of NHs and COVID-19 deaths. CONCLUSION: Side-by-side comparisons between countries allow international sharing of good practice to better enable future pandemic preparedness.


Subject(s)
COVID-19 , COVID-19/epidemiology , Europe/epidemiology , Humans , Nursing Homes , Pandemics , SARS-CoV-2
8.
EuropePMC; 2022.
Preprint in English | EuropePMC | ID: ppcovidwho-330067

ABSTRACT

Importance The case fatality rate of SARS-CoV-2 has been high among residents of long-term care (LTC) facilities. It is important to know if the excess mortality persists beyond the acute infection. Objective To evaluate whether SARS-CoV-2 is associated with higher mortality after the first month from documented infection. Design We extended the follow-up period of a previous, retrospective cohort study based on the Swedish Senior Alert register. LTC residents infected with SARS-CoV-2 were matched to uninfected controls using time-dependent propensity scores on age, sex, body mass index, health status, comorbidities, and prescription medication use. In a sensitivity analysis, residents were also matched on geographical region and time of Senior Alert registration. Setting LTC facilities in Sweden. Participants 3731 LTC residents with SARS-CoV-2 and 3731 controls (n=3604 in each group in the sensitivity analysis). Exposure SARS-CoV-2 infection, documented in the SmiNet register (until September 15, 2020). Main Outcome All-cause mortality over 8 months (until October 24, 2020). Results The median age was 87 years, and 65% were women. Excess mortality was highest 5 days after documented infection (hazard ratio 19.1;95% confidence interval [CI], 14.6-24.8), after which excess mortality decreased rapidly. After the second month, the mortality rate became lower in infected residents than in controls. Median survival of uninfected controls was 577 days (1.6 years), which is much lower than national life expectancy in Sweden at age 87 (5.05 years in men, 6.07 years in women). During days 61-210 of follow-up, the hazard ratio for death was 0.41 (95% CI, 0.34-0.50) in the main analysis and 0.76 (95% CI, 0.62-0.93) in the sensitivity analysis. Conclusions and Relevance No excess mortality was observed in LTC residents who survived the acute SARS-CoV-2 infection (the first month). The life expectancy of uninfected residents was much lower than that of the general population of the same age and sex. This difference should be taken into account in calculations of years of life lost among LTC residents. Key points Question Does SARS-CoV-2 increase mortality in residents of long-term care (LTC) facilities beyond the first month (that is, beyond the acute infection)? Findings In a matched cohort study, we found that excess mortality was high during the first month but then decreased sharply. After the second month, the mortality rate became lower in infected residents than in uninfected controls. Meaning No excess mortality was observed in LTC residents who survived the acute SARS-CoV-2 infection.

10.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-323058

ABSTRACT

Background: Sleep quality is crucial for health and wellbeing in all ages and sleep abnormalities may contribute to multimorbidity in older adults. The impact of pandemic-related disruptions to sleep quality in older adults, particularly those deemed “clinically extremely vulnerable” to COVID-19-related complications (COVID-19CEV) remains unknown.Methods: In this cross-sectional study, conducted during the first UK lockdown (April- June 2020), we surveyed 5558 adults aged 50 years and over (of whom 523 met criteria for COVID-19CEV) with assessments of sleep quality, health/medical, lifestyle, psychosocial and sociodemographic factors. We identified associations between these factors and sleep quality and explored interactions of COVID-19CEV status with factors significantly associated with sleep quality to identify potential moderating variables.Findings: 37% of participants reported poor sleep quality which was associated with younger age, female sex and multimorbidity. Significant associations with poor sleep included, among health/medical factors: COVID-19CEV status, higher BMI, arthritis, pulmonary disease, and mental health disorders;.and the following lifestyle and psychosocial factors: living alone, higher alcohol consumption, an unhealthy diet and higher depressive and anxiety symptoms. r Moderators of the COVID-19CEV status - sleep quality relationship included marital status, loneliness, anxiety and diet. Within this subgroup, less anxious and less lonely males, as well as females with healthier diets, reported better sleep quality. Interpretation: Sleep quality in older adults was compromised during the sudden unprecedented nation-wide lockdown due to distinct health/medical, lifestyle and psychosocial factors. Male and female older adults with COVID-19CEV status may benefit from targeted mental health and dietary interventions, respectively. Results inform tailored interventions and policy for older adults deemed COVID-19CEV. Funding Information: This study was sponsored by Imperial College London and partly funded by the ICHT BRC.Declaration of Interests: Dr. Middleton reports clinical trial grants from Janssen R&D, Novartis and Takeda outside the submitted work. All authors declare no competing interests related to this study.Ethics Approval Statement: Data collected as in this study are anonymized and kept strictlyconfidential in accordance with the UK General Data Protection Regulations (2016). The CCRR study was ethically approved by the Imperial College London Joint Research Compliance Office (20IC5942) and by the Health Research Authority (16/EM/0213).

11.
Frontiers in public health ; 9, 2021.
Article in English | EuropePMC | ID: covidwho-1610123

ABSTRACT

The COVID-19 pandemic and its related restrictions have affected the everyday life of older people. Advanced age is a significant predisposing factor for a more severe COVID-19 infection, increasing the risk for hospitalization and mortality. Even though restrictions have been, thus, well-grounded, they may also have had detrimental effects on the social well-being of older people. Personal networks and social activity are known protective factors against the premature decline in health and functioning, and it is widely acknowledged that social isolation increases feelings of loneliness, poor quality of life, and even the risk for diseases and disabilities among older adults. This qualitative study investigated changes in personal networks among community-dwelling oldest-old individuals (persons aged 80 and over) during the first and second waves of the COVID-19 pandemic in Finland. The data is part of the Cardiovascular Risk Factors, Aging, and Dementia (CAIDE85+) study, which is an ongoing large longitudinal population-based study in Finland. In this qualitative sub-study, we analyzed fifteen in-depth telephone interviews using directed content analyses and identified five types of changes in personal social networks during the pandemic. In type 1, all social contacts were significantly reduced due to official recommendations and fear of the virus. Type 2 included modified ways of being socially active i.e., by deploying new technology, and in type 3, social contacts increased during the lockdown. In type 4, personal social networks were changed unexpectedly or dramatically due to a death of a spouse, for example. In type 5, we observed stable social networks, which had not been affected by the pandemic. At an individual level, one person could have had different types of changes during the pandemic. These results highlight the heterogeneity of the oldest olds' personal social networks and changes related to them during the exceptional times of the COVID-19 pandemic. Social activity and personal networks play an important role in the well-being of the oldest old, but individual situations, needs, and preferences toward personal social networks should be taken into account when planning social activities, policies, and interventions.

12.
Alzheimer's & Dementia ; 17(S10):e053028, 2021.
Article in English | Wiley | ID: covidwho-1589248

ABSTRACT

Background Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) is a randomized trial that showed beneficial effect on cognition with a 2-year multidomain lifestyle intervention. During the post-intervention follow-up, COVID19 pandemic emerged resulting in lockdown and reduced services. Our aim is to investigate how lifestyle and behavior changes during the pandemic are related to lifestyle earlier in the study. Method The FINGER cohort included 1260 individuals aged 60-77 years at baseline and at risk of dementia, randomized into multidomain intervention or control groups. A postal survey was sent to all eligible participants from the FINGER study in June 2020 (end of the first wave of the pandemic in Finland), on average 10 year after the baseline. 859 (68%) were still alive and eligible for the survey. Result Total of 735 responders (85% of the eligible participants) were on average 78 years old. They were younger, had higher baseline cognition, and were more often from the former control group than non-responders (p<0.05 for all). The intervention allocation showed no association with self-reported lifestyle changes during the pandemic in diet, exercise, or cognitive activity. Among older participants (>78 y), the intervention group reported more increase in remote contact with friends and relatives (p=0.013) and health care (p=0.042) than the control, and also less pandemic-related reduction in overall contact with friends (p=0.045). Among all, reductions in physical exercise were reported among those who were less physically active earlier in the study. Both increase and decrease in contact with friends and family were reported by those more cognitively active earlier in the study. They also had more increase in remote contacts. Changes in diet were positive (increase in fruit and vegetable intake), but they were not related to earlier diet. Conclusion The FINGER participants reported only minor change in their lifestyle and behavior during the first wave of the COVID pandemic related lockdown. For physical activity, the pandemic appeared to have negative effect particularly among those with lower levels earlier, possibly adding inequalities. Intervention was related to more remote contacts, probably due to better computer literacy after the cognitive training.

13.
Alzheimer's & Dementia ; 17(S10):e055289, 2021.
Article in English | Wiley | ID: covidwho-1589229

ABSTRACT

Background U.S. POINTER is testing whether multidomain lifestyle interventions focused on physical exercise, nutrition, cognitive challenge, and risk factor management reduces risk of cognitive decline in a heterogeneous population of at-risk older adults in America. The study adapts the FINGER (Finnish Intervention Geriatric Study to Prevent Cognitive Impairment and Disability) interventions to fit the United States culture and delivers the intervention within the community at 5 sites across the country. Method U.S. POINTER is a 2-year RCT that will enroll 2000 cognitively unimpaired older adults who are at risk for cognitive decline due sedentary lifestyle, poor diet and other factors. Participants are randomized to one of two lifestyle intervention groups that differ in format and intensity. In 2020, the COVID-19 pandemic presented a number of challenges for the study that affected recruitment, assessment schedules, and intervention delivery. Result As of March 2020, when COVID-19 incidence was on an exponential rise in the US, 240 participants had been enrolled in U.S. POINTER. In response to local and national safety mandates, study activities were paused from March 23rd to July 13th. During the pause, sites remained in contact with study candidates and enrolled participants to provide ongoing support to keep them engaged in the trial. Enrollees also received regular telephone calls to encourage continued adherence to their assigned lifestyle intervention. In response to the multiple pandemic-related challenges, study protocols and procedures were adapted to facilitate and encourage participant adherence to intervention activities. At study re-start, retention was 98%. Despite climbing COVID-19 infection rates nationwide, enrollment at all 5 sites has continued at a steady rate (N=540 as of Jan2021), virtual Team Meeting attendance for both lifestyle groups exceeds 80%, and participants continue to successfully work toward their intervention goals. Conclusion The COVID-19 pandemic presented unprecedented challenges, but it also provided a unique opportunity to adapt intervention delivery so that a nonpharmacological community-based trial could continue ? even during a debilitating global health crisis. U.S. POINTER?s adaptations to pandemic-related challenges may ultimately increase the resilience of its interventions to even the most challenging of circumstances that older adults will face now and in the future.

14.
Alzheimer's & Dementia ; 17(S10):e055290, 2021.
Article in English | Wiley | ID: covidwho-1589228

ABSTRACT

Background Restrictions enforced in many counties during the COVID-19 pandemic may have both short- and long-term effects on the risk factors relevant for cognitive impairment and dementia. The COVID-19 pandemic occurred during the post-intervention follow-up phase of the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) postponing the planned follow-up visits of the participants. We investigated how the first phase of the COVID-19 pandemic affected lifestyles and other risk factors among the FINGER participants using a postal survey. Method A survey was sent in June 2020 to 859 eligible FINGER participants. The survey was developed to assess the effects of the COVID-19 pandemic and related infection-control measures on lifestyles, daily life, commitment to distancing measures, access to healthcare and social services, and changes in cognitive and social activities, as well as emotional health and wellbeing. Result A total of 735 participants responded to the survey (85% of the eligible participants). They were on average 78 years old at the time of the survey. Majority of the participants adopted some distancing practices during the first months of the pandemic. Older participants were more likely to practice total isolation than younger ones. Pandemic-related changes were reported in social engagement, including less contact with friends and family, and less frequent participation in cultural events or associations, but on the other hand the frequency of remote contacts with others was increased. About a third of the participants reported that their physical activity was reduced, and this was more common among those who had been less active earlier. Pandemic-related changes in lifestyle and activities were more evident among those living alone. Conclusion Finnish older persons were mainly reporting that they coped in the pandemic situation quite well. Older participants seemed to be more susceptible to negative changes. Also persons with less physical activity previously were likely to reduce their activities even more. This may have long-term consequences on the cognitive health of older adults, and it may also impact the longer-term effects of the FINGER intervention.

15.
Alzheimer's & Dementia ; 17(S10):e055294, 2021.
Article in English | Wiley | ID: covidwho-1589227

ABSTRACT

Background The coronavirus disease-19 (COVID-19) pandemic presents challenges to the conduct of randomized clinical trials of lifestyle interventions. Method World-Wide FINGERS is an international network of clinical trials to assess the impact of multidomain lifestyle intervention on cognitive decline in at-risk adults. Individual trials are tailoring successful approaches from the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) to local cultures and environments. The network convened forums for researchers to discuss statistical design and analysis issues they faced during the pandemic. We will provide an updated report on experiences of trials that, at various stages of conduct, altered designs and analysis plans to navigate these issues. We provide recommendations for future trials to consider as they develop and launch behavioral intervention trials. Result The pandemic led researchers to change recruitment plans, interrupt timelines for assessments and intervention delivery, and move to remote intervention and assessments protocols. The necessity of these changes add emphasis to the importance, in study design and analysis, of intention to treat approaches, flexibility, within site stratification, interim power projections, and sensitivity analyses. Conclusion Robust approaches to study design and analysis are critical to negotiate issues related to the intervention. The World Wide Network of similarly oriented clinical trials will allow us to evaluate the effectiveness of responses to the pandemic across cultures, local environments, and phases of the pandemic.

16.
Alzheimer's & Dementia ; 17(S6):e055939, 2021.
Article in English | Wiley | ID: covidwho-1589217

ABSTRACT

Background Neurocognitive manifestations of the coronavirus disease 2019 (COVID-19) have been reported in the acute phase, especially in critically ill patients. The potential mechanisms underlying these symptoms are not fully understood but probably involves the inflammatory, vascular, and neurotropic effect of the coronavirus. While short-, mid-and long-term consequences remain unclear, patients with neurocognitive sequelae reminiscent of other cognitive disorders, including AD have been reported. The aim of this study is to investigate if there is an increased risk for long-term cognitive dysfunction/impairment, biochemical and structural brain changes after a severe COVID-19. Method This is a prospective cohort study of 80 patients surviving intensive-care for COVID-19 at Karolinska University Hospital, Stockholm, Sweden. They will be examined at 3, 6 and 12 months after hospital discharge using neurological and neuropsychological (NP) tests combined with novel quantitative brain MRI and serial blood sampling to described relevant blood-borne molecular patterns. This presentation focuses on NP testing, cognitive, mental, and neurological aspects at 3 months follow-up. Cognitive testing and questionnaires (NP) include Rey Auditory Verbal Learning Test Rey Complex Figure test, Verbal Fluency Test, Category flow, Trail Making Test Symbol Digit Modalities Test, Mental Fatigue Scale, the Hospital Anxiety and Depression Scale, RAND-36, AD8 Dementia Screening Interview and Subjective cognitive decline questions. A detailed neurological examination (neurologist), including Expanded Disability Status Scale, an adapted version of the Unified Parkinson's Disease Rating Scale for extrapyramidal dysfunction, and a brief smell test. Results At present, 28 participants have completed the 3-months follow-up visit, including neuropsychological and neurological examinations. Mean age (SD) at baseline was 57.8 (11.1) years, and 68% were men. Several patients expressed cognitive and/or mental concerns and fatigue. The neuropsychological and neurological examinations have so far revealed varying and mixed patterns. Brain MRI revealed mainly microvascular pathology. Detailed analyses, including blood biomarkers for neuronal injury and astrocytic activation, based on the 3-months examination will be presented. Conclusions Repeated examinations will allow further analyses on longer term impact on cognition and underlying mechanisms. This may identify patients at risk and possible ways to mitigate cognitive complications, which is of great importance to reduce the pandemic's negative effects and socioeconomic burden.

17.
Alzheimer's & Dementia ; 17(S10):e056732, 2021.
Article in English | Wiley | ID: covidwho-1589202

ABSTRACT

Background Older adults have higher risk of cognitive impairment and dementia, and they also represent the group most severely affected by the SARS-CoV-2 (COVID-19) pandemic in terms of higher morbidity and mortality. The World-Wide FINGERS (WW-FINGERS) global network of multidomain trials for dementia risk reduction and prevention (Kivipelto et al., 2020) provides a unique framework to explore how the pandemic has affected factors related to mental and physical health of populations at increased risk of dementia, while accounting also for country-specific strategies to contain the spread of the infection. Methods The WW-FINGERS-SARS-CoV2 survey has been developed to explore direct and indirect effects of the pandemic in midlife and older age. The questions aim to measure changes in lifestyle factors (e.g., diet, physical activity), management of chronic noncommunicable diseases (e.g., diabetes, hypertension), as well as psychosocial factors - including depressive symptoms, sleep disorders, social isolation - that are relevant to cognition and are expected to be affected by the pandemic. The survey measures also established and possible epidemiologic risk factors for severe COVID-19. To facilitate distribution is different settings, both a pen-and-paper and a digital version of the survey have been developed in several languages. The digital version is supported through REDCap (Research Electronic Data Capture), a secure web-based software that is being also used for harmonized data collection. Results Over 25 countries are taking part in the survey. Local adaptations and piloting are being done to optimize implementation in both clinical-based and population-based settings. Participants are in the at-risk spectrum for dementia: from cognitively normal persons to individuals with pre-dementia cognitive symptoms. An updated report of the survey status will be presented. Conclusion the survey is a joint global action of the WW-FINGERS network which can inform better care of older adults in the context of a pandemic. The survey is also a valuable tool for pre-screening of participants for prevention trials, and results can inform adaptions to ensure successful recruitment and adherence in forthcoming multidomain trials for dementia prevention in older adults.

18.
Alzheimer's & Dementia ; 17(S10):e057643, 2021.
Article in English | Wiley | ID: covidwho-1589195

ABSTRACT

Background Mandated lockdowns and restricted activity in response to the COVID-19 pandemic has affected our everyday life1. Seniors, in particular, have been affected due to higher morbidity and mortality2. The World-Wide-FINGERS-SARS-CoV-2 survey is part of an international project, consisting of members of the World-Wide FINGERS (WW-FINGERS) Network for dementia risk reduction and prevention3. The study aims to measure the direct and indirect effects of the outbreak in midlife and older age. Preliminary results of this ongoing study is focused on lifestyle changes. Method The survey commenced in September 2020.Participants aged 45 and above were recruited from existing research cohorts, memory clinic patients and community subjects. Sociodemographic factors, health related information, impact on lifestyle and behavior as well as personality factors were collected through three modalities: self-administered online survey, telephone survey and in person with research staff. Result At present, 167 non-demented participants were included in the current preliminary analysis. Majority of the participants were Chinese (83.2%), aged 65 and above (59.3%), male (58.1%), with at least secondary education (80.8%). The survey found that 61.6% of the participants reported decreased contact with friends and relatives, with 22.2% reporting an increase in loneliness. Approximately one-third of the participants reported a decrease in physical activity (35.9%) and an increase in food intake (30.5% in snacking habits;25.1% in fruits consumption). Approximately half of the participants reported increase in usage of internet and digital services to keep in contact with family and friends. Conclusion The COVID-19 pandemic has produced measurable impacts on lifestyle-related behavior of individuals. The decrease in social interaction and increase in loneliness during the pandemic due to government directive, along with concerns of contracting the virus highlight the importance of digital services for and digital literacy in older adults to keep them connected and supported remotely.

19.
Innovation in Aging ; 5(Supplement_1):67-68, 2021.
Article in English | PMC | ID: covidwho-1584835

ABSTRACT

Risk reduction and prevention of dementia in older adults is a growing research area. In the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER randomized controlled trial) a 2-year multidomain intervention -dietary counseling, exercise, cognitive training, vascular and metabolic risk monitoring- improved cognition in older adults from the general population who had increased dementia risk. The intervention was associated also with improvement of other clinical outcomes (e.g., multimorbidity, functional status). The FINGER model is being adapted and tested in different populations and settings through the World-Wide FINGERS, the first global network of multidomain prevention trials, including over thirty countries. The network goal is to identify effective and feasible solution for dementia risk reduction across the spectrum of cognitive decline - from at-risk asymptomatic states to early-symptomatic stages. Through the World-Wide FINGERS-SARS-CoV-2 initiative, the network aims to assess the effects of the COVID-19 pandemic in older adults.

20.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-295381

ABSTRACT

Background: The Clinical Frailty Scale (CFS) is a strong predictor for worse outcomes in geriatric COVID-19 patients, but it is less clear whether an electronic frailty index (eFI) constructed from routinely collected electronic health records (EHRs) provides similar predictive value. This study aimed to investigate the predictive ability of an eFI in comparison to other frailty and comorbidity measures, using mortality, readmission, and the length of stay as outcomes in geriatric COVID-19 patients. Methods: We conducted a retrospective cohort study using EHRs from nine geriatric clinics in Stockholm, Sweden, comprising 3,405 COVID-19 patients (mean age 81.9 years) between 1/3/2020 and 31/10/2021. Frailty was assessed using a 48-item eFI developed for Swedish geriatric patients, the CFS, and Hospital Frailty Risk Score (HFRS). Comorbidity was measured using the Charlson Comorbidity Index (CCI). We analyzed in-hospital mortality and 30-day readmission using logistic regression and area under receiver operating characteristic curve (AUC). 30-day and 6-month mortality were modelled by Cox regression, and the length of stay by linear regression. Results: Controlling for age and sex, a 10% increase in the eFI was associated with higher risks of in-hospital mortality (odds ratio [OR]=2.84;95% confidence interval=2.31-3.51), 30-day mortality (hazard ratio [HR]=2.30;1.99-2.65), 6-month mortality (HR=2.33;2.07-2.62), 30-day readmission (OR=1.34;1.06-1.68), and longer length of stay (β=2.28;1.90-2.66). The CFS, HFRS and CCI similarly predicted these outcomes, but the eFI had the best predictive accuracy for in-hospital mortality (AUC=0.775). Conclusions: An eFI based on routinely collected EHRs can be applied in identifying high-risk geriatric COVID-19 patients.

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