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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.
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
3.
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.

4.
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
5.
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.

6.
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.

7.
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.

8.
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.

9.
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.

10.
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.

11.
J Neurol ; 269(5): 2265-2274, 2022 May.
Article in English | MEDLINE | ID: covidwho-1479471

ABSTRACT

Acute and post-acute neurological symptoms, signs and diagnoses have been documented in an increasing number of patients infected by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which causes Coronavirus Disease 2019 (COVID-19). In this review, we aimed to summarize the current literature addressing neurological events following SARS-CoV-2 infection, discuss limitations in the existing literature and suggest future directions that would strengthen our understanding of the neurological sequelae of COVID-19. The presence of neurological manifestations (symptoms, signs or diagnoses) both at the onset or during SARS-CoV-2 infection is associated with a more severe disease, as demonstrated by a longer hospital stay, higher in-hospital death rate or the continued presence of sequelae at discharge. Although biological mechanisms have been postulated for these findings, evidence-based data are still lacking to clearly define the incidence, range of characteristics and outcomes of these manifestations, particularly in non-hospitalized patients. In addition, data from low- and middle-income countries are scarce, leading to uncertainties in the measure of neurological findings of COVID-19, with reference to geography, ethnicity, socio-cultural settings, and health care arrangements. As a consequence, at present a specific phenotype that would specify a post-COVID (or long-COVID) neurological syndrome has not yet been identified.


Subject(s)
COVID-19 , Nervous System Diseases , COVID-19/complications , Hospital Mortality , Humans , Nervous System Diseases/epidemiology , Nervous System Diseases/etiology , SARS-CoV-2
12.
Alzheimers Dement (N Y) ; 7(1): e12143, 2021.
Article in English | MEDLINE | ID: covidwho-1135133

ABSTRACT

INTRODUCTION: The coronavirus disease-19 (COVID-19) pandemic presents challenges to the conduct of randomized clinical trials of lifestyle interventions. METHODS: 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 a forum for researchers to discuss statistical design and analysis issues they faced during the pandemic. We report on experiences of three 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. RESULTS: The pandemic led researchers to change recruitment plans, interrupt timelines for assessments and intervention delivery, and move to remote intervention and assessment 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. DISCUSSION: 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.

13.
Front Psychiatry ; 12: 624125, 2021.
Article in English | MEDLINE | ID: covidwho-1110353

ABSTRACT

Aims: This study aimed to describe how the first phase of the coronavirus disease 2019 (COVID-19) pandemic affected older persons from the general Finnish population who are at risk of developing or have cognitive impairment, specifically, to describe whether participants experienced a change in risk factors that are relevant for the prevention of cognitive decline including diet, physical activity, access to medical care, socially and cognitively stimulating activities, and emotional health and well-being. Method: A postal survey was sent in June 2020 to 859 participants from the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), an ongoing longitudinal study. The survey was developed to assess the effect of the COVID-19 pandemic and related infection-control measures on daily life, specifically commitment to distancing measures, access to health care and social services, daily activities, and changes in cognitive and social activities. Results: By September 2020, 613 (71%) participants responded (mean age = 77.7 years, 32% lived alone, and 80% had at least one chronic condition). Three quarters adopted some distancing practices during the first months of the pandemic. Older participants were more likely to practice total isolation than younger ones (29 vs. 19%; p = 0.003). Non-acute health-care visits were canceled for 5% of the participants who needed appointments, but cancellations in dental health care (43%), home aid (30%), and rehabilitative services (53%) were more common. Pandemic-related changes were reported in social engagements, for example, less contact with friends (55%) and family (31%), or less frequent attendance in cultural events (38%) or associations (25%), although remote contact with others increased for 40%. Feelings of loneliness increased for 21%, particularly those who were older (p = 0.023) or living alone (p < 0.001). Physical activity reduced for 34%, but dietary habits remained stable or improved. Pandemic-related changes in lifestyle and activities were more evident among those living alone. Conclusions: Finnish older persons generally reported less negative changes in lifestyles and behaviors during the pandemic than expected. Older people and those living alone seemed more susceptible to negative changes. It is important to compare how coping strategies may compare with other European countries to identify factors that may help older individuals to maintain healthy lifestyles during future waves of COVID-19.

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