ABSTRACT
ABSTRACT. The COVID-19 pandemic has raised significant concerns about the management and care for people with dementia and their caregivers. In this context, this work will discuss how social isolation or social distancing caused by the pandemic may impact the clinical management of people with dementia, caregivers' health, and dementia research. The pandemic disrupts all forms of social interaction and may increase the behavioral impairment of people with dementia. Regarding pharmacological treatment, telemedicine is an option, but the context of social isolation raises questions about how to manage people with dementia with lack of cognitive stimulation and non-pharmacological treatment. In addition, the impact of the pandemic on caregivers should be considered. There is some evidence that telephone counseling can reduce depressive symptoms of caregivers of people with dementia. In dementia research, social isolation imposes researchers to modify their study protocols in order to continue collecting data by developing remote tools to assess the participants such as electronic informed consent and online questionnaires and tests. Thus, there is an urgent need for the evaluation and refinement of interventions to address several cognitive, behavioral, and clinical aspects of the long-term impact of the pandemic in dementia.
RESUMO. A pandemia causada pelo COVID-19 desencadeia grandes preocupações sobre o manejo e cuidados com as pessoas com demência e seus cuidadores. Neste contexto, discutiremos como o isolamento social causado pela pandemia pode impactar o manejo clínico de pessoas com demência, a saúde do cuidador e a pesquisa sobre demência. A pandemia interrompe todas as formas de interação social e pode causar aumento do comprometimento dos sintomas neuropsiquiátricos nas pessoas com demência. Em relação ao tratamento farmacológico, a telemedicina é uma opção, mas o contexto de isolamento social levanta questões sobre como manejar as pessoas com demência com falta de estimulação cognitiva ou intervenções nãofarmacológicas. Além disso, o impacto da pandemia sobre os cuidadores deve ser considerado. Existem evidências de que o aconselhamento telefônico pode reduzir os sintomas depressivos dos cuidadores. Além disso, o isolamento social impõe que pesquisadores modifiquem seus protocolos de pesquisa com o objetivo de continuar coletando dados, através do desenvolvimento de ferramentas remotas para avaliar os participantes, como o consentimento livre e esclarecido eletrônico e questionários e testes online. Assim, há uma necessidade urgente de avaliação e refinamento das intervenções para abordar aspectos cognitivos, comportamentais e clínicos do impacto de longo prazo da pandemia na demência.
Subject(s)
Humans , Behavioral Symptoms , Caregivers , Coronavirus Infections , DementiaABSTRACT
Introduction: Theory of Mind (ToM) refers to an individual's ability to attribute mental states to others. It is well established that the behavioral variant of frontotemporal dementia can undermine ToM. However, there is no consensus on how Alzheimer's disease affects ToM. The following report represents a systematic literature review of ToM in Alzheimer's disease over the past ten years.Method: We performed a survey using the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) criteria. The literature search was performed using the electronic databases MEDLINE (Pubmed) and Science Citation Index (ISI). The following descriptors were used in the review process: theory of mind or mentalizing and Alzheimer disease or Alzheimer's disease or Alzheimer type dementia. This systematic review was recorded in the International Prospective Register of Systematic Reviews (PROSPERO) under the number CDR42018115152.Results: We identified 117 articles, 24 of which met our criteria. The most common assessment measure used in the evaluation of the ToM was the first and second order false belief task. Many studies reported that individuals with Alzheimer's disease were impaired on more complex tasks, such as second-order false belief tasks, but had intact performance on simpler tasks, such as first order false beliefs and affective ToM. In contrast, some studies reported that ToM deficits may also appears in simpler and affective tasks.Conclusions: The variability in methodologies, the design and complexity of the tasks applied, the heterogeneity in terms of dementia stage/severity, and the level of cognitive impairment contribute to the variability and inconsistency of the results. Future research should investigate the ToM using more ecological and standardized methods.
