Awareness of COVID-19 in patients with severe dementia

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IMAGE: The ongoing 2019 coronavirus disease (COVID-19) pandemic has substantially affected dementia patients and their caregivers. View More

Credits: Department of Geriatric Medicine, Tokyo Medical University, 6-7-1 Nishishinjuku

Tokyo, September 21, 2020 – The ongoing 2019 coronavirus pandemic (COVID-19) has substantially affected dementia patients and their caregivers. Due to restrictive measures taken around the world to stop the spread of COVID-19 outbreaks (including the declaration of a state of emergency in Japan), patients with dementia and their caregivers have been unable to receive support and usual care. Therefore, this is expected to lead to adverse effects on patients and their caregivers, and many researchers have warned about the risks (1-3). In fact, many scheduled appointments for routine outpatient visits and care services have been canceled and postponed due to the COVID-19 outbreak. When outpatient dementia patients came to our clinic for their postponed outpatient appointments after the declaration of emergency was lifted, we found that some patients were afraid of COVID-19 infection while others were not. We noted that patients with severe dementia tended to be less susceptible to COVID-19 than patients with mild dementia in the daily clinical setting. Based on the hypothesis that patients with severe dementia tend to be unaware of the COVID-19 outbreak and therefore may be less depressed, we compared the recognition rate of the COVID-19 outbreak and the resulting depressive tendencies among the patients with mild dementia and those with severe dementia.

In this study, patients with Alzheimer’s disease (AD) (4) are included in this study because the depressive tendency depends on the cause of the dementia. A total of 126 consecutive outpatients with AD from the Memory Disorder Clinic at the Department of Geriatric Medicine, Tokyo Medical University, were enrolled in this study from May 25, the day the declaration of emergency was revoked, to June 30, 2020. In addition to the Mini Mental State Examination (MMSE) (5) and the Geriatric Depression Scale – Short Version (GDS-S) (6) performed as routine psychological tests, participants were asked the following 2 questions: “Do you know COVID- 19? “And” Why are you wearing a face mask? “. Patients were divided into the mild AD group (MMSE score 21, n = 51) and the moderate to severe AD group (MMSE score

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Additionally, because they did not understand the severity of the COVID-19 outbreak, their GDS scores were also substantially lower.

These findings may appear to simply indicate that people with severe dementia are unaware of current events. However, these findings provide us with insight into how to care for patients with dementia and how to efficiently use the time and support of our limited staff during the COVID-19 epidemic. A previous study showed that the COVID-19 outbreak negatively impacted not only cognitive and neuropsychiatric symptoms, but also the functional independence of patients with dementia. (1) Therefore, our results indicate that for patients with deficiency moderate to severe cognitive impairment, it may be helpful to prioritize preventing their cognitive decline and maintaining their functional independence, while for those with mild cognitive impairment, it may be helpful to prioritize reducing psychological stress and preventing symptoms neuropsychiatric, such as depression. Also, when explaining the need to wear a face mask to patients with moderate to severe dementia, it is necessary to convince them to wear a mask, as they do not understand COVID-19. Not only because they are unaware of COVID-19 that patients with moderate to severe dementia are less prone to depression, but it should also be remembered that their caregivers have made great efforts trying to prevent patients from becoming depressed. Therefore, it will be important to investigate the depressive tendencies of caregivers during the COVID-19 epidemic as well.

Although these results are limited because they were obtained from a single memory clinic and a small sample size, our findings provide suggestions on how to care for patients with dementia during the COVID-19 outbreak. This study provides insights into ways to care for people with dementia as the COVID-19 epidemic continues, as we must work to provide adequate care for elderly patients with dementia in all situations.

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