The impact of lockdown during SARS-CoV-2 outbreak on behavioral and psychological symptoms of dementia.
BPSD
Covid-19
Dementia
Isolation
Mental health
SARS-CoV-2
Journal
Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology
ISSN: 1590-3478
Titre abrégé: Neurol Sci
Pays: Italy
ID NLM: 100959175
Informations de publication
Date de publication:
Mar 2021
Mar 2021
Historique:
received:
26
09
2020
accepted:
31
12
2020
pubmed:
15
1
2021
medline:
12
2
2021
entrez:
14
1
2021
Statut:
ppublish
Résumé
During Covid-19 pandemic, the Italian government adopted restrictive limitations and declared a national lockdown on March 9, which lasted until May 4 and produced dramatic consequences on people's lives. The aim of our study was to assess the impact of prolonged lockdown on behavioral and psychological symptoms of dementia (BPSD). Between April 30 and June 8, 2020, we interviewed with a telephone-based questionnaire the caregivers of the community-dwelling patients with dementia who had their follow-up visit scheduled from March 9 to May 15 and canceled due to lockdown. Among the information collected, patients' BPSDs were assessed by the Neuropsychiatric Inventory (NPI). Non-parametric tests to compare differences between NPI scores over time and logistic regression models to explore the impact of different factors on BPSD worsening were performed. A total of 109 visits were canceled and 94/109 caregivers completed the interview. Apathy, irritability, agitation and aggression, and depression were the most common neuropsychiatric symptoms experienced by patients both at baseline and during Covid-19 pandemic. Changes in total NPI and caregiver distress scores between baseline and during lockdown, although statistically significant, were overall modest. The logistic regression model failed to determine predictors of BPSD worsening during lockdown. This is one of the first studies to investigate the presence of BPSD during SARS-CoV-2 outbreak and related nationwide lockdown, showing only slight, likely not clinically relevant, differences in BPSD burden, concerning mostly agitation and aggression, anxiety, apathy and indifference, and irritability.
Sections du résumé
BACKGROUND
BACKGROUND
During Covid-19 pandemic, the Italian government adopted restrictive limitations and declared a national lockdown on March 9, which lasted until May 4 and produced dramatic consequences on people's lives. The aim of our study was to assess the impact of prolonged lockdown on behavioral and psychological symptoms of dementia (BPSD).
METHODS
METHODS
Between April 30 and June 8, 2020, we interviewed with a telephone-based questionnaire the caregivers of the community-dwelling patients with dementia who had their follow-up visit scheduled from March 9 to May 15 and canceled due to lockdown. Among the information collected, patients' BPSDs were assessed by the Neuropsychiatric Inventory (NPI). Non-parametric tests to compare differences between NPI scores over time and logistic regression models to explore the impact of different factors on BPSD worsening were performed.
RESULTS
RESULTS
A total of 109 visits were canceled and 94/109 caregivers completed the interview. Apathy, irritability, agitation and aggression, and depression were the most common neuropsychiatric symptoms experienced by patients both at baseline and during Covid-19 pandemic. Changes in total NPI and caregiver distress scores between baseline and during lockdown, although statistically significant, were overall modest. The logistic regression model failed to determine predictors of BPSD worsening during lockdown.
CONCLUSION
CONCLUSIONS
This is one of the first studies to investigate the presence of BPSD during SARS-CoV-2 outbreak and related nationwide lockdown, showing only slight, likely not clinically relevant, differences in BPSD burden, concerning mostly agitation and aggression, anxiety, apathy and indifference, and irritability.
Identifiants
pubmed: 33442845
doi: 10.1007/s10072-020-05035-8
pii: 10.1007/s10072-020-05035-8
pmc: PMC7806279
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
825-833Références
Chronology of main steps and legal acts taken by the Italian Government for the containment of the COVID-19 epidemiological emergency. http://www.protezionecivile.gov.it/documents/20182/1227694/Summary+of+measures+taken+against+the+spread+of+C-19/c16459ad-4e52-4e90-90f3-c6a2b30c17eb . Accessed 15 Jun 2020
Vergano M, Bertolini G, Giannini A et al (2020) SIAARTI recommendations for the allocation of intensive care treatments in exceptional, resource-limited circumstances. Minerva Anestesiol 86. https://doi.org/10.23736/S0375-9393.20.14619-4
Istituto Superiore di Sanità (2020) Sorveglianza Integrata COVID-19 in Italia. https://www.epicentro.iss.it/coronavirus/bollettino/Infografica_3giugno ITA.pdf . Accessed 15 Jun 2020
Hawton A, Green C, Dickens AP, Richards SH, Taylor RS, Edwards R, Greaves CJ, Campbell JL (2011) The impact of social isolation on the health status and health-related quality of life of older people. Qual Life Res 20:57–67. https://doi.org/10.1007/s11136-010-9717-2
doi: 10.1007/s11136-010-9717-2
pubmed: 20658322
World Health Organization (2020) No Title. In: Ment. Heal. Psychosoc. considerations Dur. COVID-19 outbreak. https://www.who.int/publications/i/item/WHO-2019-nCoV-MentalHealth-2020.1
Bersano A, Pantoni L (2020) On being a neurologist in Italy at the time of the COVID-19 outbreak. Neurology 94:905–906. https://doi.org/10.1212/WNL.0000000000009508
doi: 10.1212/WNL.0000000000009508
pubmed: 32245844
Wang H, Li T, Barbarino P, Gauthier S, Brodaty H, Molinuevo JL, Xie H, Sun Y, Yu E, Tang Y, Weidner W, Yu X (2020) Dementia care during COVID-19. Lancet 395:1190–1191. https://doi.org/10.1016/S0140-6736(20)30755-8
doi: 10.1016/S0140-6736(20)30755-8
pubmed: 32240625
pmcid: 7146671
Suzuki M, Hotta M, Nagase A, Yamamoto Y, Hirakawa N, Satake Y, Nagata Y, Suehiro T, Kanemoto H, Yoshiyama K, Mori E, Hashimoto M, Ikeda M (2020) The behavioral pattern of patients with frontotemporal dementia during the COVID-19 pandemic. Int Psychogeriatr 32:1–6. https://doi.org/10.1017/S104161022000109X
doi: 10.1017/S104161022000109X
Alzheimer Europe (2020) Covid-19. https://www.alzheimer-europe.org/Living-with-dementia/COVID-19 . Accessed 15 Jun 2020
Velayudhan L, Aarsland D, Ballard C (2020) Mental health of people living with dementia in care homes during COVID-19 pandemic. Int Psychogeriatr 32:1–2. https://doi.org/10.1017/S1041610220001088
doi: 10.1017/S1041610220001088
Gerlach LB, Kales HC (2018) Managing behavioral and psychological symptoms of dementia. Psychiatr Clin North Am 41:127–139. https://doi.org/10.1016/j.psc.2017.10.010
doi: 10.1016/j.psc.2017.10.010
pubmed: 29412841
Vik-Mo AO, Giil LM, Borda MG, Ballard C, Aarsland D (2020) The individual course of neuropsychiatric symptoms in people with Alzheimer’s and Lewy body dementia: 12-year longitudinal cohort study. Br J Psychiatry 216:43–48. https://doi.org/10.1192/bjp.2019.195
doi: 10.1192/bjp.2019.195
pubmed: 31506117
Hodgson NA, Gitlin LN, Winter L, Czekanski K (2011) Undiagnosed illness and neuropsychiatric behaviors in community residing older adults with dementia. Alzheimer Dis Assoc Disord 25:109–115. https://doi.org/10.1097/WAD.0b013e3181f8520a
doi: 10.1097/WAD.0b013e3181f8520a
pubmed: 20921879
pmcid: 3035741
Appleby J (2020) What is happening to non-covid deaths? BMJ m1607. https://doi.org/10.1136/bmj.m1607
Brown EE, Kumar S, Rajji TK, Pollock BG, Mulsant BH (2020) Anticipating and mitigating the impact of the COVID-19 pandemic on Alzheimer’s disease and related dementias. Am J Geriatr Psychiatry 28:712–721. https://doi.org/10.1016/j.jagp.2020.04.010
doi: 10.1016/j.jagp.2020.04.010
pubmed: 32331845
pmcid: 7165101
Volicer L (2018) Behavioral problems and dementia. Clin Geriatr Med 34:637–651. https://doi.org/10.1016/j.cger.2018.06.009
doi: 10.1016/j.cger.2018.06.009
pubmed: 30336992
Whear R, Coon JT, Bethel A, Abbott R, Stein K, Garside R (2014) What is the impact of using outdoor spaces such as gardens on the physical and mental well-being of those with dementia? A systematic review of quantitative and qualitative evidence. J Am Med Dir Assoc 15:697–705. https://doi.org/10.1016/j.jamda.2014.05.013
doi: 10.1016/j.jamda.2014.05.013
pubmed: 25037168
Canevelli M, Valletta M, Toccaceli Blasi M et al (2020) Facing dementia during the COVID-19 outbreak. J Am Geriatr Soc jgs.16644. https://doi.org/10.1111/jgs.16644
Cagnin A, Di Lorenzo R, Marra C et al (2020) Behavioral and psychological effects of coronavirus disease-19 quarantine in patients with dementia. Front Psychiatry 11. https://doi.org/10.3389/fpsyt.2020.578015
Simonetti A, Pais C, Jones M, Cipriani MC, Janiri D, Monti L, Landi F, Bernabei R, Liperoti R, Sani G (2020) Neuropsychiatric symptoms in elderly with dementia during COVID-19 pandemic: definition, treatment, and future directions. Front Psychiatry 11. https://doi.org/10.3389/fpsyt.2020.579842
Jack CR, Bennett DA, Blennow K et al (2018) NIA-AA research framework: toward a biological definition of Alzheimer’s disease. Alzheimers Dement 14:535–562. https://doi.org/10.1016/j.jalz.2018.02.018
doi: 10.1016/j.jalz.2018.02.018
pubmed: 29653606
pmcid: 5958625
Rascovsky K, Hodges JR, Knopman D, Mendez MF, Kramer JH, Neuhaus J, van Swieten JC, Seelaar H, Dopper EGP, Onyike CU, Hillis AE, Josephs KA, Boeve BF, Kertesz A, Seeley WW, Rankin KP, Johnson JK, Gorno-Tempini ML, Rosen H, Prioleau-Latham CE, Lee A, Kipps CM, Lillo P, Piguet O, Rohrer JD, Rossor MN, Warren JD, Fox NC, Galasko D, Salmon DP, Black SE, Mesulam M, Weintraub S, Dickerson BC, Diehl-Schmid J, Pasquier F, Deramecourt V, Lebert F, Pijnenburg Y, Chow TW, Manes F, Grafman J, Cappa SF, Freedman M, Grossman M, Miller BL (2011) Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. Brain 134:2456–2477. https://doi.org/10.1093/brain/awr179
doi: 10.1093/brain/awr179
pubmed: 21810890
pmcid: 3170532
McKeith IG, Dickson DW, Lowe J et al (2005) Diagnosis and management of dementia with Lewy bodies: third report of the DLB consortium. Neurology 65:1863–1872. https://doi.org/10.1212/01.wnl.0000187889.17253.b1
doi: 10.1212/01.wnl.0000187889.17253.b1
pubmed: 16237129
Armstrong MJ, Litvan I, Lang AE, Bak TH, Bhatia KP, Borroni B, Boxer AL, Dickson DW, Grossman M, Hallett M, Josephs KA, Kertesz A, Lee SE, Miller BL, Reich SG, Riley DE, Tolosa E, Troster AI, Vidailhet M, Weiner WJ (2013) Criteria for the diagnosis of corticobasal degeneration. Neurology 80:496–503. https://doi.org/10.1212/WNL.0b013e31827f0fd1
doi: 10.1212/WNL.0b013e31827f0fd1
pubmed: 23359374
pmcid: 3590050
Sachdev P, Kalaria R, O’Brien J et al (2014) Diagnostic criteria for vascular cognitive disorders. Alzheimer Dis Assoc Disord 28:206–218. https://doi.org/10.1097/WAD.0000000000000034
doi: 10.1097/WAD.0000000000000034
pubmed: 24632990
pmcid: 4139434
Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J (1994) The neuropsychiatric inventory: comprehensive assessment of psychopathology in dementia. Neurology 44:2308–2314. https://doi.org/10.1212/WNL.44.12.2308
doi: 10.1212/WNL.44.12.2308
pubmed: 7991117
Bianchetti A, Rozzini R, Guerini F, Boffelli S, Ranieri P, Minelli G, Bianchetti L, Trabucchi M (2020) Clinical presentation of COVID19 in dementia patients. J Nutr Health Aging 24:560–562. https://doi.org/10.1007/s12603-020-1389-1
doi: 10.1007/s12603-020-1389-1
pubmed: 32510106