Awareness of COVID-19 in severe dementia patients

September 21, 2020

Tokyo, September 21, 2020- The ongoing coronavirus disease 2019 (COVID-19) pandemic has substantially affected patients with dementia and their caregivers. Owing to the restrictive measures taken worldwide to block the spread of COVID-19 outbreaks (including the declaration of a state of emergency in Japan), patients with dementia and their caregivers have not been able to receive the usual support and care. Therefore, this is expected to lead to adverse effects on the patients and their caregivers, and many investigators have warned about the risks (1-3). In fact, many scheduled appointments for routine outpatients' examinations and care services have been canceled and postponed owing to the COVID-19 outbreak. When dementia outpatients came to our clinic for their postponed outpatient appointments after the state of emergency declaration was lifted, we found that some patients were afraid of COVID-19 infection whereas some were not. We noticed 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 hence may be less depressed, we compared the rate of recognition of the COVID-19 outbreak and resultant depressive tendencies between patients with mild dementia and those with severe dementia.

In this study, patients with Alzheimer disease (AD) (4) are included in this study because the depressive tendency depends on the cause of 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, on the day when the declaration of emergency was lifted, to June 30, 2020. In addition to the Mini Mental State Examination (MMSE) (5) and Geriatric Depression Scale - Short Version (GDS-S) (6) performed as routine psychological tests, the participants were asked the following 2 questions: "Do you know COVID-19?" and "Why are you wearing a face mask?". The patients were divided into the mild AD group (MMSE score ? 21, n = 51) and the moderate to severe AD group (MMSE score < 21, n = 75), and the results of the neuropsychological tests and the 2 questions were compared. During the state of emergency, none of the patients had received a diagnosis of COVID-19 or had required any treatment changes or additional treatments owing to Behavioral and Psychological Symptoms of Dementia (BPSD). Consistent with our hypothesis, AD patients with moderate to severe cognitive impairment were found to have a low COVID-19 recognition rate and did not fully understand why they were wearing face masks.
In addition, because they did not understand the seriousness of the COVID-19 outbreak, their GDS scores were also substantially lower.

These results may appear to simply indicate that people with severe dementia are unaware of current events. However, these results provide us with insights into how to care for patients with dementia and how to efficiently use of the time and support of our limited staff during the COVID-19 outbreak. A previous study demonstrated that the COVID-19 outbreak adversely affected not only cognition and neuropsychiatric symptoms but also the functional independence of patients with dementia (1)?Therefore, our results indicate that for patients with moderate to severe cognitive impairment, it may be useful to prioritize prevention of their cognitive decline and maintenance of their functional independence, whereas for those with mild cognitive impairment, it may be useful to prioritize reducing psychological stress and preventing neuropsychiatric symptoms, such as depression. Moreover, when explaining the necessity of wearing a face mask to patients with moderate to severe dementia, it is necessary to persuade them to wear a mask, as they do not understand COVID-19. Not only because they are unaware of COVID-19 that moderate to severe dementia patients are less prone to depression, but also it should be remembered that their caregivers have made great efforts trying to prevent patients from becoming depressed. Therefore, it will be important to also investigate the depressive tendencies of caregivers during the COVID-19 outbreak.

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

IOS Press

Related Science Articles from Brightsurf:

75 science societies urge the education department to base Title IX sexual harassment regulations on evidence and science
The American Educational Research Association (AERA) and the American Association for the Advancement of Science (AAAS) today led 75 scientific societies in submitting comments on the US Department of Education's proposed changes to Title IX regulations.

Science/Science Careers' survey ranks top biotech, biopharma, and pharma employers
The Science and Science Careers' 2018 annual Top Employers Survey polled employees in the biotechnology, biopharmaceutical, pharmaceutical, and related industries to determine the 20 best employers in these industries as well as their driving characteristics.

Science in the palm of your hand: How citizen science transforms passive learners
Citizen science projects can engage even children who previously were not interested in science.

Applied science may yield more translational research publications than basic science
While translational research can happen at any stage of the research process, a recent investigation of behavioral and social science research awards granted by the NIH between 2008 and 2014 revealed that applied science yielded a higher volume of translational research publications than basic science, according to a study published May 9, 2018 in the open-access journal PLOS ONE by Xueying Han from the Science and Technology Policy Institute, USA, and colleagues.

Prominent academics, including Salk's Thomas Albright, call for more science in forensic science
Six scientists who recently served on the National Commission on Forensic Science are calling on the scientific community at large to advocate for increased research and financial support of forensic science as well as the introduction of empirical testing requirements to ensure the validity of outcomes.

World Science Forum 2017 Jordan issues Science for Peace Declaration
On behalf of the coordinating organizations responsible for delivering the World Science Forum Jordan, the concluding Science for Peace Declaration issued at the Dead Sea represents a global call for action to science and society to build a future that promises greater equality, security and opportunity for all, and in which science plays an increasingly prominent role as an enabler of fair and sustainable development.

PETA science group promotes animal-free science at society of toxicology conference
The PETA International Science Consortium Ltd. is presenting two posters on animal-free methods for testing inhalation toxicity at the 56th annual Society of Toxicology (SOT) meeting March 12 to 16, 2017, in Baltimore, Maryland.

Citizen Science in the Digital Age: Rhetoric, Science and Public Engagement
James Wynn's timely investigation highlights scientific studies grounded in publicly gathered data and probes the rhetoric these studies employ.

Science/Science Careers' survey ranks top biotech, pharma, and biopharma employers
The Science and Science Careers' 2016 annual Top Employers Survey polled employees in the biotechnology, biopharmaceutical, pharmaceutical, and related industries to determine the 20 best employers in these industries as well as their driving characteristics.

Three natural science professors win TJ Park Science Fellowship
Professor Jung-Min Kee (Department of Chemistry, UNIST), Professor Kyudong Choi (Department of Mathematical Sciences, UNIST), and Professor Kwanpyo Kim (Department of Physics, UNIST) are the recipients of the Cheong-Am (TJ Park) Science Fellowship of the year 2016.

Read More: Science News and Science Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to