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In the setting of the raging COVID-19 pandemic, the search for innovative therapeutics is desperately sought after. As we learn more about the characteristics and metabolic health of patients and as our understanding of COVID-19 pathophysiology and treatment progresses, so is our understanding of medication effects that might increase disease severity. As of late, ACE inhibitors have been under investigation for a potential increase in illness severity due to ACE2 upregulation. Given our knowledge of other nutrient-pharmaceutical interactions, could the ACE inhibitor impact on COVID be due to something else? In this paper, we discuss the possibility that ACE inhibitors might be affecting COVID-19 patients by causing zinc insufficiency. KEY MESSAGES Zinc deficiency caused by chronic ACE inhibitor usage may exacerbate the pathogenicity of COVID-19 in susceptible patients. A multi-center study is needed to assess the zinc levels of patients with COVID-19 who are taking ACE inhibitors and other medications that may result in low zinc levels.

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BackgroundMaintaining healthy lifestyle behaviors and optimizing health may slow cognitive decline through risk reduction in older adults with cognitive impairments. Curriculum‐based health coaching, weekly psychosocial support, and use of biomarkers to guide health optimization may aid in establishing effective behavior change centered around multiple reversible dementia risk factors.MethodWe piloted combined use of a six‐month online Cognitive Health Program (www.amosinstitute.com) with a telehealth lifestyle support group in six patients with subjective cognitive complaints receiving ongoing outpatient memory care. These patients were given lab‐guided personalized health recommendations for dementia risk reduction throughout the pilot intervention during monthly individual appointments with the study physician overseeing the group. A registered dietician was invited to lead the weekly telehealth lifestyle support group, which was delivered in partnership with the Center’s memory clinicians and health coaches. Highlights of the online Cognitive Health Program were reviewed by the dietician each week followed by group discussion on topics including diet, exercise, sleep, stress, and cognitive training. Cognition was assessed at baseline and post‐intervention using a computerized battery (www.cambridgebrainsciences.com). The significance of cognitive changes was estimated with nonparametric tests and effect sizes (Cohen’s d). The participants were also queried qualitatively on adherence and satisfaction.ResultCompared to baseline, the participants improved significantly in the global cognition score (p<.02, d = 1.6), and had significant improvements in spatial planning (p<.01, d = 2.3) and visuospatial processing (p<.05, d = 1.1). There was a borderline improvement in verbal reasoning (p<.06, d = 1.0). Subjective reports indicated that participants were able to successfully adhere to multiple lifestyle habits in the areas of sleep, nutrition, and exercise. Participants reported high levels of satisfaction with the virtual group format, the online curriculum, and access to the additional online resources.ConclusionA virtually administered, six‐month, weekly health coaching group that addresses multiple lifestyle factors associated with brain health, supplemented by self‐paced online health education and lab‐based health optimization by a physician, is feasible and potentially efficacious for improving cognition in participants with subjective cognitive impairment. This format may facilitate behavior change to slow cognitive decline. Future studies will include neuroimaging, formal neuropsychological testing, controls, and larger sample sizes.