Atypical Presentation of Covid-19 in an Older Adult With Severe Alzheimer Disease

Isaia, Gianluca; Marinello, Renata; Tibaldi, Vittoria; Tamone, Cristina; Bo, Mario

doi:10.1016/j.jagp.2020.04.018

Cited by 49 publications

(45 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Apathy occurring in the context of altered consciousness was also described as an atypical presentation of the SARS-CoV-2 infection ( 11 ). This so-called “apathetic delirium” may supersede classical SARS-CoV-2 infection symptoms and interfere with the early identification of COVID-19 disease ( 11 , 19 ).…”

Section: Resultsmentioning

confidence: 99%

Neuropsychiatric Symptoms in Elderly With Dementia During COVID-19 Pandemic: Definition, Treatment, and Future Directions

et al. 2020

View full text Add to dashboard Cite

Background Neuropsychiatric symptoms (NPS) of dementia, such as anxiety, depression, agitation, and apathy, are complex, stressful, and costly aspects of care, and are associated to poor health outcomes and caregiver burden. A steep worsening of such symptoms has been reported during Coronavirus Disease 2019 (COVID-19) pandemic. However, their causes, their impact on everyday life, and treatment strategies have not been systematically assessed. Therefore, the aim of this review is to provide a detailed description of behavioral and psychopathological alterations in subjects with dementia during COVID-19 pandemic and the associated management challenges. Methods A PubMed search was performed focusing on studies reporting alterations in behavior and mood and treatment strategies for elderly patients with dementia, in accordance with PRISMA guidelines. The following search strategy was utilized: (COVID* OR coronavirus OR “corona vir*” OR SARS-CoV-2) AND (dementia OR demented OR dement* OR alzheimer* OR “pick’s disease” OR “lewy body” OR “mild cognitive” OR mild cognitive impairment OR MCI). Results Apathy, anxiety and agitation are the most frequently NPS during the COVID-19 pandemic and are mainly triggered by protracted isolation. Most treatment strategies rely on pharmacotherapy; technology is increasingly utilized with mixed results. Conclusions NPS of dementia during COVID-19 appear to arise from social restrictions occurring as a consequence of the pandemic. Implementation of caregiver support and the presence of skilled nursing home staff are required to restore social interaction and adjust technological support to the patients’ needs.

show abstract

Section: Resultsmentioning

confidence: 99%

Neuropsychiatric Symptoms in Elderly With Dementia During COVID-19 Pandemic: Definition, Treatment, and Future Directions

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Moreover, patients with dementia often present atypical symptoms, such as altered mental status (including confusion, agitation, disorientation, refusal of care, disorientation, and loss of appetite) as the initial COVID-19 manifestation, even without fever and cough (Isaia et al, 2020;Ward et al, 2020), along with worsening of baseline functional status (Bianchetti et al, 2020). Thus, waiting for typical respiratory symptoms to appear would delay appropriate diagnosis and treatment.…”

Section: Covid-19 Manifestations In Patients With Dementiamentioning

confidence: 99%

“…Hospitalization and mortality rates increase drastically after 65 years of age (Centers for Disease Control and Prevention, 2020; Goujon et al, 2020) and current evidence points to age along with male sex and the presence of comorbid medical conditions as factors of poor prognosis and higher risk of death (Lu et al, 2020;Martin-Sanchez et al, 2020;Williamson et al, 2020). Moreover, elderly people with chronic diseases such as dementia often present atypical symptoms at onset of COVID-19 such as altered mental status (including confusion, agitation, disorientation, refusal of care, disorientation, and loss of appetite) (Bianchetti et al, 2020;Isaia et al, 2020;Ward et al, 2020). This atypical presentation may delay appropriate diagnosis and treatment and consequently, it may worsen their prognosis and survival.…”

Section: Introductionmentioning

confidence: 99%

Cognitive and Neuropsychiatric Manifestations of COVID-19 and Effects on Elderly Individuals With Dementia

Alonso‐Lana

Marquié

Ruiz

et al. 2020

Front. Aging Neurosci.

150

View full text Add to dashboard Cite

The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread worldwide and has had unprecedented effects in healthcare systems, economies and society. COVID-19 clinical presentation primarily affects the respiratory system causing bilateral pneumonia, but it is increasingly being recognized as a systemic disease, with neurologic manifestations reported in patients with mild symptoms but, most frequently, in those in a severe condition. Elderly individuals are at high risk of developing severe forms of COVID-19 due to factors associated with aging and a higher prevalence of medical comorbidities and, therefore, they are more vulnerable to possible lasting neuropsychiatric and cognitive impairments. Several reports have described insomnia, depressed mood, anxiety, post-traumatic stress disorder and cognitive impairment in a proportion of patients after discharge from the hospital. The potential mechanisms underlying these symptoms are not fully understood but are probably multifactorial, involving direct neurotrophic effect of SARS-CoV-2, consequences of long intensive care unit stays, the use of mechanical ventilation and sedative drugs, brain hypoxia, systemic inflammation, secondary effects of medications used to treat COVID-19 and dysfunction of peripheral organs. Chronic diseases such as dementia are a particular concern not only because they are associated with higher rates of hospitalization and mortality but also because COVID-19 further exacerbates the vulnerability of those with cognitive impairment. In patients with dementia, COVID-19 frequently has an atypical presentation with mental status changes complicating the early identification of cases. COVID-19 has had a dramatical impact in long-term care facilities, where rates of infection and mortality have been very high. Community measures implemented to slow the spread of the virus have forced to social distancing and cancelation of cognitive stimulation programs, which may have contributed to generate loneliness, behavioral symptoms and worsening of cognition in patients with dementia. COVID-19 has impacted the functioning of Memory Clinics, research programs and clinical trials in the Alzheimer's field, triggering the

show abstract

“…Other risk factors include poor nutrition, dementia, dehydration, and various clinical complications, especially in frail and bedridden patients (30). A lack of a timely diagnosis and therapeutic and preventive measures increases the risk of a severe infection.…”

Section: Geriatric Risk Factors For Covid-19mentioning

confidence: 99%

Geriatric Population During the COVID-19 Pandemic: Problems, Considerations, Exigencies, and Beyond

Dhama

Patel

Kumar

et al. 2020

Front. Public Health

View full text Add to dashboard Cite

The coronavirus disease 2019 (COVID-19) pandemic wreaked havoc worldwide, with more than 20 million confirmed cases and nearly 0. 75 million deaths as of 10th August 2020. Various factors determine the severity and symptoms of this infection. Older age and underlying diseases are the challenges being faced in controlling and treating COVID-19. In 2019, 703 million of the global population was older than 65 years of age. The estimated mortality due to COVID-19 in people older than 76 years of age is reportedly 18%. Frequent infections in older people, higher disease severity, and increased mortality are major challenges in the implementation of appropriate preventive measures and future strategies to protect against this disease in geriatric population. Poor health status, weak immune function, lowered organ function, increased probability of multiple underlying diseases, and poor attention to personal health can increase the susceptibility to various diseases in the geriatric population. Concerning inadequate immunity, the decrease expression of receptors and exaggerated pathophysiologic responses can be debilitating. However, future studies will reveal the hidden facets in these aspects in this COVID-19 catastrophe. In this article, we reviewed the main concerns of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the geriatric population, including the risk of acquiring severe COVID-19 resulting in mortality, variation in clinical manifestations, and other pandemic-related concerns. We also discussed the need for increasing attention toward the elderly, taking appropriate prevention and control measures, and considering geriatric-related adjustments in vaccine design and development.

show abstract

Atypical Presentation of Covid-19 in an Older Adult With Severe Alzheimer Disease

Cited by 49 publications

References 5 publications

Neuropsychiatric Symptoms in Elderly With Dementia During COVID-19 Pandemic: Definition, Treatment, and Future Directions

Neuropsychiatric Symptoms in Elderly With Dementia During COVID-19 Pandemic: Definition, Treatment, and Future Directions

Cognitive and Neuropsychiatric Manifestations of COVID-19 and Effects on Elderly Individuals With Dementia

Geriatric Population During the COVID-19 Pandemic: Problems, Considerations, Exigencies, and Beyond

Contact Info

Product

Resources

About