Cognition, Behavior, and Caregiver Stress in Dementia during the COVID-19 Pandemic: An Indian Perspective

Abstract

<b><i>Objectives:</i></b> Little is known regarding the cognitive and behavioral status of patients with dementia and their caregivers in lower middle-income countries during the COVID-19 pandemic. This study aimed to understand the impact of the pandemic on persons with dementia and their caregivers in India. <b><i>Methods:</i></b> This was an observational study. A cohort of 66 persons with dementia and their caregivers were evaluated during the COVID-19 pandemic in 2 specialist hospitals in South India. Caregivers were interviewed at 2 distinct time points of the pandemic: during the national lockdown and 5 months after during later periods of the “cluster of cases” transmission phase. Participants were assessed via telephone utilizing validated instruments (Neuropsychiatric Inventory [NPI], Clinical Dementia Rating [CDR] Scale, and Depression, Anxiety and Stress Scale [DASS-21]) and a semi-structured questionnaire. The questionnaire documented sociodemographic information, clinical history, infection measures adopted, changes in caregiving routines, involvement in functional rehabilitation activities, and access to medical and long-term care support services. <b><i>Results:</i></b> The 2-phase follow-up study found a significant worsening of behavior in dementia patients, demonstrated by a difference in the NPI sub-domain scores for anxiety (mean difference [standard deviation, SD] = −0.552 [1.993], <i>t</i><sub>58</sub> = −2.109, <i>p</i> = 0.039) and eating disturbances (mean difference [SD] = −1.121 [2.493], <i>t</i><sub>59</sub> = −3.424, <i>p</i> = 0.001). A relatively high proportion of patients developed anxiety (cumulative incidence = 24.53%) and eating disturbances (cumulative incidence = 26.92%), without having these symptoms at baseline. There was a trend toward an increase in proportion of persons with severe dementia (19.7% vs. 39.4%) on follow-up. Caregiver distress reported was significantly associated with neuropsychiatric symptoms (<i>r</i> = 0.712, <i>p</i> < 0.001) and dementia severity (ρ = 0.365, <i>p</i> = 0.004). In addition, difficulties in accessing medical care persisted between the 2 assessments, and there were statistically significant differences between functional rehabilitation activities such as indoor activities (<i>p</i> < 0.001), outdoor activities (<i>p</i> = 0.013), and physical exercises (<i>p</i> = 0.003) between baseline and follow-up. <b><i>Conclusion:</i></b> Findings suggest interruption of functional rehabilitation activities and disruption in medical care services are likely to have had an adverse impact on patients with dementia and contributed toward caregiver distress.

The Impact of the COVID-19 Pandemic on the Psychological Well-Being of Caregivers of People with Dementia or Mild Cognitive Impairment: A Systematic Review and Meta-Analysis

“…Of 1489 studies, we examined 73 articles as full texts (Figure 1), excluding 58 articles, mainly due to data being cross-sectional. A total of 15 studies were included in the review [11,[15][16][17][18][19][20][21][22][23][24][25][26][27][28]. The risk of bias was recorded as either low risk of bias, some concern high risk of bias, or very high risk of bias.…”

“…Of 1489 studies, we examined 73 articles as full texts (Figure 1), excluding 58 articles mainly due to data being cross-sectional. A total of 15 studies were included in the review [11,[15][16][17][18][19][20][21][22][23][24][25][26][27][28].…”

“…The majority of the studies (n = 12) were conducted in Europe [11,15,[17][18][19][21][22][23][24][25][26]28], and three in Asia [16,20,27]. A total of 1702 caregivers of PwD/MCI were included (mean age 60.40 ± 12.9 years, 65.7% female).…”

“…Multiple scales were used to describe the impact on caregivers' psychological wellbeing: The Neuropsychiatric Inventory (NPI) (n = 5); Caregiver Burden Inventory (CBI) (n = 3); Generalized Anxiety Disorder Scale-7 (GAD- Across all studies (summarized in Table 1), there were no changes in psychological well-being in five studies [18,19,21,26,27] and worsening psychological well-being in ten studies.…”

“…There was a significant increase in depression (six studies [11,15,16,20,24,27], n = 1368; SMD = 0.401; 95% CI: 0.091 to 0.711; p = 0.01; I 2 = 86.8%). (b).…”