Coronavirus Disease-2019 Conundrum: RAS Blockade and Geriatric-Associated Neuropsychiatric Disorders

Abstract

Coronavirus Disease 2019 (COVID-19) is caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which primarily targets the human respiratory system and may lead to severe pneumonia and ultimately death. Mortality rate is particurlarly high among people beyond the sixth decade of life with cardiovascular and metabolic diseases. The discovery that the SARS-CoV-2 uses the renin-angiotensin system (RAS) component ACE2 as a receptor to invade host epithelial cells and cause organs damage resulted in a debate regarding the role of ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) therapies during COVID-19 pandemic. Some authors proposed the discontinuation of ACEIs and ARBs for cardiovascular, kidney, and metabolic diseases, while expert opinions have discouraged that due to limited empirical evidence of their negative effect on COVID-19 outcomes, and that withdrawing treatment may contribute to clinical decompensation in high-risk patients. Moreover, as cardiovascular and metabolic diseases are associated with neurodegenerative and psychiatric disorders, especially among older adults, a critical appraisal of the potential positive effects of ACEIs and ARBs is highly needed. Herein, we aim to discuss the conundrum of ACEIs and ARBs use in high-risk patients for COVID-19, and their potential protective role on the development and/or progression of geriatric neuropsychiatric disorders.

A Review of the Current Status of Clinical Management of COVID-19 in the Elderly

“…In the elderly, the immunomodulatory function of the vagus nerve and the response of immune cells to pathogens decrease, especially in people with cardiovascular disease and diabetes. SARS-CoV-2 infection can lead to a decrease in ACE2, which can aggravate the pro-inflammatory background, resulting in an increase in the severity of and mortality from COVID-19 [ 1 , 19 ].…”

“…The impact of the COVID-19 pandemic on elderly patients is not only directly related to morbidity and mortality, but also to negative effects on pre-existing clinical conditions and geriatric syndromes [ 39 ], and to mental illness caused by social isolation and other related factors [ 40 ], including anxiety, anger, mood disorders, stress, irritability, inattention, depression, and post-traumatic stress disorder (PTSD) [ 12 ]. Fear of illness or death and the effects of isolation may be important causes of PTSD [ 19 ].…”

COVID-19 in Older Individuals Requiring Hospitalization

“…Additionally, mucociliary clearance in the respiratory tract is reduced in older individuals, as has been shown in a study among healthy volunteers of different ages in whom mucociliary clearance and ciliary beat frequency were calculated and were found to be lower in older individuals [ 5 ]. On the other hand, SARS-CoV-2 infection may lead to a decrease in the ACE2 protein levels, which may increase the expression of pro-inflammatory mediators, leading to increased severity and higher mortality of COVID-19 [ 22 , 23 , 24 , 25 ]. This is of particular importance in older patients, as ACE2 levels decline with age, making them more vulnerable to the immunologic consequences associated with the ACE2 level reduction induced by SARS-CoV-2 [ 26 ].…”

EpistoNet: An ensemble of Epistocracy-optimized mixture of experts for detecting COVID-19 on chest X-ray images

“…This virus can spread in the form of direct contact or by droplets expelled by coughing or sneezing. In some serious cases, COVID-19 can affect the respiratory system and cause severe pneumonia and ultimately death 2 . Pneumonia is a type of infection that causes in ammation in one or both lungs.…”