Depression and anxiety in people with cognitive impairment and dementia during the COVID-19 pandemic: Analysis of the English Longitudinal Study of Ageing

Abstract

Background Some studies have identified declines in mental health during the Coronavirus Disease 2019 (COVID-19) pandemic in different age groups, including older people. As anxiety and depression are common neuropsychiatric symptoms among people with cognitive impairment, the mental health experiences of older people during the pandemic should take cognitive function into consideration, along with assessments made prior to the pandemic. This study addresses evidence gaps to test whether changes in depression and anxiety among older people through the COVID-19 pandemic were associated with cognitive impairment. It also investigates whether associations varied according to key sources of sociodemographic inequality. Methods and findings Using data from the English Longitudinal Study of Ageing (ELSA) collected from 2018/2019 to November/December 2020, we estimated changes in depression and anxiety for people aged 50+ in England across 3 cognitive function groups: no impairment, mild cognitive impairment, and dementia. Conditional growth curve models were estimated for continuous measures over 3 time points (N = 5,286), with mixed-effects logistic regression used for binary measures. All models adjusted for demographics (age, gender, ethnicity, and cohabiting partnership), socioeconomics (education, wealth, and employment status), geography (urban/rural and English region), and health (self-rated and the presence of multimorbidity). We found that depression (measured with CES-D score) worsened from 2018/2019 to November/December 2020 for people with mild cognitive impairment (1.39 (95% CI: 1.29 to 1.49) to 2.16 (2.02 to 2.30)) or no impairment (1.17 (95%CI: 1.12 to 1.22) to 2.03 (1.96 to 2.10)). Anxiety, using a single-item rating of 0 to 10 also worsened among those with mild cognitive impairment (2.48 (2.30 to 2.66) to 3.14 (2.95 to 3.33)) or no impairment (2.20 (2.11 to 2.28) to 2.85 (2.77 to 2.95)). No statistically significant increases were found for those with dementia. Using a clinical cutoff for likely depression (CES-D ≥4), we found statistically significant increases in the probability of depression between 2018/2019 and November/December 2020 for those with no impairment (0.110 (0.099 to 0.120) to 0.206 (0.191 to 0.222)) and mild impairment (0.139 (0.120 to 0.159) to 0.234 (0.204 to 0.263)). We also found that differences according to cognitive function that existed before the pandemic were no longer present by June/July 2020, and there were no statistically significant differences in depression or anxiety among cognitive groups in November/December 2020. Wealth and education appeared to be stronger drivers for depression and anxiety, respectively, than cognitive impairment. For example, those with no impairment in the richest two-thirds scored 1.76 (1.69 to 1.82) for depression in June/July, compared to 2.01 (1.91 to 2.12) for those with no impairment in the poorest third and 2.03 (1.87 to 2.19) for those with impairment in the poorest third. Results may be limited by the small number of people with dementia and are generalizable only to people living in the community, not to those in institutional care settings. Conclusions Our findings suggest a convergence in mental health across cognitive function groups during the pandemic. This suggests mental health services will need to meet an increased demand from older adults, especially those not living with cognitive impairment. Further, with little significant change among those with dementia, their existing need for support will remain; policymakers and care practitioners should ensure this group continues to have equitable access to mental health support.

Association depressive symptoms with memory function and social capital before and during COVID‐19 in community‐dwelling older adults in rural Japan: A retrospective study with a longitudinal data

“…Consistent with our hypothesis, multivariate analysis using MMRM -7 of 11 those without. 13 However, caution is warranted when comparing our results with those of previous studies due to differences in timing of data collection during the pandemic. Our study, conducted from May to November 2021 following the first wave of the pandemic, suggests that participants may have experienced increased social support during this period compared to earlier lockdowns.…”

“…Specifically, the mean (SD) civic participation score at T2 was 12.3 (2.8), indicating that the participants attended two groups once per week. The median (IQR) social cohesion score at T2 was 12 (11)(12)(13), indicating that the participants moderately agreed with the three questions about community trust and attachment. The median (IQR) reciprocity score during COVID-19 was 7 (4-10.75), indicating that there were two or three people who could the participants if they needed assistance.…”

“…9 While, the socio-cultural, economic, and psychological risk factors associated with depression in older adults have been identified, 10 the cognitive risk factors for depression have been insufficiently and inconsistently studied longitudinally. [11][12][13][14][15][16] Specifically, depressive symptoms in older adults with mild cognitive impairment did not change significantly, 11 but worsened in another study. 12,13 In long-term care residents, having dementia may be a protective factor against depression 14 ; conversely, participants with dementia increased depressive symptoms.…”

“…[11][12][13][14][15][16] Specifically, depressive symptoms in older adults with mild cognitive impairment did not change significantly, 11 but worsened in another study. 12,13 In long-term care residents, having dementia may be a protective factor against depression 14 ; conversely, participants with dementia increased depressive symptoms. 15,16 During the COVID-19 pandemic, older adults with more pronounced cognitive decline experienced greater difficulty adapting to lifestyle changes.…”

Impact of COVID on the mental health and cognitive functioning level of elderly individuals

“…Whereas in non-covid affected group, anxiety and aging influence the memory and overall cognitive domains. This indicates that anxiety and aging influence the cognitive functioning of older individual despite of non-covid affected group 32 , 28 , 33 . The potential risk factors in older individual could be the psychological and biological factors due aging process while in this pandemic even worsen the condition of the individuals 29 , 34 .…”