Incidence and Outcomes of SARS-CoV-2 Infection in Older Adults Living with Dementia: A Population-Based Cohort Study

Abstract

Background: The identification of risk factors for SARS-CoV-2 infection and mortality in patients with dementia is a key aspect to support clinical decisions and public health interventions. Objective: To assess the incidence of SARS-CoV-2 infection and COVID-19 related death in a cohort of patients with dementia residing in the Lazio region and to investigate predicting factors for both infection and mortality. Methods: This population-based study used information from administrative databases and the SARS-CoV-2 infection surveillance system. Patients with dementia (age ≥65) were enrolled as of December 31, 2019 and followed-up until February 28, 2021. Cumulative risk of infection and death within 60 days of infection onset, and age-standardized incidence (SIR) and mortality (SMR) ratios were calculated. Logistic regression models were applied to identify factors associated with infection and mortality. Results: Among 37,729 dementia patients, 2,548 had a diagnosis of SARS-CoV-2 infection. The crude risk of infection was 6.7% . An increase in risk of infection was observed both in women (SIR 1.72; 95% CI 1.64–1.80) and men (SIR 1.43; 95% CI 1.33–1.54). Pneumonia, cerebrovascular and blood diseases, femur fracture, anxiety, antipsychotic and antithrombotic use were associated with an increased risk of infection. The crude risk of death was 31.0%, the SMRs 2.32 (95% CI 2.05–2.65) for men, and 2.82 (95% CI 2.55–3.11) for women. Factors associated with mortality included: male gender, age ≥85, symptoms at the diagnosis, antipsychotic and systemic antibiotics treatment. Conclusion: These findings emphasize the need of close and tailored monitoring of dementia patients to reduce the impact of COVID-19 on this fragile population.

Dementia and psychotropic medications are associated with significantly higher mortality in geriatric patients hospitalized with COVID-19: data from the StockholmGeroCovid project

“…Importantly, the association survived adjustment for dementia, comorbidities, and oxygen saturation. Other studies concur with the direction of the association; however, the risk estimates vary between 1.26× and 11.1× the risk of death depending on the population, with large heterogeneity between the studied mortality periods [21,22,32,44]. Unfortunately, we had no information on the pre-admission or post-discharge usage of antipsychotic drugs, which would allow us to confirm the putative increase in infection rates or study time-dependent effects.…”

“…While the higher risk of death in COVID-19-infected dementia patients may be intuitive, the underlying connections interacting between the two disorders are complex. First, patients with dementia are more prone to being infected and hospitalized with COVID-19 [7,8,15,31,32] and suffer more frequently from severe outcomes of COVID-19 [7,9,10]. These associations are likely explained by overall higher comorbidity burden including respiratory complications [11,12,33], inability to follow social restrictions [8,15], increased caregiver burden [15], and possibly even higher infectious load in apolipoprotein E epsilon-4 variant carriers [15,34].…”

“…In addition, a specific concern should be given to the finding of higher mortality among psychotropic drug users, particularly antipsychotics. Importantly, there are reports of increased antipsychotic drug prescription rates among dementia patients during the pandemic [16,21] as well as associations between antipsychotics and higher probability of COVID-19 infection [32], though some reports dispute such claims [18]. In our cohort, the use of antipsychotic medication at admission to hospital was associated with 70% higher overall mortality, with the highest increase observed among in-hospital patients (3.58× higher hazard, with a 5% decrease in risk with each survived day), and the risk decreasing in the post-discharge periods (1.39× aggregate increase).…”

Is Dementia Associated with COVID-19 Mortality? A Multicenter Retrospective Cohort Study Conducted in 50 Hospitals in Germany

“…Furthermore, given that our study only included patients treated in hospitals, the association between dementia and a fatal course of COVID-19 cannot be generalized to indicate an association between dementia and COVID-19 severity in patients treated outside of hospitals in Germany. Other authors have conducted studies on dementia patients with COVID-19 in other settings and countries (Cascini et al, 2022, Hua et al, 2022. For example, in Madrid (Spain), the mortality of the residents living in nursing homes with COVID-19 was almost 45% (Cascini et al, 2022).…”

“…Other authors have conducted studies on dementia patients with COVID-19 in other settings and countries (Cascini et al, 2022, Hua et al, 2022. For example, in Madrid (Spain), the mortality of the residents living in nursing homes with COVID-19 was almost 45% (Cascini et al, 2022). Another study conducted in the USA found that the weekly mortality rate in 2020 was 68% higher among assisted living residents with dementia than among residents without dementia (Hua et al, 2022).…”