Prevalence of Behavioral and Psychological Symptoms in Patients With Cognitive Decline Before and During the COVID-19 Pandemic

Abstract

ObjectivePreventive measures to limit the spread of COVID-19 are essential, but often cause social isolation, affecting the physical and mental health of older adults. Patients with dementia are likely to have worsening behavioral and psychological symptoms of dementia (BPSD) owing to pandemic restrictions. To examine this, we described BPSD before and during the COVID-19 pandemic.MethodsWe identified patients at a memory clinic in Japan between October 2018 and December 2019 (15 months before the pandemic began, n = 1,384) and between April 2020 and June 2021 (15 months after the State of Emergency was declared; n = 675 patients). A propensity score was used to match 576 patients from each group. The Mini-Mental State Exam was used to classify cognitive function into mild and moderate/severe. Dementia Behavioral Disturbance Scale was used to evaluate BPSD. The association between BPSD before and during the pandemic was evaluated using binomial logistic regression models.ResultsThe levels of frequent night waking were higher in individuals before the pandemic than in those evaluated during the pandemic in both the mild group [adjusted odds ratio (AOR) = 1.82, 95% CI 1.02–3.23] and the moderate/severe group (AOR = 1.96, 95% CI 1.19–3.23). During the pandemic, physical attacks were higher in the mild group (AOR = 4.25, 95% CI 1.12–16.07), while night wandering was higher in the moderate/severe group (AOR = 2.22, 95% CI 1.03–4.81).ConclusionIn patients with cognitive impairment, some BPSD were more prevalent during the pandemic, depending on dementia severity. The findings pertaining to the higher frequency of sleep disturbance and aggressiveness during COVID-19 should be used to guide BPSD screening in patients with dementia and to provide evidence-based interventions.

Factors Associated with Behavioral and Psychological Symptoms of Dementia during COVID-19

“…Cagnin et al reported that sleep disturbance was the most common new BPSD during COVID-19, at a rate of 21.3% in dementia patients [ 17 ]. Our previous study also showed a higher frequency of sleep disturbance during COVID-19 than in normal times [ 18 ]. We showed here that maintaining good quality of sleep could help to reduce BPSD.…”

“…We selected 1781 before-COVID-19 and 576 during-COVID-19 participants after excluding those with missing variables, including the primary outcome measure of the study, a score on the Dementia Behavioral Disturbance (DBD) scale [ 24 ]. The dataset used in this study was designed to be highly extensive before the COVID-19 period compared to the dataset used in our previous study [ 18 ], resulting in an increased number of participants. Independent researchers ensured that the same participants were not evaluated at the two time points.…”

“…These studies were conducted only after the start of the COVID-19 pandemic, and the causality of the increase in BPSD is not clear. Therefore, in our previous study, we examined the prevalence of BPSD using continuous data from 15 months before and during the COVID-19 pandemic and found that sleep disturbances and aggressiveness were more prevalent after the start of COVID-19 [ 18 ]. Considering the results of previous studies [ 15 , 17 ], we can conclude that some cases of BPSD have worsened since the start of the COVID-19 pandemic, but the factors that have contributed to this deterioration are unclear.…”

Importance of telemedicine in mild cognitive impairment and Alzheimer disease patients population during admission to emergency departments with COVID-19

“…The epidemic of COVID-19 has had a profound impact on the organization of clinical and social care activities for people with dementia and their caregivers. Undoubtedly, preventive measures to limit the spread of COVID-19 are essential, but in patients with dementia, they have often caused social isolation, and exacerbated behavioral and psychological symptoms of dementia (BPSD) [ 1 , 2 ] resulting in increased caregiver burden. [ 3 , 4 ] BPSD, also known as neuropsychiatric symptoms, represent a heterogeneous group of noncognitive symptoms, and behaviors that occur in people with dementia.…”

Ellagic Acid: A Dietary-Derived Phenolic Compound for Drug Discovery in Mild Cognitive Impairment

“…Mild cognitive impairment (MCI) is usually associated with cognitive impairment, which is seen with general age-related cognitive decline, but is not severe enough to lead to considerably impaired daily function (Stevens et al, 2022). Furthermore, the GRAPHICAL ABSTRACT | principal cognitive domain that could be afflicted refers to a decline in the capability to acquire raw information or recall stored information (Gatz et al, 2022;Kuroda et al, 2022). Clinically, age-related cognitive impairment represents the preclinical, transitional stage between healthy aging and dementia (Levey et al, 2021).…”