Tackling challenges in care of Alzheimer's disease and other dementias amid the COVID‐19 pandemic, now and in the future

Mok, Vincent C.T.; Pendlebury, Sarah T.; Wong, Adrian; Alladi, Suvarna; Au, Lisa; Bath, Philip M.; Biessels, Geert Jan; Chen, Christopher; Cordonnier, Charlotte; Dichgans, Martin; Dominguez, Jacqueline C.; Gorelick, Philip B.; Kim, SangYun; Kwok, Timothy; Greenberg, Steven M.; Jia, Jianping; Kalaria, Rajesh N.; Kivipelto, Miia; Naegandran, Kandiah; Lam, Linda Chiu Wa; Lam, Bonnie Yin Ka; Lee, Allen T C; Markus, Hugh S.; O’Brien, John; Pai, Ming‐Chyi; Pantoni, Leonardo; Sachdev, Perminder S.; Skoog, Ingmar; Smith, Eric E.; Srikanth, Velandai; Suh, Guk-Hee; Wardlaw, Joanna M.; Ko, H. S.; Black, Sandra E.; Scheltens, Philip

doi:10.1002/alz.12143

Cited by 152 publications

(203 citation statements)

References 70 publications

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“…Social isolation due to the corona measures was experienced by one third of symptomatic patients, and by a quarter of cognitively normal memory clinic patients. Social interactions are important for patients with cognitive complaints, as is engaging in daily recreational activities, e.g., exercise (16,17). During the corona crisis, many people sought for social connections online, but this is more difficult for patients with cognitive complaints.…”

Section: Discussionmentioning

confidence: 99%

“…This may be an important moderator in the effect of discontinued care on higher caregiver burden. These behavioral problems may be even more problematic, as a recent review showed that patients who exhibit aggression, wandering or disinhibition are even at higher risk of catching and spreading COVID-19 (16), triggering a vicious circle as research now shows that catching COVID-19 has adverse impacts upon the brain and cognition.…”

Section: Discussionmentioning

confidence: 99%

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Psychosocial Effects of Corona Measures on Patients With Dementia, Mild Cognitive Impairment and Subjective Cognitive Decline

et al. 2020

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Psychosocial Effects of Corona Measures on Patients With Dementia, Mild Cognitive Impairment and Subjective Cognitive Decline

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“…An odds ratio of 3.07 was associated with dementia in a UK biobank community study [59]. The reasons for the increased risk and mortality in patients with pre-existing dementia have been well reviewed [60]. What is perhaps not as widely appreciated is that the types of brain damage seen in COVID-19 are themselves major contributors to cognitive decline and dementia.…”

Section: The Types Of Cerebral Ischaemic Damage Seen In Covid-19 Arementioning

confidence: 99%

Cognitive impact of COVID-19: looking beyond the short term

2020

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COVID-19 is primarily a respiratory disease but up to two thirds of hospitalised patients show evidence of central nervous system (CNS) damage, predominantly ischaemic, in some cases haemorrhagic and occasionally encephalitic. It is unclear how much of the ischaemic damage is mediated by direct or inflammatory effects of virus on the CNS vasculature and how much is secondary to extracranial cardiorespiratory disease. Limited data suggest that the causative SARS-CoV-2 virus may enter the CNS via the nasal mucosa and olfactory fibres, or by haematogenous spread, and is capable of infecting endothelial cells, pericytes and probably neurons. Extracranially, SARS-CoV-2 targets endothelial cells and pericytes, causing endothelial cell dysfunction, vascular leakage and immune activation, sometimes leading to disseminated intravascular coagulation. It remains to be confirmed whether endothelial cells and pericytes in the cerebral vasculature are similarly targeted. Several aspects of COVID-19 are likely to impact on cognition. Cerebral white matter is particularly vulnerable to ischaemic damage in COVID-19 and is also critically important for cognitive function. There is accumulating evidence that cerebral hypoperfusion accelerates amyloid-β (Aβ) accumulation and is linked to tau and TDP-43 pathology, and by inducing phosphorylation of α-synuclein at serine-129, ischaemia may also increase the risk of development of Lewy body disease. Current therapies for COVID-19 are understandably focused on supporting respiratory function, preventing thrombosis and reducing immune activation. Since angiotensin-converting enzyme (ACE)-2 is a receptor for SARS-CoV-2, and ACE inhibitors and angiotensin receptor blockers are predicted to increase ACE-2 expression, it was initially feared that their use might exacerbate COVID-19. Recent meta-analyses have instead suggested that these medications are protective. This is perhaps because SARS-CoV-2 entry may deplete ACE-2, tipping the balance towards angiotensin II-ACE-1-mediated classical RAS activation: exacerbating hypoperfusion and promoting inflammation. It may be relevant that APOE ε4 individuals, who seem to be at increased risk of COVID-19, also have lowest ACE-2 activity. COVID-19 is likely to leave an unexpected legacy of long-term neurological complications in a significant number of survivors. Cognitive follow-up of COVID-19 patients will be important, especially in patients who develop cerebrovascular and neurological complications during the acute illness.

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“…Similarly, our survey does not assess the extent to which our respondents felt that public health interventions could result in potentially negative impacts on their LTC residents. It is important to note that recommended public health interventions could result in worsening cognition and functional decline because of the restriction of external visitors and in-home recreational activities [21]. This negative impact ultimately lowers the quality of life for LTC residents, and should to be considered when planning future pandemic responses in LTC.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

A cross-sectional survey assessing the preparedness of the long-term care sector to respond to the COVID-19 pandemic in Ontario, Canada

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Background The COVID-19 pandemic is a significant public health emergency that impacts all sectors of healthcare. The negative health outcomes for the COVID-19 infection have been most severe in the frail elderly dwelling in Canadian long-term care (LTC) homes. Methods An online cross-sectional survey of Ontario LTC Clinicians working in LTC homes in Ontario Canada was conducted to provide the clinician perspective on the preparedness and engagement of the LTC sector during the COVID-19 pandemic. The survey questionnaire was developed in collaboration with the Ontario Long-Term Care Clinicians organization (OLTCC) and was distributed between March 30, 2020 to May 25, 2020. All registered members of the OLTCC and Nurse-led LTC Outreach Teams were invited to participate. The primary outcomes were: 1) the descriptive report of the screening measures implemented, communication and information received, and the preparation of the respondent’s LTC home to a potential COVID-19 outbreak; and 2) the level of agreement, as reported using a five-point Likert scale), to COVID-19 preparedness statements for the respondent’s LTC home was also assessed. Results The overall response rate was 54% (160/294). LTC homes implemented a wide range of important interventions (e.g. instituting established respiratory isolation protocols, active screening of new LTC admissions, increasing education on infection control processes, encouraging sick staff to take time off, etc). Ample communications pertinent to the pandemic were received from provincial LTC organizations, the government and public health officials. However, the feasibility of implementing public health recommendations, as well as the engagement of the LTC sector in pandemic planning were identified as areas of concern. Medical director status was associated with an increased knowledge of local implementation of interventions to mitigate COVID-19, as well as endorsing increased access to reliable COVID-19 information and resources to manage a potential COVID-19 outbreak in their LTC home. Conclusions This study highlights the communication and implementation of recommendations in the Ontario LTC sector, despite some concerns regarding feasibility. Importantly, LTC clinician respondents clearly indicated that better engagement with LTC leaders is needed to plan a coordinated pandemic response.

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Tackling challenges in care of Alzheimer's disease and other dementias amid the COVID‐19 pandemic, now and in the future

Abstract: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Cited by 152 publications

References 70 publications

Psychosocial Effects of Corona Measures on Patients With Dementia, Mild Cognitive Impairment and Subjective Cognitive Decline

Psychosocial Effects of Corona Measures on Patients With Dementia, Mild Cognitive Impairment and Subjective Cognitive Decline

Cognitive impact of COVID-19: looking beyond the short term

A cross-sectional survey assessing the preparedness of the long-term care sector to respond to the COVID-19 pandemic in Ontario, Canada

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