The Impact of COVID-19 Infection and Enforced Prolonged Social Isolation on Neuropsychiatric Symptoms in Older Adults With and Without Dementia: A Review

Abstract

Background: The sudden and drastic changes due to the Coronavirus Disease 19 (COVID-19) pandemic have impacted people's physical and mental health. Clinically-vulnerable older people are more susceptible to severe effects either directly by the COVID-19 infection or indirectly due to stringent social isolation measures. Social isolation and loneliness negatively impact mental health in older adults and may predispose to cognitive decline. People with cognitive impairments may also be at high risk of worsening cognitive and mental health due to the current pandemic. This review provides a summary of the recent literature on the consequences of COVID-19, due to either viral infection or social isolation, on neuropsychiatric symptoms in older adults with and without dementia. Methods: A search was conducted in PubMed and Web of Science to identify all relevant papers published up to the 7th July 2020. Two independent assessors screened and selected the papers suitable for inclusion. Additional suitable papers not detected by literature search were manually added. Results: Fifteen articles were included: 8 focussed on the psychiatric symptoms caused by the COVID-19 infection and 7 investigated the impact of social isolation on older adults' neuropsychiatric symptoms. Four studies included older adults without dementia and 11 included patients with cognitive impairment mainly due to Alzheimer's disease. All studies found that different neuropsychiatric symptoms emerged and/or worsened in older adults with and without dementia. These changes were observed as the consequence of both COVID-19 infection and of the enforced prolonged conditions of social isolation. Cases were reported of viral infection manifesting with delirium at onset in the absence of other symptoms. Delirium, agitation and apathy were the symptoms most commonly detected, especially in people with dementia. Conclusion: The available evidence suggests that the COVID-19 pandemic has a wide negative impact on the mental well-being of older adults with and without dementia. Manca et al. Ageing and COVID-19 Neuropsychiatric Complications Viral infection and the consequent social isolation to limit its spreading have a range of neuropsychiatric consequences. Larger and more robustly designed studies are needed to clarify such effects and to assess the long-term implications for the mental health of older adults, and to test possible mitigating strategies.

The effects of the COVID-19 pandemic on people with dementia

“… 8 ), possibly owing to exacerbated inflammation and cytokine production that leads to a cytokine storm. Older adults with dementia, especially those in care homes, are at high risk of worsening psychiatric symptoms and severe behavioural disturbances as a result of social isolation during the pandemic 3 . …”

“…Older adults with dementia, especially those in care homes, are at high risk of worsening psychiatric symptoms and severe behavioural disturbances as a result of social isolation during the pandemic 3 .…”

“…Furthermore, dementia-associated neuropsychiatric symptoms, such as agitation, intrusiveness or wandering, can also undermine safety protocols and increase the risk of infection among staff and other residents 1 . Accordingly, nursing and care homes have implemented increasingly severe lockdown measures, which further exacerbate pre-existing neuropsychiatric symptoms among residents with dementia 3 .…”

“…The restrictions that have been implemented in many countries to control the pandemic have also had important neuropsychiatric consequences for patients with dementia. In the population as a whole, forced social isolation has led to an increase in reported psychiatric symptoms (for example, stress, anxiety and depression) for all individuals; this relationship seems to be moderated by the loneliness associated with prolonged periods of lockdown 1 , 3 , 9 . In nursing and care homes, older adults are likely to experience additional distress owing to the absence of relatives who would normally visit them, as well as strict limitations on social activities and interactions with fellow residents.…”

“…Several studies — summarized in a review published in October 3 — have shown that, in older adults with dementia, psychiatric symptoms caused by social isolation are linked to more severe neuropsychiatric and behavioural disturbances 3 . Social isolation combined with confusion in care home residents with dementia might result in even greater agitation, boredom and loneliness than in residents without dementia, thereby leading to more severe neuropsychiatric symptoms.…”