Acute Clinical Impact of COVID-19 Quarantine on Patients with Alzheimer's Disease and Other Dementias: An Observational Study

Abstract

Background: To control the spread of the new Coronavirus (SARS-CoV-2), several governments planned quarantine. The effects of quarantine on patients with dementia and caregivers are unknown. We aimed to describe the clinical changes in patients with different dementias through a detailed caregivers’ interview. Besides, we evaluated caregivers’ psychological symptoms and the impact on public health services. Methods: Family caregivers of patients with dementia, followed at 87 Italian Dementia Centres, were interviewed 45 days after quarantine declaration. Patients with Alzheimer’s Disease (AD), Dementia with Lewy Bodies (DLB), Frontotemporal Dementia (FTD), and Vascular Dementia (VD) were eligible for the study. Main outcomes were patients’ changes in cognitive, behavioural, and motor symptoms. Secondary outcomes were changes in caregivers’ burden, and reorganization of health services. Findings: Between April 14 and April 27, 2020, we screened 4913 patients with dementia. An acute worsening in cognitive functions (+55·1%) and in behavioural symptoms (+51·9%) was reported. Patients with DLB and AD showed the greatest worsening. In logistic regression analysis, previous physical independence was associated with both cognitive and behavioural worsening (odds ratio 1·85 [95% CI 1·42-2·39]; and 1·84 [1·43-2·38], respectively). During the quarantine period, 25·9% of patients showed the onset of new behavioural symptoms. A worsening in motor function was reported by 36·7% of patients. Awareness of the pandemic was negatively associated with increase in cognitive and behavioural symptoms (odds ratio 0·74 [0·65-0·85]; and 0·72 [0·63-0·82], respectively). Finally, an increase of caregiver’s anxiety and depression was reported. Interpretation: Our study shows, for the first time, that quarantine is associated with an acute and dramatic worsening of clinical symptoms in demented patients as well as increase of caregiver’s burden. Primary care physicians and health services need to implement new strategies in order to mitigate the effects of quarantine in patients with dementia. Funding Statement: Italian Society for the Study of Dementias, SINdem. Declaration of Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Ethics Approval Statement: The study was initially approved by the Ethics Committee of the Coordinating Centre (University of Torino on April 7, 2020, n.00150/2020) and then by the local ethics boards. Participants gave first oral and then written fully informed consent to the study.