Abstract
BackgroundIn March 2020, the World Health Organization declared a global pandemic due to the novel coronavirus SARS-CoV-2 and several governments planned a national quarantine in order to control the virus spread. Acute psychological effects of quarantine in frail elderly subjects with special needs, such as patients with dementia, have been poorly investigated. The aim of this study was to assess modifications of neuropsychiatric symptoms during quarantine in patients with dementia and their caregivers.MethodsThis is a sub-study of a multicenter nation-wide survey. A structured telephone interview was delivered to family caregivers of patients with diagnosis of Alzheimer disease (AD), dementia with Lewy bodies (DLB), frontotemporal dementia (FTD), and vascular dementia (VD), followed regularly at 87 Italian memory clinics. Variations in behavioral and psychological symptoms (BPSD) were collected after 1 month since quarantine declaration and associations with disease type, severity, gender, and caregiver’s stress burden were analyzed.ResultsA total of 4,913 caregivers participated in the survey. Increased BPSD was reported in 59.6% of patients as worsening of preexisting symptoms (51.9%) or as new onset (26%), and requested drug modifications in 27.6% of these cases. Irritability, apathy, agitation, and anxiety were the most frequently reported worsening symptoms and sleep disorder and irritability the most frequent new symptoms. Profile of BPSD varied according to dementia type, disease severity, and patients’ gender. Anxiety and depression were associated with a diagnosis of AD (OR 1.35, CI: 1.12–1.62), mild to moderate disease severity and female gender. DLB was significantly associated with a higher risk of worsening hallucinations (OR 5.29, CI 3.66–7.64) and sleep disorder (OR 1.69, CI 1.25–2.29), FTD with wandering (OR 1.62, CI 1.12–2.35), and change of appetite (OR 1.52, CI 1.03–2.25). Stress-related symptoms were experienced by two-thirds of caregivers and were associated with increased patients’ neuropsychiatric burden (p<0.0001).ConclusionQuarantine induces a rapid increase of BPSD in approximately 60% of patients and stress-related symptoms in two-thirds of caregivers. Health services need to plan a post-pandemic strategy in order to address these emerging needs.
Highlights
IntroductionAn outbreak of a novel coronavirus (severe acute respiratory syndrome coronavirus 2 -SARS-CoV-2) emerged in Wuhan, China, in late 2019 and spread to Europe in February 2020 with the first infected patient diagnosed in Italy
An outbreak of a novel coronavirus emerged in Wuhan, China, in late 2019 and spread to Europe in February 2020 with the first infected patient diagnosed in Italy
Alzheimer’s disease; DLB, dementia with Lewy bodies; FTD, frontotemporal dementia; VD, vascular dementia; BPSD, behavioral and psychological symptoms of dementia. In this nation-wide survey performed in Italy after 1 month from the beginning of COVID-19 quarantine an increased burden of neuropsychiatric symptoms was reported in approximately 60% of community-dwelling persons affected by dementia by their family caregivers
Summary
An outbreak of a novel coronavirus (severe acute respiratory syndrome coronavirus 2 -SARS-CoV-2) emerged in Wuhan, China, in late 2019 and spread to Europe in February 2020 with the first infected patient diagnosed in Italy. It has since spread globally, with over 10 million confirmed cases as of June 30, 2020. In March 2020, the World Health Organization declared a global pandemic due to the novel coronavirus SARS-CoV-2 and several governments planned a national quarantine in order to control the virus spread. Acute psychological effects of quarantine in frail elderly subjects with special needs, such as patients with dementia, have been poorly investigated. The aim of this study was to assess modifications of neuropsychiatric symptoms during quarantine in patients with dementia and their caregivers
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