Depression in older patients with dementia during COVID‐19 pandemics in Romania ‐ a geriatric center perspective

Abstract

AbstractBackgroundA convincing body of evidence identifies depression as a risk factor for later life dementia, whereas later life depression should be considered as a prodrome for dementia. COVID‐19 pandemics highly affected elderly, and those suffering from dementia were among the most vulnerable populations to a severe evolution of SARS‐CoV2 infection as well as impacted by social isolation.MethodWe analyzed the association of depression in a study group of 162 geriatric patients, admitted due to complains of neurocognitive and psychiatric symptoms but also to other comorbidities, hospitalized in 2020‐2021 in our Geriatric Clinic after the pandemic was declared. All patients were evaluated using standard Mini Mental State Evaluation (MMSE) scale, Clock‐ Drawing Test (CDT) and Geriatric Depression Scale (GDS). Native cerebral CT‐scan imaging was used to assess if any neurobiological changes occurred.ResultThe incidence of dementia was 72.8% in the study group of 162 consecutive hospital admissions in the geriatric department. Out of the 118 cognitively impaired patients (out of which 9 were previously diagnosed with Alzheimer Disease), 73.7% had associated depression; other prevalent comorbidities in the geriatric lot were cardiovascular, neurologic, metabolic and musculoskeletal disorders. The relative risk of depression associated to dementia was 1.75. The complex relationship linking dementia and depression has also neuropathological underlying mechanisms‐ decreased cortical thickness and white matter loss were associated with both depressive symptoms and impairment of cognitive functions. In our study the majority of the patients (62.3%) presented structural abnormalities of different categories in cerebral CT‐scan imaging.ConclusionThis high incidence reported on the association between dementia and depression in geriatric hospitalized patients is in line with the results of other studies, supporting the idea of standardizing a clinical assessment protocol for evaluating both cognitive dysfunction and depression in all elderly patients and monitoring their evolution. COVID‐19 conditions isolating elderly and restricting their access to medical services increased the risk of worsening their cognitive status and mental health. As the effective treatments for dementia remain scarce, clinicians could use a preventive approach by identification of high‐risk individuals ‐ one of the most relevant dementia risk factors being depression.