Abstract
ObjectivePreventive measures to limit the spread of COVID-19 are essential, but often cause social isolation, affecting the physical and mental health of older adults. Patients with dementia are likely to have worsening behavioral and psychological symptoms of dementia (BPSD) owing to pandemic restrictions. To examine this, we described BPSD before and during the COVID-19 pandemic.MethodsWe identified patients at a memory clinic in Japan between October 2018 and December 2019 (15 months before the pandemic began, n = 1,384) and between April 2020 and June 2021 (15 months after the State of Emergency was declared; n = 675 patients). A propensity score was used to match 576 patients from each group. The Mini-Mental State Exam was used to classify cognitive function into mild and moderate/severe. Dementia Behavioral Disturbance Scale was used to evaluate BPSD. The association between BPSD before and during the pandemic was evaluated using binomial logistic regression models.ResultsThe levels of frequent night waking were higher in individuals before the pandemic than in those evaluated during the pandemic in both the mild group [adjusted odds ratio (AOR) = 1.82, 95% CI 1.02–3.23] and the moderate/severe group (AOR = 1.96, 95% CI 1.19–3.23). During the pandemic, physical attacks were higher in the mild group (AOR = 4.25, 95% CI 1.12–16.07), while night wandering was higher in the moderate/severe group (AOR = 2.22, 95% CI 1.03–4.81).ConclusionIn patients with cognitive impairment, some BPSD were more prevalent during the pandemic, depending on dementia severity. The findings pertaining to the higher frequency of sleep disturbance and aggressiveness during COVID-19 should be used to guide BPSD screening in patients with dementia and to provide evidence-based interventions.
Highlights
Outbreaks of COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to be the most important issue in health risk management in Japan since the first case was found there in January 2020
In a survey of dementia patients and their families after COVID-19 in Japan, 39% of medical and nursing facilities and 38% of care support specialists reported that their dementia patients were affected in some way, such as the appearance or worsening of BPSD, decline in cognitive function, and decline in physical activity [12]
In a survey of care support specialists and physicians certified in dementia care by academic societies in Japan, 40% of dementia patients experienced a worsening of their condition, most frequently a worsening of cognitive function (47%) and an increase or worsening of BPSD (46%)
Summary
Outbreaks of COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continue to be the most important issue in health risk management in Japan since the first case was found there in January 2020. The International Epidemiology Association’s Dictionary of Epidemiology defines a pandemic as “an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people” [1] The complexity of this pandemic is that while minimizing the infection risk is extremely important, the most vulnerable members of society, such as patients with dementia and those requiring long-term care, are likely to be affected by long-term measures, such as social distancing. In a survey of dementia patients and their families after COVID-19 in Japan, 39% of medical and nursing facilities and 38% of care support specialists reported that their dementia patients were affected in some way, such as the appearance or worsening of BPSD, decline in cognitive function, and decline in physical activity [12]. In a survey of care support specialists and physicians certified in dementia care by academic societies in Japan, 40% of dementia patients experienced a worsening of their condition, most frequently a worsening of cognitive function (47%) and an increase or worsening of BPSD (46%)
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