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. 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.
Highlights
The current pandemic of Coronavirus Disease 2019 (COVID-19) has brought abrupt and pervasive changes in our lives that go beyond the infection itself and its consequences on the physical and mental health of those infected
Of equal relevance are the psycho-social consequences generated by the measures put in place worldwide by governments to limit the spreading of COVID-19 and by the traumatic course of events experienced by all those directly involved in this crisis
Analyses carried out using clinical data accumulated over the first half of 2020 and prognostic prediction models clearly show that older adults are vulnerable to COVID-19 infection [4], especially if they are affected by comorbidities such as Alzheimer’s disease (AD) [5]
Summary
The current pandemic of Coronavirus Disease 2019 (COVID-19) has brought abrupt and pervasive changes in our lives that go beyond the infection itself and its consequences on the physical and mental health of those infected. The mental well-being of people with dementia who are socially isolating is considered to be at extremely high risk and a thorough clinical management of this population is regarded as a top priority, especially for those living in care homes, since up to 98% of them present with neuropsychiatric symptoms [6, 7]. 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. 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
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