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. 2020 Sep 9:11:578015.
doi: 10.3389/fpsyt.2020.578015. eCollection 2020.

Behavioral and Psychological Effects of Coronavirus Disease-19 Quarantine in Patients With Dementia

Annachiara Cagnin  1 , Raffaele Di Lorenzo  2 , Camillo Marra  3 , Laura Bonanni  4 , Chiara Cupidi  5 , Valentina Laganà  2 , Elisa Rubino  6 , Alessandro Vacca  7 , Paolo Provero  8   9 , Valeria Isella  10 , Nicola Vanacore  11 , Federica Agosta  12   13 , Ildebrando Appollonio  10 , Paolo Caffarra  14 , Ilaria Pettenuzzo  1 , Renato Sambati  15   16 , Davide Quaranta  3 , Valeria Guglielmi  3 , Giancarlo Logroscino  15   16 , Massimo Filippi  12   13 , Gioacchino Tedeschi  17 , Carlo Ferrarese  10 , Innocenzo Rainero  7 , Amalia C Bruni  2 ; SINdem COVID-19 Study Group
Collaborators, Affiliations

Behavioral and Psychological Effects of Coronavirus Disease-19 Quarantine in Patients With Dementia

Annachiara Cagnin et al. Front Psychiatry. .

Abstract

Background: 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.

Methods: This 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.

Results: A 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).

Conclusion: Quarantine 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.

Keywords: behavioral and psychological symptoms; behavioral symptoms; caregiver; coronavirus disease; dementia; gender; psychological symptoms; quarantine.

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Figures

Figure 1
Figure 1
Distribution of classes of behavioral and psychological symptoms (BPSD) burden defined as number of neuropsychiatric symptoms during quarantine divided by disease type.
Figure 2
Figure 2
Frequency of behavioral and psychological symptoms (BPSD) worsened (dark blue) and newly ongoing (light blue) in the sample of patients with BPSD changes (worsened and/or new onset, n = 2,929).
Figure 3
Figure 3
Frequency of neuropsychiatric symptoms in patients with behavioral and psychological symptoms (BPSD) changes (worsened and/or new onset, n=2,929) divided by disease severity defined by Clinical Dementia Rating scale (CDR): mild: CDR-1 gray bar; moderate: CDR-2 orange bar and severe: CDR-3 blue bar.
Figure 4
Figure 4
Multivariate analyses of behavioral and psychological symptoms (BPSD) changes associated to disease severity defined by CDR (Clinical Dementia Rating) in mild (CDR-1), moderate (CDR-2), and severe (CDR-3).
Figure 5
Figure 5
Frequency of neuropsychiatric symptoms in patients with behavioral and psychological symptoms (BPSD) changes (worsened and/or new onset, n=2,929) divided by disease type (blue bar AD, green DLB, yellow FTD, gray VD).
Figure 6
Figure 6
Multivariate analyses of worsened neuropsychiatric symptoms associated to disease types (diagnosis of AD, Alzheimer disease; DLB, dementia with Lewy bodies; FTD, frontotemporal dementia; VD, vascular dementia).
Figure 7
Figure 7
(A) Graphical representation of frequency distribution of neuropsychiatric symptoms according to male (blue) and female (violet) gender in patients with behavioral and psychological symptoms (BPSD) changes (worsened and/or new onset, n=2,929). (B) Type of neuropsychiatric symptoms significantly associated with male gender (blue color) and female gender (violet) in the entire population of patients with dementia.
Figure 8
Figure 8
Type of neuropsychiatric symptoms significantly associated with male gender (blue circles) and female gender (violet circles) by disease type.
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References

    1. Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus–infected pneumonia. N Engl J Med (2020) 382:1199–207. 10.1056/NEJMoa2001316 - DOI - PMC - PubMed
    1. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients with 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA (2020) 323:1061–9. 10.1001/jama.2020.1585 - DOI - PMC - PubMed
    1. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med (2020) 382:1708–20. 10.1056/NEJMoa2002032 - DOI - PMC - PubMed
    1. Shahid Z, Kalayanamitra R, McClafferty B, Kepko D, Ramgobin D, Patel R, et al. COVID-19 and Older Adults: What We Know. J Am Geriatr Soc (2020) 68:926–9. 10.1111/jgs.16472 - DOI - PMC - PubMed
    1. Bianchetti A, Rozzini R, Guerini F, Boffelli S, Ranieri P, Minelli G, et al. Clinical Presentation of COVID19 in Dementia Patients. J Nutr Health Aging (2020) 24:560–2. 10.1007/s12603-020-1389-1 - DOI - PMC - PubMed