Effectively Caring for Individuals With Behavioral and Psychological Symptoms of Dementia During the COVID-19 Pandemic

Abstract

The COVID-19 pandemic has significantly affected the elderly and particularly individuals with Alzheimer's disease and related disorders (ADRD). Behavioral and psychological symptoms of dementia (BPSD) are heterogeneous and common in individuals with ADRD and are associated with more severe illness. However, unlike the cognitive symptoms of ADRD that are usually progressive, BPSD may be treatable. Individuals with BPSD are facing unique challenges during the pandemic due to the inherent nature of the illness and the biological and psychosocial impacts of COVID-19. These challenges include a higher risk of severe COVID-19 infection in individuals with BPSD due to their frailty and medical vulnerability, difficulty participating in screening or testing, and adhering to infection control measures such as physical distancing. Further, biological effects of COVID-19 on the brain and its psychosocial impact such as isolation and disruption in mental health care are likely to worsen BPSD. In this paper, we discuss these challenges and strategies to manage the impact of COVID-19 and to effectively care for individuals with BPSD in community, long-term care, or hospital settings during the pandemic. Despite the ongoing uncertainty associated with this pandemic, we can reduce its impact on individuals with BPSD with a proactive approach.

Keywords: Alzheimer’s disease and related disorders; COVID-19; behavioral and psychological symptoms of dementia; caregivers; clinical care; clinical research; coronavirus; pandemic.

Figure 1

Figure describing potential interactions between COVID-19 and behavioral and psychological symptoms of dementia (BPSD). (A) BPSD are clustered here, based on previous consensus, into four main groups (hyperactivity, affective, psychosis, euphoria), and five other symptoms are listed individually (disinhibition, motor disturbances, apathy, night-time behaviors, eating disturbances) (4). Boxes colored gold indicate BPSD symptoms or clusters that may get worse due to the biological or psychological impact of COVID-19, and also the symptoms themselves interfere with infection control precautions and thus increase the chances of spread of COVID-19 infections (i.e. individuals with an increased propensity to wander or decreased likelihood of cooperating with isolation). Boxes colored blue indicate symptoms or clusters that are likely to worsen due to the biological or psychosocial impact of the COVID-19 but may not present challenges from infection control perspective (i.e. social isolation, loss of scheduled activities and routines). (B) COVID-19 and its hypothetical bidirectional relationship with BPSD, emphasizing the risk of more severe COVID-19 infection in individuals with BPSD due to their frailty and medical vulnerability. (C) COVID-19 can present with neurological symptoms and delirium due to its biological impact on the brain and nervous system and other systemic effects. Delirium and other neurological symptoms may also mimic BPSD.