Neuropsychiatric Effects of COVID-19 Pandemic on Alzheimer's Disease: A Comparative Study of Total and Partial Lockdown

Abstract

Objectives: Coronavirus disease 2019 (COVID-19)-related lockdown may have a negative effect on the neuropsychiatric status of Alzheimer's disease (AD) cases. In this study, it was aimed to find future implications by evaluating the neuropsychiatric conditions of AD cases during total and partial lockdown periods.

Methods: It is a prospective, cross-sectional, and multicenter study that includes AD cases which have been followed for at least 1 year by outpatient clinics from different regions of Turkey. Sociodemographic data, comorbidities, mobility, existence of social interactions, clinical dementia rating (CDR) scale, and neuropsychiatric inventory (NPI) for total and partial lockdown were questioned by the caregivers with the help of case files of the patients.

Results: A total of 302 AD cases were enrolled to the study (mean age: 78±8 years, mean duration of education: 5.8±9 years). The total comorbidity ratio was found to be 84%, with the most frequent comorbidity being hypertension. The mean NPI score was 22.9±21 in total lockdown and 17.7±15 in partial lockdown, which is statistically significantly different. When lockdown periods were compared with the total scores of NPI scores according to gender, existence of social interactions, mobility, and comorbidities were found higher in the total lockdown than the partial lockdown. When switching from total lockdown to partial lockdown, the presence of comorbidities, mobility, and CDR were found to be factors that had a significant effect on NPI scores. In regression analysis, CDR score was found as the most effective parameter on the neuropsychiatric status of AD cases for both lockdown periods.

Conclusion: When lockdown-related restrictions were reduced, the neuropsychological conditions of AD cases were significantly improved. Lockdown rules should be considered with these data in mind.

Keywords: Alzheimer’s disease; Coronavirus; Lockdown; Neuropsychiatric status; Pandemic.

Figure 1

The frequency of comorbidities. DM: Diabetes mellitus, CVD: Cerebrovascular disease, and COPD: Chronic obstructive pulmonary disease.

Figure 1

Relationship between NPI 1 - 2 scores and other risk factors. When NPI total scores were compared according to age stage during quarantine periods, a statistically significant difference was found between the ages of 60-90 and >90 years (a). NP2 was found to be significantly lower in those with an education level above 13 years; however, there was a borderline statistical difference (b). The NP1 scores of the group with comorbidities were found to be significantly higher (c). When mobile and immobile patients were compared in terms of NP scores, NP1 scores were found to be significantly higher (d). CDR scores were significantly effective on NP scores (e). NPI 1: The score of neuropsychiatric inventory in total lockdown; NPI 2: The score of neuropsychiatric inventory in partial lockdown; CDR: clinical dementia rating.