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Cited by 227COVID-19 and Mental HealthLong-Term Effects of COVID-19Dementia and Cognitive Impairment Research

The impact of COVID-19 infection and enforced prolonged social isolation on neuropsychiatric symptoms in older adults with and without dementia: A review

Open access
Manca, Riccardo, De Marco, Matteo, Venneri, Annalena·2020·Frontiers in Psychiatry
DOI 10.3389/fpsyt.2020.585540PMC PMC7649825
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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 on 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.

AI snapshot

Written from the paper’s full text.

TL;DR

This review synthesizes 15 studies published up to July 2020 on neuropsychiatric effects of COVID-19 infection and enforced social isolation in older adults with and without dementia. It reports that delirium, agitation, and apathy commonly emerged or worsened via both direct infection and isolation-related pathways.

Key findings

  • Across 15 included articles (8 on COVID-19 infection, 7 on social isolation; 4 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.
  • In acute COVID-19, delirium was common at onset, especially in dementia: Bianchetti et al. found delirium in 67% of dementia patients at onset (hypoactive in 50%) and behavioural symptoms in 11%; Annweiler et al. found higher delirium in major neurocognitive disorder vs no MND (hypoactive 27.6% vs 11.4%; overactive 14.9% vs 5.5%) and altered consciousness (17.2% vs 6.4%); Varatharaj et al. found altered mental status in 31.2% of 125 patients with complete assessments, with 59% of these meeting criteria for psychiatric diagnoses, 91.3% of which were new.
  • In social isolation without COVID-19 infection, Canevelli et al. reported NPS worsened in 57.3% of patients with dementia and 48.8% of those with MCI/SCD, while NPS improved in only 2.1% and 7%, respectively; Boutoleau-Bretonnière et al. found caregiver-reported worsening of NPS in 26.3% of patients and a correlation between confinement duration and NPI-Q score/caregiver distress; Lara et al. found general worsening of NPI scores after 5 weeks of confinement, especially agitation, apathy, and aberrant motor behaviour.
  • Among older adults without dementia, Emerson et al. found no differences in self-rated mental health between ages 60–70 and 70+, but the younger group reported higher stress after social isolation; Shrira et al. found loneliness due to social isolation was positively associated with anxiety, depression, and peritraumatic distress, especially among individuals feeling older than their age.

Methods

  • A systematic literature search was conducted in PubMed and Web of Science up to 7 July 2020, using keywords for COVID-19, populations of interest (dementia, MCI, neurodegeneration, Alzheimer’s disease, older adults, ageing/aging), and neuropsychiatric symptoms (including delirium); no date-of-publication interval was set, but only papers published up to the search date were included.
  • Two independent assessors screened and selected papers, with a third assessor resolving disagreements; original data were required, but letters and commentaries were included if they presented novel data; exclusion criteria included non-English manuscripts, non-target populations, disease/treatment mechanisms, irrelevant clinical or social aspects, and non-clinical subsidiary topics; additional relevant papers were manually added.
  • The search yielded 344 entries; 127 duplicates were discarded; 217 manuscripts were screened; the final review included 15 manuscripts (12 from the search plus 3 manually added), summarized in a table of study characteristics and outcomes.

Limitations

  • Stated: the evidence base is limited to a small number of studies; infection findings came from clinical environments hosting severe cases needing hospitalisation, so it remains undetermined whether milder infections may lead to these or other psychiatric symptoms; social isolation studies used simple exploratory designs, mainly online/telephone surveys, without control groups or pre-lockdown baseline data, preventing definite conclusions; larger, more robustly designed, theory-grounded studies are needed.
  • Stated: variables that may mitigate cognitive and neuropsychiatric decline were not considered by the included studies, such as number of people living in the household or width of the social network; mechanistic hypotheses are speculative at this stage, and there is a paucity of neuropathological research.
  • Evident from the text: infection studies often relied on clinical judgment rather than standardised tools, whereas social isolation studies more often used standardised tools such as the NPI; most evidence is short-term, rapidly published in the first half of 2020, and heterogeneous in design and sample.

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Integrity signals

Registry

Crossref · 10.3389/fpsyt.2020.585540

Cites

60 of 60 references verified0 citation errors · 0 not checkable

Statistics

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Claims the paper makes

0 of 89 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    All included studies found that different neuropsychiatric symptoms emerged and/or worsened in older adults with and without dementia.

    “All studies found that different neuropsychiatric symptoms emerged and/or worsened in older adults with and without dementia.”
    Quote in the paperSubstantial claim
  • Findingown data

    Delirium, agitation and apathy were the symptoms most commonly detected, especially in people with dementia.

    “Delirium, agitation and apathy were the symptoms most commonly detected, especially in people with dementia.”
    Quote in the paperNot a substantial claim
  • Findingnone given

    Cases were reported of viral infection manifesting with delirium at onset in the absence of other symptoms.

    “Cases were reported of viral infection manifesting with delirium at onset in the absence of other symptoms.”
    Quote in the paperNot a substantial claim
  • Findingcitation

    Patients with Alzheimer's disease whose caregivers reported worsening of neuropsychiatric symptoms presented with significantly lower global cognitive status before social isolation enforcement.

    “Moreover, one of the studies in this review found that patients with AD whose caregivers reported to have experienced worsening of neuropsychiatric symptoms presented with significantly lower global cognitive status before social isolation enforcement (23).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] Boutoleau-Bretonnière, 2020, The effects of confinement on neuropsychiatric symptoms in Alzheimer's disease during the COVID-19 crisis, J Alzheimers Dis source

      Not checked in the free run.

  • Findingcitation

    Worsening or emergence of new neuropsychiatric symptoms was found in about 25-60% of patients with cognitive decline as a result of social isolation.

    “Similarly, worsening or emergence of new neuropsychiatric symptoms was found in a substantial proportion (about 25–60%) of patients with cognitive decline as a result of social isolation (23, 24), although changes in symptom severity were found to be similar between patients with mild cognitive impairment and dementia (26).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [23] Boutoleau-Bretonnière, 2020, The effects of confinement on neuropsychiatric symptoms in Alzheimer's disease during the COVID-19 crisis, J Alzheimers Dis source

      Not checked in the free run.

    • cites [24] Canevelli, 2020, Facing dementia during the COVID-19 outbreak, J Am Geriatr Soc. source

      Not checked in the free run.

  • May combine two claims. 32
  • Classified as probably not a substantial claim. 17

  • May combine two claims.

    Findingown data

    The review included 15 articles: 8 focused on psychiatric symptoms caused by COVID-19 infection and 7 investigated the impact of social isolation on older adults' neuropsychiatric symptoms.

    “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.”
    • Also stated in: § Results · plain
      “Three additional manuscripts of pertinence were found and manually added to this pool of publications, for a total of 15 manuscripts.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Four studies included older adults without dementia and 11 included patients with cognitive impairment mainly due to Alzheimer's disease.

    “Four studies included older adults without dementia and 11 included patients with cognitive impairment mainly due to Alzheimer's disease.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Structural MRI of 30 in vivo severe acute COVID-19 cases revealed multifocal subcortical FLAIR and diffusion-weighted signal changes compatible with oedema, particularly in the mediotemporal lobe, with an aetiological role played by haemorrhagic lesions.

    “structural magnetic resonance imaging of 30 in vivo severe acute cases revealed multifocal subcortical FLAIR and diffusion-weighted signal changes, compatible with oedema, particularly in the mediotemporal lobe, with an aetiological role played by haemorrhagic lesions as well (35).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [35] Kremer, 2020, Brain MRI findings in severe COVID-19: A retrospective observational study, Radiology source

      Not checked in the free run.

  • May combine two claims.

    Findingreasoning

    Conditions of social isolation led to exacerbation or manifestation of a variety of neuropsychiatric symptoms in cognitively healthy older adults (especially stress, mood and anxiety) and those with dementia (mainly agitation and apathy).

    “Nonetheless, these publications suggest, overall, that conditions of social isolation led to exacerbation or manifestation of a variety of neuropsychiatric symptoms in cognitively healthy older adults (especially stress, mood and anxiety) and those with dementia (mainly agitation and apathy).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    Healthy older adults forced to isolate socially reported high levels of stress, anxiety and depression that seem particularly associated with loneliness.

    “The studies here reviewed also highlight how healthy older adults forced to isolate socially reported high levels of stress (21), anxiety and depression that seem to be particularly associated with loneliness (22).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [21] Emerson, 2020, Coping with being cooped up: Social distancing during COVID-19 among 60+ in the United States, Rev Panam Salud Publica. source

      Not checked in the free run.

    • cites [22] Shrira, 2020, COVID-19-related loneliness and psychiatric symptoms among older adults: the buffering role of subjective age, Am J Geriatr Psychiatry. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    A young adult hospitalised because of COVID-19-induced meningitis was described to have hyperintense FLAIR signal in the right hippocampus.

    “Similarly, a young adult hospitalised because of COVID-19-induced meningitis was described to have hyperintense FLAIR signal in the right hippocampus (36).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [36] Moriguchi, 2020, A first case of meningitis/encephalitis associated with SARS-Coronavirus-2, Int J Infect Dis. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    A neuropathological study of 18 adults aged 53-75 who died from COVID-19 revealed neither CT-informed macrostructural abnormalities nor microstructural damage ascribable to the virus, but only mild hypoxia-related modifications with limited evidence of viral presence in the brain.

    “a study carried out on the brains of 18 adults between the ages of 53 and 75 fallen victim to the virus revealed neither CT-informed macrostructural abnormalities, nor microstructural damage ascribable to the virus, but only mild hypoxia-related modifications with, importantly, limited evidence of viral presence in the brain (34).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [34] Solomon, 2020, Neuropathological features of Covid-19, N Eng J Med. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Delirium is the most common behavioural symptom recorded at the peak of COVID-19 infection, and even at onset, in the absence of any other symptoms, especially in patients with dementia.

    “The evidence we have reviewed in the current manuscript is limited to a small number of studies that converge towards delirium being the most common behavioural symptom recorded at the peak of the infection, and even at onset, in the absence of any other symptoms (13), especially in patients with dementia (17).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [13] Alkeridy, 2020, A unique presentation of delirium in a patient with otherwise asymptomatic COVID-19, J Am Geriatr Soc. source

      Not checked in the free run.

    • cites [17] Bianchetti, 2020, Clinical presentation of COVID19 in dementia patients, J Nutr Health Aging source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    A suddenly and drastically impoverished social environment may be particularly detrimental to older people and may contribute to worsen neurological ageing and neurodegeneration-related processes.

    “Therefore, a suddenly and drastically impoverished social environment may be particularly detrimental to older people, and may contribute to worsen neurological ageing and neurodegeneration-related processes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Among severe COVID-19 cases admitted to palliative care units, about 30% were people with dementia and many presented with agitation and delirium.

    “Lovell et al. (18) found that, among the more severe cases of COVID-19 infection admitted to palliative care units, about 30% were people with dementia and many presented with a range of neuropsychiatric symptoms, such as agitation, and delirium.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] Lovell, 2020, Characteristics, symptom management, and outcomes of 101 patients with COVID-19 referred for hospital palliative care, J Pain Symptom Manage source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In that multi-centre study, 59% of patients with altered mental status met criteria for psychiatric diagnoses, with the great majority being new cases of psychoses, neurocognitive disorders, and affective disorders.

    “As many as 59% of these patients met criteria for psychiatric diagnoses, with the great majority being new cases of psychoses, neurocognitive disorders, and affective disorders.”
    • Also stated in: § Results · plain
      “59% met the criteria for different psychiatric diagnoses (91.3% of which were new). The most common disorders were: psychoses, neurocognitive disorders, and affective disorders.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [14] Varatharaj, 2020, Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study, Lancet Psychiatry. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    An 81-year-old man with dementia due to AD, resident in a nursing home, experienced increasing depression, anxiety, apathy, irritability, difficulty sleeping, and general restlessness after his relative's visits were suspended; all symptoms improved after video calls with his daughter were arranged.

    “An 81-year-old man, resident in a nursing home, experienced increasing depression, anxiety, apathy, irritability, difficulty sleeping, and general restlessness after his relative's visits had been suspended. All symptoms improved after video calls with his daughter were arranged (27).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] Padala, 2020, Facetime to reduce behavioral problems in a nursing home resident with Alzheimer's dementia during COVID-19, Psychiatry Res. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    A third assessor helped resolve any disagreement on publications to be included.

    “A third assessor (AV) helped resolving any disagreement on publications to be included.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Older adults are particularly vulnerable to COVID-19 infection, especially if they are affected by comorbidities such as Alzheimer's disease.

    “older adults are particularly vulnerable to COVID-19 infection (4), especially if they are affected by comorbidities such as Alzheimer's disease (AD) (5).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [4] Wynants, 2020, Prediction models for diagnosis and prognosis of covid-19 infection: systematic review and critical appraisal, BMJ. source

      Not checked in the free run.

    • cites [5] Hwang, 2020, Neurological diseases as mortality predictive factors for patients with COVID-19: a retrospective cohort study, Neurol Sci source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In a telephone survey, caregivers of people with cognitive impairment reported worsening of patients' neuropsychiatric symptoms in 57.3% of dementia patients and 48.8% of MCI/SCD patients, while only a small proportion noticed amelioration.

    “In a telephone survey, caregivers of people with cognitive impairment reported mainly worsening of patients' neuropsychiatric symptoms, both when the underlying clinical diagnosis was subjective/mild cognitive impairment (48.8%) and dementia (57.3%), while only a small proportion noticed amelioration of symptoms (24).”
    • Also stated in: § Results · plain
      “Overall, NPS improved in only a few patients (2.1% of demented and 7% of MCI/SCD), while NPS worsened in the majority of patients (57.3 and 48.8%, respectively)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [24] Canevelli, 2020, Facing dementia during the COVID-19 outbreak, J Am Geriatr Soc. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Two independent assessors screened and selected the papers suitable for inclusion.

    “Two independent assessors screened and selected the papers suitable for inclusion.”
    • Also stated in: § Methods · plain
      “The abstracts of these were reviewed by two independent assessors (MDM and RM) to select all relevant papers to be retained.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    At hospitalisation, all patients with dementia in the case series presented with agitation and 7 out of 8 with delirium.

    “At hospitalisation, all patients presented with agitation and 7 out of 8 with delirium.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [16] Beach, 2020, Delirium in COVID-19: a case series and exploration of potential mechanisms for central nervous system involvement, Gen Hosp Psychiatry. source

      Not checked in the free run.

    • cites [19] Sinvani, 2020, The COVID-19 pandemic: experiences of a geriatrician-hospitalist caring for older adults, J Am Geriatr Soc. source

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    • cites [20] Ward, 2020, Altered mental status as a novel initial clinical presentation for COVID-19 infection in the elderly, Am J Geriatr Psychiatry. source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductcitation

    In both studies on older adults without dementia with acute COVID-19, assessment of neuropsychiatric symptoms was based on a clinician's judgment, and no use of standardised tools was reported.

    “In both studies, assessment of neuropsychiatric symptoms was based on a clinician's judgment, and no use of standardised tools was reported.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [13] Alkeridy, 2020, A unique presentation of delirium in a patient with otherwise asymptomatic COVID-19, J Am Geriatr Soc. source

      Not checked in the free run.

    • cites [14] Varatharaj, 2020, Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study, Lancet Psychiatry. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Social isolation and loneliness negatively impact mental health in older adults and may predispose to cognitive decline.

    “Social isolation and loneliness negatively impact mental health in older adults and may predispose to cognitive decline.”
    • Also stated in: § Introduction · hedged
      “a significant association between social isolation and both mental health (8) and levels of cognitive abilities (9) has already been observed in older adults and appears to be mediated by loneliness”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [8] Santini, 2020, Social disconnectedness, perceived isolation, and symptoms of depression and anxiety among older Americans (NSHAP): a longitudinal mediation analysis, Lancet Public Health. source

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    • cites [9] Lara, 2019, Are loneliness and social isolation associated with cognitive decline?, Int J Geriatr Psychiatry. source

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    • cites [11] Penninkilampi, 2018, The association between social engagement, loneliness, and risk of dementia: a systematic review and meta-analysis, J Alzheimers Dis. source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Up to 98% of people with dementia living in care homes present with neuropsychiatric symptoms.

    “since up to 98% of them present with neuropsychiatric symptoms (6, 7).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [6] Devita, 2020, The psychological and cognitive impact of Covid-19 on individuals with neurocognitive impairments: research topics and remote intervention proposals, Aging Clin Exp Res source

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    • cites [7] Velayudhan, 2020, Mental health of people living with dementia in care homes during COVID-19 pandemic, Int Psychogeriatr source

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  • May combine two claims.

    Study design and conductcitation

    The majority of studies on social isolation included standardised tools to assess presence and severity of neuropsychiatric symptoms, mostly the Neuropsychiatric Inventory (NPI).

    “The majority of these studies included standardised tools to assess the presence and severity of neuropsychiatric symptoms, mostly the Neuropsychiatric Inventory (NPI) (23, 26, 27).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [23] Boutoleau-Bretonnière, 2020, The effects of confinement on neuropsychiatric symptoms in Alzheimer's disease during the COVID-19 crisis, J Alzheimers Dis source

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    • cites [26] Lara, 2020, Neuropsychiatric symptoms and quality of life in Spanish Alzheimer's disease patients during COVID-19 lockdown, Eur J Neurol. source

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    • cites [27] Padala, 2020, Facetime to reduce behavioral problems in a nursing home resident with Alzheimer's dementia during COVID-19, Psychiatry Res. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    One study found symptoms worsening in patients with more compromised cognitive status prior to social isolation and a direct correlation between length of social isolation and both severity of symptoms and caregivers' distress.

    “one found symptoms worsening in patients with more compromised cognitive status prior to social isolation and a direct correlation between length of social isolation and both severity of symptoms and caregivers' distress (23)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [23] Boutoleau-Bretonnière, 2020, The effects of confinement on neuropsychiatric symptoms in Alzheimer's disease during the COVID-19 crisis, J Alzheimers Dis source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    These changes were observed as the consequence of both COVID-19 infection and of the enforced prolonged conditions of social isolation.

    “These changes were observed as the consequence of both COVID-19 infection and of the enforced prolonged conditions of social isolation.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationreasoning

    The topography of network dysfunction may account for the onset of chronic behavioural symptoms.

    “it is of central importance to shed light on the map of regional brain damage caused by the virus, because the topography of network dysfunction may account for the onset of chronic behavioural symptoms.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    It is too soon to establish a definite theoretical framework and define mechanistic models at the basis of chronic neurological and psychiatric symptoms.

    “While these scant pieces of evidence are extremely important to lay the foundations for hypotheses in support of the mechanistic causes of psychiatric and behavioural symptoms in COVID-19, it is too soon to establish a definite theoretical framework and define mechanistic models at the basis of chronic neurological and psychiatric symptoms.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In 2 cases of severe delirium, disorientation and loss of appetite were also reported.

    “In 2 cases of severe delirium, disorientation and loss of appetite were also reported (20).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Ward, 2020, Altered mental status as a novel initial clinical presentation for COVID-19 infection in the elderly, Am J Geriatr Psychiatry. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Study design and conductreasoning

    Studies on socially-isolating older adults were conducted remotely, recruiting people with no COVID-19 infection mostly living at home.

    “This is likely to be due to the fact that studies on socially-isolating older adults were conducted remotely, by recruiting people with no COVID-19 infection mostly living at home.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    If COVID-19 infection damages neural tissue, it might result in impoverishment of neural pathways supporting normal psychological functioning and could lead to the onset of cognitive and/or psychiatric dysfunction.

    “If COVID-19 infection damages the neural tissue, it might result into an impoverishment of the neural pathways that support normal psychological functioning and could lead to the onset of cognitive and/or psychiatric dysfunction.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The frailest COVID-19 patients requiring ICU admission are also more predisposed to developing delirium, and hospitalisation routines may further exacerbate their profile.

    “In summary, it is unfortunate that the frailest who require admission to an intensive care unit are also the more predisposed to developing delirium, and that the routines associated with hospitalisation provide a further hit that might exacerbate their profile.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    While delirium and agitation during acute COVID-19 may be due to a more general neuroinflammatory response, more specific neural mechanisms might underlie future chronic psychiatric symptoms.

    “In summary, while the presence of delirium and agitation during the acute phase of the infection may be due to a more general neuroinflammatory response, more specific neural mechanisms might underlie the future presence of chronic psychiatric symptoms.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Major precipitating factors for delirium are more than three medications added and use of bladder catheter.

    “Likewise, major precipitating factors for delirium are “more than three medications added” and “use of bladder catheter” (31), that are a normal occurrence in the hospitalisation of the most severe cases.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] Inouye, 1996, Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability, JAMA. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Adults who have experienced particularly severe acute COVID-19 might go on to develop PTSD symptoms that would increase the burden on the reactive symptomatological profile.

    “Moreover, a number of adults who have experienced a particularly severe acute disease might go on developing post-traumatic stress disorder symptoms (1) that would increase the burden on the “reactive” symptomatological profile.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Rogers, 2020, Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic, Lancet Psychiatry. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    The COVID-19 pandemic has the potential to act as a major trigger for the onset or exacerbation of detrimental psychological traits that may lead to behavioural/psychiatric symptoms of clinical concern.

    “For this reason, the advent of the pandemic has the potential to act as a major trigger for the onset or exacerbation of certain detrimental psychological traits that in turn may lead to behavioural/psychiatric symptoms of clinical concern.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationreasoning

    Older people (older than 60) and people with dementia are among the segments of the population most susceptible to the detrimental effects of COVID-19.

    “In this context, older people (i.e., older than 60) and people with dementia are among the segments of the population most susceptible to the detrimental effects of COVID-19.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Older adults are clinically vulnerable to COVID-19 viral infection.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Higher levels of serum brain-derived neurotrophic factor have been suggested to play a mediating role between emotional support gained through social engagement and risk of dementia.

    “Higher levels of serum brain-derived neurotrophic factor (involved, among other functions, in synaptogenesis) have been suggested to play a mediating role between emotional support gained through social engagement and risk of dementia (44).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [44] Salinas, 2017, Associations between social relationship measures, serum brain-derived neurotrophic factor, and risk of stroke and dementia, Alzheimers Dement (N Y). source

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  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationreasoning

    Current acute neurological and biochemical changes increase the risk of agitation.

    “Meanwhile, the current acute neurological and biochemical changes increase the risk of agitation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Older adults participating in larger social networks appear to show lower rates of dementia.

    “It has long been established that older adults participating in larger social networks appear to show lower rates of dementia (42).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [42] Fratiglioni, 2000, Influence of social network on occurrence of dementia: a community-based longitudinal study, Lancet. source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    Simple and exploratory designs were used in the reviewed studies, mainly online/telephone surveys, without control groups or pre-lockdown baseline data, preventing definite conclusions on the strength of recorded changes.

    “In general, simple and exploratory designs were used, mainly in the form of online/telephone surveys, but control groups and pre-lockdown baseline data were not included, thus preventing definite conclusions on the strength of the recorded changes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Alkeridy et al. described a 73-year-old man without dementia who tested positive for COVID-19 and presented exclusively with delirium at onset, in the absence of common COVID-19 symptoms.

    “Alkeridy et al. (13) described the single case of a 73-year-old man without dementia who resulted positive to testing for COVID-19. The authors observed that this patient presented exclusively with delirium at onset, in the absence of the most common symptoms observed in people infected with COVID-19”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [13] Alkeridy, 2020, A unique presentation of delirium in a patient with otherwise asymptomatic COVID-19, J Am Geriatr Soc. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    At least in one case, behavioural disturbance subsided with personalised care.

    “At least in one case, behavioural disturbance subsided with personalised care (19).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] Sinvani, 2020, The COVID-19 pandemic: experiences of a geriatrician-hospitalist caring for older adults, J Am Geriatr Soc. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Both loneliness and social isolation are significantly associated with cognitive decline over 4 years among older adults.

    “Shankar et al. (46) observed that both loneliness and social isolation are significantly associated with cognitive decline over 4 years among older adults”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Shankar et al. (46) Shankar, 2013, Social isolation and loneliness: relationships with cognitive function during 4 years of follow-up in the english longitudinal study of ageing, Psychosom Med. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Older adults who experience both social isolation and loneliness report poorer health quality, with worse depressive symptoms and a higher number of comorbidities.

    “Similarly, older adults who experience both social isolation and loneliness have been found to report poorer health quality, with worse depressive symptoms and a higher number of comorbidities (8, 48–50).”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [8] Santini, 2020, Social disconnectedness, perceived isolation, and symptoms of depression and anxiety among older Americans (NSHAP): a longitudinal mediation analysis, Lancet Public Health. source

      Not checked in the free run.

    • cites [48] Evans, 2019, Social isolation, cognitive reserve, and cognition in older people with depression and anxiety, Aging Ment Health. source

      Not checked in the free run.

    • cites [49] Smith, 2020, Typologies of loneliness, living alone and social isolation, and their associations with physical and mental health | ageing & society | Cambridge core, Ageing Soc. source

      Not checked in the free run.

    • cites [50] Taylor, 2018, Social isolation, depression, and psychological distress among older adults, J Aging Health. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The number of close relationships, poor social engagement/isolation and loneliness may significantly increase the likelihood of developing dementia.

    “several studies have suggested that the number of close relationships, poor social engagement/isolation and loneliness may significantly increase the likelihood of developing dementia (11, 12, 47).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [11] Penninkilampi, 2018, The association between social engagement, loneliness, and risk of dementia: a systematic review and meta-analysis, J Alzheimers Dis. source

      Not checked in the free run.

    • cites [12] Lara, 2019, Does loneliness contribute to mild cognitive impairment and dementia? A systematic review and meta-analysis of longitudinal studies, Ageing Res Rev. source

      Not checked in the free run.

    • cites [47] Rafnsson, 2020, Loneliness, social integration, and incident dementia over 6 Years: prospective findings from the english longitudinal study of ageing, J Gerontol B Psychol Sci Soc Sci source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    It cannot be ruled out that protracted social isolation and/or loneliness might have affected biological processes linked to neural dysfunction that could have contributed to manifestation of neuropsychiatric symptoms in older adults.

    “However, it cannot be ruled out that protracted social isolation and/or loneliness might have also affected a range of biological processes (linked to neural dysfunction) that could have contributed to the manifestation of neuropsychiatric symptoms in older adults (55).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [55] Lozupone, 2020, Social determinants of late-life depression epigenetics, Epigenomics. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Many older adults felt part of a common effort to limit the spread of COVID-19 and, as a consequence, experienced less loneliness despite an initial increase in the first phase of lockdown.

    “It is probably due to such fast society-wide changes that many older adults also felt to be part of a common effort to limit the spreading of COVID-19 and, as a consequence, experienced less loneliness despite an initial increase in the first phase of lockdown (54).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [54] Luchetti, 2020, The trajectory of loneliness in response to COVID-19, Am Psychol. source

      Not checked in the free run.

45 of 45

  • The paper relies on this without support.

    Many questions about the potential detrimental effects of the current pandemic on neuropsychiatric manifestations in older adults remain unanswered.

    “However, many of the questions sparked around the potential detrimental effects of the current pandemic on neuropsychiatric manifestations in older adults still remain unanswered.”

  • The paper relies on this without support.

    The relevant findings on the effects of the COVID-19 pandemic on neuropsychiatric symptoms in older adults are quite scattered at the time of writing (July 2020).

    “As a result of such hectic efforts, however, the relevant findings are quite scattered at time of writing (July 2020).”

  • The paper relies on this without support.

    Older adults are clinically vulnerable to COVID-19 viral infection.

    “On one hand they are clinically vulnerable to the viral infection, on the other hand they are at risk of suffering from the negative consequences of reduced social interactions (Figure 1).”

  • The paper relies on this without support.

    Governmental instructions provided to older adults objectively steer towards increased isolation.

    “Although the governmental instructions provided to older adults objectively steer towards increased isolation, the extent to which this translates into a psychological sense of loneliness may vary.”
4 of 4

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Agitation timing differs for one case

    Minor

    The summary says all eight patients presented with agitation at hospitalisation, but the Sinvani case is described as developing agitation only after a few days of hospitalisation.

1 of 1

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Authors
Manca, R., De Marco, M., & Venneri, A.
Affiliations
University of Sheffield (GB)
Corresponding author
Venneri, Annalena
ORCID
Venue
Frontiers in Psychiatry
Publisher
Frontiers Media SA
Published
2020-10-22
Volume
11
Pages
585540-585540
ISSN
1664-0640 (ISSN-L)
DOI
10.3389/fpsyt.2020.585540
PMC
PMC7649825
OpenAlex
W3093935683
Semantic Scholar
3a9728a68f98cc48517a9694b17257a39d72d6ce
Cited by
227
References
60
Citations by year
2026: 9 · 2025: 17 · 2024: 25 · 2023: 49 · 2022: 75 · 2021: 49 · 2020: 2 · 2018: 1
FWCI
3.42
Type
journal article
Language
en
Open access
Licence
Locations
  • Frontiers in Psychiatry (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
  • Brunel University Research Archive (BURA) (Brunel University London) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
National Institute for Health and Care Research (NIHR-INF-0478)
Topics
  • Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
  • Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
Keywords
COVID-19 pandemic, social isolation, neuropsychiatric symptoms, older adults, dementia, Alzheimer's disease, delirium, agitation, apathy, mental health, cognitive impairment, lockdown

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

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