The Impact of COVID-19 Infection and Enforced Prolonged Social Isolation on Neuropsychiatric Symptoms in Older Adults With and Without Dementia: A Review

In the paper

“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.”

In the paper

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

In the paper

“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).”

What the sources say

• Not checked yetcites [35] Kremer, 2020, Brain MRI findings in severe COVID-19: A retrospective observational study, Radiology source

In the paper

“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).”

In the paper

“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).”

What the sources say

• Not checked yetcites [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 yetcites [22] Shrira, 2020, COVID-19-related loneliness and psychiatric symptoms among older adults: the buffering role of subjective age, Am J Geriatr Psychiatry. source

In the paper

“Similarly, a young adult hospitalised because of COVID-19-induced meningitis was described to have hyperintense FLAIR signal in the right hippocampus (36).”

What the sources say

• Not checked yetcites [36] Moriguchi, 2020, A first case of meningitis/encephalitis associated with SARS-Coronavirus-2, Int J Infect Dis. source

In the paper

“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).”

What the sources say

• Not checked yetcites [34] Solomon, 2020, Neuropathological features of Covid-19, N Eng J Med. source

In the paper

“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).”

What the sources say

• Not checked yetcites [13] Alkeridy, 2020, A unique presentation of delirium in a patient with otherwise asymptomatic COVID-19, J Am Geriatr Soc. source
• Not checked yetcites [17] Bianchetti, 2020, Clinical presentation of COVID19 in dementia patients, J Nutr Health Aging source

In the paper

“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.”

In the paper

“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.”

What the sources say

• Not checked yetcites [18] Lovell, 2020, Characteristics, symptom management, and outcomes of 101 patients with COVID-19 referred for hospital palliative care, J Pain Symptom Manage source

In the paper

“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.”

What the sources say

• Not checked yetcites [14] Varatharaj, 2020, Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study, Lancet Psychiatry. source

In the paper

“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).”

What the sources say

• Not checked yetcites [27] Padala, 2020, Facetime to reduce behavioral problems in a nursing home resident with Alzheimer's dementia during COVID-19, Psychiatry Res. source

In the paper

“A third assessor (AV) helped resolving any disagreement on publications to be included.”

In the paper

“older adults are particularly vulnerable to COVID-19 infection (4), especially if they are affected by comorbidities such as Alzheimer's disease (AD) (5).”

What the sources say

• Not checked yetcites [4] Wynants, 2020, Prediction models for diagnosis and prognosis of covid-19 infection: systematic review and critical appraisal, BMJ. source
• Not checked yetcites [5] Hwang, 2020, Neurological diseases as mortality predictive factors for patients with COVID-19: a retrospective cohort study, Neurol Sci source

In the paper

“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)”

What the sources say

• Not checked yetcites [24] Canevelli, 2020, Facing dementia during the COVID-19 outbreak, J Am Geriatr Soc. source

In the paper

“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.”

In the paper

“At hospitalisation, all patients presented with agitation and 7 out of 8 with delirium.”

What the sources say

• Not checked yetcites [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 yetcites [19] Sinvani, 2020, The COVID-19 pandemic: experiences of a geriatrician-hospitalist caring for older adults, J Am Geriatr Soc. source
• Not checked yetcites [20] Ward, 2020, Altered mental status as a novel initial clinical presentation for COVID-19 infection in the elderly, Am J Geriatr Psychiatry. source

In the paper

“In both studies, assessment of neuropsychiatric symptoms was based on a clinician's judgment, and no use of standardised tools was reported.”

What the sources say

• Not checked yetcites [13] Alkeridy, 2020, A unique presentation of delirium in a patient with otherwise asymptomatic COVID-19, J Am Geriatr Soc. source
• Not checked yetcites [14] Varatharaj, 2020, Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study, Lancet Psychiatry. source

In the paper

“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”

What the sources say

• Not checked yetcites [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 yetcites [9] Lara, 2019, Are loneliness and social isolation associated with cognitive decline?, Int J Geriatr Psychiatry. source
• Not checked yetcites [11] Penninkilampi, 2018, The association between social engagement, loneliness, and risk of dementia: a systematic review and meta-analysis, J Alzheimers Dis. source

In the paper

“since up to 98% of them present with neuropsychiatric symptoms (6, 7).”

What the sources say

• Not checked yetcites [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
• Not checked yetcites [7] Velayudhan, 2020, Mental health of people living with dementia in care homes during COVID-19 pandemic, Int Psychogeriatr source

In the paper

“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).”

What the sources say

• Not checked yetcites [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 yetcites [26] Lara, 2020, Neuropsychiatric symptoms and quality of life in Spanish Alzheimer's disease patients during COVID-19 lockdown, Eur J Neurol. source
• Not checked yetcites [27] Padala, 2020, Facetime to reduce behavioral problems in a nursing home resident with Alzheimer's dementia during COVID-19, Psychiatry Res. source

In the paper

“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)”

What the sources say

• Not checked yetcites [23] Boutoleau-Bretonnière, 2020, The effects of confinement on neuropsychiatric symptoms in Alzheimer's disease during the COVID-19 crisis, J Alzheimers Dis source

In the paper

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

In the paper

“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.”

In the paper

“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.”

In the paper

“In 2 cases of severe delirium, disorientation and loss of appetite were also reported (20).”

What the sources say

• Not checked yetcites [20] Ward, 2020, Altered mental status as a novel initial clinical presentation for COVID-19 infection in the elderly, Am J Geriatr Psychiatry. source

In the paper

“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.”

In the paper

“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.”

In the paper

“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.”

In the paper

“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.”

In the paper

“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.”

What the sources say

• Not checked yetcites [31] Inouye, 1996, Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability, JAMA. source

In the paper

“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.”

What the sources say

• Not checked yetcites [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

In the paper

“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.”

In the paper

“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.”

In the paper

“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).”

What the sources say

• Not checked yetcites [44] Salinas, 2017, Associations between social relationship measures, serum brain-derived neurotrophic factor, and risk of stroke and dementia, Alzheimers Dement (N Y). source

In the paper

“Meanwhile, the current acute neurological and biochemical changes increase the risk of agitation.”

In the paper

“It has long been established that older adults participating in larger social networks appear to show lower rates of dementia (42).”

What the sources say

• Not checked yetcites [42] Fratiglioni, 2000, Influence of social network on occurrence of dementia: a community-based longitudinal study, Lancet. source

In the paper

“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.”

In the paper

“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”

What the sources say

• Not checked yetcites [13] Alkeridy, 2020, A unique presentation of delirium in a patient with otherwise asymptomatic COVID-19, J Am Geriatr Soc. source

In the paper

“At least in one case, behavioural disturbance subsided with personalised care (19).”

What the sources say

• Not checked yetcites [19] Sinvani, 2020, The COVID-19 pandemic: experiences of a geriatrician-hospitalist caring for older adults, J Am Geriatr Soc. source

In the paper

“Shankar et al. (46) observed that both loneliness and social isolation are significantly associated with cognitive decline over 4 years among older adults”

What the sources say

• Not checked yetcites 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

In the paper

“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).”

What the sources say

• Not checked yetcites [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 yetcites [48] Evans, 2019, Social isolation, cognitive reserve, and cognition in older people with depression and anxiety, Aging Ment Health. source
• Not checked yetcites [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 yetcites [50] Taylor, 2018, Social isolation, depression, and psychological distress among older adults, J Aging Health. source

In the paper

“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).”

What the sources say

• Not checked yetcites [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 yetcites [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 yetcites [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

In the paper

“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).”

What the sources say

• Not checked yetcites [55] Lozupone, 2020, Social determinants of late-life depression epigenetics, Epigenomics. source

In the paper

“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).”

What the sources say

• Not checked yetcites [54] Luchetti, 2020, The trajectory of loneliness in response to COVID-19, Am Psychol. source