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Acute Clinical Impact of COVID-19 Quarantine on Patients with Alzheimer's Disease and Other Dementias: An Observational Study

36 Pages Posted: 14 Aug 2020

See all articles by Innocenzo Rainero

Innocenzo Rainero

University of Torino - Aging Brain and Memory Clinic

Amalia C. Bruni

Regional Neurogenetic Centre ASP Catanzaro, Italy

Camillo Marra

Università Cattolica del Sacro Cuore - Memory Clinic

Annachiara Cagnin

University of Padova - Department of Neurosciences

Laura Bonanni

'Gabriele d'Annunzio' University of Chieti-Pescara - Department of Neuroscience

Chiara Cupidi

AUSL Ferrara - CDCD Ospedale del Delta

Valentina Laganà

Regional Neurogenetic Centre ASP

Elisa Rubino

AOU Città della Salute e della Scienza di Torino - Department of Neuroscience and Mental Health

Alessandro Vacca

University of Torino - Aging Brain and Memory Clinic

Raffaele Di Lorenzo

Regional Neurogenetic Centre ASP

Paolo Provero

University of Torino - Department of Neuroscience

Valeria Isella

University of Milano-Bicocca - Department of Medicine and Surgery

Nicola Vanacore

National Institute of Health (Italy)

Federica Agosta

Università Vita-Salute San Raffaele - Neuroimaging Research Unit

Ildebrando Appollonio

University of Milano-Bicocca - Department of Medicine and Surgery

Paolo Caffarra

University of Parma - Department of Medicine and Surgery

Cinzia Bussè

University of Padova - Department of Neurosciences

Renato Sambati

Bari Aldo Moro University - Neurodegenerative Disease Unit

Davide Quaranta

Catholic University of the Sacred Heart, Rome - Memory Clinic

Valeria Guglielmi

Catholic University of the Sacred Heart, Rome - Memory Clinic

Giancarlo Logroscino

Università degli Studi di Bari “Aldo Moro” (UNIBA)

Massimo Filippi

Università Vita-Salute San Raffaele - Neuroimaging Research Unit

Gioacchino Tedeschi

University of Campania “Luigi Vanvitelli” - First Division of Neurology

Carlo Ferrarese

University of Milano-Bicocca - Department of Medicine and Surgery

More...

Abstract

Background: To control the spread of the new Coronavirus (SARS-CoV-2), several governments planned quarantine. The effects of quarantine on patients with dementia and caregivers are unknown. We aimed to describe the clinical changes in patients with different dementias through a detailed caregivers’ interview. Besides, we evaluated caregivers’ psychological symptoms and the impact on public health services.

Methods: Family caregivers of patients with dementia, followed at 87 Italian Dementia Centres, were interviewed 45 days after quarantine declaration. Patients with Alzheimer’s Disease (AD), Dementia with Lewy Bodies (DLB), Frontotemporal Dementia (FTD), and Vascular Dementia (VD) were eligible for the study. Main outcomes were patients’ changes in cognitive, behavioural, and motor symptoms. Secondary outcomes were changes in caregivers’ burden, and reorganization of health services.

Findings: Between April 14 and April 27, 2020, we screened 4913 patients with dementia. An acute worsening in cognitive functions (+55·1%) and in behavioural symptoms (+51·9%) was reported. Patients with DLB and AD showed the greatest worsening. In logistic regression analysis, previous physical independence was associated with both cognitive and behavioural worsening (odds ratio 1·85 [95% CI 1·42-2·39]; and 1·84 [1·43-2·38], respectively). During the quarantine period, 25·9% of patients showed the onset of new behavioural symptoms. A worsening in motor function was reported by 36·7% of patients. Awareness of the pandemic was negatively associated with increase in cognitive and behavioural symptoms (odds ratio 0·74 [0·65-0·85]; and 0·72 [0·63-0·82], respectively). Finally, an increase of caregiver’s anxiety and depression was reported.

Interpretation: Our study shows, for the first time, that quarantine is associated with an acute and dramatic worsening of clinical symptoms in demented patients as well as increase of caregiver’s burden. Primary care physicians and health services need to implement new strategies in order to mitigate the effects of quarantine in patients with dementia.

Funding Statement: Italian Society for the Study of Dementias, SINdem.

Declaration of Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Ethics Approval Statement: The study was initially approved by the Ethics Committee of the Coordinating Centre (University of Torino on April 7, 2020, n.00150/2020) and then by the local ethics boards. Participants gave first oral and then written fully informed consent to the study.

Keywords: Quarantine; Covid-19; Dementia; Alzheimer's Disease; Dementia with Lewy Bodies; Frontotemporal Dementia; Vascular Dementia; Cognitive symptoms; Behavioural symptoms; Motor symptoms; Caregiver burden

Suggested Citation

Rainero, Innocenzo and Bruni, Amalia C. and Marra, Camillo and Cagnin, Annachiara and Bonanni, Laura and Cupidi, Chiara and Laganà, Valentina and Rubino, Elisa and Vacca, Alessandro and Di Lorenzo, Raffaele and Provero, Paolo and Isella, Valeria and Vanacore, Nicola and Agosta, Federica and Appollonio, Ildebrando and Caffarra, Paolo and Bussè, Cinzia and Sambati, Renato and Quaranta, Davide and Guglielmi, Valeria and Logroscino, Giancarlo and Filippi, Massimo and Tedeschi, Gioacchino and Ferrarese, Carlo, Acute Clinical Impact of COVID-19 Quarantine on Patients with Alzheimer's Disease and Other Dementias: An Observational Study (6/10/2020). Available at SSRN: https://ssrn.com/abstract=3627275 or http://dx.doi.org/10.2139/ssrn.3627275

Innocenzo Rainero (Contact Author)

University of Torino - Aging Brain and Memory Clinic ( email )

Via Cherasco 15
Torino, 10126
Italy
+39 011 6334763 (Phone)

Amalia C. Bruni

Regional Neurogenetic Centre ASP Catanzaro, Italy

Catanzaro
Italy

Camillo Marra

Università Cattolica del Sacro Cuore - Memory Clinic

Rome
Italy

Annachiara Cagnin

University of Padova - Department of Neurosciences

Padua
Italy

Laura Bonanni

'Gabriele d'Annunzio' University of Chieti-Pescara - Department of Neuroscience

Chieti
Italy

Chiara Cupidi

AUSL Ferrara - CDCD Ospedale del Delta

Ferrara
Italy

Valentina Laganà

Regional Neurogenetic Centre ASP

Catanzaro
Italy

Elisa Rubino

AOU Città della Salute e della Scienza di Torino - Department of Neuroscience and Mental Health

Torino
Italy

Alessandro Vacca

University of Torino - Aging Brain and Memory Clinic

Torino
Italy

Raffaele Di Lorenzo

Regional Neurogenetic Centre ASP

Catanzaro
Italy

Paolo Provero

University of Torino - Department of Neuroscience

Torino
Italy

Valeria Isella

University of Milano-Bicocca - Department of Medicine and Surgery

Piazza Ateneo Nuovo 1
Italy, MI Milano 20126
Italy

Nicola Vanacore

National Institute of Health (Italy)

Rome, 00161
Italy

Federica Agosta

Università Vita-Salute San Raffaele - Neuroimaging Research Unit

Milano
Italy

Ildebrando Appollonio

University of Milano-Bicocca - Department of Medicine and Surgery

Piazza Ateneo Nuovo 1
Bicocca, MI Milano 20126
Italy

Paolo Caffarra

University of Parma - Department of Medicine and Surgery

Via Amendola 10
Parma, 43100
United States

Cinzia Bussè

University of Padova - Department of Neurosciences

Padua
Italy

Renato Sambati

Bari Aldo Moro University - Neurodegenerative Disease Unit

Bari
Italy

Davide Quaranta

Catholic University of the Sacred Heart, Rome - Memory Clinic

Rome
Italy

Valeria Guglielmi

Catholic University of the Sacred Heart, Rome - Memory Clinic

Rome
Italy

Giancarlo Logroscino

Università degli Studi di Bari “Aldo Moro” (UNIBA)

Piazza Umberto I
Bari, 70121
Italy

Massimo Filippi

Università Vita-Salute San Raffaele - Neuroimaging Research Unit

Milano
Italy

Gioacchino Tedeschi

University of Campania “Luigi Vanvitelli” - First Division of Neurology

Napoli
Italy

Carlo Ferrarese

University of Milano-Bicocca - Department of Medicine and Surgery

Piazza Ateneo Nuovo 1
Italy, MI Milano 20126
Italy

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