Effect of COVID-19 greatest on people living with dementia

Evidence suggest people with dementia are more likely to contract COVID-19 and to have severe disease outcomes from the virus, including increased risk of death.

HEIDI DOUGLASS | h.douglass@unsw.edu.au

The COVID-19 global pandemic is affecting people with Alzheimer’s disease and other dementias in a unique way.

Not only does evidence suggest that people with dementia are more likely to contract COVID-19 than people without dementia, but also that older adults with dementia are more likely to have severe disease outcomes from the virus, including increased risk of death.

Researchers at UNSW Sydney’s Centre for Healthy Brain Ageing (CHeBA) are calling for increased caregiver support and skilled staff to provide extra support for people living with dementia during and after the pandemic. 

Writing for Nature Reviews Neurology, Study Coordinator of CHeBA’s Sydney Memory and Ageing Study, Dr Katya Numbers, says safeguarding procedures - such as physical distancing and wearing of masks - are extremely difficult for people with dementia to follow, which increases their risk of infection.

The article, which is co-authored by Co-Director of CHeBA Scientia Professor Henry Brodaty, also highlights the fact that living arrangements within aged care facilities increase viral propagation.

“Most people living in aged care homes, where infection rates are disproportionately high worldwide, have dementia,” says Professor Brodaty.

"This type of living arrangement - where residents live in close proximity and where physical distancing is impossible for residents who are dependent on staff for most of their daily activities – drastically increases virus transmission."

Scientia Professor Henry Brodaty, Co-Author and CHeBA Co-Director

Not only is this population group more susceptible to the virus and its effects, but they are also more impacted by the negative effects of the measures taken worldwide to control its spread. Forced social isolation during lockdown periods has led to an increase in anxiety and depression for persons living with dementia, who are more likely to have pre-existing anxious and depressive symptoms

According to Dr Numbers, the loneliness associated with protracted lockdown periods and social isolation is generating the increase in reported neuropsychiatric symptoms. 

“Older adults are likely to experience additional distress as a result of the absence of relatives they would normally engage with on a regular basis,” says Dr Numbers.

"The strict limitations imposed on their social activities and engagement with each other appear to have a direct impact on neuropsychiatric symptoms and behavioural complications – mostly in residents with dementia but also in people without any cognitive impairment."

Dr Katya Numbers, Co-Author and Sydney Memory and Ageing Study Coordinator

Further, there is evidence to suggest that some of the brain pathology that exists in people living with dementia can increase the risk of neurological complications from COVID-19. 

“A study conducted in the UK showed that COVID-19 related hospitalisation was increased by twofold among people who had a particular genetic profile known as APOE ε4/ ε4.

“This is possibly due to an increased permeability across the blood-brain barrier of these individuals, which increases inflammation in the central nervous system in response to the virus.

“This process ultimately causes further neurodegeneration,” says Dr Numbers.

The evidence is clear that older adults with dementia have a higher risk of contracting COVID-19 and an increased risk of worsening neuropsychiatric symptoms and mortality from the virus. 

Professor Henry Brodaty says it is imperative that proper support is accessible for older adults with dementia.

"Throughout the pandemic and its ensuing aftermath, the impact of COVID-19 on older adults living with dementia, and the need for effective caregiver support and skilled nursing home staff, must not be ignored."

Professor Henry Brodaty