Top

Neurological Sciences

Published in:

01-02-2021 | Alzheimer's Disease | COVID-19

Direct and indirect neurological, cognitive, and behavioral effects of COVID-19 on the healthy elderly, mild-cognitive-impairment, and Alzheimer’s disease populations

Authors: Francesco Iodice, Valeria Cassano, Paolo M. Rossini

Published in: Neurological Sciences | Issue 2/2021

Abstract

Introduction

Healthy elderly, mild cognitive impairment and Alzheimer’s disease populations have been among the most affected in the early stages of the COVID-19 pandemic due to the direct effects of the virus, and numerous indirect effects now emerge and will have to be carefully assessed over time.

Methods

This article reviews the main articles that have been published so far about the direct and indirect effects of the COVID-19 pandemic on these particularly fragile populations.

Results

The pandemic associated to COVID-19 has shifted most of the health resources to the emergency area and has consequently left the three main medical areas dealing with the elderly population (oncology, time-dependent diseases and degenerative disease) temporarily “uncovered”. In the phase following the emergency, it will be crucial to guarantee to each area the economic and organizational resources to quickly return to the level of support of the prepandemic state.

Conclusions

The emergency phase represented a significant occasion of discussion on the possibilities of telemedicine which will inevitably become increasingly important, but all the limits of its use in the elderly population have to be considered. In the post-lockdown recovery phase, alongside the classic medical evaluation, the psychological evaluation must become even more important for doctors caring about people with cognitive decline as well as with their caregivers.

Nath A (2020) Neurologic complications of coronavirus infections. Neurology 94:809–810. https://doi.org/10.1212/WNL.0000000000009455CrossRefPubMed

Baig AM (2020) Neurological manifestations in COVID-19 caused by SARS-CoV-2. CNS Neurosci Ther 26:499–501. https://doi.org/10.1111/cns.13372CrossRefPubMedPubMedCentral

Tang N, Li D, Wang X, Sun Z (2020) Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 18:844–847. https://doi.org/10.1111/jth.14768CrossRefPubMedPubMedCentral

Han H, Yang L, Liu R, Liu F, Wu KL, Li J, Liu XH, Zhu CL (2020) Prominent changes in blood coagulation of patients with SARS-CoV-2 infection. Clin Chem Lab Med 58:1116–1120. https://doi.org/10.1515/cclm-2020-0188CrossRefPubMed

Wu L, O’Kane AM, Peng H et al (2020) SARS-CoV-2 and cardiovascular complications: from molecular mechanisms to pharmaceutical management. Biochem Pharmacol 178:114114. https://doi.org/10.1016/j.bcp.2020.114114CrossRefPubMedPubMedCentral

Kontis V, Bennett JE, Rashid T et al (2020) Magnitude, demographics and dynamics of the effect of the first wave of the COVID-19 pandemic on all-cause mortality in 21 industrialized countries. Nat Med. https://doi.org/10.1038/s41591-020-1112-0

Alvarez M (2020) COVID-19 cases and case fatality rate by age. In: Knowledge for policy. European Commission. https://ec.europa.eu/knowledge4policy/publication/covid-19-cases-case-fatality-rate-age_en. Accessed 16 Nov 2020

CDC (2020) Coronavirus Disease 2019 (COVID-19) – prevention & treatment. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html. Accessed 16 Nov 2020

Coronavírus Brasil. https://covid.saude.gov.br/. Accessed 22 Jun 2020

10.

Coronavirus. https://www.who.int/emergencies/diseases/novel-coronavirus-2019. Accessed 16 Nov 2020

11.

Zubair AS, McAlpine LS, Gardin T et al (2020) Neuropathogenesis and neurologic manifestations of the coronaviruses in the age of coronavirus disease 2019: a review. JAMA Neurol 77:1018–1027. https://doi.org/10.1001/jamaneurol.2020.2065CrossRefPubMedPubMedCentral

12.

The spatial and cell-type distribution of SARS-CoV-2 receptor ACE2 in human and mouse brain | bioRxiv. https://www.biorxiv.org/content/10.1101/2020.04.07.030650v1. Accessed 22 Jun 2020

13.

Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, Chang J, Hong C, Zhou Y, Wang D, Miao X, Li Y, Hu B (2020) Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol 77:683–690. https://doi.org/10.1001/jamaneurol.2020.1127CrossRefPubMed

14.

Hascup ER, Hascup KN (2020) Does SARS-CoV-2 infection cause chronic neurological complications? GeroScience 42:1–5. https://doi.org/10.1007/s11357-020-00207-yCrossRef

15.

National Academies of Sciences, Engineering, and Medicine (2020) Evaluating data types: a guide for decision makers using data to understand the extent and spread of COVID-19. The National Academies Press, Washington, DC

16.

Brenner SR (2020) The potential of memantine and related adamantanes such as amantadine, to reduce the neurotoxic effects of COVID-19, including ARDS and to reduce viral replication through lysosomal effects. J Med Virol. https://doi.org/10.1002/jmv.26030

17.

Fotuhi M, Mian A, Meysami S, Raji CA (2020) Neurobiology of COVID-19. J Alzheimers Dis 76:3–19. https://doi.org/10.3233/JAD-200581CrossRefPubMedPubMedCentral

18.

Kai H, Kai M (2020) Interactions of coronaviruses with ACE2, angiotensin II, and RAS inhibitors—lessons from available evidence and insights into COVID-19. Hypertens Res 43:648–654. https://doi.org/10.1038/s41440-020-0455-8CrossRefPubMedPubMedCentral

19.

Verdecchia P, Cavallini C, Spanevello A, Angeli F (2020) The pivotal link between ACE2 deficiency and SARS-CoV-2 infection. Eur J Intern Med 76:14–20. https://doi.org/10.1016/j.ejim.2020.04.037CrossRefPubMedPubMedCentral

20.

Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ, HLH Across Specialty Collaboration, UK (2020) COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet 395:1033–1034. https://doi.org/10.1016/S0140-6736(20)30628-0CrossRefPubMedPubMedCentral

21.

Xiong M, Liang X, Wei Y-D (2020) Changes in blood coagulation in patients with severe coronavirus disease 2019 (COVID-19): a meta-analysis. Br J Haematol 189:1050–1052. https://doi.org/10.1111/bjh.16725CrossRefPubMed

22.

Lippi A, Domingues R, Setz C, Outeiro TF, Krisko A (2020) SARS-CoV-2: at the crossroad between aging and neurodegeneration. Mov Disord 35:716–720. https://doi.org/10.1002/mds.28084CrossRefPubMedPubMedCentral

23.

Helms J, Kremer S, Merdji H, Clere-Jehl R, Schenck M, Kummerlen C, Collange O, Boulay C, Fafi-Kremer S, Ohana M, Anheim M, Meziani F (2020) Neurologic features in severe SARS-CoV-2 infection. N Engl J Med 382:2268–2270. https://doi.org/10.1056/NEJMc2008597CrossRefPubMed

24.

Fotuhi M, Hachinski V, Whitehouse PJ (2009) Changing perspectives regarding late-life dementia. Nat Rev Neurol 5:649–658. https://doi.org/10.1038/nrneurol.2009.175CrossRefPubMed

25.

McCann A, Wu J, Katz J (2020) How the coronavirus compares with 100 years of deadly events. The New York Times. Accessed 16 Nov 2020

26.

Clarfield AM, Dwolatzky T, Brill S, Press Y, Glick S, Shvartzman P, Doron I(I) (2020) Israel ad hoc COVID-19 committee: guidelines for Care of Older Persons during a pandemic. J Am Geriatr Soc 68:1370–1375. https://doi.org/10.1111/jgs.16554CrossRefPubMed

27.

Vergano M, Bertolini G, Giannini A et al (2020) Clinical ethics recommendations for the allocation of intensive care treatments in exceptional, resource-limited circumstances: the Italian perspective during the COVID-19 epidemic. Crit Care 24. https://doi.org/10.1186/s13054-020-02891-w

28.

Jöbges S, Vinay R, Luyckx VA, Biller-Andorno N (2020) Recommendations on COVID-19 triage: international comparison and ethical analysis. Bioethics. https://doi.org/10.1111/bioe.12805

29.

Gopalan PD, Pershad S (2019) Decision-making in ICU – a systematic review of factors considered important by ICU clinician decision makers with regard to ICU triage decisions. J Crit Care 50:99–110. https://doi.org/10.1016/j.jcrc.2018.11.027CrossRefPubMed

30.

Nicola M, Alsafi Z, Sohrabi C, Kerwan A, al-Jabir A, Iosifidis C, Agha M, Agha R (2020) The socio-economic implications of the coronavirus pandemic (COVID-19): a review. Int J Surg 78:185–193. https://doi.org/10.1016/j.ijsu.2020.04.018CrossRefPubMedPubMedCentral

31.

Wang H, Li T, Barbarino P et al (2020) Dementia care during COVID-19. Lancet 395:1190–1191. https://doi.org/10.1016/S0140-6736(20)30755-8CrossRefPubMedPubMedCentral

32.

Wang H, Li T, Barbarino P, Gauthier S, Brodaty H, Molinuevo JL, Xie H, Sun Y, Yu E, Tang Y, Weidner W, Yu X (2020) Dementia care during COVID-19. Lancet 395:1190–1191. https://doi.org/10.1016/S0140-6736(20)30755-8CrossRefPubMedPubMedCentral

33.

Palmer K, Monaco A, Kivipelto M, onder G, Maggi S, Michel JP, Prieto R, Sykara G, Donde S (2020) The potential long-term impact of the COVID-19 outbreak on patients with non-communicable diseases in Europe: consequences for healthy ageing. Aging Clin Exp Res 32:1189–1194. https://doi.org/10.1007/s40520-020-01601-4CrossRefPubMedPubMedCentral

34.

Palmieri L, Vanacore N, Donfrancesco C, Lo Noce C, Canevelli M, Punzo O, Raparelli V, Pezzotti P, Riccardo F, Bella A, Fabiani M, D’Ancona FP, Vaianella L, Tiple D, Colaizzo E, Palmer K, Rezza G, Piccioli A, Brusaferro S, onder G, Italian National Institute of Health COVID-19 Mortality Group, Palmieri L, Andrianou X, Barbariol P, Bella A, Bellino S, Benelli E, Bertinato L, Boros S, Brambilla G, Calcagnini G, Canevelli M, Rita Castrucci M, Censi F, Ciervo A, Colaizzo E, D’Ancona F, del Manso M, Donfrancesco C, Fabiani M, Facchiano F, Filia A, Floridia M, Galati F, Giuliano M, Grisetti T, Kodra Y, Langer M, Lega I, Lo Noce C, Maiozzi P, Malchiodi Albedi F, Manno V, Martini M, Mateo Urdiales A, Mattei E, Meduri C, Meli P, Minelli G, Nebuloni M, Nisticò L, Nonis M, onder G, Palmisano L, Petrosillo N, Pezzotti P, Pricci F, Punzo O, Puro V, Raparelli V, Rezza G, Riccardo F, Cristina Rota M, Salerno P, Serra D, Siddu A, Stefanelli P, de Bella MT, Tiple D, Unim B, Vaianella L, Vanacore N, Vichi M, Rocco Villani E, Zona A, Brusaferro S (2020) Clinical characteristics of hospitalized individuals dying with COVID-19 by age Group in Italy. J Gerontol A Biol Sci Med Sci 75:1796–1800. https://doi.org/10.1093/gerona/glaa146CrossRefPubMed

35.

Chiao C-Y, Wu H-S, Hsiao C-Y (2015) Caregiver burden for informal caregivers of patients with dementia: a systematic review. Int Nurs Rev 62:340–350. https://doi.org/10.1111/inr.12194CrossRefPubMed

36.

Abbatecola AM, Antonelli-Incalzi R (2020) Editorial: COVID-19 spiraling of frailty in older Italian patients. J Nutr Health Aging 24:453–455. https://doi.org/10.1007/s12603-020-1357-9CrossRefPubMedPubMedCentral

37.

Bostanciklioglu M (2020) Severe acute respiratory syndrome coronavirus 2 is penetrating to dementia research. Curr Neurovasc Res 17. https://doi.org/10.2174/1567202617666200522220509

38.

Rossini PM, Cappa SF, Lattanzio F, Perani D, Spadin P, Tagliavini F, Vanacore N (2019) The Italian INTERCEPTOR project: from the early identification of patients eligible for prescription of antidementia drugs to a Nationwide organizational model for early Alzheimer’s disease diagnosis. J Alzheimers Dis 72:373–388. https://doi.org/10.3233/JAD-190670CrossRefPubMed

39.

Geerts H, van der Graaf PH (2020) Salvaging CNS Clinical Trials halted due to COVID-19. CPT Pharmacometrics Syst Pharmacol. https://doi.org/10.1002/psp4.12535

40.

Geerts H, van der Graaf PH (2020) Salvaging CNS clinical trials halted due to COVID-19. CPT Pharmacometrics Syst Pharmacol 9:367–370. https://doi.org/10.1002/psp4.12535CrossRefPubMedPubMedCentral

41.

Ousset PJ, Vellas B (2020) Viewpoint: impact of the Covid-19 outbreak on the clinical and research activities of memory clinics: an Alzheimer’s disease center facing the Covid-19 crisis. J Prev Alzheimer’s Dis 7:197–198. https://doi.org/10.14283/jpad.2020.17CrossRef

42.

Costanzo M, Signorelli M, Aguglia E (2014) EPA-0715 – telemedicine and Alzheimer: a systematic review. Eur Psychiatr 29:1. https://doi.org/10.1016/S0924-9338(14)78073-3CrossRef

43.

Cuffaro L, Di Lorenzo F, Bonavita S et al (2020) Dementia care and COVID-19 pandemic: a necessary digital revolution. Neurol Sci 41:1977–1979. https://doi.org/10.1007/s10072-020-04512-4CrossRefPubMed

44.

Francisco EM (2020) Guidance to sponsors on how manage clinical trials during the COVID-19 pandemic. European Medicines Agency. https://www.ema.europa.eu/en/news/guidance-sponsors-how-manage-clinical-trials-during-covid-19-pandemic. Accessed 16 Nov 2020

45.

Research C for DE and (2020) COVID-19: developing drugs and biological products for treatment or prevention. U.S. Food and Drug Administration.https://www.fda.gov/regulatory-information/search-fda-guidance-documents/covid-19-developing-drugs-and-biological-products-treatment-or-prevention. Accessed 16 Nov 2020

46.

(2020) Alzheimer’s Disease Research Enterprise in the Era of COVID‐19/SARS‐CoV‐2. Alzheimers Dement 16:587–588. https://doi.org/10.1002/alz.12093

47.

(2020) Alzheimer’s Disease Research Enterprise in the Era of COVID-19/SARS-CoV-2. Alzheimers Dement 16:587–588. https://doi.org/10.1002/alz.12093

48.

Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, Rubin GJ (2020) The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet 395:912–920. https://doi.org/10.1016/S0140-6736(20)30460-8CrossRefPubMedPubMedCentral

49.

Ward CF, Figiel GS, McDonald WM (2020) Altered mental status as a novel initial clinical presentation for COVID-19 infection in the elderly. Am J Geriatr Psychiatry 28:808–811. https://doi.org/10.1016/j.jagp.2020.05.013CrossRefPubMedPubMedCentral

50.

Cawthon P, Orwoll E, Ensrud K et al (2020) Assessing the impact of the covid-19 pandemic and accompanying mitigation efforts on older adults. J Gerontol A Biol Sci Med Sci 75:e123–e125. https://doi.org/10.1093/gerona/glaa099CrossRefPubMedPubMedCentral

51.

Dubey S, Biswas P, Ghosh R, Chatterjee S, Dubey MJ, Chatterjee S, Lahiri D, Lavie CJ (2020) Psychosocial impact of COVID-19. Diabetes Metab Syndr 14:779–788. https://doi.org/10.1016/j.dsx.2020.05.035CrossRefPubMedPubMedCentral

52.

Rajkumar RP (2020) COVID-19 and mental health: a review of the existing literature. Asian J Psychiatr 52:102066. https://doi.org/10.1016/j.ajp.2020.102066CrossRefPubMedPubMedCentral

53.

Buonsenso D, Cinicola B, Raffaelli F, Sollena P, Iodice F (2020) Social consequences of COVID-19 in a low resource setting in Sierra Leone, West Africa. Int J Infect Dis 97:23–26. https://doi.org/10.1016/j.ijid.2020.05.104CrossRefPubMedPubMedCentral

54.

Chetterje P (2020) Gaps in India’s preparedness for COVID-19 control. Lancet Infect Dis 20:544. https://doi.org/10.1016/S1473-3099(20)30300-5CrossRefPubMedPubMedCentral

55.

Xu X, Zhang L, Chen L, Wei F (2020) Does COVID-2019 have an impact on the purchase intention of commercial long-term care insurance among the elderly in China? Healthcare (Basel) 8. https://doi.org/10.3390/healthcare8020126

56.

Zhu J, Sun L, Zhang L, Wang H, Fan A, Yang B, Li W, Xiao S (2020) Prevalence and influencing factors of anxiety and depression symptoms in the first-line medical staff fighting against COVID-19 in Gansu. Front Psychiatry 11. https://doi.org/10.3389/fpsyt.2020.00386

57.

Lara BB, Carnes A, Dakterzada F et al (2020) Neuropsychiatric symptoms and quality of life in Spanish Alzheimer’s disease patients during COVID-19 lockdown. Eur J Neurol. https://doi.org/10.1111/ene.14339

58.

Thoits P (1995) Stress, coping, and social support processes - where are we - what next. J Health Soc Behav 35:53–79. https://doi.org/10.2307/2626957CrossRef

59.

Bavel JJV, Baicker K, Boggio PS, Capraro V, Cichocka A, Cikara M, Crockett MJ, Crum AJ, Douglas KM, Druckman JN, Drury J, Dube O, Ellemers N, Finkel EJ, Fowler JH, Gelfand M, Han S, Haslam SA, Jetten J, Kitayama S, Mobbs D, Napper LE, Packer DJ, Pennycook G, Peters E, Petty RE, Rand DG, Reicher SD, Schnall S, Shariff A, Skitka LJ, Smith SS, Sunstein CR, Tabri N, Tucker JA, Linden S, Lange P, Weeden KA, Wohl MJA, Zaki J, Zion SR, Willer R (2020) Using social and behavioural science to support COVID-19 pandemic response. Nat Hum Behav 4:460–471. https://doi.org/10.1038/s41562-020-0884-zCrossRefPubMed

60.

Cagnin A, Di Lorenzo R, Marra C et al (2020) Behavioral and psychological effects of coronavirus Disease-19 quarantine in patients with dementia. Front Psychiatr 11. https://doi.org/10.3389/fpsyt.2020.578015

61.

Zhou H, Lu S, Chen J, Wei N, Wang D, Lyu H, Shi C, Hu S (2020) The landscape of cognitive function in recovered COVID-19 patients. J Psychiatr Res 129:98–102. https://doi.org/10.1016/j.jpsychires.2020.06.022CrossRefPubMedPubMedCentral

Title: Direct and indirect neurological, cognitive, and behavioral effects of COVID-19 on the healthy elderly, mild-cognitive-impairment, and Alzheimer’s disease populations
Authors: Francesco Iodice
Valeria Cassano
Paolo M. Rossini
Publication date: 01-02-2021
Publisher: Springer International Publishing
Keywords: Alzheimer's Disease
Dementia
COVID-19
Alzheimer's Disease
Dementia
Mild Cognitive Impairment
Anxiety
Published in: Neurological Sciences / Issue 2/2021
Print ISSN: 1590-1874
Electronic ISSN: 1590-3478
DOI: https://doi.org/10.1007/s10072-020-04902-8

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Direct and indirect neurological, cognitive, and behavioral effects of COVID-19 on the healthy elderly, mild-cognitive-impairment, and Alzheimer’s disease populations

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2021

Acupuncture helps to regain the consciousness of a COVID-19 patient complicated with hypoxic-ischemic encephalopathy: a case report

Hyperkinetic manifestations in superficial siderosis: evidence for pathogenic network disruption

Seizures in steroid-responsive encephalopathy

Impact of COVID-19 on neurological patients attending a botulinum toxin service

Is DAT imaging abnormality in normal pressure hydrocephalus always suggestive of degeneration?

Clinical, cerebrospinal fluid, and neuroimaging findings in COVID-19 encephalopathy: a case series