Impact of COVID pandemic on neuropsychiatric symptoms and caregiver distress in cognitively impaired older adults

Abstract

BACKGROUND: Neuropsychiatric symptoms (NPS) are cardinal symptoms of dementia. They are often associated with functional decline, poor quality of life, and caregiver burden. Anecdotal reports have suggested increase in NPS during the COVID pandemic. However, decreased time demands on the caregivers could be hypothesized to have improved relationships and indirectly NPS. There has been limited literature on whether NPS improved or worsened during the current pandemic. The current study examines the prevalence of NPS and changes in NPS profile during the pandemic. Loneliness, cognition, function, and caregiver distress were also studied. METHODS: The COVID Dementia study is an ongoing cross-sectional study of community dwelling cognitively impaired older adults (N=102). Loneliness was assessed with the 3-item loneliness questionnaire, cognition with the Tele-Montreal Cognitive Assessment (T-MoCA), and functional status with the Functional Activities Questionnaire (FAQ). Neuropsychiatry symptoms including severity and distress were collected using the Neuropsychiatric Inventory (NPI) and change during COVID was also recorded for each symptom. RESULTS: Mean age was 73.0 (±8.0) years, 96.1% male, 42.2% rural, 75.2% Caucasian, and 24.8% non-Caucasian. T-MoCA and FAQ mean scores were 15.2 (±4.6) and 8.0 (±9.3), respectively. Loneliness was prevalent in majority of participants (53.5%). Mean loneliness score was 4.7 (±2.1). Mean NPI total severity and total distress were 7.5 (±6.5) and 10.9 (±8.8), respectively. Irritability and night-time behavior were most frequently reported symptoms (45.7% each), followed by anxiety (45.3%), and agitation (41.1%). Majority of the participants reported worsening of neuropsychiatric symptoms during COVID (61.5%). Irritability, agitation, and anxiety was the cluster that was reported as most frequently worsened symptoms during the pandemic followed by depression and apathy cluster (Fig. 1). Among those that reported worsening of neuropsychiatric symptoms, 66.1% noted an increase in ≥ two symptoms. CONCLUSIONS: Older adults with pre-existent cognitive impairment may be at high risk for loneliness and worsening of neuropsychiatric symptoms during the COVID pandemic. Some NPS might worsen more frequently during the pandemic and need particular attention.