Impact of COVID-19 restrictions on behavioural and psychological symptoms in home-dwelling people with dementia: a prospective cohort study (PAN.DEM)

Marie H Gedde; Bettina S Husebo; Ipsit V Vahia; Janne Mannseth; Maarja Vislapuu; Mala Naik; Line I Berge

doi:10.1136/bmjopen-2021-050628

Impact of COVID-19 restrictions on behavioural and psychological symptoms in home-dwelling people with dementia: a prospective cohort study (PAN.DEM)

BMJ Open. 2022 Jan 24;12(1):e050628. doi: 10.1136/bmjopen-2021-050628.

Authors

Marie H Gedde^{1

2}, Bettina S Husebo^{2

3}, Ipsit V Vahia^{4

5}, Janne Mannseth⁶, Maarja Vislapuu², Mala Naik^{7

8}, Line I Berge^{2

9}

Affiliations

¹ Haraldsplass Deaconess Hospital, Bergen, Norway marie.gedde@uib.no.
² Centre for Elderly and Nursing Home Medicine, Department of Global Public Health Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway.
³ Bergen Municipality, Bergen, Norway.
⁴ McLean Hospital, Belmont, Massachusetts, USA.
⁵ Harvard Medical School, Boston, Massachusetts, USA.
⁶ Section for Epidemiology and Medical Statistic, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway.
⁷ Haraldsplass Deaconess Hospital, Bergen, Norway.
⁸ Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway.
⁹ NKS Olaviken Gerontopsychiatric Hospital, Askøy, Norway.

Abstract

Objectives: To investigate the impact of the COVID-19 restrictions on behavioural and psychological symptoms of dementia (BPSD).

Design: Prospective cohort study (PAN.DEM) nested within the halted parent trial (LIVE@Home.Path).

Setting: Households in Norway immediate before and 6-9 weeks into the COVID-19 restrictions.

Participants: 104 dyads (persons with mild to moderate dementia aged ≥65 and their informal carers) completed both prepandemic and pandemic assessments, among 237 in the parent trial. Mini-Mental Status Examination score 15-26 or Functional Assessment Staging score 3-7 covered dementia severity.

Main outcome measures: Neuropsychiatric Inventory (NPI-12) total (range 0-144), psychosis (range 0-24), hyperactive behaviour (range 0-60) and mood subsyndrome (range 0-48) scores; Cornell Scale for Depression in Dementia (CSDD) total score (range 0-38).

Results: We found an overall increase in BPSD by NPI-12 total score comparing prepandemic to pandemic levels (median 16 IQR (4.5-29) to 20 (7-32.5), p=0.03) over a mean of 86 days (SD 19). NPI-12 total score worsened in 57 (55%) of people with dementia and was associated with postponed or averted contacts with healthcare professionals (logistic regression, OR 3.96, 95% CI 1.05 to 14.95). Psychosis subsyndrome levels increased (0 (0-3) to 0.5 (0-6), p=0.01) in 37 (36%) persons; this worsening was associated with partial insight (9.57, 1.14 to 80.71) and reduced informal carer contact (4.45, 1.01 to 19.71). Moreover, depressive symptoms increased as assessed by CSDD total score (5 (3-9) to 7 (4-12), p=0.01) and worsened for 56 (54%), which was inversely associated with psychotropic drugs on-demand (0.16, 0.03 to 0.75).

Conclusions: BPSD worsened during the first months of the COVID-19 restrictions, most pronounced for psychosis and depression. These BPSD exacerbations have implications for pandemic policies, emphasising that restrictions must balance COVID-19 morbidity and mortality against dementia deterioration.

Trial registration number: NCT04043364; Results.

Keywords: COVID-19; dementia; health policy; old age psychiatry; primary care.

MeSH terms

COVID-19*
Caregivers
Dementia*
Humans
Prospective Studies
SARS-CoV-2

Associated data

ClinicalTrials.gov/NCT04043364