Awareness of COVID-19 in severe dementia patients
The ongoing coronavirus disease 2019 (COVID-19) pandemic has substantially affected patients with dementia and their caregivers. Owing to the restrictive measures taken worldwide to block the spread of COVID-19 outbreaks (including the declaration of a state of emergency in Japan), patients with dementia and their caregivers have not been able to receive the usual support and care. Therefore, this is expected to lead to adverse effects on the patients and their caregivers, and many investigators have warned about the risks. In fact, many scheduled appointments for routine outpatients' examinations and care services have been canceled and postponed owing to the COVID-19 outbreak.
When dementia outpatients came to our clinic for their postponed outpatient appointments after the state of emergency declaration was lifted, we found that some patients were afraid of COVID-19 infection whereas some were not. We noticed that patients with severe dementia tended to be less susceptible to COVID-19 than patients with mild dementia in the daily clinical setting. Based on the hypothesis that patients with severe dementia tend to be unaware of the COVID-19 outbreak and hence may be less depressed, we compared the rate of recognition of the COVID-19 outbreak and resultant depressive tendencies between patients with mild dementia and those with severe dementia.
In this study, patients with Alzheimer disease (AD) are included in this study because the depressive tendency depends on the cause of dementia. A total of 126 consecutive outpatients with AD from the Memory Disorder Clinic at the Department of Geriatric Medicine, Tokyo Medical University, were enrolled in this study from May 25, on the day when the declaration of emergency was lifted, to June 30, 2020. In addition to the Mini Mental State Examination (MMSE) and Geriatric Depression Scale—Short Version (GDS-S) (6) performed as routine psychological tests, the participants were asked the following 2 questions: "Do you know COVID-19?" and "Why are you wearing a face mask?"
The patients were divided into the mild AD group (MMSE score >= 21, n = 51) and the moderate to severe AD group (MMSE score < 21, n = 75), and the results of the neuropsychological tests and the 2 questions were compared. During the state of emergency, none of the patients had received a diagnosis of COVID-19 or had required any treatment changes or additional treatments owing to Behavioral and Psychological Symptoms of Dementia (BPSD). Consistent with our hypothesis, AD patients with moderate to severe cognitive impairment were found to have a low COVID-19 recognition rate and did not fully understand why they were wearing face masks.