Alzheimer’s disease: Living with a chronic disease during the COVID-19 pandemic

Elderly man with COVID mask

 

September is World Alzheimer’s Month. [1] Although this has been an annual campaign since 2012, [2] awareness of Alzheimer’s disease is especially important at present because people with Alzheimer’s disease may be acutely affected by COVID-19, not only in terms of managing the symptoms of dementia in a changing healthcare environment but also with regard to vulnerability to COVID-19. [3] Alzheimer’s disease is the most common type of dementia, which is a group of disorders affecting the brain, altering memory, decision-making and behaviour. [4]

Increased strain on healthcare services due to the need to hospitalise high numbers of patients with COVID-19 has contributed to adaptations to healthcare environments. Although some aspects of non-urgent patient care have been transitioned to a virtual setting, it is not clear if this setting would be suitable for the neurological and cognitive examinations used in the diagnosis and monitoring of people with Alzheimer’s disease. [3] Patient monitoring with blood tests and neuroimaging cannot be conducted without direct patient contact. In addition, some adverse events associated with treatments for dementia are linked with higher incidences of morbidity and mortality if not addressed promptly, so a lack of direct patient contact could be highly detrimental for patients experiencing these adverse events. [3]

Aside from clinical assessments that cannot be performed within a virtual setting, the transition to the virtual world may not be a straightforward process for people with dementia if they cannot access or adopt the necessary technologies. Further support should be considered to ensure that patients can make the most of the options available to them. [3, 4]

A report from the Alzheimer’s Society states that there have been reductions in referrals from primary care to memory clinics, which may be due in part to effects on early patient assessments because of the pandemic or clinicians being redeployed to manage patients with COVID-19. [3, 4]

In contrast with the benefits of direct contact with a clinician for people with Alzheimer’s disease, there is a need to balance the risks that people with the disease may encounter when attending on-site medical appointments. People with Alzheimer’s disease are at an increased risk of symptomatic COVID-19 and hospitalisation and death due to COVID-19 because of two key factors affecting COVID-19 outcomes – age and the presence of other medical conditions. [5] Of the patients who died with COVID-19 between March and June 2020 in the UK, 27.5% had dementia, emphasising the vulnerability of this population. [6] As well as an increased susceptibility to more severe COVID-19 infections, it is possible that not all of those with dementia will have found lockdown and social distancing instructions easy to understand or adhere to [3], and this may further increase their risk of developing COVID-19.

This year, the warning signs of dementia are the focus of World Alzheimer’s Month, with the aim of supporting potential patients to understand the signs of dementia and obtain the support they need. [1] In the world of healthcare communications, we are at the forefront of diagnostic and treatment advances; this month, it is time to reflect on how we can communicate with individuals who need additional support, such as those with Alzheimer’s disease, so that the headline therapies that we are so passionate about reach the people who need them.

References

  1. Alzheimer’s Disease International. World Alzheimer’s Month. Available at: https://www.alzint.org/get-involved/world-alzheimers-month/. Accessed September 2021.
  2. Alzheimer’s Disease International. Frequently asked questions – World Alzheimer’s Month. Available at: https://www.alzint.org/get-involved/world-alzheimers-month/frequently-asked-questions/. Accessed September 2021.
  3. Brown EE, Kumar S, Rajji TK et al. Anticipating and mitigating the impact of the COVID-19 pandemic on Alzheimer’s disease and related dementias. Am J Geriatr Psychiatry 2020; 28 (7): 712–721.
  4. Alzheimer’s Disease International. What is dementia? Available at: https://www.alzint.org/about/. Accessed September 2021.
  5. Alzheimer’s Society. Alzheimer’s Society comment on how coronavirus is affecting dementia assessment and diagnosis. Available at: https://www.alzheimers.org.uk/news/2020-08-10/coronavirus-affecting-dementia-assessment-diagnosis. Accessed September 2021.
  6. British Heart Foundation. What factors put you at risk from coronavirus? Available at: https://www.bhf.org.uk/informationsupport/heart-matters-magazine/news/coronavirus-and-your-health/what-makes-you-at-risk-from-coronavirus. Accessed September 2021.
  7. Alzheimer’s Society. Worst hit: Dementia during coronavirus. Available at: https://www.alzheimers.org.uk/sites/default/files/2020-09/Worst-hit-Dementia-during-coronavirus-report.pdf. Accessed September 2021.

Author: Emma Conran | Principal Medical Writer | Porterhouse Medical