Psychiatric and neuropsychiatric syndromes and COVID-19

The systematic review and meta-analysis by Rogers and colleagues¹ of acute and post-illness psychiatric and neuropsychiatric presentations of individuals with suspected or laboratory-confirmed coronavirus infection was much needed. However, it does not address one of the key susceptible groups with high rates of neuropsychiatric symptoms—people with dementia.

People with dementia have an increased risk of delirium,² and might also be particularly sensitive to the potential neurotropic effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).³ 98% of patients with dementia experience neuropsychiatric symptoms over the course of their disease.⁴ These symptoms might be exacerbated during the acute or post-illness phases of infection with SARS-CoV-2 as a result of the virus itself and related social and environmental effects. Importantly, inappropriate management of neuropsychiatric symptoms in people with dementia could lead to substantial excess morbidity and deaths.

It is essential to gather further evidence regarding the effect of delirium on individuals with dementia who are infected with SARS-CoV-2, the broader impact and management of neuropsychiatric symptoms, and the different approaches to physical distancing. Optimising management and preventing inappropriate and potentially harmful management strategies are all the more urgent given people with dementia are at an increased risk of mortality and strokes associated with the antipsychotic medications⁵ that are too often used for managing delirium and neuropsychiatric symptoms.