Skip to main content
Wiley - PMC COVID-19 Collection logoLink to Wiley - PMC COVID-19 Collection
letter
. 2020 Jul 21;20(7):732–734. doi: 10.1111/ggi.13942

Impact of dementia on clinical outcomes in elderly patients with coronavirus 2019 (COVID‐19): an experience in New York

Satoshi Miyashita 1, Takayuki Yamada 1, Takahisa Mikami 1, Hirotaka Miyashita 1, Nitin Chopra 1, Dahlia Rizk 1
PMCID: PMC7404346  PMID: 32691924

Dear Editor,

Table 1.

Basic characteristics and outcomes of patients with COVID‐19

COVID‐19 positive total (n = 2071)

P

With dementia (n = 98) (n, %) Without dementia (n = 1973) (n, %)
Male 43 (43.9) 1056 (51.0) 0.618
Age, years
60–79 31 (31.6) 1526 (77.3) <0.001
≥80 67 (68.4) 447 (22.7)
Essential hypertension 75 (76.5) 1166 (59.1) 0.0059
Diabetes mellitus 40 (40.8) 647 (32.8) 0.0996
Chronic kidney disease 7 (7.1) 169 (8.6) 0.6220
Admission 77 (78.6) 1271 (64.4)
Intubation 4 (4.1) 207 (10.5)
ICU admission 25 (25.5) 540 (27.4)
Death 39 (39.8) 390 (19.8)
Dementia types
Alzheimer 18 (18.4) NA
Vascular 3 (3.1) NA
Dementia with Lewy body 0 (0) NA
Unspecified 77 (78.6) NA
Age 60–79 years RR (95% CI) Age ≥80 years RR (95% CI)
N 31/1526 67/447
Admission 21/945 1.09 (0.86–1.40) 56/326 1.15 (1.02–1.29)
Intubation 0/158 0 4/49 0.54 (0.20–1.46)
ICU admission 9/429 1.03 (0.59–1.80) 16/111 0.96 (0.61–1.52)
Death 11/235 2.30 (1.41–3.76) 28/155 1.21 (0.88–1.64)
Events in dementia/events in without dementia

CI, confidence interval; NA, not applicable; RR, relative risk.

In December 2019, a novel new coronavirus known as SARS‐CoV‐2 was first detected in China, causing outbreaks of coronavirus 2019 (COVID‐19) that have spread globally. 1 There are many risk factors associated with a poor prognosis of COVID‐19, including advanced age. 2 Dementia is common among elderly patients, affecting up to 7% of individuals ≥65 years worldwide. 3 However, it remains unclear whether dementia is associated with poor clinical outcomes in elderly patients infected with COVID‐19. Therefore, our study, aimed to investigate associations between dementia and poor clinical outcomes in patients with COVID‐19.

Our study analyzed Mount Sinai Health System (MSHS) medical records from March 1 to April 2, 2020, using Epic SlicerDicer software. We extracted data from patients who had a positive result for the COVID‐19 reverse transcription‐polymerase chain reaction test during this period and continued to track them through April 11, 2020. We included patients aged ≥60 years old and compared clinical outcomes between patients with and without dementia. Our primary outcome was all‐cause mortality. Secondary outcomes included the need for hospital admission, intubation or intensive care unit admission. We conducted subgroup analyses by age groups. P values were calculated using a two‐tailed χ2 test, and relative risk (RR) was calculated with a 95% confidence interval (CI). MSHS waived Institutional Review Board approval as this research used only de‐identified, aggregate‐level data. In total, 2071 COVID‐19 cases were reported. Of these, 1099 (53.1%) patients were men, and 98 (4.7%) had dementia. In total, 429 (20.7%) patients died during the study period. Baseline characteristics and the primary and secondary outcomes are summarized in Table 1. The proportions of those aged ≥80 years old (68.4% vs. 22.7%, P < 0.001) and those with hypertension (76.5% vs. 59.1%, P < 0.0059) were significantly higher in the dementia group. After adjusting by age group, we found a significantly increased risk of hospital admissions (RR [95% CI]: 1.15 [1.02–1.29]) in those aged ≥80 years old as well as an elevated risk of mortality (RR [95% CI]: 2.30 [1.41–3.76]) in 60–79 year olds. In contrast, no differences were observed among other comparisons.

To the best of our knowledge, this is the first study to show that patients with dementia may be at high risk for poor clinical outcomes. After dividing our patients into two age groups, thereby reducing the effects of confounding, we found that patients with dementia who are infected with COVID‐19 are at higher risk for both hospital admissions and death. Dementia is a common neurocognitive disease characterized by a decline in memory and multiple skills. 3 As suggested in our study, patients with dementia generally have multiple comorbidities as compared with others, and these afflictions increase their risk of hospitalizations and mortality from viral and bacterial infections. 4 COVID‐19 is known to cause severe inflammation throughout the body via disruption of the renin–angiotensin system, which is one possible mechanism for increased hospital admissions and mortality in patients with dementia who are particularly susceptible to inflammation due to multiple comorbidities. 5 Our study revealed no difference in mortality in those aged ≥80 years old. In elderly patients, the mortality rate was remarkably high (35.6%), and we speculate that these patients are at risk for death regardless of the presence of dementia. One limitation of our study is an unclear causation between COVID‐19 and clinical outcomes. In addition, the heterogeneity of dementia types may obscure the rationale of our findings. However, to our knowledge, this is the first report on the prognosis of COVID‐19 in patients with dementia in the USA. The relatively large number of patients in the study allowed for the adjustment of age, which is one of the strongest prognostic factors. As the number of cases of COVID‐19 is increasing rapidly, more studies of patients with dementia are possible and warranted in this pandemic.

Disclosure statement

The authors declare no conflict of interest.

Funding information

This research did not receive any funding from agencies in the public, commercial or not‐for‐profit sectors.

Miyashita S, Yamada T, Mikami T, Miyashita H, Chopra N, Rizk D. Impact of dementia on clinical outcomes in elderly patients with coronavirus 2019 (COVID‐19): an experience in New York. Geriatr. Gerontol. Int. 2020;20:732–734. 10.1111/ggi.13942

References

  • 1. Guan WJ, Ni ZY, Hu Y et al Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382: 1708–1720. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2. Wang D, Hu B, Hu C et al Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus‐infected pneumonia in Wuhan, China. JAMA 2020; 323: 1061–1069. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3. Gale SA, Acar D, Daffner KR. Dementia. Am J Med 2018; 131: 1161–1169. [DOI] [PubMed] [Google Scholar]
  • 4. Naumova EN, Parisi SM, Castronovo D, Pandita M, Wenger J, Minihan P. Pneumonia and influenza hospitalizations in elderly people with dementia. J Am Geriatr Soc 2009; 57: 2192–2199. [DOI] [PubMed] [Google Scholar]
  • 5. Xie X, Chen J, Wang X, Zhang F, Liu Y. Age‐ and gender‐related difference of ACE2 expression in rat lung. Life Sci 2006; 78: 2166–2171. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Geriatrics & Gerontology International are provided here courtesy of Wiley

RESOURCES