Table 1.
Characteristics and summary of the results of the studies included.
| Article | COVID-19 effects | Population diagnosis | Methodology | Sample size | Age (years) | Neuropsychiatric symptoms | Assessment tools | Results |
|---|---|---|---|---|---|---|---|---|
| INDIVIDUALS WITH ACUTE COVID-19 INFECTION—STUDIES ON OLDER ADULTS WITHOUT DEMENTIA | ||||||||
| Alkeridy et al. (13) | Effects of infection | Older adults without dementia | Case description | 1 | 73-year-old man | Delirium | Clinical judgment | The patient presented with delirium as onset symptom of COVID-19 infection. |
| Varatharaj et al. (14) | Effects of infection | Adults without dementia | Multi-centre clinical repository | 153 (only 125 with complete assessments) | 61–70 (n = 23), 71–80 (n = 31), 81–90 (n = 23), ≥ 91 (n = 5) | Altered mental status | Clinical judgment | Altered mental status was observed in 31.2% of the patients with complete assessments: 41% of these had encephalopathy/encephalitis, while 59% met the criteria for different psychiatric diagnoses (91.3% of which were new). The most common disorders were: psychoses, neurocognitive disorders, and affective disorders. |
| INDIVIDUALS WITH ACUTE COVID-19 INFECTION—STUDIES INCLUDING OLDER ADULTS WITH DEMENTIA | ||||||||
| Annweiler et al. (15) | Effects of infection | Older adults with and without MND above 70 years of age | Multi-centre retrospective description of last 10 patients per institution | 353 (no MND = 219, MND = 134) | 84.7 (±7.0)* | Delirium and altered consciousness | Clinical judgment | Older adults with compared to those without MND were more likely to present with delirium, both hypoactive (27.6 vs. 11.4%) and overactive (14.9 vs. 5.5%), and altered consciousness (17.2 vs. 6.4%). Rates of delirium and loss of consciousness were similar between individuals aged 70–80 and over 80. |
| Beach et al. (16) | Effects of infection | MND (unspecified cause) and DLB | Case series description | 3 (an additional case with COVID-19 infection and schizophrenia also included) | 70-year-old man, 76-year-old man, and 87-year-old woman | Delirium | Clinical judgment | Two cases of MND, one with behavioural and psychotic problems and one with depression with psychotic features, and one case of DLB presented with delirium and agitation during hospitalisation. |
| Bianchetti et al. (17) | Effects of infection | Dementia (unspecified cause) | Retrospective analysis of regional acute hospital admissions | 627 (no dementia = 545, dementia = 82) | 82.6 (± 5.3), IQR 80–86 (dementia) | Behavioural symptoms and delirium | Clinical judgement | At onset: most common symptom in people with dementia was delirium (67%), especially hypoactive (50%); behavioural symptoms were present in 11% of patients |
| Lovell et al. (18) | Effects of infection | Older adults with and without dementia (unspecified cause) | Retrospective analysis of case series | 101 (dementia = 31) | 82 (72–89)† | Agitation, drowsiness, and delirium | Clinical judgment | At time of referral to palliative care unit, dementia was the third most common comorbidity (30.7%). Overall, 42.5% of patients presented with agitation, 35.6% with drowsiness, and 23.8% with delirium. |
| Sinvani et al. (19) | Effects of infection | Advanced dementia due to AD | Case series description | 1 (other two severe cases of older adults with COVID-19 infection were also included) | 76-year-old woman | Behavioural symptoms | Clinical judgment | After a few days of hospitalisation, the patient showed agitation and violent behavioural changes that, however, resolved with personalised care. |
| Ward et al. (20) | Effects of infection | AD, FTD, VD | Case series description | 4 (2 AD; 1 FTD, 1 VD) | 83.3 (± 10.2)*, 3 women, and 1 man | Altered mental status | Clinical judgment | All cases presented at onset with delirium and agitation. Delirium was particularly severe in 2 cases and associated with loss of appetite and disorientation. |
| INDIVIDUALS WITHOUT COVID-19 INFECTION IN CONDITIONS OF INCREASED SOCIAL ISOLATION—STUDIES ON OLDER ADULTS WITHOUT DEMENTIA | ||||||||
| Emerson et al. (21) | Effects due to social isolation | Older adults without dementia above 60 years of age | Online survey | 833 | 60–70 (n = 523), 71+ (n = 310) | Overall mental health and stress | Web-based survey, self-reported assessment | No differences in self-rated mental health were found between older adults aged 60–70 and 70+. However, the younger group reported having experienced higher levels of stress than the older group after social isolation enforcement. |
| Shrira et al. (22) | Effects due to social isolation | Older adults without dementia | Online questionnaire completed by older adults | 277 | 69.58 (± 6.72)*, range 60–92 | Anxiety, depression, and peritraumatic distress | Web-based GAD-7, PHQ-9, and PDI | Loneliness due to social isolation was positively associated with levels of anxiety, depression and peritraumatic distress, especially among individuals feeling older than their age. |
| INDIVIDUALS WITHOUT COVID-19 INFECTION IN CONDITIONS OF INCREASED SOCIAL ISOLATION—STUDIES INCLUDING OLDER ADULTS WITH DEMENTIA | ||||||||
| Boutoleau-Bretonnière et al. (23) | Effects due to social isolation | Dementia due to probable AD | Telephonic questionnaires administered to a caregiver | 38 | 71.89 (± 8.24)* | NPS | NPI-Q | Caregiver-reported worsening of NPS in 26.3% of patients. Duration of confinement correlated with NPI-Q score and caregivers' distress in patients who showed worsening of NPS. |
| Canevelli et al. (24) | Effects due to social isolation | Dementia, MCI, SCD (unspecified cause) | Telephonic survey administered to patients or caregivers | 139 (dementia = 96, MCI/SCD = 43) | 80.5 (76–85)‡ (dementia); 73 (65.5–77.5)‡ (MCI/SCD) | NPS | Patient- and caregiver-reported changes | Overall, NPS improved in only a few patients (2.1% of demented and 7% of MCI/SCD), while NPS worsened in the majority of patients (57.3 and 48.8%, respectively), especially agitation, apathy, depression and irritability. |
| Fahed et al. (25) | Effects due to social isolation | Dementia due to AD | Case series description | 1 (a second case of a patient with narcissistic personality disorder was also included) | 83-year-old man | Behavioural symptoms | Clinical judgment | The patient was admitted to an inpatient psychiatric unit during COVID-19 pandemic because of severe agitation. During hospital stay he experienced mood lability, agitation and violent behaviours. All symptoms worsened after he was room isolated because suspected to have COVID-19. All interventions had little or no effect. |
| Lara et al. (26) | Effects due to social isolation | Dementia due to mild AD and amnestic MCI | Telephonic questionnaires administered to a caregiver | 40 (AD = 20, MCI = 20) | 77.4 (± 5.25)* | NPS | NPI | General worsening of NPI scores was observed after 5 weeks of confinement in agitation, apathy and aberrant motor behaviour symptoms particularly. Changes were similar between patient groups. Apathy and anxiety worsened especially in the MCI group; while apathy, agitation, and aberrant motor behaviours worsened mainly in the AD group. |
| Padala et al. (27) | Effects due to social isolation | Dementia due to AD | Case description | 1 | 81-year-old man | NPS | NPI | After restrictions were enforced for relatives' visits to people in nursing homes, this patient with AD showed increased depression, anxiety, apathy, irritability, difficulty sleeping, and general restlessness. Symptoms improved after video calls with relative were arranged. |
*
mean (± Standard deviation).
†
median (Range).
‡
mean (Interquartile range).
AD, Alzheimer's Disease; DLB, Dementia with Lewy Bodies; FTD, Frontotemporal Dementia; GAD-7, 7-item Generalized Anxiety Disorder scale; IQR, Interquartile range; MCI, Mild Cognitive Impairment; MND, Major Neurocognitive disorder; NPI, Neuropsychiatric Inventory; NPI-Q, Neuropsychiatric Inventory Questionnaire; NPS, Neuropsychiatric Symptoms; PDI, 13-item Peritraumatic Distress Inventory; PHQ-9, 9-item Patient Health Questionnaire; SCD, Subjective Cognitive Decline; VD, Vascular Dementia.