Dementia and COVID-19: a conjunction of pandemics

Of people who have Alzheimer’s dementia (AD), 81 percent are aged 75 or older.¹ The mean age at onset of motor symptoms of Parkinson’s disease (PD) is around sixty years.² The number of comorbidities rises steeply with age: in a recent study, 39% of Americans aged over 65 had three or more chronic conditions.³

So it is clear that people with these forms of neurodegenerative disease – and especially those with AD dementia – have a high age-related risk of developing complications from COVID-19 infection, and hence a high risk of hospitalization and need for intensive care.⁴

Double hit

With 50 million people in the world having dementia,⁵ and with the global total of known COVID-19 cases rocketing towards a million on a rapidly accelerating curve,⁶ we have an unfortunate conjunction of pandemics.

Wang et al⁷ have recently given the situation a sober appraisal. Their letter to The Lancet identified many factors that pose particular problems for people with dementia, even when they live outside nursing homes:

• Limited access to and understanding of scientific information
• Memory problems making it difficult to maintain social distance and other protective measures such as handwashing
• Little or no capacity to use the internet and social media
• Reliance on one or more carers, and the inevitability of intimate contact
• For those very ill to need hospital care, there is the stress of displacement and the risk of hypoxia-induced delirium.

Although to a lesser extent, similar considerations apply to elderly people with advanced PD. Lack of contact with physiotherapists and the inability to take recommended outdoor exercise are specific problems.

Sources of support

Recent experience in China suggests the importance of multidisciplinary working, of making counseling available to carers, and of the remote delivery of stress reduction programs such as relaxation and meditation.⁷

Resources to help cope with the COVID-19 emergency have been developed by the American Academy of Neurology.⁸ These cover recommentations on the implementation of telemedicine, including how to perform a remote neurologic exam.⁹ There is specific advice on telemedicine for PD, and a live demonstration.