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Preliminary reports from the U.S. Centers for Disease Control and Prevention indicate that there were at least 42,000 more deaths from Alzheimer’s and other dementias in 2020 compared with the average of the five years prior, according to a report released Tuesday by the Alzheimer’s Association. This was approximately 16% more than expected.
About 40% of COVID-19 deaths in the United States have been residents or staffers of long-term-care facilities, said the report, which is the organization’s annual Facts and Figures assessment.
The report also noted that by 2050, the number of people 65 and older living with Alzheimer’s in the United States will skyrocket from 6.2 million now to 12.7 million, as the number of people in that age bracket increases from 58 million to 88 million.
The biggest spike in deaths among dementia patients in 2020 occurred early in the pandemic, when the virus raged in nursing homes and other communal-living locations, killing many residents before medical professionals and caregivers had a full understanding of how to protect people, said Maria Carrillo, the association’s chief science officer. “I think we’re going to see a leveling out of that now that we’re getting vaccines,” she said.
But for people with cognitive impairment who did not die of COVID-19, the effects of the coronavirus may be deadly far beyond the initial surge. For the past year, the pandemic has interrupted routines, divided families and curtailed social interactions that might have helped keep patients functioning longer.
Social isolation has been shown to correlate with cognitive problems among older people. But determining the depth of its effect, along with the impact of disrupted routines, pared-down medical care and other factors during the pandemic will take time, Carrillo said.
“There is so much to unpack,” she said. “We’re going to be analyzing this data in the coming years.”
Along with studying people previously diagnosed with dementia, researchers will need to follow the rates of new diagnoses, which may be delayed until older people and their families feel more comfortable with in-person medical appointments.
“People might be holding off on going to the doctor … or their physicians are only doing virtual visits,” where it can be harder to detect subtle changes in cognitive function, Carrillo said. Putting off appointments could have delayed the diagnosis of co-morbidities such as diabetes, she said. “Have the safety measures actually impacted our older population [by] accelerating dementia? We don’t know yet,” she said.
A survey of 389 patients and 147 caregivers associated with a memory clinic in the Netherlands found that patients had experienced an increase in social isolation, psychological symptoms and discontinuation of care. Both patients and caregivers said they were worried about faster cognitive decline, and three-quarters of caregivers reported an increase in problems including apathy, sleeping issues, agitation and repetitive behavior.
These could have a snowball effect, the report said, noting that “a recent review showed that patients who exhibit aggression, wandering or disinhibition are even at higher risk of catching and spreading COVID-19, triggering a vicious circle as research now shows that catching COVID-19 has adverse impacts upon the brain and cognition.”
The study, which was published in the journal Frontiers in Psychiatry, surveyed patients living alone or with partners or family members and included both those whose cognitive decline was diagnosed by tests and those who performed normally in tests but had subjectively experienced cognitive decline.
Because of the pandemic, many people sought out social connections online, “but this is more difficult for patients with cognitive complaints,” the study said. “We even found that some patients did not go outside at all.” That included skipping visits to the doctor or hospital, either by choice or because health facilities were closed.
“The loss [of] structure and social cohesion may be the final push toward onset of overt symptoms,” the study said, adding that symptoms could also have been exacerbated by uncertainty and anxiety tied directly to the pandemic.