Dados do Trabalho

Título

Impact of the SARS-Cov-2 pandemic on Alzheimer's disease patients: a retrospective and evolutionary analysis of cognitive aspects.

Resumo

Alzheimer's Disease(AD) is a neurodegenerative disorder that manifests as deterioration of multiple cognitive domains. These patients are at greater risk of Covid-19 and suffering with the pandemic, which can lead to accelerated functional and cognitive impairment. Thus, it is necessary to understand the clinical and social impact of the SARS-Cov-2 pandemic in this group. The aim of the study was to describe the evolution of cognitive and functional performance of AD patients from 2018-22. A retrospective cohort of 77 AD patients treated at a tertiary hospital in Fortaleza was carried out from 2018 to 2022. Cognitive(cross-sectional and retrospective) assessment was performed with the Mini Mental State Examination(MMSE), Semantic Verbal Fluency(SVF) and Clock Drawing Test(CDT) and functional assessment with the Clinical Dementia Rating Scale(CDR) and Functional Staging Scale(FAST), in addition to clinical aspects, caregiver stress, satisfaction with telemedicine and social isolation. We used MMSE and FAST 2 and 3 [(1-17) and (1-7), respectively, discrete numerical variables] to define significant impairment. The evolution of the data in relation to the beginning of the pandemic was recorded as: before(2018-19), during(2020-21/22), and in the transition(2019-20). The three annual evolutions were then compared to each other. The results showed that in four years of outpatient follow-up, there was a functional deterioration, assessed by an increase in CDR [1(0.5-2) to 3(2-3)], FAST 2 [4(3-5) to 8(5-11)] and FAST 3 [4(3-5) to 6(5-7)](p<0.05). The last two configured significant functional impairment. There was an increase in the prevalence of anticholinesterase, anti-NMDA and antipsychotic use (36.5% to 74.3%; 20.3% to 45.9%; 18.9% to 44.6%, respectively) and its side effects. We found an increase in the prevalence of urge incontinence (1.4% to 37.8%) and of neuropsychiatric symptoms such as anxiety (35.1 to 58.1%) and insomnia (17.6 to 40.5%). Cognitive worsening was evidenced through the MMSE, SVF and CDT scores (15 to 11; 6 to 4.5; and 2 to 0, respectively;p<0.05), the first of which configured significant cognitive impairment. There was an increase in caregiver stress (10.8 to 74.3%). It was possible to conclude that AD patients showed significant cognitive and functional impairment after the beginning of the pandemic. The follow-up of these patients is necessary in order to better describe the long-term extent of the effects of the pandemic in this group.

Palavras Chave

Dementia, cognition, Alzheimer's Disease, pandemic, COVID-19, SARS-Cov-2, cognitive impairment, functional impairment, Mini Mental State Examination (MMSE), Functional Assessment Staging (FAST), Clinical Dementia Rating (CDR).