Dados do Trabalho

Título

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

Resumo

Background:Patients with Alzheimer's Disease(AD) are at greater risk not only of contracting COVID-19, but of increased physical and psychological suffering from the pandemic and greater vulnerability to accelerated functional and cognitive decline. Thus, it is necessary to understand the clinical and social impact of the SARS-Cov-2 pandemic in this group. Objective:The objective was to evaluate an evolution of the cognitive and functional performance of AD patients from 2018-22. Methods:A retrospective cohort of 74 AD patients treated at a tertiary hospital in Fortaleza was carried out, from 2018-22. Cognitive assessments were carried out, longitudinally and retrospectively, with the Mini-Mental State Examination(MMSE), Semantic Verbal Fluency(SVF) and Clock Design Test(CDT); with the Clinical Dementia Rating Scale(CDR) and Functional Assessment Staging(FAST), in addition to assessments that sought to characterize neuropsychiatric symptoms, medication use, social isolation, caregiver stress and satisfaction with telemedicine care. We used MMSE, FAST 2(1-17) and 3(1-7) to define significant decline; the last two being, respectively, numerical encodings of the FAST categorical variables. The evolution of the data in relation to the beginning of the pandemic was recorded as:before(2018-19),after(2020-22) and during the transition to the beginning of the pandemic(2019-20). The annual evolution was then compared:2018-
19x2019-20x2020-22. Results:We evidenced that in four years of follow-up there was a functional deterioration, disproportionately between 2019-2020; assessed by increasing the CDR from 1 to 2; increase in FAST 2 from 4,5 to 6,5 and in FAST 3 from 4,5 to 6; p<0.05.The last two configured significant functional decline. There was an increase in the prevalence, over the four years, of the use of anticholinesterases, anti-NMDA and antipsychotics(36,5x74%; 20x46%; 19x45%, respectively) and their side effects. We also found a higher prevalence of urge-incontinence(1,4x38%) and of some neuropsychiatric symptoms, such as anxiety symptoms(35x58%) and insomnia(18x40,5%). Cognitive worsening was evidenced, disproportionately between 2019-2020; through the MMSE, SVF and CDT(15x11; 6x4,5; and 2x0, respectively; p<0,05), the first of which configured significant cognitive decline. There was a significant increase in caregiver stress(11x74%). Conclusion:Patients with AD showed significant cognitive and functional decline after the beginning of the pandemic.