Section 1.1: Investigating the Effects of COVID-19 on Dementia Patients

A recent study examined fourteen dementia patients who were otherwise stable prior to contracting COVID-19. These individuals were admitted to dementia wards between 2013 and 2022 and later tested positive for the virus.

Detailed neuropsychological and neuroimaging assessments (MRI) were conducted three months prior to and one year following their COVID-19 infection. Cognitive functioning was evaluated through a range of tests, including the Addenbrooke’s Cognitive Examination III, the Frontal Assessment Battery, and the Trail Making Test Part B. These assessments covered various cognitive domains such as attention, language, memory, visuospatial skills, and fluency. Additionally, fatigue and depression levels were measured using specific scales.

The findings were significant:

• Following the COVID-19 infection, participants showed notable increases in fatigue and depression scores.
• Cognitive evaluations revealed substantial declines, particularly in attention, memory, fluency, language, and visuospatial skills.
• Executive functions also exhibited significant deterioration.
• Neuroimaging indicated an increase in white matter abnormalities and global cortical atrophy post-infection. Interestingly, researchers observed similarities between the white matter lesions in post-COVID dementia patients and those seen in multiple sclerosis.

What’s more, slowly progressive dementias like Alzheimer’s and vascular dementia, which typically follow a fluctuating course, displayed an unusual pattern of rapid and significant deterioration.

Overall, the rapid progression of dementia, alongside worsened cognitive abilities and increased white matter lesions, was common across the participants, regardless of dementia type, severity of COVID-19, or presence of vascular risk factors. This suggests that brains already compromised by dementia have limited resilience to additional stressors, such as infections or immune responses.

Section 1.2: The Interplay of Depression and Cognitive Decline

While it's important to assess the specific role of the virus in these outcomes, we must also consider other factors such as isolation and the physical toll of recovery. For instance, rising depression scores are likely influenced by the broader context rather than solely by the virus itself. Importantly, increased depressive symptoms are a known risk factor for the progression of dementia.

Thus, it appears that fatigue, depression, cognitive decline, and COVID-19 are intertwined in a complex feedback loop, each influencing the others.

It’s also crucial to acknowledge that this study focused on only fourteen individuals in Indian hospitals, lacking a control group of dementia patients who did not contract COVID-19. While the accelerated cognitive decline was consistent among participants, the extent to which these findings can be generalized remains uncertain.

Nonetheless, it stands to reason that for individuals already experiencing cognitive difficulties, the addition of a COVID-19 infection presents a significant risk.