Alonso-Lana Silvia, Marquié Marta, Ruiz Agustín, Boada Mercè
Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain.
Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain.
Front Aging Neurosci. 2020 Oct 26;12:588872. doi: 10.3389/fnagi.2020.588872. eCollection 2020.
The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread worldwide and has had unprecedented effects in healthcare systems, economies and society. COVID-19 clinical presentation primarily affects the respiratory system causing bilateral pneumonia, but it is increasingly being recognized as a systemic disease, with neurologic manifestations reported in patients with mild symptoms but, most frequently, in those in a severe condition. Elderly individuals are at high risk of developing severe forms of COVID-19 due to factors associated with aging and a higher prevalence of medical comorbidities and, therefore, they are more vulnerable to possible lasting neuropsychiatric and cognitive impairments. Several reports have described insomnia, depressed mood, anxiety, post-traumatic stress disorder and cognitive impairment in a proportion of patients after discharge from the hospital. The potential mechanisms underlying these symptoms are not fully understood but are probably multifactorial, involving direct neurotrophic effect of SARS-CoV-2, consequences of long intensive care unit stays, the use of mechanical ventilation and sedative drugs, brain hypoxia, systemic inflammation, secondary effects of medications used to treat COVID-19 and dysfunction of peripheral organs. Chronic diseases such as dementia are a particular concern not only because they are associated with higher rates of hospitalization and mortality but also because COVID-19 further exacerbates the vulnerability of those with cognitive impairment. In patients with dementia, COVID-19 frequently has an atypical presentation with mental status changes complicating the early identification of cases. COVID-19 has had a dramatical impact in long-term care facilities, where rates of infection and mortality have been very high. Community measures implemented to slow the spread of the virus have forced to social distancing and cancelation of cognitive stimulation programs, which may have contributed to generate loneliness, behavioral symptoms and worsening of cognition in patients with dementia. COVID-19 has impacted the functioning of Memory Clinics, research programs and clinical trials in the Alzheimer's field, triggering the implementation of telemedicine. COVID-19 survivors should be periodically evaluated with comprehensive cognitive and neuropsychiatric assessments, and specific mental health and cognitive rehabilitation programs should be provided for those suffering long-term cognitive and psychiatric sequelae.
由严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）引起的 2019 冠状病毒病（COVID-19）已在全球迅速传播，并对医疗系统、经济和社会产生了前所未有的影响。COVID-19 的临床表现主要影响呼吸系统，导致双侧肺炎，但它越来越被认为是一种全身性疾病，轻度症状患者中也有神经系统表现的报道，但最常见于重症患者。由于与衰老相关的因素以及较高的医疗合并症患病率，老年人患重症 COVID-19 的风险很高，因此，他们更容易受到可能持续的神经精神和认知障碍的影响。几份报告描述了一部分患者出院后出现失眠、情绪低落、焦虑、创伤后应激障碍和认知障碍。这些症状背后的潜在机制尚未完全了解，但可能是多因素的，包括 SARS-CoV-2 的直接神经营养作用、长期入住重症监护病房的后果、机械通气和镇静药物的使用、脑缺氧、全身炎症、用于治疗 COVID-19 的药物的继发效应以及外周器官功能障碍。痴呆等慢性疾病尤其令人担忧，不仅因为它们与更高的住院率和死亡率相关，还因为 COVID-19 进一步加剧了认知障碍患者的脆弱性。在痴呆患者中，COVID-19 通常表现不典型，精神状态改变使病例的早期识别复杂化。COVID-19 对长期护理机构产生了巨大影响，那里的感染率和死亡率非常高。为减缓病毒传播而实施的社区措施迫使人们保持社交距离并取消认知刺激项目，这可能导致痴呆患者产生孤独感、行为症状和认知恶化。COVID-19 影响了记忆诊所的运作、阿尔茨海默病领域的研究项目和临床试验，引发了远程医疗的实施。COVID-19 幸存者应定期进行全面的认知和神经精神评估，对于患有长期认知和精神后遗症的患者，应提供特定的心理健康和认知康复项目。
