D'Cruz Migita, Banerjee Debanjan
Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India.
Front Psychiatry. 2020 Oct 27;11:603231. doi: 10.3389/fpsyt.2020.603231. eCollection 2020.
The Coronavirus disease 2019 (COVID-19) pandemic has presented an unprecedented threat to global public and psychosocial health. Certain vulnerable populations, especially the older adults, are at disproportionate risks both to the physiological and social effects of the outbreak. A special section among them who face unique challenges during this pandemic, are those living with neurocognitive disorders, like dementia. Limited research in the field shows ApoE4 allele to confer an increased risk for COVID-19 severity, while the behavioral problems associated with dementia reduces compliance to precautionary measures, thereby exposing them to the virus and increasing caregiver strain. Reduced healthcare access, limited resources and fear of the infection act as major barriers to dementia care during such a crisis. Besides, there are the additional burden of stigma, abuse, ageism and financial impoverishment. Institutionalization, loneliness and lack of stimulation can potentially accelerate the cognitive decline and worsen the behavioral and psychological problems. India has been one of the worst hit countries by COVID-19 and shares a significant dementia load. As the country is aging fast along with the world, this commentary reviews the risks of people living with dementia during the pandemic and discusses certain advocacies for their care.
2019年冠状病毒病(COVID-19)大流行对全球公众健康和心理社会健康构成了前所未有的威胁。某些弱势群体,尤其是老年人,在疫情爆发所带来的生理和社会影响方面面临着不成比例的风险。其中,在这场大流行期间面临独特挑战的一个特殊群体是患有神经认知障碍(如痴呆症)的人。该领域有限的研究表明,载脂蛋白E4(ApoE4)等位基因会增加患重症COVID-19的风险,而与痴呆症相关的行为问题会降低对预防措施的依从性,从而使他们暴露于病毒之下,并增加照料者的负担。在这样的危机期间,医疗保健机会减少、资源有限以及对感染的恐惧成为痴呆症护理的主要障碍。此外,还存在耻辱感、虐待、年龄歧视和经济贫困等额外负担。机构化、孤独感和缺乏刺激可能会加速认知衰退,并使行为和心理问题恶化。印度是受COVID-19影响最严重的国家之一,痴呆症负担也很重。随着该国与世界一起迅速老龄化,本评论文章回顾了痴呆症患者在大流行期间面临的风险,并讨论了针对他们护理的某些倡导措施。