Scuteri Damiana, Contrada Marianna, Tonin Paolo, Corasaniti Maria Tiziana, Nicotera Pierluigi, Bagetta Giacinto
Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy.
Regional Center for Serious Brain Injuries, S. Anna Institute, 88900 Crotone, Italy.
Pharmaceuticals (Basel). 2022 Feb 4;15(2):199. doi: 10.3390/ph15020199.
The coronavirus disease 2019 (COVID-19) pandemic imposes an unprecedented lifestyle, dominated by social isolation. In this frame, the population to pay the highest price is represented by demented patients. This group faces the highest risk of mortality, in case of severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection, and they experience rapid cognitive deterioration, due to lockdown measures that prevent their disease monitoring. This complex landscape mirrors an enhancement of neuropsychiatric symptoms (NPSs), with agitation, delirium and reduced motor performances, particularly in non-communicative patients. Due to the consistent link between agitation and pain in these patients, the use of antipsychotics, increasing the risk of death during COVID-19, can be avoided or reduced through an adequate pain treatment. The most suitable pain assessment scale, also feasible for e-health implementation, is the Mobilization-Observation-Behaviour-Intensity-Dementia (MOBID-2) pain scale, currently under validation in the Italian real-world context. Here, we report the case of an 85-year-old woman suffering from mild cognitive impairment, subjected to off-label treatment with atypical antipsychotics, in the context of undertreated pain, who died during the pandemic from an extensive brain hemorrhage. This underscores the need for appropriate assessment and treatment of pain in demented patients.
2019年冠状病毒病（COVID-19）大流行带来了前所未有的生活方式，社交隔离占据主导。在此背景下，受影响最大的人群是痴呆患者。这一群体在感染严重急性呼吸综合征冠状病毒（SARS-CoV-2）时面临着最高的死亡风险，并且由于封锁措施阻碍了对其病情的监测，他们的认知能力迅速衰退。这种复杂的情况反映出神经精神症状（NPSs）有所增加，表现为躁动、谵妄和运动能力下降，尤其是在无法交流的患者中。鉴于这些患者的躁动与疼痛之间存在紧密联系，通过适当的疼痛治疗可以避免或减少使用抗精神病药物，因为这类药物会增加COVID-19期间的死亡风险。最合适的疼痛评估量表，也是电子健康实施中可行的量表，是动员-观察-行为-强度-痴呆（MOBID-2）疼痛量表，目前正在意大利实际应用中进行验证。在此，我们报告一例85岁患有轻度认知障碍的女性病例，在疼痛未得到充分治疗的情况下接受了非典型抗精神病药物的标签外治疗，该患者在大流行期间死于大面积脑出血。这凸显了对痴呆患者进行适当疼痛评估和治疗的必要性。
