Manca Riccardo, De Marco Matteo, Colston Amanda, Raymont Vanessa, Amin Jay, Davies Rhys, Kumar Pramod, Russell Gregor, Blackburn Daniel J, Venneri Annalena
Department of Life Sciences, Brunel University London, Uxbridge, United Kingdom.
Oxford Health NHS Foundation Trust, Oxford, United Kingdom.
Front Psychiatry. 2022 May 10;13:877595. doi: 10.3389/fpsyt.2022.877595. eCollection 2022.
People with dementia (PWD) are vulnerable to abrupt changes to daily routines. The lockdown enforced on the 23rd of March 2020 in the UK to contain the expansion of the COVID-19 pandemic limited opportunities for PWD to access healthcare services and socialise. The SOLITUDE study explored the potential long-term effects of lockdown on PWD's symptoms and carers' burden.
Forty-five carers and 36 PWD completed a telephone-based assessment at recruitment (T0) and after 3 (T1) and 6 months (T2). PWD completed measures validated for telephonic evaluations of cognition and depression. Carers completed questionnaires on their burden and on PWD's health and answered a customised interview on symptom changes observed in the initial months of lockdown. Longitudinal changes were investigated for all outcome variables with repeated-measures models. Additional multiple regression analyses were carried out to investigate whether several objective factors (i.e., demographics and time under social restrictions) and carer-reported symptom changes observed following lockdown before T0 were associated with all outcomes at T0.
No significant changes were observed in any outcomes over the 6 months of observations. However, analyses showed that the length of social isolation before T0 was negatively correlated with episodic and semantic memory performance at T0. Carers reporting worsening of neuropsychiatric symptoms and faster disease progression in PWD also reported higher burden. Moreover, carer-reported worsening of cognitive symptoms was associated with poorer semantic memory at T0.
PWD's symptoms and carers' burden remained stable over 6 months of observation. However, the amount of time spent under social restrictions before T0 appears to have had a significant detrimental impact on cognitive performance of patients. In fact, carer-reported cognitive decline during social isolation was consistent with the finding of poorer semantic memory, a domain sensitive to progression in Alzheimer's disease. Therefore, the initial stricter period of social isolation had greater detrimental impact on patients and their carers, followed then by a plateau. Future interventions may be designed to maintain an optimal level of social and cognitive engagement for PWD in challenging times, to prevent abrupt worsening of symptoms and associated detrimental consequences on patients' carers.
痴呆症患者（PWD）易受日常生活规律突然变化的影响。2020年3月23日英国实施封锁以遏制新冠疫情的蔓延，这限制了痴呆症患者获得医疗服务和社交的机会。孤独研究探讨了封锁对痴呆症患者症状和护理人员负担的潜在长期影响。
45名护理人员和36名痴呆症患者在招募时（T0）、3个月后（T1）和6个月后（T2）完成了基于电话的评估。痴呆症患者完成了经过验证的用于认知和抑郁电话评估的测量。护理人员完成了关于他们负担以及痴呆症患者健康状况的问卷，并回答了关于封锁最初几个月观察到的症状变化的定制访谈。使用重复测量模型对所有结果变量的纵向变化进行了研究。还进行了额外的多元回归分析，以调查几个客观因素（即人口统计学和社会限制下的时间）以及在T0之前封锁后护理人员报告的症状变化是否与T0时的所有结果相关。
在6个月的观察期内，任何结果均未观察到显著变化。然而，分析表明，T0之前的社会隔离时间长度与T0时的情景记忆和语义记忆表现呈负相关。报告痴呆症患者神经精神症状恶化和疾病进展更快的护理人员也报告了更高的负担。此外，护理人员报告的认知症状恶化与T0时较差的语义记忆相关。
在6个月的观察期内，痴呆症患者的症状和护理人员的负担保持稳定。然而，T0之前在社会限制下花费的时间似乎对患者的认知表现产生了重大不利影响。事实上，护理人员报告的社会隔离期间的认知下降与较差的语义记忆这一发现一致，语义记忆是对阿尔茨海默病进展敏感的一个领域。因此，最初更严格的社会隔离期对患者及其护理人员的不利影响更大，随后趋于平稳。未来的干预措施可能旨在在具有挑战性的时期为痴呆症患者维持最佳水平的社会和认知参与，以防止症状突然恶化以及对患者护理人员产生相关的不利后果。
