Increased risk for COVID-19 infection, death among adults with dementia

Older adults with dementia are at greater risk for SARS-CoV-2 infection and death, highlighting the need for close monitoring of these patients, researchers reported in the Journal for Alzheimer’s Disease.

“Previous studies reported that people with dementia are more likely to contract SARS-CoV-2 infection than people without, and that dementia is in itself a risk factor for COVID-19-related mortality,” Silvia Cascini, MSc, of the department of epidemiology at Lazio Regional Health Service in Italy, said in a related press release. “However, there was still little knowledge about individual factors increasing the risk of SARS-CoV-2 infection and mortality in this particularly fragile population.”

Cascini and colleagues aimed to assess the incidence of SARS-CoV-2 infection and COVID-19-related deaths in a cohort of patients with dementia in the Lazio region of Italy. They conducted a retrospective, population-based study using health administrative databases and a SARS-CoV-2 infection surveillance system established in Lazio during the pandemic.

Researchers enrolled all individuals with dementia in Lazio aged 65 years and older, as of Dec. 31, 2019, and followed up with each patient between Jan. 1, 2020, and Feb. 28, 2021. They determined cumulative risk for infection and death within 60 days of infection onset, as well as age-standardized incidence (SIR) and mortality (SMR) ratios, and used logistic regression models to identify factors associated with infection and mortality.

Among 37,729 dementia patients, 2,548 had a diagnosis of SARS-CoV-2 infection. The authors reported a crude risk for infection of 6.7%, with an increased risk for infection in both women (SIR = 1.72; 95% CI, 1.64-1.8) and men (SIR = 1.43; 95% CI, 1.33-1.54). Factors associated with an increased risk for infection included pneumonia, cerebrovascular and blood diseases, femur fracture, anxiety, and antipsychotic and antithrombotic use.

The authors also reported the crude risk for death was 31%, with an SMR of 2.32 for men (95% CI, 2.05-2.65) and 2.82 for women (95% CI, 2.55-3.11). Factors contributing to increased mortality risk were male gender, age 85 years and older, symptoms at the time of diagnosis, and treatment with antipsychotics and systemic antibiotics.

“Our analysis revealed a strong association between presence of symptoms at diagnosis and short-term mortality,” study co-author Nera Agabiti, MD, also of the department of epidemiology at Lazio Regional Health Service, said in the release. “We have to keep in mind that although much has been learned about how to prevent the infection, elderly with dementia require to be adequately monitored by both physicians and caregivers to minimize exposure to the virus, recognize timely signs/symptoms of COVID-19 and ensure proper disease management.”

Reference:

Dementia and COVID-19: determinants of infection and mortality. https://www.eurekalert.org/news-releases/964002. Published Sept. 7, 2022. Accessed Sept. 7, 2022.