Over a year into the global pandemic caused by COVID-19, we know the virus has far-reaching effects that go beyond the disease itself. The methods found to be most effective for controlling the spread of the virus — isolation and social distancing — have had a negative impact on the mental health of many.
But a recent study shows that one group of people in particular has been negatively affected by quarantine: those with dementia.
The difference between dementia and Alzheimer’s disease
Dementia is a general term describing abnormal brain changes that cause a noticeable change or decline in memory, behavior and everyday thinking skills. Contrary to popular belief, it’s not a normal part of aging — it’s the result of damage to the brain cells.
Dementia can be caused by a number of things, including:
The most common cause of dementia is Alzheimer’s disease, which is a degenerative brain disease. Alzheimer’s disease shares some common symptoms with dementia — including memory loss and a decline in thinking skills — but unlike dementia, it can lead to physical conditions such as difficulty speaking, swallowing and walking as the brain continues to deteriorate.
Negative impact on patients with dementia
In 2020, a study was conducted to assess changes in behavioral and psychological symptoms in both patients with dementia and their caregivers as a result of COVID-19 quarantines.
The study found there was a rapid increase of symptoms in approximately 60% of the patients. Most frequently reported was a worsening of irritability, apathy, agitation and anxiety, as well as development of sleep disorders. Of the caregivers surveyed, two-thirds reported an increase in stress-related symptoms.
Coronavirus-related depression can worsen dementia symptoms
The study information is no surprise to David Trinh, M.D., a geriatrician who works with elderly patients — including those with memory loss or dementia — through his Fresno-based private practice. To maintain good cognitive function in an older adult, as well as good emotional and physical health, Dr. Trinh recommends two things: regular social interaction and physical activity. Unfortunately, COVID-19 quarantining has put a stop to these activities for many.
According to Dr. Trinh, when it comes to memory loss, you’re talking about a spectrum. For those with severe dementia, who may not register the effects of isolation, there’s been little change in behavior. But for those in the early stages, with very mild memory problems, he’s seen a negative impact.
“In all that I've seen, so many suddenly become more anxious, more depressed,” says Dr. Trinh. “People [who had] mild cognitive problems, it’s now tipped them into dementia.”
Home isolation presents unique challenges
There are a number of struggles, both for patients who are isolated at home with a caregiver, and those living in assisted living facilities. For those at home, lack of social activity can cause emotional and even physical decline. One challenge for dementia patients is being able to connect virtually with family, friends and even doctors.
“If patients have memory loss or thinking problems, they're going to be less able to navigate Zoom meetings, and the computer or iPad,” says Dr. Loren Alving, director of the UCSF Fresno Alzheimer’s and Memory Center. Hearing and vision loss, as well as spotty internet, can also be hard for patients to deal with, and they may become reluctant to engage as often as they should, increasing feelings of loneliness and isolation.
Isolation can affect physical health, as well. Dementia patients who are at home can develop infections or other illnesses that go unreported. Also, as they spend more time in their homes, they get weaker physically, which can lead to falls and broken bones.
How to tell if someone is experiencing decline
Determining if a family member with dementia is experiencing depression or decline requires a little detective work, says Dr. Alving. “Engaging with [them] and finding out what they’re doing in daily life. If they’re sitting in front of the TV all day, and they didn’t used to, that might be an important sign.”
Dr. Trinh says with older patients the first sign something isn’t right is when they lose the ability to take care of themselves. He teaches his medical students to use their eyes and nose when evaluating a patient for worsening signs of dementia.
Your loved one may not tell you outright if something is wrong, so look for signs something is different:
Are they wearing the same clothes whenever you see them in person or on Zoom?
Do they look like they haven’t showered? Is their hair unwashed or uncombed?
Do they smell bad?
Are they losing weight?
Are they wearing pajamas in the afternoon when they never did before?
Is there food in the fridge? Is it spoiled?
Are the proper medications being taken?
What you can do to help a loved one who’s struggling
Although COVID-19 has made things more difficult, there are still ways to engage with a loved one in isolation. Plan activities to keep their minds and bodies active: games over Zoom or in person, walks and frequent phone calls are just a few examples.
If your loved one is in a care facility, visitor restrictions may make this more difficult. Visits can be limited by frequency, duration or even location, so take advantage of any time you can get, whether that’s walking together outside or spending time talking through a window or glass door.
And take the time to check in on caregivers who might not reach out themselves. “They don't want to bother other people,” says Dr. Alving. “Well, now's the time to bother other people.”
She suggests caregivers reach out for support from groups like the Alzheimer's Association or from their families, even if it's just for some psychological support. “I think it's important for caregivers to realize that they're not alone. This is happening to many people. And it's not a reflection of their caregiving abilities.”
Safety the number one concern
The most important thing to keep in mind, explains Dr. Trinh, is safety. Masking up (even wearing two masks at once), staying six feet away and spending time outdoors are all essential in helping fight the spread of the virus.
Don’t visit a loved one at home or in a care facility if there’s a possibility you’ve been exposed to COVID-19. The last thing you want to do, warns Dr. Trinh, is pass along the virus to an older adult, especially one with dementia:
“The COVID infection can worsen memory problems. So if your loved one has mild dementia … it will be even worse.”