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      Behavioral and Psychological Effects of Coronavirus Disease-19 Quarantine in Patients With Dementia

      research-article
      1 , 2 , 3 , 4 , 5 , 2 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 10 , 14 , 1 , 15 , 16 , 3 , 3 , 15 , 16 , 12 , 13 , 17 , 10 , 7 , 2 , SINdem COVID-19 Study Group
      Frontiers in Psychiatry
      Frontiers Media S.A.
      behavioral and psychological symptoms, behavioral symptoms, psychological symptoms, quarantine, dementia, caregiver, coronavirus disease, gender

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          Abstract

          Background

          In March 2020, the World Health Organization declared a global pandemic due to the novel coronavirus SARS-CoV-2 and several governments planned a national quarantine in order to control the virus spread. Acute psychological effects of quarantine in frail elderly subjects with special needs, such as patients with dementia, have been poorly investigated. The aim of this study was to assess modifications of neuropsychiatric symptoms during quarantine in patients with dementia and their caregivers.

          Methods

          This is a sub-study of a multicenter nation-wide survey. A structured telephone interview was delivered to family caregivers of patients with diagnosis of Alzheimer disease (AD), dementia with Lewy bodies (DLB), frontotemporal dementia (FTD), and vascular dementia (VD), followed regularly at 87 Italian memory clinics. Variations in behavioral and psychological symptoms (BPSD) were collected after 1 month since quarantine declaration and associations with disease type, severity, gender, and caregiver’s stress burden were analyzed.

          Results

          A total of 4,913 caregivers participated in the survey. Increased BPSD was reported in 59.6% of patients as worsening of preexisting symptoms (51.9%) or as new onset (26%), and requested drug modifications in 27.6% of these cases. Irritability, apathy, agitation, and anxiety were the most frequently reported worsening symptoms and sleep disorder and irritability the most frequent new symptoms. Profile of BPSD varied according to dementia type, disease severity, and patients’ gender. Anxiety and depression were associated with a diagnosis of AD (OR 1.35, CI: 1.12–1.62), mild to moderate disease severity and female gender. DLB was significantly associated with a higher risk of worsening hallucinations (OR 5.29, CI 3.66–7.64) and sleep disorder (OR 1.69, CI 1.25–2.29), FTD with wandering (OR 1.62, CI 1.12–2.35), and change of appetite (OR 1.52, CI 1.03–2.25). Stress-related symptoms were experienced by two-thirds of caregivers and were associated with increased patients’ neuropsychiatric burden (p<0.0001).

          Conclusion

          Quarantine induces a rapid increase of BPSD in approximately 60% of patients and stress-related symptoms in two-thirds of caregivers. Health services need to plan a post-pandemic strategy in order to address these emerging needs.

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          Most cited references54

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          Clinical Characteristics of Coronavirus Disease 2019 in China

          Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)
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            Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China

            In December 2019, novel coronavirus (2019-nCoV)-infected pneumonia (NCIP) occurred in Wuhan, China. The number of cases has increased rapidly but information on the clinical characteristics of affected patients is limited.
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              Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia

              Abstract Background The initial cases of novel coronavirus (2019-nCoV)–infected pneumonia (NCIP) occurred in Wuhan, Hubei Province, China, in December 2019 and January 2020. We analyzed data on the first 425 confirmed cases in Wuhan to determine the epidemiologic characteristics of NCIP. Methods We collected information on demographic characteristics, exposure history, and illness timelines of laboratory-confirmed cases of NCIP that had been reported by January 22, 2020. We described characteristics of the cases and estimated the key epidemiologic time-delay distributions. In the early period of exponential growth, we estimated the epidemic doubling time and the basic reproductive number. Results Among the first 425 patients with confirmed NCIP, the median age was 59 years and 56% were male. The majority of cases (55%) with onset before January 1, 2020, were linked to the Huanan Seafood Wholesale Market, as compared with 8.6% of the subsequent cases. The mean incubation period was 5.2 days (95% confidence interval [CI], 4.1 to 7.0), with the 95th percentile of the distribution at 12.5 days. In its early stages, the epidemic doubled in size every 7.4 days. With a mean serial interval of 7.5 days (95% CI, 5.3 to 19), the basic reproductive number was estimated to be 2.2 (95% CI, 1.4 to 3.9). Conclusions On the basis of this information, there is evidence that human-to-human transmission has occurred among close contacts since the middle of December 2019. Considerable efforts to reduce transmission will be required to control outbreaks if similar dynamics apply elsewhere. Measures to prevent or reduce transmission should be implemented in populations at risk. (Funded by the Ministry of Science and Technology of China and others.)
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                Author and article information

                Contributors
                Journal
                Front Psychiatry
                Front Psychiatry
                Front. Psychiatry
                Frontiers in Psychiatry
                Frontiers Media S.A.
                1664-0640
                09 September 2020
                2020
                09 September 2020
                : 11
                : 578015
                Affiliations
                [1] 1 Department of Neuroscience (DNS), University of Padua , Padua, Italy
                [2] 2 Regional Neurogenetic Centre, Department of Primary Care, ASP-CZ , Catanzaro, Italy
                [3] 3 Memory Clinic, Fondazione Policlinico Gemelli, IRCCS Università, Cattolica del Sacro Cuore , Rome, Italy
                [4] 4 Department of Neuroscience, Imaging and Clinical Sciences, University G. d’Annunzio of Chieti-Pescara , Chieti, Italy
                [5] 5 CDCD Ospedale del Delta, AUSL Ferrara , Ferrara, Italy
                [6] 6 Department of Neuroscience and Mental Health, AOU Città della Salute e della Scienza di Torino , Turin, Italy
                [7] 7 Aging Brain and Memory Clinic, Department of Neuroscience, University of Torino , Turin, Italy
                [8] 8 Department of Molecular Biotechnology and Health Sciences, University of Torino , Turin, Italy
                [9] 9 Center for Omics Sciences, IRCCS San Raffaele Scientific Institute , Milan, Italy
                [10] 10 Department of Medicine and Surgery and Milan Center for Neuroscience (NeuroMi), University of Milano – Bicocca , Monza, Italy
                [11] 11 National Institute of Health , Rome, Italy
                [12] 12 Division of Neuroscience, IRCCS San Raffaele Scientific Institute , Milan, Italy
                [13] 13 Vita-Salute San Raffaele University , Milan, Italy
                [14] 14 Unit of Neuroscience, University of Parma , Parma, Italy
                [15] 15 Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain, University of Bari , Bari, Italy
                [16] 16 Department of Basic Medicine Neuroscience and Sense Organs, University Aldo Moro Bari , Bari, Italy
                [17] 17 Department of Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli” , Naples, Italy
                Author notes

                Edited by: Katie Palmer, Catholic University of the Sacred Heart—Rome, Italy

                Reviewed by: Manabu Ikeda, Osaka University, Japan; Josep Garre-Olmo, Institute of Biomedical Research of Girona, Spain

                *Correspondence: Annachiara Cagnin, annachiara.cagnin@ 123456unipd.it

                †A list of the collaborators in the SINdem COVID-19 Study Group is found in the Appendix

                This article was submitted to Aging Psychiatry, a section of the journal Frontiers in Psychiatry

                Article
                10.3389/fpsyt.2020.578015
                7509598
                33033486
                dc6aadcb-79e4-456a-bcd5-3e5a0503759f
                Copyright © 2020 Cagnin, Di Lorenzo, Marra, Bonanni, Cupidi, Laganà, Rubino, Vacca, Provero, Isella, Vanacore, Agosta, Appollonio, Caffarra, Pettenuzzo, Sambati, Quaranta, Guglielmi, Logroscino, Filippi, Tedeschi, Ferrarese, Rainero, Bruni and SINdem COVID-19 Study Group

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 30 June 2020
                : 18 August 2020
                Page count
                Figures: 8, Tables: 3, Equations: 0, References: 53, Pages: 15, Words: 5887
                Categories
                Psychiatry
                Original Research

                Clinical Psychology & Psychiatry
                behavioral and psychological symptoms,behavioral symptoms,psychological symptoms,quarantine,dementia,caregiver,coronavirus disease,gender

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