The Impact of Coronavirus Infection on The Relationship Between Quality of Life and Cognitive and Emotional Impairments in Individuals With Mild Vascular Dementia

Relevance. The coronavirus pandemic has had the most painful impact on older patients, including those living in social homes. Residents of closed-type care facilities are more at risk of contracting novel coronavirus infection (COVID-19) due to overcrowding and frequent contact with staff. They often experience a loss of support, there is forced social isolation amid anti-epidemic measures, and there is a decrease in cognitive stimulation. All these factors cause emotional disorders of the anxiety-depressive spectrum, and accelerate the decline of cognitive functions. Patients with acquired dementia are more sensitive to COVID­-19, since its risk factors are identical to the risk factors for vascular dementia (cardiovascular diseases, obesity, diabetes mellitus); and, in addition, mental disorders themselves prevent patients from complying with preventive measures. The study of cognitive and non­cognitive impairments in people after COVID­-19 is associated with the obvious need for their better psychological adaptation to cognitive dysfunction in vascular dementia, improving quality of life (QOL) and functional independence.

Aim: to study the dependence of quality of life on cognitive and emotional disorders in patients with mild vascular dementia following COVID-19. Materials and methods. We studied 132 residents (67 men, 65 women; mean age 73.05±3.48 years) from the “Severnoye Izmailovo” nursing home, the Department of Labor and Social Protection of the Population of Moscow, with mild vascular dementia (according to ICD­10 diagnostic criteria). We identified two comparison groups: subjects with a duration of clinical onset of COVID-19 confirmed by a positive PCR test, 6 months +/– 1 month, with an outcome of recovery confirmed by a negative PCR test (n = 65; 33 men, 32 women), and non-survivors of COVID­-19 (hospital control group) (n = 67; 34 men, 33 women). The gender and age composition of the compared groups was homogeneous (p > 0.05). To study the quality of life of patients, we used the Quality of LifeAlzheimer's Disease (QoL-AD) questionnaire, which includes the study of selfassessment of quality of life (QoL-AD-SR (self-rating)) and proxy rating of quality of life (indirect assessment QoL by caregivers (QoL-AD-PR (proxy rating)) This questionnaire assessed the following areas of QoL: physical health, strength, mood, living conditions, memory, family, marriage (relationships with loved ones), friends, general self-esteem , ability to do housework, ability to have fun, money, life in general. To evaluate the current emotional state, the Cornell Scale for Depression in Dementia (SCDD; probable depression was diagnosed when a score exceeded 10) was used. In addition, to estimatete cognitive status of patients, we used the Montreal Cognitive Assessment (MoCA), which assesses various cognitive areas: attention and concentration, executive functions, memory, language, visual constructive skills, abstract thinking, counting and orientation. Cognitive dysfunction was recorded when the result was less than 26 points on this scale. Statistical processing of the study data was carried out using the Statistica 6.0 package.

Results and discussion. It was found that COVID-19 aggravated cognitive deficits in older people with LSD (MoCA 20.80 ± 0.59 / 21.40 ± 0.78 points; p<0.05) in the absence of depression (SCDD 1.52 ± 0 .50 / 1.52 ± 0.84 points in the group of survivors of COVID-­19 / hospital control group, respectively; p > 0.05). The results obtained indicated direct damage to the brain contributed by COVID­19 have led to increased existing cognitive impairment in persons with vascular dementia. Self-assessment of quality of life (QoL-AD-SR) in persons with mild vascular dementia was 30.32 ± 2.89 points. In patients who recovered from COVID­19 and 29.76 ± 4.08 b. in those who were not ill, and the proxy rating of quality of life (QoL-AD-PR) was 30.26 ± 2.08 points and 29.22 ± 3.67 b. in the study groups, respectively, without statistical differences between them (p > 0.05). Such results were explained by the fact that in patients living in psychoneurological boarding schools, “pre-Covid” cognitive disorders and somatogenic asthenia “mask” the progressive deterioration of QoL.

In survivors of COVID-19, a correlation was found between the proxy rating of QoL and the severity of cognitive dysfunction according to MoCA (R = — 0.28); and in the hospital control group — between the proxy rating of QoL and the severity of depressive symptoms (R = — 0.33). No other significant correlations were found in the study groups between self-assessment of quality of life (QoL-AD-SR) and the severity of cognitive and emotional disorders.

In other words, there was a correlation between progressive cognitive impairment and QoL in older individuals with LSD following COVID-19. They showed symptoms of irritable weakness as part of the asthenic variant of the psychoorganic syndrome; There was a worsening of labile cerebrastia due to an increase in cognitive disorders with a decrease in the proxy assessment of QoL, which caused intrapersonal disadaptation (“capitulation” to the disease, “withdrawal”) and required individual forms of psychotherapeutic work (cognitive training).

In addition, a correlation was found between the severity of depressive symptoms and quality of life in older individuals with mild vascular dementia without comorbidity with previous COVID-19. This cohort of patients was distinguished by an acute experience of feelings of loneliness and worthlessness, a pessimistic worldview, vulnerability, concern about unfavorable assessments of others (patients were afraid of pity and being a burden, which led to instability of mood in interpersonal contacts), which indicated their interpersonal maladaptation, requiring group forms of psychotherapeutic correction of negative emotional experiences.

Conclusions. In older patients — residents of psychoneurological boarding schools, suffering from mild vascular dementia and having undergone COVID-19, there is a significant worsening of only cognitive deficit, without depressive manifestations. COVID-19 worsens the proxy assessment of their QOL due to worsening cognitive deficits. In “covid-free” patients, the proxy rating of QoL has a correlation with the severity of emotional disturbances. The identified patterns can contribute to the optimization of personalized models of medical and psychological rehabilitation of older patients with mild vascular dementia living in psychoneurological boarding schools. To improve psychological adaptation to cognitive deficit and improve quality of life in this cohort of patients, individual cognitive training is advisable among those who have suffered from mild vascular dementia, and group psychotherapeutic correction of negative emotional experiences among those who have not suffered from COVID-19.