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Patients with dementia are at high risk for COVID-19

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A new study reveals how dementia can increase the risk of developing COVID-19, especially between two groups of African Americans and people with vascular dementia.

Heading findings Recent research Overall, people with dementia were found to face twice the risk of COVID-19 infection as adults without dementia. But the other two results from that study are more remarkable than ever.

First, African-Americans with dementia were three times more likely to develop COVID-19 and were more likely to be life-threatening if they did. African Americans with both dementia and COVID-19 have higher hospitalization rates (73% compared to 54%) and mortality rates compared to 19% of whites 23. %it was high.From the point of view Health inequalities already in color, This is especially annoying.

The study also found that patients with vascular dementia were at the highest risk among patients with COVID-19 dementia. This type of dementia is associated with stroke and damage to small blood vessels, reducing blood flow to the white matter of the brain and damaging connections between neurons. This damage can be confirmed by an MRI scan. With sufficient damage, cognitive function can be impaired.

We are both neurologists.One of us Psychiatrist And other Deputy Director This study is interesting, if not definitive, at the McKnight Brain Institute at the University of Florida. This is at least a step towards understanding the relationship between dementia and an increased predisposition to acquire COVID-19.

Danger to blood vessels

There is evidence of COVID-19 Causes many vascular changes Whole body. It targets the endothelium, which is the inner layer of blood vessels, and contributes to damage and inflammation of blood vessels. These injuries can then cause blood clots in the lungs and toes. “COVID toes.”

One of the major questions raised in this study is how these vascular changes due to COVID-19 may affect the brain.

Although COVID-19 rarely invades the brain directly, Inflammation of blood vessels in the brain It occurs in some patients. Extensive brain inflammation in a patient can manifest itself as a loss of attention, concentration, and awareness of the environment. Encephalopathy Or delirium. Vascular and inflammatory factors are already known to contribute to dementia in the absence of viral infections. Additional damage from the infection can exacerbate vascular damage and inflammation, reduce blood flow, and cause additional brain damage (ischemia) and minor strokes.

These two facts may support the research claims on the risk of poor outcomes in patients with dementia with COVID-19 infection.

Some questions to consider

The study is based on data collected in the United States from February to August 2020 from 360 hospitals, more than 300,000 healthcare providers, and 1,064,960 patients with all types of dementia. This group included 15,770 patients diagnosed with COVID-19, of whom 810 had dementia.

In their statistical analysis, Researchers managed whether older people and patients live in nursing homes. Both are independently associated with increased risk of COVID-19 and worsening outcomes. They also took into account whether the patient is known to have cardiovascular disease and diabetes. Even when managing these factors, that is, statistically excluding them from the risk calculation, people with dementia were at twice the risk.

However, this survey has some limitations.

Its statistical analysis was entirely based on medical diagnostic codes from electronic medical records. Did all clinicians use exactly the same criteria when making the diagnosis compared to dementia specialists? We do not know. Also, the diagnostic code does not provide information about the severity of dementia. There is also a great deal of overlap between the dementia subtypes. It is not uncommon for patients diagnosed with Alzheimer’s disease to also have serious cerebrovascular disease that contributes to cognitive impairment.

The data are also from the first 6 months of the pandemic, Treatment strategy Since then, COVID-19 has evolved with better results.

Protection of vulnerable patients

Patients with dementia are already at increased risk of COVID-19 because they may live in a nearby chronic treatment facility. Many cannot defend themselves and may not understand the need to wear a mask and the social distance. This can make you more susceptible to infection.

When studying the special risks COVID-19 poses to patients with dementia, healthcare providers need to ensure that they take basic steps to protect these most vulnerable patients.

This article has been republished by The Conversation under a Creative Commons license. Read the original article here..

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