Behavioral, Environmental and Pharmacotherapy Challenges in Dementia during COVID-19 Pandemic: Solutions and Management Issues
Abstract
With the increase in the world's elderly population, age-related disorders such as cognitive disorders and dementia have increased in this group, and with the onset of the COVID-19 pandemic in 2019, many of the world's rules and regulations have changed, and personal protection recommendations against infection have been recommended by various medical centers, which is very challenging for patients with dementia and can even lead to the development or exacerbation of behavioral symptoms in their everyday life.
On the other hand, caregivers of dementia patients are exposed to the burden of disease caused by the stress of transmitting infection along with the usual care needed for dementia patients, which has definitely increased this time during the pandemic. Therefore, caregivers of dementia patients, both at home and in care centers, need the advice to care for patients and prevent pandemic physical and psychological complications on themselves and their patients.
Regarding the administration of drugs effective on COVID-19 infection and the possibility of their interaction with drugs prescribed in patients with dementia or cognitive complications, delirium, and exacerbation of dementia, there is a need for solutions that are briefly reviewed in this report. It is hoped to provide assistance and support in providing services and care to dementia patients, health care providers, and physicians.
1. Wang H, Li T, Barbarino P, et al. Dementia care during COVID-19. Lancet.2020;395.
2. Alzheimer’s Disease International. ADI offers advice and support during COVID-19. https://www.alz.co.uk/news/March 17, 2020.
3. Ahmed MZ, Ahmed O, Aibao Z, Hanbin S, Siyu L, Ahmad A. Epidemic of COVID-19 in China and associated Psychological Problems. Asian J Psychiatr 2020;51:102092.
4. Hao F, Tan W, Jiang L, et al. Do psychiatric patients experience more psychiatric symptoms during COVID-19 pandemic and lockdown? A case-control study with service and research implications for immunopsychiatry. Brain Behav Immun 2020;87:100-6.
5. Montemurro N. The emotional impact of COVID-19: From medical staff to common people. Brain Behav Immun 2020;87:23-4.
6. Brown E, Kumar S, Rajji T, Pollock B, Mulsant B. Anticipating and Mitigating the Impact of COVID-19 Pandemic on Alzheimer's Disease and Related Dementias. Am J Geriatr Psychiatry 2020; 28(7): 712–721.
7. Ostuzzi G, Papola D, Gastaldon C, et al. Safety of psychotropic medications in people with COVID-19: evidence review and practical recommendations. BMC Med 2020;18(1):215.
8. Parsons C. Polypharmacy and inappropriate medication use in patients with dementia: an underresearched problem. Ther Adv Drug Saf 2017;8(1):31-46.
9. Tuijt R, Frost R, Wilcock J, Ret al. Life under lockdown and social restrictions - the experiences of people living with dementia and their carers during the COVID-19 pandemic in England. BMC Geriatrics 2021;21(1):301.
10. Cagnin A, Di Lorenzo R, Marra C, et al. Behavioral and psychological effects of coronavirus disease-19 quarantine in patients with dementia. Front Psychiatry 2020;11: 578015.
11. Wang H, Li T, Barbarino P, Gauthier S, et al. Dementia care during COVID-19. Lancet 2020;395(10231):1190-1.
12. Sutcliffe C, Giebel C, Bleijlevens M, et al. Caring for a Person With Dementia on the Margins of Long-Term Care: A Perspective on Burden From 8 European Countries. J Am Med Dir Assoc 2017;18(11):967-73.e1.
13. Kozloff N, Mulsant BH, Stergiopoulos V, Voineskos AN. The COVID-19 Global Pandemic: Implications for People With Schizophrenia and Related Disorders. Schizophr Bull 2020;46(4):752-7.
14. Husebo BS, Heintz HL, Berge LI, Owoyemi P, Rahman AT, Vahia IV. Sensing Technology to Monitor Behavioral and Psychological Symptoms and to Assess Treatment Response in People With Dementia. A Systematic Review. Front Pharmacol 2020;10:1699.
15. Boots LMM, de Vugt ME, van Knippenberg RJM, Kempen GIJM, Verhey FRJ. A systematic review of Internet-based supportive interventions for caregivers of patients with dementia. International Journal of Geriatric Psychiatry 2014;29(4):331-44.
16. Mok VCT, Pendlebury S, Wong A, et al. Tackling challenges in care of Alzheimer's disease and other dementias amid the COVID-19 pandemic, now and in the future. Alzheimers Dement 2020;16(11):1571-81.
17. Lim WS, Liang CK, Assantachai P, et al. COVID-19 and older people in Asia: Asian Working Group for Sarcopenia calls to action. Geriatr Gerontol Int 2020;20(6):547-58.
18. Ranney ML, Griffeth V, Jha AK. Critical Supply Shortages - The Need for Ventilators and Personal Protective Equipment during the Covid-19 Pandemic. New Engl J Med 2020;382(18):e41.
19. Trabucchi M, De Leo D. Nursing homes or besieged castles: COVID-19 in northern Italy. Lancet Psychiatry 2020;7(5):387-8.
20. Therapeutics and COVID-19: living guideline. WHO 2020. Available from:URL: https://www.who.int/publications/i/item/WHO-2019-nCoV-therapeutics-2021.
21. Balli F, Kara E, Demirkan SK. The another side of COVID-19 in Alzheimer’s disease patients: Drug-drug interactions. Int J Clin Pract 2020;74(10):e13596.
22. Ho V, Tee C, See KC. Drug interactions with potential antivirals used for COVID-19 in older persons. Geriatr Gerontol Int 2020;20(7):737-9.
23. Campos C, Rocha NBF, Teles et al. Treatment of cognitive deficits in Alzheimer's disease: A psychopharmacological review. Psychiatr Danub 2016;28(1):2-12.
24. Cacabelos R. Donepezil in Alzheimer’s disease: From conventional trials to pharmacogenetics. Neuropsychiatr Dis Treat 2007;3(3):303.
25. Colovic MB, Krstic DZ, Lazarevic-Pasti TD, Bondzic AM, Vasic VM. Acetylcholinesterase inhibitors: pharmacology and toxicology. Curr Neuropharmacol 2013;11(3):315-35.
26. Kumar A, Sharma S. Donepezil. StatPearls [Internet]: StatPearls Publishing; 2019.
27. von Hentig N, Lötsch J. Cytochrome P450 3A inhibition by atazanavir and ritonavir, but not demography or drug formulation, influences saquinavir population pharmacokinetics in human immunodeficiency virus type 1-infected adults. Antimicrob agents chemother 2009;53(8):3524-7.
28. Tiseo P, Perdomo C, Friedhoff L. Metabolism and elimination of 14C-donepezil in healthy volunteers: a single-dose study. Brit J Clin Pharmacol 1998;46(Suppl 1):19.
29. Tiseo P, Perdomo C, Friedhoff L. Concurrent administration of donepezil HCl and ketoconazole: assessment of pharmacokinetic changes following single and multiple doses. Brit J Clin Pharmacol 1998;46(Suppl 1):30.
30. Tönnesmann E, Kandolf R, Lewalter T. Chloroquine cardiomyopathy–a review of the literature. Immunopharmacol immunotoxicol 2013;35(3):434-42.
31. Takaya T, Okamoto M, Yodoi K, et al. Torsades de Pointes with QT prolongation related to donepezil use. J Cardiol 2009;54(3):507-11.
32. Scott LJ, Goa KL. Galantamine. Drugs 2000;60(5):1095-122.
33. Grossberg GT, Tong G, Burke AD, Tariot PN. Present algorithms and future treatments for Alzheimer’s disease. J Alzheimers Dis 2019;67(4):1157-71.
34. Lim ML, Min SS, Eron JJ, et al. Coadministration of lopinavir/ritonavir and phenytoin results in two-way drug interaction through cytochrome P-450 induction. Journal of Acquired Immune Deficiency Syndromes 2004;36(5):1034-40.
35. López-Cortés LF. Pharmacology, pharmacokinetics and interactions of atazanavir. Infectious Diseases and Clinical Microbiology 2008;26:2-8.
36. Kayrak M, Yazici M, Ayhan SS, Koc F, Ulgen MS. Complete atrioventricular block associated with rivastigmine therapy. Am J Health Syst Pharm 2008;65(11):1051-3.
37. Knudtzen FC, Christophersen TB. Third degree atrioventricular block associated with treatment with rivastigmine transdermal patch. J Geriatr Cardiol 2013;10(1):113.
38. Amley X, Mastrine L, Esses J, Hollander G. Rivastigmine adverse effects: complete heart block. North American Journal of Medicine and Science 2010;3(4):199-200.
39. Chen CY, Wang FL, Lin CC. Chronic hydroxychloroquine use associated with QT prolongation and refractory ventricular arrhythmia. Clin Toxicol 2006;44(2):173-5.
40. McShane R, Westby MJ, Roberts E, et al. Memantine for dementia. Cochrane Database Syst Rev 2019; 2019(3): CD003154.
41. Robinson DM, Keating GM. Memantine. Drugs 2006;66(11):1515-34.
42. Micuda S, Mundlova L, Anzenbacherova E, et al. Inhibitory effects of memantine on human cytochrome P450 activities: prediction of in vivo drug interactions. Europ J Clin Pharmacol 2004;60(8):583-9.
43. Cheng Y, Luo R, Wang K, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int 2020;97(5).
44. Ronco C, Reis T. Kidney involvement in COVID-19 and rationale for extracorporeal therapies. Nature Reviews Nephrology 2020;16:1-3.
45. Farlow MR. Clinical pharmacokinetics of galantamine. Clin Pharmacokinetics 2003;42(15):1383-92.
46. Lefevre G, Callegari F, Gsteiger S, Xiong Y. Effects of renal impairment on steady-state plasma concentrations of rivastigmine: a population pharmacokinetic analysis of capsule and patch formulations in patients with Alzheimer’s disease. Drugs Aging 2016;33(10):725-36.
47. Periclou A, Ventura D, Rao N, Abramowitz W. Pharmacokinetic study of memantine in healthy and renally impaired subjects. Clin Pharmacol Ther 2006;79(1):134-43.
48. Zhang C, Shi L, Wang F-S. Liver injury in COVID-19: management and challenges. Lancet Gastroenterol Hepatol 2020;5(5):428-30.
49. Zhao Q, Iyer GR, Verhaeghe T, Truyen L. Pharmacokinetics and safety of galantamine in subjects with hepatic impairment and healthy volunteers. J Clin Pharmacol 2002;42(4):428-36.
50. Spencer CM, Noble S. Rivastigmine. Drugs Aging 1998;13(5):391-411.
51. Shams GE-DA, Khairy MH, Saleh MA, Antar SA. Adverse Effects of Memantine. Zagazig Veterinary Journal 2017;45(Supplementary 1):221-34.
52. Shams GED, Khairy MH, Saleh MA, Antar SA. Protective Effects of Vitamin E on Memantine Adverse Effects. Zagazig Veterinary Journal 2017;45(Supplementary 1):277-88.
2. Alzheimer’s Disease International. ADI offers advice and support during COVID-19. https://www.alz.co.uk/news/March 17, 2020.
3. Ahmed MZ, Ahmed O, Aibao Z, Hanbin S, Siyu L, Ahmad A. Epidemic of COVID-19 in China and associated Psychological Problems. Asian J Psychiatr 2020;51:102092.
4. Hao F, Tan W, Jiang L, et al. Do psychiatric patients experience more psychiatric symptoms during COVID-19 pandemic and lockdown? A case-control study with service and research implications for immunopsychiatry. Brain Behav Immun 2020;87:100-6.
5. Montemurro N. The emotional impact of COVID-19: From medical staff to common people. Brain Behav Immun 2020;87:23-4.
6. Brown E, Kumar S, Rajji T, Pollock B, Mulsant B. Anticipating and Mitigating the Impact of COVID-19 Pandemic on Alzheimer's Disease and Related Dementias. Am J Geriatr Psychiatry 2020; 28(7): 712–721.
7. Ostuzzi G, Papola D, Gastaldon C, et al. Safety of psychotropic medications in people with COVID-19: evidence review and practical recommendations. BMC Med 2020;18(1):215.
8. Parsons C. Polypharmacy and inappropriate medication use in patients with dementia: an underresearched problem. Ther Adv Drug Saf 2017;8(1):31-46.
9. Tuijt R, Frost R, Wilcock J, Ret al. Life under lockdown and social restrictions - the experiences of people living with dementia and their carers during the COVID-19 pandemic in England. BMC Geriatrics 2021;21(1):301.
10. Cagnin A, Di Lorenzo R, Marra C, et al. Behavioral and psychological effects of coronavirus disease-19 quarantine in patients with dementia. Front Psychiatry 2020;11: 578015.
11. Wang H, Li T, Barbarino P, Gauthier S, et al. Dementia care during COVID-19. Lancet 2020;395(10231):1190-1.
12. Sutcliffe C, Giebel C, Bleijlevens M, et al. Caring for a Person With Dementia on the Margins of Long-Term Care: A Perspective on Burden From 8 European Countries. J Am Med Dir Assoc 2017;18(11):967-73.e1.
13. Kozloff N, Mulsant BH, Stergiopoulos V, Voineskos AN. The COVID-19 Global Pandemic: Implications for People With Schizophrenia and Related Disorders. Schizophr Bull 2020;46(4):752-7.
14. Husebo BS, Heintz HL, Berge LI, Owoyemi P, Rahman AT, Vahia IV. Sensing Technology to Monitor Behavioral and Psychological Symptoms and to Assess Treatment Response in People With Dementia. A Systematic Review. Front Pharmacol 2020;10:1699.
15. Boots LMM, de Vugt ME, van Knippenberg RJM, Kempen GIJM, Verhey FRJ. A systematic review of Internet-based supportive interventions for caregivers of patients with dementia. International Journal of Geriatric Psychiatry 2014;29(4):331-44.
16. Mok VCT, Pendlebury S, Wong A, et al. Tackling challenges in care of Alzheimer's disease and other dementias amid the COVID-19 pandemic, now and in the future. Alzheimers Dement 2020;16(11):1571-81.
17. Lim WS, Liang CK, Assantachai P, et al. COVID-19 and older people in Asia: Asian Working Group for Sarcopenia calls to action. Geriatr Gerontol Int 2020;20(6):547-58.
18. Ranney ML, Griffeth V, Jha AK. Critical Supply Shortages - The Need for Ventilators and Personal Protective Equipment during the Covid-19 Pandemic. New Engl J Med 2020;382(18):e41.
19. Trabucchi M, De Leo D. Nursing homes or besieged castles: COVID-19 in northern Italy. Lancet Psychiatry 2020;7(5):387-8.
20. Therapeutics and COVID-19: living guideline. WHO 2020. Available from:URL: https://www.who.int/publications/i/item/WHO-2019-nCoV-therapeutics-2021.
21. Balli F, Kara E, Demirkan SK. The another side of COVID-19 in Alzheimer’s disease patients: Drug-drug interactions. Int J Clin Pract 2020;74(10):e13596.
22. Ho V, Tee C, See KC. Drug interactions with potential antivirals used for COVID-19 in older persons. Geriatr Gerontol Int 2020;20(7):737-9.
23. Campos C, Rocha NBF, Teles et al. Treatment of cognitive deficits in Alzheimer's disease: A psychopharmacological review. Psychiatr Danub 2016;28(1):2-12.
24. Cacabelos R. Donepezil in Alzheimer’s disease: From conventional trials to pharmacogenetics. Neuropsychiatr Dis Treat 2007;3(3):303.
25. Colovic MB, Krstic DZ, Lazarevic-Pasti TD, Bondzic AM, Vasic VM. Acetylcholinesterase inhibitors: pharmacology and toxicology. Curr Neuropharmacol 2013;11(3):315-35.
26. Kumar A, Sharma S. Donepezil. StatPearls [Internet]: StatPearls Publishing; 2019.
27. von Hentig N, Lötsch J. Cytochrome P450 3A inhibition by atazanavir and ritonavir, but not demography or drug formulation, influences saquinavir population pharmacokinetics in human immunodeficiency virus type 1-infected adults. Antimicrob agents chemother 2009;53(8):3524-7.
28. Tiseo P, Perdomo C, Friedhoff L. Metabolism and elimination of 14C-donepezil in healthy volunteers: a single-dose study. Brit J Clin Pharmacol 1998;46(Suppl 1):19.
29. Tiseo P, Perdomo C, Friedhoff L. Concurrent administration of donepezil HCl and ketoconazole: assessment of pharmacokinetic changes following single and multiple doses. Brit J Clin Pharmacol 1998;46(Suppl 1):30.
30. Tönnesmann E, Kandolf R, Lewalter T. Chloroquine cardiomyopathy–a review of the literature. Immunopharmacol immunotoxicol 2013;35(3):434-42.
31. Takaya T, Okamoto M, Yodoi K, et al. Torsades de Pointes with QT prolongation related to donepezil use. J Cardiol 2009;54(3):507-11.
32. Scott LJ, Goa KL. Galantamine. Drugs 2000;60(5):1095-122.
33. Grossberg GT, Tong G, Burke AD, Tariot PN. Present algorithms and future treatments for Alzheimer’s disease. J Alzheimers Dis 2019;67(4):1157-71.
34. Lim ML, Min SS, Eron JJ, et al. Coadministration of lopinavir/ritonavir and phenytoin results in two-way drug interaction through cytochrome P-450 induction. Journal of Acquired Immune Deficiency Syndromes 2004;36(5):1034-40.
35. López-Cortés LF. Pharmacology, pharmacokinetics and interactions of atazanavir. Infectious Diseases and Clinical Microbiology 2008;26:2-8.
36. Kayrak M, Yazici M, Ayhan SS, Koc F, Ulgen MS. Complete atrioventricular block associated with rivastigmine therapy. Am J Health Syst Pharm 2008;65(11):1051-3.
37. Knudtzen FC, Christophersen TB. Third degree atrioventricular block associated with treatment with rivastigmine transdermal patch. J Geriatr Cardiol 2013;10(1):113.
38. Amley X, Mastrine L, Esses J, Hollander G. Rivastigmine adverse effects: complete heart block. North American Journal of Medicine and Science 2010;3(4):199-200.
39. Chen CY, Wang FL, Lin CC. Chronic hydroxychloroquine use associated with QT prolongation and refractory ventricular arrhythmia. Clin Toxicol 2006;44(2):173-5.
40. McShane R, Westby MJ, Roberts E, et al. Memantine for dementia. Cochrane Database Syst Rev 2019; 2019(3): CD003154.
41. Robinson DM, Keating GM. Memantine. Drugs 2006;66(11):1515-34.
42. Micuda S, Mundlova L, Anzenbacherova E, et al. Inhibitory effects of memantine on human cytochrome P450 activities: prediction of in vivo drug interactions. Europ J Clin Pharmacol 2004;60(8):583-9.
43. Cheng Y, Luo R, Wang K, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int 2020;97(5).
44. Ronco C, Reis T. Kidney involvement in COVID-19 and rationale for extracorporeal therapies. Nature Reviews Nephrology 2020;16:1-3.
45. Farlow MR. Clinical pharmacokinetics of galantamine. Clin Pharmacokinetics 2003;42(15):1383-92.
46. Lefevre G, Callegari F, Gsteiger S, Xiong Y. Effects of renal impairment on steady-state plasma concentrations of rivastigmine: a population pharmacokinetic analysis of capsule and patch formulations in patients with Alzheimer’s disease. Drugs Aging 2016;33(10):725-36.
47. Periclou A, Ventura D, Rao N, Abramowitz W. Pharmacokinetic study of memantine in healthy and renally impaired subjects. Clin Pharmacol Ther 2006;79(1):134-43.
48. Zhang C, Shi L, Wang F-S. Liver injury in COVID-19: management and challenges. Lancet Gastroenterol Hepatol 2020;5(5):428-30.
49. Zhao Q, Iyer GR, Verhaeghe T, Truyen L. Pharmacokinetics and safety of galantamine in subjects with hepatic impairment and healthy volunteers. J Clin Pharmacol 2002;42(4):428-36.
50. Spencer CM, Noble S. Rivastigmine. Drugs Aging 1998;13(5):391-411.
51. Shams GE-DA, Khairy MH, Saleh MA, Antar SA. Adverse Effects of Memantine. Zagazig Veterinary Journal 2017;45(Supplementary 1):221-34.
52. Shams GED, Khairy MH, Saleh MA, Antar SA. Protective Effects of Vitamin E on Memantine Adverse Effects. Zagazig Veterinary Journal 2017;45(Supplementary 1):277-88.
| Files | ||
| Issue | Vol 9, No 3 (Summer 2021) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/jpc.v9i3.7374 | |
| Keywords | ||
| Dementia; COVID-19; Behavior; Environment; Pharmacotherapy | ||
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How to Cite
1.
Mohammadian F, Moghadamnia M, Talebi A, Mohebbi N. Behavioral, Environmental and Pharmacotherapy Challenges in Dementia during COVID-19 Pandemic: Solutions and Management Issues. J Pharm Care. 2021;9(3):148-151.
