Ron Petersen, MD, PhD, FAAN, explains the impact of COVID-19 on Alzheimer’s disease patients
Ron Petersen, MD, PhD, FAAN, Professor at the Mayo Clinic College of Medicine, Behavioral Neurologist and Director of the Mayo Clinic Alzheimer’s Disease Research Center, hosted a Facebook Live with the American Brain Foundation to speak about COVID-19 and its impact on those with Alzheimer’s disease. From risk factors and preventive measures to suggestions for explaining the pandemic to loved ones with Alzheimer’s disease, watch Dr. Petersen’s video to learn more about Alzheimer’s and COVID-19.
COVID-19 Impact and Risk Factors
To understand the risk factors of COVID-19 for those with Alzheimer’s, it’s important to understand that Alzheimer’s is a degenerative disease of the brain. It’s also the most common cause of dementia for individuals in their 70s and 80s. According to Dr. Petersen, “There is nothing in the biology of Alzheimer’s itself that would make a person more susceptible to COVID-19.” However, he explains, patients diagnosed with Alzheimer’s are likely older and at greater risk for complications just by virtue of age. In addition, these patients may have other conditions such as heart disease. They may also have an immune system that is not as efficient at fighting off infection.
Dr. Petersen notes that the impact of COVID-19 infection on a patient with Alzheimer’s depends on the patient’s stage in progression of the disease. However, regardless of stage, it complicates life for someone already experiencing cognitive impairment.
Preventive Measures for Caregivers and Patients with Alzheimer’s
When it comes to preventing COVID-19 infection in individuals with Alzheimer’s, the responsibility lies with the caregiver(s). All caregivers who live in the home, including family members, should follow protective measures such as frequent handwashing, keeping social distance and wearing a mask to minimize risk to the household.
If one or more caregivers enter the home from elsewhere, it is appropriate to follow the typical COVID-19 questioning. Ask if they are well, had any symptoms, or been exposed to someone who might be carrying the COVID-19 virus. These caregivers should follow the recommendations and practice social distancing to the best of their abilities, though Dr. Petersen says it may be difficult as they must provide care to the person with Alzheimer’s. He proposes that these at-home caregivers wear gloves.
Dr. Petersen acknowledges that it may be difficult to share these recommendations with patients with cognitive impairment due to their Alzheimer’s. He recommends putting visual reminders around the home to help them follow some of these procedures, such as washing hands carefully. People with Alzheimer’s may not understand the totality of the situation because of the effects it has on their cognition. But they may be able to contribute to preventive actions.
In addition, Dr. Petersen notes that for those with Alzheimer’s, wearing masks may result in trouble communicating for some patients because the mask may hide speech, make speech more unintelligible or limit vision. Social distancing from family may also pose a problem when it comes to mental health and happiness. He advocates the use of technology, including video and phone calls, to provide comfort to the person with Alzheimer’s and allow them to remain connected to their family members.
Considerations for At-Home Caregivers
Dr. Petersen emphasizes the importance of the health and wellbeing of the caregiver. Many caregivers who also live in the home have 24/7 responsibility. “If the caregiver becomes ill, if the caregiver develops COVID-19 or another other medical problem, then the whole system breaks down. So, it’s a good idea to have a backup plan,” he says.
Another important consideration is how to talk with the person with Alzheimer’s about COVID-19 if they notice and ask about the changes in routine or safety protocols. He suggests responding with, “Don’t worry about it. We’re trying to prevent any kind of infection. We want you to remain well.” However, if the patient can understand the situation, a caregiver might explain further, “There is a pandemic affecting people around the world, and we want to keep you safe.”
Finally, caregivers in the home should remember that if the patient gets a fever or other symptoms, they may not be able to verbalize their experience. Dr. Petersen recommends looking out for any COVID-19 symptoms as well as cognitive and behavioral changes that may indicate infection.
Considerations for Congregate Living Facilities
If the person with Alzheimer’s lives in a nursing home, prevention and risk management become more complicated. Dr. Petersen acknowledges that distancing between staff and residents may be a problem as the workers must care for the residents of the facility and cannot always maintain distance.
He provides a list of questions that loved ones should ask of a care facility where a loved one is staying or where they are thinking of sending a loved one:
- What happens when someone has COVID? Is there an isolation wing?
- Do workers get daily temperature checks? If they’re exposed in their external world, are they required to quarantine themselves? What if someone works at more than one facility?
- Are residents suspected of infection quarantined at the facility?
- Is there adequate PPE for the individuals working with residents?
Another issue that people with Alzheimer’s may experience in a care facility results from the necessary limits to visitors. Patients, especially those with a cognitive disability, may become distraught or depressed. Thus they may not understand the reasons they are unable to see their spouse, children or grandchildren. Dr. Petersen notes that celebrations outside the windows of nursing homes may provide some comfort as a temporary solution, along with the use of technology for video calls when staff support is available for assistance. For individuals whose remote memories are relatively preserved, Dr. Petersen recommends bringing out photographs of their younger selves and music from their youth as this may be calming for patients and also help them relate to family members in a helpful way.
COVID-19 Infection
If someone with Alzheimer’s becomes infected with COVID-19, Dr. Petersen bringing them to a healthcare provider. Caregivers may consult healthcare providers consulted through a video visit initially. However, Dr. Petersen says not to hesitate before taking them to the emergency room if needed. Most care facilities have protocols in place for what to do in the event that they suspect a patient has COVID-19.
Dr. Petersen reminds viewers, “We have to use the same kinds of precautions we are using in our everyday lives. No public gatherings, keeping the distance, hand washing, personal hygiene, and wearing a mask if at all appropriate are probably the best measures we can take to try to prevent developing COVID infection in ourselves and in our loved ones.” He says caregivers should take steps to maintain the utmost quality of life for the person with Alzheimer’s, and that the measures taken should be individualized based on the progression of the disease.
The American Brain Foundation was founded to bring researchers and donors together in the fight against brain disease. We believe that when we cure one disease, we will cure many. Learn more about Alzheimer’s disease, dementia and other brain diseases or help us in our mission by giving today. For more timely resources on COVID-19 and its impact on brain diseases, visit the AAN COVID Resource Center.