The impact of the COVID-19 pandemic on the psychological well-being of caregivers of people with dementia or Mild Cognitive Impairment: A systematic review and meta-analysis

The aim of this systematic review was to investigate the effects of the COVID-19 lockdown on the psychological well-being of caregivers of people with dementia or mild cognitive impairment (PwD/MCI). Electronic databases were searched from inception to August 2022 for observational studies investigating the COVID-19 lockdown and psychological well-being of caregivers of PwD/MCI. Summary estimates of standardized mean differences (SMD) in psychological well-being scores pre- versus during COVID-19 were calculated using a random-effects model. Fifteen studies including 1702 caregivers (65.7% female, mean age 60.40 ± 12.9 years) with PwD/MCI were evaluated. Five studies found no change in psychological well-being parameters, including depression, anxiety, distress, caregiver burden, and quality of life. Ten studies found a worsening in at least one parameter: depression (six studies, n = 1368; SMD = 0.40; 95%CI: 0.09–0.71; p = 0.01, I2 = 86.8%), anxiety (seven studies, n = 1569; SMD = 1.35; 95%CI: 0.05–2.65; I2 = 99.2%), caregiver distress (six studies, n = 1320, SMD = 3.190; 95%CI: 1.42–4.95; p < 0.0001; I2 = 99.4%), and caregiver burden (four studies, n = 852, SMD = 0.34; 95%CI: 0.13–0.56; p = 0.001; I2 = 54.1%) (p < 0.05). There was an increase in depression, anxiety, caregiver burden, and distress in caregivers of PwD/MCI during the lockdown in the COVID pandemic. This could have longer term consequences, and it is essential that caregivers’ psychological well-being is assessed and supported, to benefit both themselves and those for whom they care.</p

Adjusted estimates of physical performance mean values [mean (SE)] by serum 25-hydroxyvitamin D (25OHD) in men: the Pro.V.A Study.

<p>Notes: Adjusted mean values were obtained using the GLM procedure. Model 1 was adjusted for confounder variables (age, BMI, smoking habit, regular physical activity, season, depression, cognitive status, glomerular filtration rate (according to the MDRD formula). Model 2 was adjusted for the variables in Model 1 plus the covariates cardiovascular diseases, osteoarticular disease, COPD, and visual impairment;</p><p>SE =  standard error.</p

Participants' characteristics by serum 25-hydroxyvitamin D (25OHD) quintiles in men: the Pro.V.A. Study.

*<p>also adjusted for smoking habit; BMI (body mass index), MMSE (Mini-Mental State Examination), COPD (Chronic Obstructive Pulmonary Diseases), PTH (parathyroid hormone), GFR (glomerular filtration rate), 25OHD (serum 25-hydroxyvitamin D).</p><p>For conversion from nmol/L to ng/ml divide by 2.496.</p><p>Numbers are mean values (and Standard Deviations) or percentage (%), as appropriate.</p

Loess regression plots of 6-minute walking distance (meters) by 25-hydroxyvitamin D (25OHD) concentrations; straight line–for women and diamond line ◊◊ for men.

<p>Loess regression plots of 6-minute walking distance (meters) by 25-hydroxyvitamin D (25OHD) concentrations; straight line–for women and diamond line ◊◊ for men.</p

Loess regression plots of 5 timed chair stands measure (seconds) by 25-hydroxyvitamin D (25OHD) concentrations; straight line–for women and diamond line ◊◊ for men.

<p>Loess regression plots of 5 timed chair stands measure (seconds) by 25-hydroxyvitamin D (25OHD) concentrations; straight line–for women and diamond line ◊◊ for men.</p

Participants' characteristics by serum 25-hydroxyvitamin D (25OHD) quintiles in women: the PRO.V.A. Study.

*<p>also adjusted for smoking habit; BMI (body mass index), MMSE (Mini-Mental State Examination), COPD (Chronic Obstructive Pulmonary Diseases), PTH (parathyroid hormone), GFR (glomerular filtration rate), 25OHD (serum 25-hydroxyvitamin D).</p><p>For conversion from nmol/L to ng/ml divide by 2.496.</p><p>Numbers are mean values (and Standard Deviations) or percentage (%), as appropriate.</p

Observed physical performance measures (mean[SD]) by serum 25-hydroxyvitamin D (25OHD) in men: the Pro.V.A. Study.

<p>Observed physical performance measures (mean[SD]) by serum 25-hydroxyvitamin D (25OHD) in men: the Pro.V.A. Study.</p

Loess regression plots gait speed (meter/seconds) by 25-hydroxyvitamin D (25OHD) concentrations; straight line–for women and diamond line ◊◊ for men.

<p>Loess regression plots gait speed (meter/seconds) by 25-hydroxyvitamin D (25OHD) concentrations; straight line–for women and diamond line ◊◊ for men.</p

Loess regression plots of handgrip strength (kg) by 25-hydroxyvitamin D (25OHD) concentrations; straight line–for women and diamond line ◊◊ for men.

<p>Loess regression plots of handgrip strength (kg) by 25-hydroxyvitamin D (25OHD) concentrations; straight line–for women and diamond line ◊◊ for men.</p

Changes in secondary outcomes (as percentages) from baseline to follow-up by group.

<p><u>Notes:</u> the changes are represented as mean ± standard error of mean (SEM). Changes were calculated as the difference between the follow-up and baseline values (delta), divided by the baseline value and multiplied by 100. <u>Abbreviations</u>: PT = peak torque; 6MWT = 6-minute walking test.</p