The Impact of COVID-19 Confinement on Cognition and Mental Health and Technology Use Among Socially Vulnerable Older People: Retrospective Cohort Study

COVID 19; Salut mental; Aïllament socialCOVID 19; Salud mental; Aislamiento socialCOVID-19; Mental Health; Social isolationBackground: COVID-19 forced the implementation of restrictive measures in Spain, such as lockdown, home confinement, social distancing, and isolation. It is necessary to study whether limited access to basic services and decreased family and social support could have deleterious effects on cognition, quality of life, and mental health in vulnerable older people. Objective: This study aims to explore the impact of the COVID-19 outbreak on cognition in older adults with mild cognitive impairment or dementia as the main outcome and the quality of life, perceived health status, and depression as secondary outcomes and to analyze the association of living alone and a change in living arrangements with those outcomes and other variables related with the use of technology and health services. Likewise, this study aims to analyze the association of high and low technophilia with those variables, to explore the access and use of health care and social support services, and, finally, to explore the informative-, cognitive-, entertainment-, and socialization-related uses of information and communications technologies (ICTs) during the COVID-19 outbreak. Methods: This cohort study was conducted in Málaga (Spain). In total, 151 participants with mild cognitive impairment or mild dementia, from the SMART4MD (n=75, 49.7%) and TV-AssistDem (n=76, 50.3%) randomized clinical trials, were interviewed by telephone between May 11 and June 26, 2020. All participants had undergone 1-3 assessments (in 6-month intervals) on cognition, quality of life, and mood prior to the COVID-19 breakout. Results: The outbreak did not significantly impact the cognition, quality of life, and mood of our study population when making comparisons with baseline assessments prior to the outbreak. Perceived stress was reported as moderate during the outbreak. After correction for multiple comparisons, living alone, a change in living arrangements, and technophilia were not associated with negative mental health outcomes. However, being alone was nominally associated with self-perceived fear and depression, and higher technophilia with better quality of life, less boredom, perceived stress and depression, and also less calmness. Overall, health care and social support service access and utilization were high. The most used ICTs during the COVID-19 outbreak were the television for informative, cognitive, and entertainment-related uses and the smartphone for socialization. Conclusions: Our findings show that the first months of the outbreak did not significantly impact the cognition, quality of life, perceived health status, and depression of our study population when making comparisons with baseline assessments prior to the outbreak. Living alone and low technophilia require further research to establish whether they are risk factors of mental health problems during lockdowns in vulnerable populations. Moreover, although ICTs have proven to be useful for informative-, cognitive-, entertainment-, and socialization-related uses during the pandemic, more evidence is needed to support these interventions

Validación de una plataforma de estimulación cognitiva en pacientes con demencia

Los principales resultados y conclusiones son: se ha desarrollado una plataforma informática que ha permitido la aplicación de programas de estimulación cognitiva en pacientes con enfermedad de Alzheimer. La aplicación de los programas de estimulación cognitiva han permitido obtener tasas de aprendizaje positivas en las tareas realizadas. No hubo diferencias significativas en las tasas de aprendizaje entre los pacientes tratados con estimulación tradicional y con ordenador, mostrándose ambos procedimientos eficaces. Las tasas de aprendizaje positivas no se han asociado a mejoras significativas en el rendimiento neuropsicológico de las funciones cognitivas estudiadas. La avanzada fase de la enfermedad y la heterogeneidad de los pacientes dentro de cada grupo, mostrada en las medidas de dispersión, han influido también en estos resultados. Los pacientes que recibieron estimulación cognitiva con ordenador han mostrado una tendencia no significativa de mejora en el rendimiento cognitivo. Estos resultados preliminares permiten sugerir que la estimulación cognitiva mediante ordenador puede ser más eficaz que la estimulación cognitiva tradicional, especialmente mientras se mantiene. Ha de considerarse además que los pacientes de este grupo presentaban fases avanzadas de la enfermedad y factores de riesgo cardiovascular relevantes. Se recomienda el uso de plataformas informáticas de estimulación cognitiva ya que permiten su uso continuado en el tiempo tanto en centros sociosanitarios como en domicilios particulares de los pacientes Los niveles de estrés y carga del cuidador han sido menores en los grupos tratados con estimulación cognitiva que en el grupo que no recibió estimulación cognitiva. Se recomienda el diseño de estudios similares en personas sin deterioro cognitivo, en pacientes con deterioro cognitivo leve y en pacientes en fases iniciales de la demencia.Estudio realizado dentro del ámbito aplicado de las neurociencias, el propósito ha sido validar la eficacia de una plataforma de rehabilitación cognitiva en pacientes con Alzheimer en fase leve-moderada. Esta investigación se ha llevado a cabo en varios centros y residencias entre Málaga y Granada. Se trabaja con una muestra de 34 pacientes, 12 en el grupo papel, 11 en el grupo ordenador, y 11 en el que no recibió estimulación. Se valoró el estado cognitivo de los pacientes a través de una batería neuropsicológica: Mini Mental State Examination, test del dibujo del reloj, test de Stroop, test de recuerdo libre y selectivamente facilitado, test de fluencia verbal semántica y fonológica, test de denominación de Boston, Prueba aritmética y prueba de dígitos de la Escala de Inteligencia de Wechsler; así como del estado funcional, escala Bayer de las actividades de la vida diaria; y el estado de la demencia y nivel estrés de sus cuidadores a través del Inventario Neuropsiquiátrico. El estudio planteado corresponde a un estudio de casos y control, enmarcándose dentro de los estudios observacionales, de tipo retrospectivo, en los que se hace una comparación entre la aplicación de una intervención o no en tres poblaciones diagnosticadas con Enfermedad de Alzheimer. Se utilizaron técnicas descriptivas, correlacionales y de contraste tanto paramétricas como no paramétricas, a fin de comparar las las relaciones con los niveles de rendimiento en las diferentes variables estudiadas

Cognitive Outcomes During COVID-19 Confinement Among Older People and Their Caregivers Using Technologies for Dementia: Protocol for an Observational Cohort Study

Background: The COVID-19 pandemic has led to worldwide implementation of unprecedented restrictions to control its rapid spread and mitigate its impact. The Spanish government has enforced social distancing, quarantine, and home confinement measures. Such restrictions on activities of daily life and separation from loved ones may lead to social isolation and loneliness with health-related consequences among community-dwelling older adults with mild cognitive impairment or mild dementia and their caregivers. Additionally, inadequate access to health care and social support services may aggravate chronic conditions. Home-based technological interventions have emerged for combating social isolation and loneliness, while simultaneously preventing the risk of virus exposure. Objective: The aim of this cohort study is to explore, analyze, and determine the impact of social isolation on (1) cognition, quality of life, mood, technophilia, and perceived stress among community-dwelling older adults with mild cognitive impairment or mild dementia and on the caregiver burden; (2) access to and utilization of health and social care services; and (3) cognitive, social, and entertainment-related uses of information and communication technologies. Methods: This study will be conducted in Málaga (Andalucía, Spain). In total 200 dyads, consisting of a person with mild cognitive impairment or mild dementia and his/her informal caregiver, will be contacted by telephone. Potential respondents will be participants of the following clinical trials: support, monitoring, and reminder technology for mild dementia (n=100) and television-based assistive integrated service to support European adults living with mild dementia or mild cognitive impairment (n=100). Results: As of May 2021, a total of 153 participants have been enrolled and assessed during COVID-19 confinement, of whom 67 have been assessed at 6 months of enrollment. Changes in the mean values of the variables will be analyzed relative to baseline findings of previous studies with those during and after confinement, using repeated-measures analysis of variance or the nonparametric Friedman test, as appropriate. The performance of multivariate analysis of covariance (ANCOVA) to introduce potential covariates will also be considered. Values of 95% CI will be used. Conclusions: If our hypothesis is accepted, these findings will demonstrate the negative impact of social isolation owing to COVID-19 confinement on cognition, quality of life, mood, and perceived stress among community-dwelling older adults with mild cognitive impairment and mild dementia, the impact on technophilia, caregiver burden, the access to and utilization of health and social care services, and the cognitive, social, and entertainment-related use of information and communication technologies during and after COVID-19 confinement.Ye

The Impact of COVID-19 Confinement on Cognition and Mental Health and Technology Use Among Socially Vulnerable Older People: Retrospective Cohort Study.

COVID-19 forced the implementation of restrictive measures in Spain, such as lockdown, home confinement, social distancing, and isolation. It is necessary to study whether limited access to basic services and decreased family and social support could have deleterious effects on cognition, quality of life, and mental health in vulnerable older people. This study aims to explore the impact of the COVID-19 outbreak on cognition in older adults with mild cognitive impairment or dementia as the main outcome and the quality of life, perceived health status, and depression as secondary outcomes and to analyze the association of living alone and a change in living arrangements with those outcomes and other variables related with the use of technology and health services. Likewise, this study aims to analyze the association of high and low technophilia with those variables, to explore the access and use of health care and social support services, and, finally, to explore the informative-, cognitive-, entertainment-, and socialization-related uses of information and communications technologies (ICTs) during the COVID-19 outbreak. This cohort study was conducted in Málaga (Spain). In total, 151 participants with mild cognitive impairment or mild dementia, from the SMART4MD (n=75, 49.7%) and TV-AssistDem (n=76, 50.3%) randomized clinical trials, were interviewed by telephone between May 11 and June 26, 2020. All participants had undergone 1-3 assessments (in 6-month intervals) on cognition, quality of life, and mood prior to the COVID-19 breakout. The outbreak did not significantly impact the cognition, quality of life, and mood of our study population when making comparisons with baseline assessments prior to the outbreak. Perceived stress was reported as moderate during the outbreak. After correction for multiple comparisons, living alone, a change in living arrangements, and technophilia were not associated with negative mental health outcomes. However, being alone was nominally associated with self-perceived fear and depression, and higher technophilia with better quality of life, less boredom, perceived stress and depression, and also less calmness. Overall, health care and social support service access and utilization were high. The most used ICTs during the COVID-19 outbreak were the television for informative, cognitive, and entertainment-related uses and the smartphone for socialization. Our findings show that the first months of the outbreak did not significantly impact the cognition, quality of life, perceived health status, and depression of our study population when making comparisons with baseline assessments prior to the outbreak. Living alone and low technophilia require further research to establish whether they are risk factors of mental health problems during lockdowns in vulnerable populations. Moreover, although ICTs have proven to be useful for informative-, cognitive-, entertainment-, and socialization-related uses during the pandemic, more evidence is needed to support these interventions. ClinicalTrials.gov NCT04385797; https://clinicaltrials.gov/ct2/show/NCT04385797. RR2-10.2196/26431

Attitudes and use of information and communication technologies in older adults with mild cognitive impairment or early stages of dementia and their caregivers : cross-sectional study

BACKGROUND: Information and communication technologies are promising tools to increase the quality of life of people with dementia or mild cognitive impairment and that of their caregivers. However, there are barriers to their use associated with sociodemographic factors and negative attitudes, as well as inadequate knowledge about technologies. OBJECTIVE: The aim of this study was to analyze technophilia (attitudes toward new technologies) and the use of smartphones and tablets along with associated factors in people with dementia/mild cognitive impairment and their caregivers. METHODS: Data from the first visit of the Support Monitoring and Reminder for Mild Dementia (SMART4MD) randomized multicenter clinical trial were used for this analysis. Data were obtained from two European countries, Spain and Sweden, and from three centers: Consorci Sanitari de Terrassa (Catalonia, Spain), Servicio Andaluz de Salud (Andalusia, Spain), and the Blekinge Institute of Technology (Sweden). Participants with a score between 20 and 28 in the Mini Mental State Examination, with memory problems (for more than 6 months), and who were over the age of 55 years were included in the study, along with their caregivers. The bivariate Chi square and Mann-Whitney tests, and multivariate linear and logistic regression models were used for statistical analysis. RESULTS: A total of 1086 dyads were included (N=2172). Overall, 299 (27.53%) of people with dementia/mild cognitive impairment had a diagnosis of dementia. In addition, 588 (54.14%) of people with dementia/mild cognitive impairment reported using a smartphone almost every day, and 106 (9.76%) used specific apps or software to support their memory. Among the caregivers, 839 (77.26%) used smartphones and tablets almost every day, and 181 (16.67%) used specific apps or software to support their memory. The people with dementia/mild cognitive impairment showed a lower level of technophilia in comparison to that of their caregivers after adjusting for confounders (B=0.074, P=.02) with differences in technology enthusiasm (B=0.360, P&lt;.001), but not in technology anxiety (B=-0.042, P=.37). Technophilia was associated with lower age (B=-0.009, P=.004), male gender (B=-0.160, P&lt;.001), higher education level (P=.01), living arrangement (living with children vs single; B=-2.538, P=.01), country of residence (Sweden vs Spain; B=0.256, P&lt;.001), lower depression (B=-0.046, P&lt;.001), and better health status (B=0.004, P&lt;.001) in people with dementia/mild cognitive impairment. Among caregivers, technophilia was associated with comparable sociodemographic factors (except for living arrangement), along with a lower caregiver burden (B=-0.005, P=.04) and better quality of life (B=0.348, P&lt;.001). CONCLUSIONS: Technophilia was associated with a better quality of life and sociodemographic variables in people with dementia/mild cognitive impairment and caregivers, suggesting potential barriers for technological interventions. People with dementia/mild cognitive impairment frequently use smartphones and tablets, but the use of specific apps or software to support memory is limited. Interventions using these technologies are needed to overcome barriers in this population related to sociodemographic characteristics and the lack of enthusiasm for new technologies. TRIAL REGISTRATION: ClinicalTrials.gov NCT03325699; https://clinicaltrials.gov/ct2/show/NCT03325699. ©Jose Guzman-Parra, Pilar Barnestein-Fonseca, Gloria Guerrero-Pertiñez, Peter Anderberg, Luis Jimenez-Fernandez, Esperanza Valero-Moreno, Jessica Marian Goodman-Casanova, Antonio Cuesta-Vargas, Maite Garolera, Maria Quintana, Rebeca I García-Betances, Evi Lemmens, Johan Sanmartin Berglund, Fermin Mayoral-Cleries.CC BY 4.0Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 01.06.2020.</p