COVID-19 and Neurocognitive Disorders

Elizabeta B. Mukaetova-Ladinska; Golo Kronenberg; Ruma Raha-Chowdhury


Curr Opin Psychiatry. 2021;34(2):149-156. 

In This Article

COVID-19 and Mental Health

Apart from the broad global mental health effects of the pandemic, SARS-CoV-2 has caused an additional mental health burden directly linked to the COVID-19 infection. To illustrate, nearly 20% of COVID-19 survivors develop mental health problems, that is anxiety and depression, very early in their convalescence period (14–90 days post diagnosis), with 5.8% developing the first episode of a psychiatric disorder. The incidence of a first diagnosis of dementia in the 14–90 days after COVID-19 diagnosis is 1.6% [95% confidence interval (95% CI) 1.2–2.1] in people older than 65 years.[1] A relevant minority of COVID-19 patients have suffered from encephalitis and stroke as a result of the viral infection and delirium has been reported frequently in those patients who required intensive care treatment (reviewed in[2]). In addition, the pandemic brought unexpected premature deaths. Over the last year, the SARS-CoV-2 (COVID-19) pandemic has claimed more than 1.25 million lives out of the 54 million infected (2.5%). The death rate is particularly high in the UK, reaching 4% (50 000 deaths in 1.17 million infected, as per the government statistic of 08 November 2020), in contrast to the reported 1.7–2.5% death rate in the Russian Federation and the USA, respectively.

Deaths have been recorded mostly among older people and those with chronic health conditions such as diabetes, respiratory infections, cancer and dementia, indicating that physical and mental frailty alongside old age constitute the main risk factors for SARS-CoV-2 deaths. According to the latest UK figures, COVID-19 accounted for one in 10 deaths in England [23 October 2020 (]. Living in a care home appears to be the most relevant factor for both an increased risk of COVID-19 infection and consequent death, with Alzheimer's disease patients having a higher risk than those with other neurodegenerative dementias.[3] One of the reasons for this state of affairs may be insufficient testing in care homes to detect the virus and stop it from spreading. Also, elderly care home residents may not always show typical symptoms of COVID-19. Joint use of audio and video devices including mobile phones (not sanitised adequately before sharing) has also been mentioned as a source of passing on the viral infection. Additional factors, including social isolation, poor sleeping pattern, anxiety and psychological distress, may have all aggravated the problems in care homes. Although, to date, there is a paucity of research on how this situation has affected the families of the deceased and the wider population, initial reports are starting to emerge reporting that 55% of those who lost loves ones had intense grief reactions (N.M. Melhem et al., unpublished data).

All of the above illustrates the multiple adverse effects of the pandemic on physical and mental health and, in particular, on the development of neurocognitive disorders (Table 1).