Impact of Coronavirus Disease on Persons with Dementia and Their Caregivers: An Audit Study

To the editor: The ongoing coronavirus disease (COVID-19) pandemic has disproportionately affected persons with dementia (PWD).A diagnosis of dementia is an important risk factor for mortality in patients with COVID-19.1) Not surprisingly, many countries have implemented strict public health measures to protect vulnerable groups such as PWD from the deleterious physical effects of COVID-19.The profound impact of the secondary consequences of the pandemic, such as reduced access to healthcare services, disruption of social support networks, and increased social isolation and loneliness, 2,3) on PWD and their caregivers is being increasingly appreciated, prompting the need for a balanced approach to pandemic control.A recent study highlighted that the duration of home confinement was significantly correlated with both the severity of neuropsychiatric symptoms and the distress experienced by caregivers of PWD. 4) Effective non-pharmacological interventions for behavioral and psychological symptoms of dementia (BPSD) involve social and physical contact, 5) which would be compromised by social distancing measures.The sudden discontinuation of community services, such as the operation of dementia daycare centers (DDC) and domiciliary services, would further increase the caregiver burden.The Singapore government implemented a set of safe distancing measures from April 7 to June 1, 2020, locally known as the "circuit breaker (CB) period," to curb the local transmission of COVID-19.6) During the CB period, only essential services remained available.DDC were temporarily closed, with limited designated centers remaining open for individuals with inadequate family support.In addition, caregiver support services run by the Alzheimer's Disease Association (ADA), such as Eldersit Respite Care service, person-centered home-based interventions, and caregiver support group sessions, were also affected.