16 Jun 2020

Impact of the pandemic in people with limited cognitive reserve

The new coronavirus pandemic (SARS-COV-2) has changed our way of life. From the fear of infection to suffering during illness, going through the pain of mourning at the loss of a loved one, the effects of the pandemic on the mental health of the general population will have consequences that differ, in many aspects, from those directly related to the disease caused by the virus (COVID-19). Social isolation, loss of income, unemployment or work overload are some examples of the impact of the pandemic that may indirectly compromise the mental health of each and every one of us.

As usually happens in crisis situations that affect societies, whatever their nature, people with more fragile mental health become vulnerable. In the context of the current pandemic, people with a limited cognitive reserve are not excluded from this reality. Individuals with dementia, cerebrovascular disease, Parkinson’s disease, intellectual disability, and many other congenital or acquired brain abnormalities are part of this group.

Rui Albuquerque, psychiatrist .

Throughout the life or progression of the disease of these people, the existence of psychopathologies remains constant. Also, the consequences of the pandemic may have a more significant impact on already fragile mental health. People with dementia, for example, may have trouble understanding why they are not receiving visits from family members at the institution where they reside. They may also develop the conviction that they have been forgotten and become depressed. On the other hand, home confinement for a young man with an intellectual disability who used to go to a special education centre every day and enjoy outdoor activities, may produce anxiety that is difficult to control. These are just a few examples of the indirect consequences of the pandemic; those consequences that arise from the necessary measures to contain the virus. Excluding people who, due to their age or the medical pathology they suffer, are part of the so-called risk groups, there is a greater probability that people with a limited cognitive reserve will suffer more indirect consequences of the pandemic on their health, especially at the mental level, than direct consequences, such as infection with the new coronavirus and the development of COVID-19. Therefore, mental health interventions in this most vulnerable sector are essential during the current pandemic.

The correct approach for the treatment of a patient with psychopathology must follow the biopsychosocial model with a technical intervention as the central axis, based on an empathetic attitude, the understanding of the symptoms and the socio-family contextualization. This methodology presupposes a face-to-face consultation with the patient and, sometimes, with the family or caregiver. However, during the pandemic, the entire health system has had to be restructured and has become less accessible at the scheduled treatment level (such as consultations). In addition, the population has avoided going to health centres for fear of contagion. It is recommended that both patients and family members or caregivers be attentive to signs and symptoms that may reflect the severity and that they do not hesitate to contact health centres. On the other hand, it is to be expected that social isolation and confinement will provoke the appearance of transitory symptoms of anxiety and depression, which should be understood as reactive and to which we must adopt an attitude of observation, without the need for immediate medical intervention.

It is important to remember that during the pandemic, the rest of the health problems will continue to exist and need treatment. We must not forget the people most vulnerable to the direct and indirect consequences of the pandemic. We must adopt proactive measures throughout the health system to guarantee their correct clinical surveillance.

Dr Rui Albuquerque, Bachelor of Medicine from the Lisbon Faculty of Medicine. Psychiatry specialist. Clinical director of the “Nossa Senhora de Fátima Psycho-geriatric Center”, of Sisters Hospitallers in Cascais (Portugal), since 2016