key: cord-0695187-n9hn9ipl authors: Canevelli, Marco; Palmieri, Luigi; Raparelli, Valeria; Lo Noce, Cinzia; Colaizzo, Elisa; Tiple, Dorina; Vaianella, Luana; Vanacore, Nicola; Brusaferro, Silvio; Onder, Graziano title: Prevalence and clinical correlates of dementia among COVID‐19‐related deaths in Italy date: 2020-11-14 journal: Alzheimers Dement (Amst) DOI: 10.1002/dad2.12114 sha: 4d4cbd55804748e06bac13d8d8d294abab40aa28 doc_id: 695187 cord_uid: n9hn9ipl INTRODUCTION: We aimed at exploring the proportion of patients dying with COVID‐19 and concomitant dementia in Italy, as well as their clinical characteristics and trajectories of care. METHODS: The proportion of COVID‐19‐related deaths occurring in people with dementia and the clinical characteristics of deceased individuals according to their dementia status were explored by considering the medical charts of a representative sample of patients deceased in Italian hospitals (n = 2621). RESULTS: A total of 415 individuals with dementia were identified in the study population, accounting for 15.8% of overall COVID‐19‐related deaths. Patients with dementia less frequently presented with cough, had lower chance of receiving supportive therapies and intensive care approaches, and showed a faster clinical worsening as compared with individuals with intact cognition. DISCUSSION: Dementia confers a relevant risk of adverse outcomes in case of SARS‐CoV‐2 infection and influences the clinical presentation, course and management of affected individuals. Infections represent common complications and life-threatening events in people living with dementia, especially in the advanced stages of the disease. 1 Specifically, lower respiratory tract infections are a major cause of hospitalization and death in people with dementia. 2, 3 Patients with dementia may be particularly vulnerable in the ongoing COVID-19 pandemic. The weaker defense mechanisms, the close physical contact with caregivers, and the poor adherence to safeguarding measures (eg, social distancing, wearing masks) and hygienic practices (eg, washing hands) expose them to a higher risk of infection by SARS-CoV-2. 4 The difficulty at reporting symptoms and the presentation with atypical and misleading manifestations (eg, sudden confusion and delirium, exacerbation of neuropsychiatric symptoms) can contribute to late diagnosis and management. 4 The effectiveness of some supportive interventions (eg, continuous positive airway pressure) might be limited by partial adherence and tolerability. A relevant proportion of people with dementia lives in long-term facilities where the highest fatality rates have been observed. 5 Based on these premises, it might be expected that a relevant number of COVID-19related deaths occurs in patients with dementing illnesses. Italy, one of the oldest nations in the World, has been severely hit by the SARS-CoV-2 outbreak and > 1 million people with dementia live in the country. 6 At the outset of the COVID-19 outbreak, the Italian National Institute of Health (Istituto Superiore di Sanità-ISS) launched an integrated national surveillance system to collect information on all individuals with COVID-19 throughout the country. 8 A total of 415 individuals with dementia were identified in the study population, accounting for 15.8% of overall COVID-19-related deaths. Such dementia prevalence was higher than expected based on the considered reference data (15.8% vs 11.3%; P < .001). Compared to individuals without dementia, people with dementia were significantly older (84.3, SD 8.1 years vs 77.0, SD 10.9 years; P < .001) and more frequently women (47.2% vs 29.6%; P < .001) ( The present study investigated the prevalence of dementia among indi- In parallel, in light of the limited accessibility of patients with dementia to intensive care, access to appropriate end-of-life/palliative care must be enhanced. Helping patients and families to understand and decide, managing pain and symptoms, ensuring comfort in dying, and supporting families and providers become key priorities. 17 The main limitation of the present study is the lack of informa- possibility of collecting detailed information on each comorbid illness. It may therefore be assumed that dementia might have been underreported based on the charts analysis. 12 Another shortcoming is the lack of information on specific dementia diagnoses that was available only in a minority of charts. In conclusion, our study confirms that people with dementia are particularly vulnerable to COVID-19 and must be protected to reduce the human, social, and healthcare impact of the ongoing and future pandemics. Dementia must not be used as an exclusionary criterion for guiding medical choices in contingencies of limited resources. Abbreviation: OR, odds ratio. Conversely, every effort must be made to support the dignity and wellbeing of the more vulnerable members of our societies. None. Authors have no conflicts of interest to disclose for the present study. Authors have no funding source to disclose for the present study. Advanced dementia Causes of hospital admission for people with dementia: a systematic review and meta-analysis Pneumoniaassociated death in patients with dementia: a systematic review and meta-analysis Dementia care during COVID-19 England and Wales see 20 000 excess deaths in care homes Italian Dementia National Plan Working Group. 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