“What I really wanted was to have coffee with my friends, because I know being alone is driving me a little crazy. (…) There’s no one to get the bad thoughts, the confused thoughts, out of my head. Normally, you think, ‘Oh my God, I’m going to die’, or, ‘my grandchildren are going to die if they go to school.’ A quick chat with a friend will make you realize you’re talking nonsense. But I haven’t had that, so, things are getting completely out of hand.”
“There are people who learned to speak a new language. I didn’t do anything. I just stood there, looking at the walls. I went upstairs and asked myself, what did I come up here to do?”
This is how the 88-year-old British actress and writer Sheila Hancock describes the experience of living in isolation during the covid-19 pandemic in an interview with BBC Radio 4.
Many people around the world might identify with Hancock’s testimony. But at the age of the actress, the absence of social contact and cognitive stimuli can have serious consequences. In some cases it is a risk factor for developing dementia.
There is already an epidemic of dementia in the world. According to the World Health Organization (WHO), there are currently 50 million people living with dementia on the planet, and this number is expected to exceed 150 million in 2050.
The sad news is that the covid-19 pandemic is expected to increase these rates.
In an interview with BBC News Brasil, neurologist specializing in dementia and professor at the University of São Camilo Fábio Porto describes the negative impact of the pandemic on the cognitive health of his patients and tells us what the most recent studies tell us about the subject.
But the doctor doesn’t just bring us bad news. Porto recommends ways to mitigate the problem and reminds us that the pandemic offers us, in addition to the difficulties, a unique opportunity to learn.
And it points out that society needs to start talking about dementia. “It can no longer be taboo to talk about this subject.”
Impacts of isolation on the neurological health of the elderly
The human being is a social animal, not programmed to live in isolation. So, the obligation to isolate ourselves causes great stress, says Fábio Porto to BBC News Brasil.
About the isolation experience reported by actress Sheila Hancock at the beginning of this article, the expert ponders:
“It’s not possible that this isn’t bad for the brain. Breaking contact, having no stimulation, no cognitive challenge. It’s not natural, and the consequences happen.”
As a specialist in dementia, Porto has been able to closely observe the impact of isolation on the elderly.
“It’s been very bitter for the elderly. I work with the elderly. And there’s one thing that the elderly have less: it’s cognitive reserves.”
But how so?
Cognitive reserve is like a bank of ideas, knowledge, knowledge and affection that we accumulate throughout life. And the more we accumulate, the more we have the resources to resist when a degenerative disease sets in in our brain.
This happens because, with each new knowledge we acquire, new synapses are opened, that is, new connections between neurons. Synapses are like roads. The more roads, the more possibilities to reach our destination.
For example, when a person with good vocabulary cannot find a word, they substitute that word for another.
But in the elderly population, cognitive reserves are more fragile, they can be “used up” much more quickly, explains Porto.
“Several elderly people who were doing well, because they were walking, doing physical therapy, doing Pilates, stopped. All of a sudden. These patients often decompensate from a neuropsychiatric point of view,” he says.
“What I have seen the most here, and I have a bias because I work with dementia, are families saying, look, my father, my mother was fine until the pandemic started. In the pandemic, I started to see that memory was bad.”
This is not to say that all of these patients developed dementia after the onset of the pandemic, he points out.
“Either the family started spending more time with that elderly person and realized a problem that already existed, or the person had to change their routine drastically and failed to do a lot of things that stimulated cognition and promoted health.”
How does covid-19 affect the brain?
Social isolation is an indirect effect of the covid-19 pandemic, and therefore more difficult to assess. Let’s see what studies that try to measure the direct impact of the pandemic and the virus on the population’s cognitive health say.
“In those who had covid, studies show a high prevalence of cognitive decline”, says Porto.
“The cognitive impairment can be mild. The person is more inattentive, less motivated, more indecisive,” he continues. “Or the person may have dementia.”
A study of 236,000 people who had covid published in the prestigious journal Lancet Psychiatry in April this year revealed that, within six months of being infected, 12% of those people received, for the first time, a diagnosis of neurological or psychiatric illness.
The study also reveals that, in the same period, 0.67% of the 236,000 patients studied had a diagnosis of dementia, although it is not known how many of these were new diagnoses.
Commenting on this study, Porto ponders: “The prevalence of dementia in this group was 0.67%. These studies do not select by age, but those who have dementia by covid are usually elderly.”
These are people who, according to him, probably have less cognitive reserves and therefore do not tolerate much aggression, he explains. “A triggering factor, an aggression like covid, is the little push that was needed for a person to fall.”
The study also identified an important risk factor for post-covid dementia: the incidence of delirium (hallucinations) associated with covid.
“This study says that if you had covid, needed to be admitted to the ICU and had delirium (which is encephalopathy), the chance of developing dementia is four times greater.”
Again, recalls the doctor, the study does not discriminate by age. “But those who have delirium are usually older people.”
Despite the worrying statistics, Porto says that in his classes he tries to draw students’ attention to the great opportunity that the pandemic also offers to science:
“We are learning some things. For example, the pandemic will be a unique chance to understand the effect of stress on the brain,” he says.
Another example: “Coronavirus causes inflammation that includes the central nervous system. This is implicated in cognitive and behavioral changes”, he explains. “Well then, how does inflammation affect behavior?”
And further: “How deleterious is social isolation? This notion that brain reserve drains away with behavioral and environmental changes, it wasn’t clear how much this is relevant to cognition.”
How to protect elderly people from the effects of isolation?
The results of this gigantic uncontrolled population experiment created by the social isolation imposed in several countries around the world will be understood more clearly in the future.
In the meantime, Porto and medical colleagues emphasize that it is necessary to protect the elderly and other vulnerable groups from its negative effects. And the solutions go through the same path: digital technology.
“We have to promote digital inclusion, cognitive stimulation and physical exercise among the elderly”, he says. “The digital inclusion of the elderly will allow contact, even at a distance.”
Once access to the internet is guaranteed, it is also necessary to seek group activities that act on some cognitive function.
“Everything that is collective and stimulates cognition is valid. Bingo, games, movies and conversation, music. Cognitive stimulation linked to something that gives pleasure”, says the doctor. “Very likely, these are some of the things that were missed (during the isolation period).”
Another key point: exercise. “Those who manage to exercise via digital inclusion alleviate the deleterious effect of isolation”, says Porto.
And on this subject the neurologist understands well.
“My doctoral thesis was on the effects of exercise on the brain, I am a strong advocate of exercising to improve brain function.”
“Exercise improves metabolism, improves the volume of the hippocampus, which is the memory region. It improves vascular health, improves neurotransmitters. Exercise is a medicine that should be in every doctor’s therapeutic arsenal.”
He continues: “In my thesis, patients walked 50 minutes twice a week. That’s super little, but it’s already made a difference.”
And it’s never too late. “Everyone in my thesis had a memory problem and was over 65.”
In times of pandemic, however, walking requires that extra care. “But of course, wear a mask, keep your distance. Use common sense.”
we need to talk about dementia
These measures will not protect our society from the inevitable: the dementia epidemic we are already experiencing today.
Fábio Porto, who works voluntarily at the Brazilian Association of Alzheimer’s and Other Dementias (ABRAz), says that in order for us to deal better with dementia, we will all have to learn more about it.
“It’s what I call psychoeducation, that is, how to deal non-pharmacologically with people who have behavioral disorders.”
“At ABRAz, we promote psychoeducation in this area. It involves study, a lot of conversation, understanding and acceptance: understanding, the rational thing, and acceptance, in the emotional domain.”
At the end of this journey, says the doctor, you may discover something surprising: “There is quality of life, even with dementia.”