Psychiatrist warns COVID-19 can cause agitation, behavioral changes in some Alzheimer's patients

By now you likely already know the early warning signs of COVID-19: the cough, the fever, the shortness of breath.

But, two Atlanta psychiatrists who work with patients in assisted living centers say they're seeing some very different early warning signs of infection in people with Alzheimer's disease.

Two months ago, geriatric neuropsychiatrist Dr. Gary Figiel of the Southeastern Geriatric Healthcare Group wanted to better understand how the virus affects the seniors he treats in Metro-Atlanta assisted living care facilities.

So, he started looking through the records of the first residents infected.

"And interestingly, the first four patients who were positive had Alzheimer's disease," he says.

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Yet, when Dr. Figiel looked at their recorded symptoms, he noticed something odd.

"None of them had a fever, none of them had a cough or shortness of breath," he says.

Instead, Figiel says, the patients with dementia had reportedly become more agitated, and their behavior had changed.

"They weren't able to take care of themselves as well as they had up until that time," he says. "They weren't able to bathe, dress themselves or follow simple directions.  And, these had been relatively high-functioning Alzheimer's patients up until that time."

Figiel and McDonald expanded their research, looking at the files of12 assisted living residents who were infected.

Eight have Alzheimer's disease.

"And, [of those eight] none of them, for the first 48 to 72 hours, had a fever, cough or shortness of breath," Figiel says. "And, interestingly, the other 4 elderly patients, who did not have Alzheimer's in assisted living, presented with the typical symptoms you're finding with coronavirus.  They all had fever or cough or shortness of breath."

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The two psychiatrists are now studying data from 40 assisted living patients who have tested positive for this novel coronavirus.

This is a small, as-yet-unpublished study.

Still, given what's happening in long-term care facilities across the country, Figiel says, caretakers should be aware

Alzheimer's patients may experience non-traditional symptoms.

As of Friday, 247 residents in long-term care facilities in Georgia have died from complications of COVID-19, and 230 long-term care facilities have at least one positive case in either a resident or a staff member, according to the Georgia Department of Community Health.

Until we know more about how this virus behaves in seniors with dementia, Dr. Figiel urges caregivers in assisted living care facilities and nursing homes to watch for cognitive and behavioral changes in patients with dementia, and consider isolating and testing them quickly.

"Start thinking of, this could be COVID, and (do not) call up the doctor and ask for more medication to sedate them further," he says.   "Just have the idea of the virus much more in the front of your mind."

The Alzheimer's Association says more than half of patients in assisted living or nursing care facilities have dementia.

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Best prevention measures:

• Wash your hands often with soap and warm water for at least twenty seconds.

• If soap and water are not available, use an alcohol-based hand sanitizer.

• Avoid touching your eyes, nose, and mouth with unwashed hands.

• Avoid close contact with people who are sick.

• Stay home when you are sick.

• Cover your cough or sneeze with a tissue, then throw the tissue in the trash.

• Clean and disinfect frequently touched objects and surfaces


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