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Impact of COVID-19 pandemic on mortality rate in memory clinic patients
Els D Bakker1,2, Ingrid S van Maurik1,2,3,4,5, Marissa D Zwan1,2
1Alzheimer Center Amsterdam, Neurology Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc Amsterdam The Netherlands.
Insights
Mortality risk increased for memory clinic patients during the COVID-19 pandemic, particularly for those with dementia. This excess mortality was primarily linked to coronavirus disease 2019 infections.
Area of Science:
- Neurology
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic significantly impacted global health, necessitating investigations into its effects on vulnerable populations.
- Memory clinics serve diverse patient groups, including those with cognitive impairments, making them a key focus for assessing pandemic-related mortality.
- Understanding mortality trends in memory clinic attendees is crucial for public health preparedness and clinical management.
Purpose of the Study:
- To determine if mortality rates changed in memory clinic patients during the COVID-19 pandemic compared to a pre-pandemic historical control group.
- To identify specific patient subgroups within memory clinics who experienced altered mortality risks during the pandemic.
- To ascertain the primary causes of death contributing to any observed changes in mortality.
Main Methods:
- A cohort study design was employed, comparing 923 patients from the Amsterdam Dementia Cohort during the pandemic (2017-2021) with 830 historical control patients (2015-2019).
- Patients included individuals across the cognitive spectrum: subjective cognitive decline (SCD), mild cognitive impairment (MCI), and dementia.
- Cox regression analysis was used to compare mortality rates, with Fisher's exact test examining differences in causes of death.
Main Results:
- Memory clinic patients during the pandemic exhibited a significantly higher mortality risk (HR: 1.34; 95% CI: 1.05-1.70) compared to historical controls.
- This increased risk was particularly pronounced and remained significant in patients diagnosed with dementia (HR: 1.35; 95% CI: 1.03-1.78).
- Excluding deaths due to COVID-19 infection attenuated the overall increased mortality risk (HR: 1.24; 95% CI: 0.97-1.58), highlighting COVID-19 as a major contributing factor (p=0.001).
Conclusions:
- Memory clinic patients faced an elevated risk of mortality during the COVID-19 pandemic.
- The increased mortality was significantly attributable to patients with dementia.
- Deaths directly resulting from COVID-19 infection were the primary driver of the excess mortality observed in this cohort.
Introduction:
We investigated whether mortality in memory clinic patients changed due to coronavirus disease 2019 (COVID-19) pandemic.
Methods:
We included patients from the Amsterdam Dementia Cohort: (1) n = 923 pandemic patients (baseline visit: 2017-2018, follow-up: until 2021), and (2) n = 830 historical control patients (baseline visit: 2015-2016, follow-up: until 2019). Groups were well-balanced. We compared mortality during pandemic with historical control patients using Cox regression. Differences in cause of death between groups were explored using Fisher's exact test.
Results:
Pandemic patients had a higher risk of mortality than historical control patients (hazard ratio [HR] [95% confidence interval {CI}] = 1.34 [1.05-1.70]). Stratified for syndrome diagnosis, the effect remained significant in dementia patients (HR [95% CI] = 1.35 [1.03-1.78]). Excluding patients who died of COVID-19-infection, the higher mortality risk in pandemic patients attenuated (HR [95% CI] = 1.24 [0.97-1.58]). Only the difference in cause of death between pandemic patients and historical control patients for death to COVID-19-infection (p = 0.001) was observed.
Conclusion:
Memory clinic patients had increased mortality risk during COVID-19 compared to historical control patients, attributable to dementia patients.
Highlights:
We investigated if mortality rates in memory clinic patients changed due to COVID-19 pandemic.We included patients along the cognitive continuum, including SCD, MCI, and dementia.We used a well-balanced historical control group.Memory clinic patients had higher risk for mortality during COVID-19 lockdown.Our results indicate that excess mortality is mainly caused by death to COVID-19 infection.
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