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Cognitive decline before and during COVID-19 pandemic among older people with multimorbidity: a longitudinal study

  • Chenglong Li
    Affiliations
    Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China

    PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China
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  • Rong Hua
    Affiliations
    Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China

    PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China
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  • Darui Gao
    Affiliations
    Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China

    PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China
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  • Fanfan Zheng
    Correspondence
    corresponding author: Fanfan Zheng, School of Nursing, Peking Union Medical College, 33 Ba Da Chu Road, Shijingshan District, 100144, Beijing, China; ;
    Affiliations
    School of Nursing, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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  • Wuxiang Xie
    Correspondence
    corresponding author: Wuxiang Xie, Peking University Clinical Research Institute, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, 100034, Beijing, China; .
    Affiliations
    Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China

    PUCRI Heart and Vascular Health Research Center at Peking University Shougang Hospital, Beijing, China
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Published:January 12, 2023DOI:https://doi.org/10.1016/j.jamda.2023.01.001
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      Abstract

      Objectives

      To investigate whether older people living with multimorbidity would suffer an accelerated decline in cognition during the COVID-19 pandemic, compared with pre-pandemic data.

      Design

      A 5-year cohort conducting surveys from year 2016 to 2021, with 2016 to 2019 as the control period and 2019 to 2021 the pandemic period

      Setting and Participants

      9304 cognitively healthy older participants aged ≥ 50 years were included from the Health and Retirement Study (HRS).

      Methods

      Multimorbidity was defined as the concurrent presence of 2 or more chronic diseases. A global cognition Z score was calculated using memory (immediate and delayed word recall tests) and executive function (counting backwards and the serial sevens tests). Incident dementia was defined using either the reported physician diagnosis or an alternative approach based on cognition summary score. Linear mixed models were used to assess longitudinal changes, while modified Poisson regression models were used to analyze the risk of incident dementia.

      Results

      Of the 9304 participants included, 3649 (39.2%) were men, with a mean age of 65.8 ± 10.8 years. Participants with multimorbidity (N=4375) suffered accelerated declines of 0.08 standard deviation (95% confidence interval [CI]: 0.03, 0.13, P=0.003) in global cognition and an elevated dementia risk (risk ratio [RR]: 1.66, 95% CI: 1.05 to 2.61, P=0.029), compared with individuals without morbidity (N=1818) during the pandemic period. After further adjusting sociodemographic characteristics and pre-pandemic cognitive measurements, these differences remained evident. In contrast, no significant differences in cognitive declines were observed during the control period.

      Conclusions and Implications

      During the COVID-19 pandemic, older people with multimorbidity suffered an accelerated decline in cognition and elevated incident dementia risk, while no evident differences in cognitive decline rates were observed before the pandemic. Measures targeting vulnerable older people with multimorbidity could be significant for assisting these individuals to tackle neurocognitive challenges during the pandemic.

      Key words