February 9, 2022

expert reaction to study of new and persistent conditions developed after COVID-19 infection in older adults

A study published in The BMJ looks at risk of new and persistent conditions among adults aged 65 years and over during the post-acute phase of SARS-CoV-2 infection.

Dr James Connell, Head of Translational Science from Alzheimer’s Research UK, said:

“COVID-19 has had a disproportionate impact on people with dementia, their carers and their families. Age, genetics and lifestyle all contribute to someone’s individual risk for developing dementia. Some evidence suggests that other pre-exiting health conditions can also contribute to increased dementia risk.

“In this large research study looking at health records of people aged 65 and over, scientists found that people were at higher risk of developing dementia following COVID-19 infection. This observation however may also result from pre-existing health conditions. Relatively little is known about the long-term impacts of COVID-19 on brain health, and Alzheimer’s Research UK remains committed to monitoring the emerging evidence in this space.

“Even before the pandemic, we were facing a crisis in dementia diagnosis, now fewer than 2 in 3 dementia cases are being formally diagnosed in the UK. These results suggest in future years we may be facing an even larger problem and heightens urgency for the government to take action with an ambitious dementia strategy.

“If anyone is worried about their memory and thinking, or long-term effects of COVID-19, they should consult with their doctor.”

Lea Milligan, CEO MQ Mental Health Research, said:

“The findings from this Cohen et al study reflects the findings from the UK PHOSP COVID study. This project, which monitored patients who were admitted to hospital within the UK for COVID, also found that significant symptoms of both physical and mental health problems persisted at 5 months post discharge, with 20% now considered to have a new disability. Additionally, 25% of patients experienced significant symptoms of depression and anxiety five months after discharge and 12% experienced symptoms of PTSD.

“The relationship between ongoing physical health conditions and mental health conditions post infection cannot be understated, and require continued study.

“Because of the findings from research like this recent paper and the PHOSP study, MQ Mental Health Research is investing in a new programme with Oxford University examining COVID-induced cognitive decline.”

Dr David Strain, Chair of BMA Board of Science and Clinical senior lecturer and honorary consultant, University of Exeter Medical School, said:

“This report explores the use of health care services after 3 weeks from a diagnosis of COVID-19 up to 3 months.  It uses a large data set to compare those who have tested positive with a matched group of people who did not have symptomatic COVID in the same time period.

“It demonstrates that 1 in 3 older adults will seek medical attention within the three months of their diagnosis. This compares to approximately 1 in 5 of the same age group who did not have COVID, an extra 11% of the total population. Amongst these visits are some of the diagnoses that are already acknowledged as symptoms of Long COVID, such fatigue, blood clotting disorders and shortness of breath, however there were also increases in other conditions that are currently not recognised as part of long COVID syndrome such as kidney failure. Of greatest concern was the increased risk of dementia that was approximately 2½ times more likely to occur. This is not completely unexpected; brain fog is recognised in the younger population already, therefore it is not surprising that in a population with pre-existing cognitive decline this could push them over a threshold into dementia. The longer term repercussions of this for a health a social care sector that is already dealing in a substantial backlog will be significant, and the personal impact on people who thought they had recovered from the virus, and their families could be devastating. When compared to individuals who had non-COVID viral respiratory infections, this increased risk of dementia, as  well as the breathing issues and fatigue, remained significant suggesting that this is a COVID specific complication.

“These numbers are substantially higher than the Office of National Statistics (ONS) reports in the UK, although are aligned with some other reports, such as the review of healthcare workers which also suggested 32% were left with symptoms at 3 months.  This may be because the ONS is dependent on people with self-reported symptoms associated with long COVID, however only once all health care appointments are evaluated do these excess in unexpected diagnoses manifest themselves. It is important to highlight that this only looked at the healthcare needs of the population, and will not capture the more subtle symptoms that people with an awareness of long COVID may choose to accept their symptoms without seeking medical support. Indeed in the study of healthcare workers only 16% of them reported their symptoms to their general practitioners. If this is also the case in the older population, the number of older adults suffering with long COVID may be much higher than previously recognised.”

Reference for the HCPs data:  Gaber TAK, Ashish A, Unsworth A. Persistent post-covid symptoms in healthcare workers. Occup Med (Lond). 2021 Jun 16;71(3):144-146. doi: 10.1093/occmed/kqab043. PMID: 33830208; PMCID: PMC8083525)

‘Risk of persistent and new clinical sequelae among adults aged  65 years and older during the post-acute phase of SARS-CoV-2 infection: retrospective cohort study’ by Ken Cohen et al. was published in The BMJ at 23:30 UK time on Wednesday 9 February.

DOI: 10.1136/bmj-2021-068414

Declared interests

Dr James Connell: “Alzheimer’s Research UK, who collaborate on The Post-hospitalisation COVID-19 study (PHOSP-COVID) in the UK.”

Dr David Strain: “No conflicts of interest.”

None others received.