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Coronavirus, Stress and Increased Dementia Risk

The amount of stress caused by the Coronavirus can be extremely substantial in both people suffering from cognitive disorders, as well as their family and friends. People with cognitive disorders may have a difficult time isolating themselves inside their homes, and often become restless, want to go out, and may seem to forgot the need to stay in the house due to the stay-at-home orders. They may forget the need to use masks or for repeated hand washings, and take their masks off multiple times during the day, or need to be reminded multiple times during the day to wash their hands.

This can also be particularly stressful for caregivers, who are occupied with the tasks of maintaining a daily routine for them 24/7, especially if they are waking up in the middle of the night thinking it is time to get up and go to work or start the day.

I am here to provide support, recommendations, and counseling for you during these difficult times. It is very important to maintain a daily routine for people with cognitive disorders during this stressful time, and is usually WAY TOO MUCH for one person, particularly a spouse, or child to provide this on their own. Don't be afraid to ask for help. Insurances often cover home health aides who can come to the house for 20 hours per week and help a person with activities of daily living, such as washing hands, remembering to use a mask, and even bathing or using the bathroom. They also should be trained in how to entertain a person with daily activities. If they are not, then perhaps it is time to find someone who is trained and interested in this. I have posted before on several activities to do while at home with COVID, but it should not be the responsibility of just one member of the family. DO NOT BE AFRAID to delegate responsbilities to family members who have offered to help in the past. They may have said, "I'm here for you, call me if you need anything," and you may be afraid to call them because you're not sure how to ask them what to do.

May suggestion is to think about a clear task and for how many hours per week you would need them to do it. As part of a person's daily routine, you could ask them to come to the house for a few hours and play a game or listen to music with your loved one, or even take them for a walk outside. As the primary caregiver, you DESERVE the respite needed for these few hours to take care of yourself, either by taking a nap, or even checking into a hotel and getting a good night's sleep while a trusted friend or family member stays with your loved one overnight.

Stress disorders during, and particularly early in life, are associated with an increased risk of neurodegenerative brain disease later in life, including Alzheimer's Disease and other Related Dementias (ADRD), Dementia, and particularly Vascular Cognitive Impairment (VCI)

In a recent study, stress disorders were associated with an 80% increased risk of VCI, and up to a 67% increased risk of other neurodegenerative brain disorders (Alzheimer's Disease and other Related Dementias, ADRD) later on in life.

How do trauma, stress disorders, or PTSD increase the risk of cognitive impairment and Dementia later in life? The study suggested that chronic, repeated, or intense stress may impair the hypothalamic-pituitary-adrenal axis and alter stress hormone levels, causing brain inflammation, which can lead to neurodegeneration or vascular injury.

What can we do about it? Reducing stress is extremely difficult, particularly for the primary caregivers for people with cognitive impairment, young people who are still working, have family disagreements, or have been exposed to misunderstanding, trauma, abuse, or bullying by their families or in toxic work environments. If you have a family history of alcohol abuse, or have personally experienced not just sexual abuse or physical trauma, but also verbal and emotional abuse, or criticism or misunderstanding from family, I would highly suggest seeing a specialist (either a therapist or psychiatrist) with expertise in trauma-informed care or stress disorders. This will help you become a better caregiver for your loved one, as well as prolong your life so that you can be there for your loved one as they progress along the cognitive impairment path.

These particular specialists can be difficult to find, as there is no psychiatry fellowship in trauma or stress-related disorders. I would suggest using and searching for "Post Traumatic Stress Disorder" to find a psychiatrist with an interest in Stress disorders or trauma. We often think of PTSD in terms of its applicability to military veterans, but it is often misdiagnosed as a different disorder (such as depression, anxiety, or even bipolar or schizophrenia/shizoaffective disorder) by psychiatrists. The prevalence of sexual abuse in this country is extremely high and honestly shocks me (Usually when I ask, up to 1 in 2 patients who see me have a history of either sexual, physical, or emotional and verbal abuse). Sometimes I forget to ask, but I suspect that many cognitive disorders are triggered by early life sexual, physical, or verbal abuse, and can be reversed when a person seeks trauma-informed care through both a therapist and a psychiatrist.

Even the abuse suffered by family members caring for a loved one with cognitive impairment is often under-recognized, or not fully expressed in meetings with me because the loved one is present and the caregiver may not be willing to share how much they feel hurt or disempowered, or even abused by their loved one. Part of this may be guilt about "complaining" when their loved one seems to be going through something that seems more painful for them, but we often forget to acknowledge the reality that most people with cognitive impairment are often unaware or in denial of their cognitive impairment due to their brain condition, and are actually very happy and unaware of the stress they are causing their caregiver. So please don't be afraid to talk to me about the stress, trauma, or abuse that has been going on at home. More than any other dementias, Vascular Cognitive Impairment and sometimes Alzheimer's Disease provokes a certain type of irritability or lack of control of anger, and can cause a great deal of emotional or even physical abuse on the caregiver. It is not that person's fault because they have a brain condition, but it should be your priority as a caregiver to express this to me or other physicians directly and openly. Please do not feel afraid to send me a confidential text, email, or voicemail about it, or request a separate meeting with me to discuss the emotional suffering you have been going through as a caregiver. It is often the person whom the impaired person loves the most who suffers the brunt of the emotional abuse and crticisim because they may be the only person the patient trusts with their emotions, and they get the full force of them while the person cannot control their anger, criticism, or physical or emotional violence towards them. I have written in the past that I suspect my mother has mild Alzheimer's and frontal lobe impairment, and the degree of emotional and verbal abuse I suffer when talking to her has contributed to my PTSD. So please don't be afraid to talk to me about it, send me a confidential email, text, or note, so I know to meet with you individually or schedule a private phone call or video chat sometime soon so we can solve these issues together.

In terms of seeking outside help, good psychiatrists who listen and give accurate diagnoses are difficult to find. I would suggest using, clicking "psychiatrist" on the drop-down menu to find psychiatrists interested in trauma recovery, and actually calling the office to speak to the psychiatrist ahead of time to discuss their experience and interest in treating someone with a stress disorder, childhood or adult trauma, or PTSD. Often psychiatrists dismiss a diagnosis of PTSD or do want to evaluate the impact of childhood trauma, so it is important to find someone who is open-minded and willing to discuss the impact of trauma and abuse on cognition and the mind.

In terms of finding a therapist who is a specialist in stress-related or trauma-related disorders, I would log on to the online directory of trauma-informed therapists here and search for trauma-informed psychologists.

Please feel free, in a confidential voicemail, text, email, or note to me to express what type of trauma or abuse you may have gone through on the past or as caregivers for your loved one. Together, we can formulate a plan to help you ASAP.

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