They demonstrate the association between Alzheimer's biomarkers and symptoms of anxiety and depression during COVID-19 confinement

Alzheimer's disease risk markers such as beta-amyloid protein or neuroinflammation are related to increased symptoms of anxiety and depression during COVID-19 confinement. This is one of the main results of a study led by the Pasqual Maragall Foundation's research centre, the Barcelonaβeta Brain Research Center (BBRC).

The study, which was published in Neurology®, the medical journal of the American Academy of Neurology, analysed the negative impact of COVID-19 confinement on mental health in cognitively healthy people and was carried out with 921 participants in the ALFA Study, promoted by the "la Caixa" Foundation. Of the total number of participants, results were analysed with biomarkers of Alzheimer's disease in 254 people. The research also involved the collaboration of the University of Gotheburg, the Hong Kong Centre for Neurodegenerative Diseases, Pompeu Fabra University, the Hospital del Mar Medical Research Institute and the CIBER on Frailty and Healthy Ageing (CIBERFES), among others.

The research has studied, through multivariate analysis regression models, the association between Alzheimer's-related biomarkers and sociodemographic factors, as well as the results of the Hospital Anxiety and Depression Scale (HADS) questionnaire during and before confinement. In a previous assessment, most of the study participants had standard levels of anxiety and depression, but during confinement 16.6% of the participants experienced an increase in anxiety, while 9.9% reported depressive symptoms. According to previous studies, this increase is considered clinically significant, and could have an impact on the participants' quality of life.

The study cohort, enriched for risk factors, has provided the basis for a possible association between the pandemic and Alzheimer's disease: the results indicate a link between disease-related risk markers, such as amyloid protein and neuroinflammation, and the increase in anxious and depressive symptoms during confinement. This association is important because it may imply a worse clinical prognosis in people at risk of Alzheimer's disease after the pandemic.

During the preclinical stage of Alzheimer's, there is an increase in anxiety and depressive symptoms that may accelerate disease progression. In addition, during the COVID-19 pandemic, these symptoms have increased on a global scale, with long-term consequences for the mental health and cognitive impairment of vulnerable groups. "In this context, it was relevant to investigate the possible association between anxiety and depression symptomatology during COVID-19-derived confinement and biomarkers of Alzheimer's disease," explains Müge Akinci, BBRC researcher and lead author of the study.

The research also explored the role of stress and lifestyle changes (sleep, eating, drinking, smoking habits and medication use) during this period, as well as socio-demographic factors such as sex/gender differences and the mental health of caregivers. Differences have been observed between men and women regarding hours of sleep during confinement and food consumption, as well as differences between carers and non-carers.

Anxiety and depression pose an increased risk of developing cognitive impairment and Alzheimer's disease, and the prevalence observed in this study is higher among women. On the HADS scale, women scored higher than men for both anxiety and depression symptoms.

"Overall, the results support the link between neuropsychiatric symptomatology and beta-amyloid burden in the brain in the preclinical stage of Alzheimer's disease, especially for women," says Dr Eider Arenaza-Urquijo, study investigator and team leader at the BBRC. "Modest but significant changes are shown and it is therefore appropriate that they are taken into account in the clinical setting," she concludes.

The findings of this study open the door to future research into the consequences of the pandemic on the mental health and clinical prognosis of people in the preclinical stage of the disease.

Bibliographic reference

Akinci, Müge; Peña-Gómez, Cleofé; Operto, Gregory, et al., 'Pre-pandemic Alzheimer disease biomarkers and anxious-depressive symptoms during the COVID-19 confinement in cognitively unimpaired adults', Neurology, August 2, 2022. DOI: https://doi.org/10.1212/WNL.0000000000200948