Study cites link between older COVID hospital patients, antidepressants, dementia

Older COVID-19 hospital patients on antidepressants, anti-anxiety drugs and other types of psychotropic medications were much more likely to develop dementia than those who were not, a newly released study by Northwell Health researchers found.

The study found that 24% of patients 65 and older who were using these medications before contracting the coronavirus developed dementia, compared with 9% of patients who were not using psychotropic drugs, which are medications that affect the mind, emotions and behavior.

Previous studies have linked COVID-19 and, separately, psychiatric conditions to increased likelihood of dementia, but this is the first that associates psychotropic drugs in older COVID-19 patients to dementia, said Dr. Liron Sinvani, lead author of the study and assistant professor in the Institute of Health System Science at the Feinstein Institutes for Medical Research, which is Northwell’s Manhasset-based research center.

Sinvani warned, "We cannot show causality. We can’t say the psychotropic medications caused the dementia. We know there’s an association."

More research is needed, said Sinvani, who led a team of Feinstein researchers.

But, she said, the "interplay" of COVID-19, psychiatric conditions and the medications may have "hastened" the development of dementia.

"Whereas these patients may have developed dementia in 20 or 30 years, all of a sudden now they’re developing it very quickly after COVID," she said Saturday in a phone interview.

Peer-reviewed study

The peer-reviewed study, published Friday in the medical journal Frontiers in Medicine, was of 1,755 people ages 65 and older who were hospitalized with COVID-19 between March 1 and April 20, 2020. The large majority were hospitalized on Long Island, Sinvani said.

A quarter had used at least one psychotropic drug before their COVID-19 diagnosis. More than half of those using psychotropic drugs were on antidepressants. Others were on antipsychotics, mood stabilizers, anticonvulsants, Parkinson’s disease medications or benzodiazepines, which can be used to treat anxiety, insomnia and muscle spasms and reduce seizures.

It’s unclear to what extent the psychiatric or neurological condition for which people were taking the drugs may have helped lead to dementia, Sinvani said. Researchers compared some people with the conditions who were using the psychotropic medications with those who were not, and those using the drugs were about three times more likely to develop dementia, she said. But that was a much smaller group of patients, not enough to draw definitive conclusions, she said.

Typically, about 1% or 2% of adults 65 and older develop dementia every year, Sinvani said. Research has found that number increases to nearly 3% for older adults with COVID-19, she said.

This study focused on hospitalized patients with more serious cases of COVID-19, which is likely why the rates of dementia were significantly higher, even in patients not on psychotropic drugs, Sinvani said.

Severe COVID-19 is more likely to have an impact on the brain, said Dr. Yun Freudenberg-Hua, a study co-author and associate professor of psychiatry and molecular medicine at the Zucker School of Medicine at Hofstra/Northwell.

"People having mild symptoms may not have this higher risk," she said.

The study was specific to older COVID-19 patients, and it’s unclear if there’s an association between the use of psychotropic medications in younger COVID-19 patients and the later development of dementia, she said.

The lengths of time that patients were on the medications were not compared because they weren’t in the electronic health records that were analyzed, Freudenberg-Hua said.

A caution against avoiding medications

Sinvani cautioned against avoiding psychotropic medications because of the study results. All drugs have potential negative side effects, she said.

Although alternatives to medication should always be considered, "If an older adult truly has depression or depressive symptoms and this medication improves their quality of life and their lifestyle, then yes, they need to be on this medication, because at this point, we don’t know enough to say they shouldn’t," Sinvani said.

Freudenberg-Hua said doctors with older adult patients who had severe COVID-19 and used psychotropic medications should be especially alert for signs of cognitive decline.

Psychotropic medicines are sometimes used off-label to manage the symptoms of dementia, but Sinvani said that, even before COVID-19, they should have only been used as a last resort, after other methods failed.

"This study is another reason why we should avoid them when possible" to manage dementia, she said.

Researchers also found that the COVID-19 patients in the study admitted with delirium were more than twice as likely to develop dementia than those without delirium. Scientists already knew delirium can lead to cognitive decline. But the isolation many COVID-19 patients had might have contributed to the development of dementia, Sinvani said.

"To isolate patients from their loved ones — we had to do it at one point, but this continued isolation has consequences," she said.

The study was released as Long Island's seven-day COVID-19 positivity rate continued to rise amid the spread of a subvariant of omicron and as few mask and other restrictions remain.

The region's 1.88% seven-day rate on Friday is up from 1.78% on Thursday and 1.52% on March 9.

There were 144 people with COVID-19 in Long Island hospitals on Friday, down from 150 on Thursday.

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By David Olson

david.olson@newsday.com@DavidOlson11

David Olson covers health care. He has worked at Newsday since 2015 and previously covered immigration, multicultural issues and religion at The Press-Enterprise in Southern California.