Alzheimer’s And Parkinson’s Diseases Predict Different COVID-19 Outcomes: A UK Biobank Study Part 3
May 31, 2024
5. Limitations
This study presents several caveats. First, our cohort is not representative of the UK population. For instance, the majority of COVID-19-related deaths in the UK took place in care homes [56].
With the global outbreak of COVID-19, people have begun to pay attention to the impact of this virus on the human body. Some studies show that COVID-19 may cause some effects on memory, but there is also increasing evidence that this effect is not permanent.
Because COVID-19 is a new virus, there is not much research data in human history. However, some medical experts say that COVID-19 may cause some long-term effects, including some memory-related problems.
However, we should not worry too much about this. In most COVID-19 patients, any memory-related effects are only short-lived. This means that after the recovery period, their memory is likely to return to normal levels.
At the same time, we should also note that the drugs or treatment regimens used during the treatment of COVID-19 may have an impact on memory. However, this effect can be controlled or mitigated with the right drugs and dosages used in the treatment plan.
To maintain and improve memory, we should actively adopt healthy living habits, such as:
1. Exercise
Proper physical exercise can promote blood circulation and increase the supply of oxygen and nutrients to the brain. Regular aerobic exercise, such as walking, swimming, jogging, etc., can keep your memory healthy and improve your mental state.
2. Get enough sleep
Stress and anxiety related to COVID-19 and other factors not only affect sleep but also affect our thinking ability and memory retention. Getting enough sleep every day can help us keep our minds clear to better process information.
3. Balanced diet
A healthy diet is key to maintaining brain and body health. We should choose foods such as vegetables, fruits, healthy proteins, and refined carbohydrates, and try to avoid foods high in sugar, salt, and fat.
Finally, we should maintain an optimistic attitude. COVID-19 is a serious health problem, but we should believe that scientists and doctors are working hard to solve it. At the same time, we can also improve our physical and mental state through an active lifestyle, so we should not worry too much about possible health problems. It can be seen that we need to improve our memory, and Cistanche can significantly improve memory because Cistanche can also regulate the balance of neurotransmitters, such as increasing the levels of acetylcholine and growth factors, which are very important for memory and learning. In addition, Cistanche deserticola can improve blood flow and promote oxygen delivery, which can ensure that the brain obtains adequate nutrition and energy, thereby improving brain vitality and endurance.
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However, only six patients included in our study were reported to live in long-term care facilities, and none of them tested positive for COVID-19. Therefore, our analysis of patients affected by chronic neurodegenerative diseases included only patients living in domestic residences where rapid changes in social behavior and domestic care may have affected distinct patient groups differently.
This feature might have led us to overestimate the effect of chronic neurodegenerative disorders on the risk of COVID-19 and mortality, and further investigation is needed to confirm the generalisability of our results.
In addition, it is important to recognize the indirect effects of the current pandemic on AD patients. Because elderly individuals are at increased risk of severe outcomes from COVID-19, government guidelines recommend the isolation of these individuals and limited contact with their family members [57]. However, social activities as well as time spent with other people are generally considered to help prevent cognitive decline in elderly individuals [58]. Therefore, it is plausible that isolation, albeit necessary, may lead to increased stress and cognitive decline among AD patients [59].
In turn, these behavioral difficulties may exacerbate underlying neurodegenerative disorders, contributing to higher rates of hospitalization and a higher risk of COVID-19 and mortality [59].
Our findings warrant a more rigorous assessment of functional disabilities in patients with AD and PD and their association with COVID-19 mortality. While these effects are challenging to measure amid a pandemic, large-scale retrospective studies will reveal the full range of implications of current isolation measures on AD and COVID-19.
Finally, several potentially relevant comorbidities, such as kidney disease, previous myocardial infarction, and stroke, were not included in the data collection. Future studies should validate our results by examining the effect of additional comorbidities as well as other factors that we were unable to examine, including access to personal protective equipment, employment, exposure to environmental hazards, and the effect of living in care home facilities.
6. Conclusions
In conclusion, we report that a pre-existing diagnosis of dementia or AD predicted the largest risk of COVID-19 and mortality. Conversely, PD patients were found to be at heightened risk of SARS-CoV-2 infection but not mortality from COVID-19.
Our results support detailed analyses of the biological mechanisms underlying disease-specific vulnerability to SARS-CoV-2 infection among patients with neurodegenerative disorders.
Improved knowledge of these factors is critical to developing appropriate strategies to protect clinically vulnerable patients affected by neurodegenerative diseases during this pandemic.
Our results have important implications for disease management and further highlight the important role of disease-specific neuropathology and management in the potential susceptibility to COVID-19.
Supplementary Materials: The following are available online at https://www.mdpi.com/2308-341 7/6/1/10/s1, Table S1: Descriptive statistics of the UK Biobank cohort data.
This table is related to Figure 1. Baseline characteristics of 13,338 UK Biobank participants included in the study. The C-reactive protein levels were normalized to total protein levels and log-transformed. White matter hyperintensity levels were normalized to total brain volumes and log-transformed.
The household number refers to the number of people per household. N-Miss, number of missing values; SD, standard deviation; A-levels/AS levels, participants with Advanced Level (A-level) or Advanced Subsidiary Level (AS level) qualifications.
NVQ/HND/HNC, participants who received vocational qualifications such as National Vocational Qualifications (NVQ), Higher National Certificate (HNC) or Higher National Diploma (HND); CSEs, participants with a Certificate of Secondary Education (CSEs); O-levels/GCSEs, participants with either a General Certificate of Secondary Education (GCSE) or a General Certificate of Education (GCE) Ordinary Level (O-levels), a secondary school leaving qualification. Table S2: Descriptive statistics for minority groups in the UK Biobank.
This table is related to Figure 1. Summary of the number of individuals from each ethnic group included in the analysis and the outcomes of the COVID-19 test. The data are presented as the number of patients, followed by the percentage of the number of participants relative to the total number of participants in parentheses. N-Miss, number of missing values. Table S3: The diagnosis of dementia increases the risk of COVID-19.
This table is related to Figure 2A. Risk factors associated with COVID-19 diagnosis in the UK Biobank cohort. The household number refers to the number of people per household.
The odds ratios for education levels are relative to A-levels. NVQ/HND/HNC, participants who received vocational qualifications such as National Vocational Qualifications (NVQ), Higher National Certificate (HNC) or Higher National Diploma (HND); CSEs, participants with a Certificate of Secondary Education (CSEs); O-levels/GCSEs, participants with either a General Certificate of Secondary Education (GCSE) or a General Certificate of Education (GCE) Ordinary Level (O-levels), a secondary school leaving qualification. Table S4: The diagnosis of dementia increases the risk of COVID-19 death.
This table is related to Figure 2B. Risk factors associated with both testing positive and dying from COVID-19 within the UK Biobank cohort. Blood pressure is relative to participants who were not tested for blood pressure.
Smoking is relative to being a current smoker. The C-reactive protein levels were normalized to total protein levels and log-transformed. The household number refers to the number of people per household. Table S5: Diagnoses of Alzheimer's and Parkinson's diseases increase the risk of COVID-19. This table is related to Figure 3A.
Risk factors associated with COVID-19 diagnosis in the UK Biobank cohort. The household number refers to the number of people per household. The odds ratios for education levels are relative to A-levels.
NVQ/HND/HNC, participants who received vocational qualifications such as National Vocational Qualifications (NVQ), Higher National Certificate (HNC) or Higher National Diploma (HND); CSEs, participants with a Certificate of Secondary Education (CSEs); O-levels/GCSEs, participants with either a General Certificate of Secondary Education (GCSE) or a General Certificate of Education (GCE) Ordinary Level (O-levels), a secondary school leaving qualification. Table S6: Diagnoses of Alzheimer's disease and parkinsonism increase the risk of COVID-19.
Risk factors associated with COVID-19 diagnosis in the UK Biobank cohort. The household number refers to the number of people per household. The odds ratios for education levels are relative to A-levels.
NVQ/HND/HNC, participants who received vocational qualifications such as National Vocational Qualifications (NVQ), Higher National Certificate (HNC) or Higher National Diploma (HND); CSEs, participants with a Certificate of Secondary Education (CSEs); O-levels/GCSEs, participants with either a General Certificate of Secondary Education (GCSE) or a General Certificate of Education (GCE) Ordinary Level (O-levels), a secondary school leaving qualification. Table S7: The diagnosis of Alzheimer's disease increases the risk of COVID-19 death. This table is related to Figure 3B.
Risk factors associated with both testing positive for and dying from COVID-19 within the UK Biobank cohort. The C-reactive protein levels were normalized to total protein levels and log-transformed.
Table S8: Participants with Alzheimer's disease have an increased risk of dying from COVID-19, independent of other common risk factors. Risk factors associated with both testing positive for and dying from COVID-19 within the UK Biobank cohort in the subset of patients with a positive diagnosis of Alzheimer's disease.
The model shows that a diagnosis of Alzheimer's disease increases the risk of COVID-19 death, independent of underlying risk factors characterizing the Alzheimer's disease patients within the UK Biobank. Table S9: The diagnosis of Parkinson's disease does not explain the risk of COVID-19 death.
Risk factors associated with dying from COVID-19 within the UK Biobank cohort in the subset of patients with a positive diagnosis of Parkinson's disease. The model shows that a diagnosis of Parkinson's disease did not explain the risk of COVID-19 death, indicating that other comorbidities in participants with PD may explain their risk of dying from COVID-19.
Table S10: Effect of drug treatment on COVID-19 mortality in the UK Biobank. Effect of drug treatments on COVID-19 mortality in the UK Biobank cohort. For each drug treatment (Drug treatment), the number of patients (Number of participants) taking the drug (TRUE) and not taking the drug (FALSE) were defined and compared to the number of patients who died from COVID-19 (COVID-19 death) compared to the total number of patients in the UK Biobank tested for COVID-19 (Total participants tested).
The percentage of the number of participants relative to the total number of participants is indicated in parentheses. Table S11: Demographic and clinical characteristics of amantadine-treated patients.
Demographic and clinical characteristics of amantadine-treated participants (n = 9) included in the study. The household number refers to the number of people per household.
Housing type refers to the type of accommodation in which patients live (flat/maisonette, house/bungalow, caravan, sheltered accommodation, care home). NVQ/HND/HNC, participants who received vocational qualifications such as National Vocational Qualifications (NVQ), Higher National Certificate (HNC) or Higher National Diploma (HND); CSEs, participants with a Certificate of Secondary Education (CSEs); O-levels/GCSEs, participants with either a General Certificate of Secondary Education (GCSE) or a General Certificate of Education (GCE) Ordinary Level (O-levels), a secondary school leaving qualification.
Author Contributions: Conceptualisation: Y.Y., M.T., and L.M.M.; data curation: Y.Y. and M.T.; formal analysis: Y.Y.; funding acquisition: L.M.M.; investigation: R.P. and N.S.L.; methodology: Y.Y., R.P., and N.S.L.; visualization: N.S.L.; writing original draft, M.T.; writing, review, and editing: Y.Y., R.P., N.S.L., and L.M.M. All authors have read and agreed to the published version of the manuscript.
Funding: This study was funded by the UK Medical Research Council, intramural project MC_UU_00025/3 (RG94521).
Institutional Review Board Statement: UK Biobank ethical approval was granted from the North West Multi-Centre Research Ethics Committee. The current analysis was approved under the UK Biobank application #60124.
Informed Consent Statement: Informed consent was obtained from all subjects involved in the study by the UK Biobank.
Data Availability Statement: Data regarding the current analysis can be requested through the UK Biobank and fully reproduced using the code available in the GitHub repository.
Acknowledgments: We thank G. Fedele and S. Loh for helpful discussions as well as the UK Biobank team for their efforts in tackling the COVID-19 pandemic.
Conflicts of Interest: The authors have no conflict of interest to declare.
Abbreviations
AD: Alzheimer's disease; COPD, chronic obstructive pulmonary disease; COVID-19, coronavirus disease-19; PD, Parkinson's disease; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
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