The COVID-19 pandemic has been an unprecedented global health crisis, affecting millions of lives around the world. Among the most vulnerable populations during this time have been adults with Alzheimer's disease and related dementias (ADRD). Their susceptibility to both the direct and indirect effects of the pandemic has raised concerns and highlighted the need for better understanding of the impact on this group.

A recent study, published today in JAMA Neurology, has shed light on the fatality trends associated with ADRD during the first 2 years of the pandemic, revealing some intriguing findings. The cross-sectional study sought to determine how mortality with ADRD as an underlying or contributing cause changed during the COVID-19 pandemic. The investigators analyzed a total of 2,334,101 death certificates, comparing the excess deaths by age, sex, race, ethnicity, and place of death.

In the initial year of the pandemic (from March 2020 to February 2021), the impact on ADRD-related deaths was staggering. The study's analysis of death certificates of US decedents aged 65 years and older revealed a total of approximately 94,688 excess deaths associated with ADRD during this period. The number is alarming, considering the already vulnerable nature of individuals with ADRD.

These initial findings indicated that the COVID-19 pandemic posed a significant threat to older adults with ADRD, resulting in a substantial increase in mortality rates compared to pre-pandemic years. The study authors noted that a combination of factors such as limited access to healthcare, social isolation, and disruptions in care routines likely contributed to this surge in ADRD-related deaths.

As the pandemic progressed into its second year (from March 2021 to February 2022), there was a glimmer of hope with the widespread availability of prevention strategies, including more accessible testing and COVID-19 vaccines. The study aimed to determine whether these interventions had any effect on the mortality rates associated with ADRD.

Remarkably, the findings demonstrated a significant decline in ADRD-related deaths in pandemic year 2. The number of excess deaths decreased dramatically, with an estimated 21,586 deaths linked to ADRD during this period. This notable reduction in mortality points towards the efficacy of preventive measures and vaccination campaigns in protecting vulnerable populations, including those with ADRD.

The study further analyzed the data to explore how the pandemic affected various demographic groups and places of death. Declines in ADRD-related deaths were found to be consistent across all age, sex, and racial and ethnic groups evaluated. This suggests that the preventive measures and vaccinations were effective across diverse populations.

Notably, the most significant declines in ADRD-related deaths were observed in nursing home and long-term care settings. The numbers dropped considerably from approximately 34,259 excess deaths in year 1 to a negative value of -22,050 in year 2, highlighting the success of targeted interventions and focused efforts to protect residents in these facilities.

However, the picture was different when it came to deaths at home or medical facilities. Excess deaths at home remained relatively high, with an estimated 28,804 deaths in year 2, and medical facilities also saw a notable number of excess deaths during this time.

The study's findings reveal a tale of 2 years during the COVID-19 pandemic for adults with Alzheimer's disease and related dementias. The first year witnessed a substantial increase in ADRD-related mortality, underscoring the vulnerability of this population to the pandemic's effects. However, the second year brought about a decline in excess deaths, mainly attributed to better prevention strategies, testing, and widespread vaccination efforts.

Nevertheless, the study emphasizes the continued importance of safeguarding vulnerable individuals with ADRD, particularly those living at home or in medical facilities. Ongoing efforts to ensure their safety and access to care remain crucial, even as the pandemic evolves. The findings provide valuable insights into the dynamic interplay between the pandemic and ADRD mortality, guiding future public health responses and strategies to protect this vulnerable population.

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