Table 4

Factors associated with worsening in behavioural and psychological symptoms of dementia from the prepandemic to the pandemic assessment

Covariates	NPI-12 total score				NPI-12 psychosis subsyndrome				CSDD total score
	OR	95% CI		P value	OR	95% CI		P value	OR	95% CI		P value
	OR	Lower	Upper	P value	OR	Lower	Upper	P value	OR	Lower	Upper	P value
Prepandemic characteristics
Person with dementia
Age	1.01	0.92	1.11	0.79	0.91	0.82	1.01	0.16	1.09	0.97	1.22	0.16
Female gender	0.51	0.13	1.98	0.34	0.36	0.09	1.52	0.09	0.19	0.03	1.31	0.09
Living alone	0.20	0.04	1.01	0.05	2.69	0.41	17.80	0.31	0.55	0.07	4.18	0.57
Alzheimer’s disease*	0.18	0.05	0.63	0.01¶¶	0.84	0.23	3.08	0.79	0.21	0.05	0.85	0.03¶¶
MMSE†	1.19	1.01	1.40	0.04¶¶	0.97	0.82	1.14	0.68	0.96	0.80	1.15	0.65
FAST‡	0.98	0.45	2.16	0.97	2.59	1.07	6.27	0.04¶¶	4.96	1.57	15.65	0.01¶¶
IADL§	0.96	0.80	1.15	0.64	1.19	0.98	1.45	0.08	0.84	0.67	1.07	0.16
PSMS¶	1.00	0.79	1.28	0.99	0.68	0.51	0.91	0.01¶¶	0.99	0.76	1.29	0.96
GMHR**	0.91	0.36	2.32	0.84	2.06	0.72	5.88	0.18	0.84	0.28	2.50	0.76
Psychotropic drugs††
Regularly	1.16	0.54	2.48	0.71	0.67	0.31	1.47	0.32	1.11	0.49	2.53	0.80
On-demand	0.35	0.09	1.46	0.15	2.95	0.69	12.66	0.15	0.16	0.03	0.75	0.02¶¶
Informal carer
Age	0.97	0.92	1.03	0.40	1.04	0.98	1.12	0.21	0.99	0.93	1.06	0.87
Female gender	1.81	0.50	6.49	0.36	0.70	0.18	2.80	0.62	0.82	0.16	4.27	0.82
Pandemic characteristics, person with dementia
Insight to the COVID-19 situation‡‡
Partial	0.61	0.10	3.69	0.60	9.57	1.14	80.71	0.04¶¶	0.67	0.10	4.44	0.68
Sufficient	1.14	0.15	8.82	0.90	3.69	0.33	40.93	0.29	2.70	0.26	28.27	0.41
Contact with the informal carer§§
Reduced	1.88	0.48	7.44	0.37	4.45	1.01	19.71	0.049¶¶	1.40	0.27	7.27	0.69
Increased	2.41	0.61	9.49	0.21	3.21	0.71	14.55	0.13	0.30	0.07	1.23	0.10
Ceased volunteering services	0.30	0.04	2.24	0.24	0.20	0.02	2.11	0.18	0.59	0.04	7.91	0.69
Change in healthcare services	0.48	0.13	1.78	0.28	0.48	0.11	2.08	0.33	1.16	0.28	4.83	0.84
Postponed or averted contacts with healthcare professionals	3.96	1.05	14.95	0.04¶¶	1.55	0.45	5.42	0.49	3.37	0.70	16.08	0.13

Change dichotomised into worsening/not worsening. OR explored by multiple logistic regression, estimates adjusted for all other factors in the models.
*Alzheimer’s disease, reference: all other dementia aetiologies.
†MMSE, range 0–30, higher scores indicate better cognition, reference: 30.
‡FAST, range 1–7, lower scores indicate better functioning, reference: 1.
§IADL, range 8–31, lower scores indicate better functioning, reference: 8.
¶PSMS, range 6–30, lower scores indicate better functioning, reference 6.
**GMHR, range 1–4, lower score indicate higher comorbidity burden, reference 4.
††Number of psychotropic drugs according to the Anatomical Therapeutic Chemical Index: antipsychotics (N05A), anxiolytics (N05B), hypnotics/sedatives (N05C), antidepressants (N06A) and anti-dementia drugs (N06D), reference: 0.
‡‡Degree of insight into the COVID-19 situation as perceived by the informal carer, reference: no insight.
§§Change in contact with the informal carer, reference: no change.
¶¶P: two-tailed p<0.05
CSDD, Cornell Scale of Depression in Dementia ; FAST, Functional Assessment Staging, at inclusion; GMHR, General Medical Health Rating Scale; IADL, Instrumental Activities of Daily Living Scale; MMSE, Mini-Mental Status Examination, at inclusion; n, 89 dyads (person with dementia and informal carer); NPI-12, Neuropsychiatric Inventory, twelve item version, with psychosis subsyndrome constituting delusions and hallucinations; Pandemic, PAN.DEM assessment (20 April 2020 to 15 May 2020); Prepandemic, Six-month assessment of parent trial (12 December 2019 to 11 March 2020); PSMS, Physical Self-Maintenance Scale.