How the COVID-19 pandemic affected lifestyle and wellbeing factors associated with dementia risk in older adults with Subjective Cognitive Decline and Mild Cognitive Impairment participating in the APPLE-Tree (Active Prevention in People at risk of dementia through Lifestyle, bEhaviour change and Technology to build REsiliEnce) in England

The COVID-19 pandemic negatively affected known dementia risk factors and cognition in older adults. We invited adults with mild cognitive concerns without dementia, aged ≥60 years participating in a randomised controlled trial of a psychosocial, secondary dementia prevention intervention, to complete a co-designed, semi-structured qualitative survey, regarding how the pandemic impacted their lifestyle and wellbeing in areas relevant to dementia risk: social connections, activities, diet, mental and physical health, community and family support. Data was collected between October 2020 and December 2022; we conducted manifest content analysis.

551/746 trial participants completed the survey. Most (n=530, 96%) described pandemic-related changes to lifestyle or wellbeing; two thirds (n=369/545, 67.7%) reported less activities. A quarter (n=145, 26.8%) identified no change in social connections, with others reporting less in-person meetings (n=139, 25.7%) or speaking to less people (n=99; 18.2%); a minority engaged in compensatory online activities (n=31, 5.7%) and online (n=63, 11.6%) or phone (n=90, 16.6%) social contact. Relatively few reported weight gain (n=22, 4.0%); two-thirds reported no change in their diet (n=360, 66.1%), with others eating more unhealthy food (n=31, 4.8%), more food (n=21, 3.9%) and/or snacks (n=11, 2.0%); others reporting more healthy eating (n=26, 4.8%) and/or more home cooking (n=57, 10.5%). Modes of support changed, with reliance on food parcels, online services and shopping by neighbours. Over half reported (almost exclusively negative) mental health pandemic-related changes (n=307, 56.9%), including depression, stress, fear and loneliness; many reported declines in physical health (n=153, 28.1%) and/or fitness (n=70, 12.8%).

Stoical accounts of adaptation and resilience, enabled by technology and community support predominated, but were not possible for all. Reducing the digital divide, tackling loneliness and developing inclusive online/in-person support programmes that are more resilient in future lockdowns could protect cognitively frail people now and in any future pandemic, and contribute to national dementia prevention strategy.

Trial registration: ISRCTN17325135 ; https://doi.org/10.1186/ISRCTN17325135 (27.11.19)