Heightened Vulnerability of Alzheimer’s disease in COVID-19 Cataclysm and Putative Management Strategies

Alzheimer’s Disease (AD) susceptibility has been soared during global pandemic of coronavirus disease 2019 (COVID-19). People of advanced ages, especially those over sixty years old are more vulnerable to AD and COVID-19 conundrum. Concordant and discordant etiology, pathophysiology and management strategies of AD and COVID-19 had been highlighted in this review. Considering the grave concern of AD and COVID-19 specifi cally on global aged old population, some recommendations for managing both of the crises had been put forward. Mini Review Heightened Vulnerability of Alzheimer’s disease in COVID-19 Cataclysm and Putative Management Strategies Mohammad Azizur Rahman1*, Mohammad Saidur Rahman2 and Nur Alam3 1Department of Biochemistry and Molecular Biology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh 2Department of Chemistry, Jahangirnagar University, Savar, Dhaka-1342, Bangladesh 3Department of Pharmacy, Jahangirnagar University, Savar, Dhaka-1342, Bangladesh Received: 29 October, 2020 Accepted: 25 November, 2020 Published: 27 November, 2020 *Corresponding author: Mohammad Azizur Rahman, Department of Biochemistry and Molecular Biology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh, E-mail:


Introduction
According to the World Health Organization (WHO), global number of people over sixty years old will soar from 900 million to 200 billion in the time scale 2015-2050 accounting 12% of current total population up to 22% of that time [1]. As the older people are more vulnerable to age-onset disorders like Alzheimer's Disease (AD), the world is approaching a severe crisis with care giving and management of the vast expanse of aged population [2]. Unfortunately, current corona virus disease 2019 (COVID- 19) pandemic has been adding insult to the AD injury [1,2]. Epidemiolgical studies reveal 20 -40% of COVID-19 patients are over sixty years of age [3]. Emerging data of escalating COVID-19 cases in aged people warn highly perilious state for those already affl icted with dementia, Mild Cognitive Impairment (MCI) and AD [4]. Family members, care-givers, health care professionals, researchers and scientists should take necessary steps in managing this ever increasing catastrophe. This state-of-the art review explores the current trends and future aspects of AD in concordance with COVID-19 catastrophe.
AD is a neurodegenerative disorder associated with multiple co-morbidities including cardiovascular diseases (CVD), diabetes, hypercholesterolemia, hypertension, oxidative stress [8]. These co-morbidities intensify the AD-COVID-19 tie with grave consequence on the aged people. Accumulating evidence suggest that COVID-19 patients bear 7-10 times higher risk of developing CVD complications [9]. Even, COVID-19 augments the existing CVD complications [10]. Bidirectional impact between COVID-19 and diabetes patients have been observed that magnify overall metabolic dysregulation [11]. Pneumonia is the most predominant feature of COVID-19 [12]. AD and dementia patients are at escalated rate of developing pneumonia [12]. Similar commination persists for hypertensive patients [13]. and anti-hypertensive drugs such as ACE Inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) have been found prospective in ameliorating COVID-19 complications [13].
Neurological manifestations abutting COVID-19 are impaired consciousness, delirium, disorientation of space and time, hallucination, schizophrenia, Guillain-Barré syndrome, encephalopathy, aphasia, seizures, tremors, diffi culty in problem solving and performing errands, distorted emotional state, cerebral hemorrhage and ischemic stroke [8,14]. As olfactory neurons become affected, both AD and COVID-19 patients lose smelling and can not differentiate between aroma and bad odor. Even, they fail to enjoy food taste [8,14].

Management muddle
AD patients, at their severe stages, become solely dependent on their family members and care-givers. Caregivers must attend their patients constantly and aid in their every daily activities ranging from feeding to lodging even during using toilets. COVID-19 management warrants usage of masks, maintenance of social distance, avoidance of personal contact, withdrawn of sharing personal belongings with others, washing of hands repeatedly with sanitizers. Quarantine or self-isolation is another highly practiced stratagem in COVID-19 pandemic. All these management strategies go against AD care-giving and management at home and at hospital [15]. Even, AD patient cannot take his or her own medicine by himself or herself and must rely on others for treatment purpose that violates COVID-19 management process. Perturbed olfactory neuronal activity in AD and COVID-19 patients truss them together to depend on others while management strategy of one mar another. Psychological alteration, anxiety and depression of both types of patients bar them from their common management practices.

Putative management for AD -COVID-19 havoc
Following are the recommendations that could be applied for management and mitigation of AD -COVID-19 havoc a. Continuation of the ongoing treatment and management processes for both AD and COVID-19 patients at home and hospital with proper sanitization. n. Therapeutic approaches against AD such as regular intake of choline esterase inhibitors (aricept, donepezil, galantamine, memantine, rivastigmine) [16].

Conclusion
COVID-19 poses grave threat to the already suffering AD patients and also to those ageing over sixty. As the number of population over sixty years old will double by 2050, the risk for developing AD at exponential rate knocks the health-care system overtly. Time is up to take proper steps in tackling this global crisis. Adequate management strategy along with proper medico-therapy, life style modifi cation can beacon towards AD -COVID-19 free global community. Thus, graceful ageing with healthy life style practice and management are of utmost importance.