The global impact of COVID-19 control measures on people with dementia living at home and their carers during the two first waves: A systematic review of quantitative and qualitative research across 27 countries

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Yet, uncertainty exists regarding the global impact of such measures, and whether differences exist between countries and global regions. We aimed to synthesize evidence on this topic. Methods We searched Medline, PsycINFO, EMBASE, Web of Science, CINAHL, Latin American and Caribbean Health Literature (Lilacs), Scientific Electronic Library online (Scielo), and EM Premium, from the start of the pandemic to July 2022. At least two researchers independently screened citations and performed quality assessment following recommended criteria for critical appraisal according to study methodology. We analyzed data by country and region, and synthesized results descriptively. Results Sixty-nine studies met inclusion criteria (74% qualitative and 26% quantitative; 22% included PWD, 44% carers of PWD, 4% dyads), with a total of 209,738 participants. Most studies were conducted in Europe (59%), followed by Asia and North America (15% each), South America (7%) and Oceania (1%). Two studies presented data from multiple regions (3%). The quality of the studies varied, with the majority (62%) being of moderate quality. Across the study populations and global regions, COVID-19 control measures had implications for PWD and carers’ access to health services, physical and mental health and daily routine, cognition, behaviour, with accompanying social and economic costs. Conclusion Our results highlight how public health measures impacted PWD and their carers living at home globally, and suggest the need for proactive planning of preventive measures to mitigate the negative impact, in anticipation of future public health threats. Other This work was funded by the JPND Call for Expert Working Groups: The Impact of COVID-19 on Neurodegenerative Diseases in partnership with the CIHR-Institute of Aging; Public Health Agency (CIHR #02342-000). PROSPERO CRD42024554701. 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HRB Open Res 2025, 8 :99 ( https://doi.org/10.12688/hrbopenres.14202.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Systematic Review The global impact of COVID-19 control measures on people with dementia living at home and their carers during the two first waves: A systematic review of quantitative and qualitative research across 27 countries [version 1; peer review: 1 approved with reservations] Yaohua Chen https://orcid.org/0000-0003-1778-1790 1-4 , Tatyana Mollayeva https://orcid.org/0000-0002-2787-1848 2-5 , Rachel Fitzpatrick 3 , [...] Thaisa Tylinski Sant’Ana 5,6 , Francesca R Farina 2-4,7 , D Swiatek https://orcid.org/0000-0003-4787-4269 8 , K Sopidou https://orcid.org/0009-0005-4722-2174 9 , E Tabilo 10,11 , M Betka 12 , Iracema Leroi 2-4 , T Leon 2-4,10 , Geeske Peeters 2-4,13 , STRAP consortium Yaohua Chen https://orcid.org/0000-0003-1778-1790 1-4 , Tatyana Mollayeva https://orcid.org/0000-0002-2787-1848 2-5 , [...] Rachel Fitzpatrick 3 , Thaisa Tylinski Sant’Ana 5,6 , Francesca R Farina 2-4,7 , D Swiatek https://orcid.org/0000-0003-4787-4269 8 , K Sopidou https://orcid.org/0009-0005-4722-2174 9 , E Tabilo 10,11 , M Betka 12 , Iracema Leroi 2-4 , T Leon 2-4,10 , Geeske Peeters 2-4,13 , STRAP consortium PUBLISHED 04 Sep 2025 Author details Author details 1 CHU Lille, Department of Geriatrics, University of Lille, Lille, Hauts-de-France, France 2 Global Brain Health Institute, County Dublin, County Dublin, Ireland 3 Trinity College Dublin School of Medicine, Dublin, Leinster, Ireland 4 University of California San Francisco, San Francisco, California, USA 5 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada 6 KITE-Toronto Rehab-University Health Network, Toronto, Ontario, Canada 7 The University of Chicago Medicine, Chicago, Illinois, USA 8 Regional Specialist Hospital in Wrocław Research and Development Center, Wroclaw, Poland 9 Neurosciences and Neurodegenerative diseases, Medical School, Faculty of HealthSciences, Aristotle University, Thessaloniki, Greece 10 Memory and Neuropsychiatric Center (CMYN) Neurology Department, Hospital del Salvador & Faculty of Medicine, University of Chile, Santiago, Santiago Metropolitan Region, Chile 11 Gerosciences Center for Brain Health and Metabolism (GERO), Santiago, Chile 12 Mazowiecki Szpital Bródnowski, Warsaw Medical University, Warsaw, Masovian Voivodeship, Poland 13 Radboudumc Alzheimer Center and Department of Geriatric Medicine, Radboud university medical center, Nijmegen, Gelderland, The Netherlands Yaohua Chen Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Supervision, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Tatyana Mollayeva Roles: Conceptualization, Formal Analysis, Funding Acquisition, Investigation, Methodology, Validation, Writing – Review & Editing Rachel Fitzpatrick Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Thaisa Tylinski Sant’Ana Roles: Investigation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Francesca R Farina Roles: Conceptualization, Formal Analysis, Funding Acquisition, Investigation, Methodology, Validation, Writing – Review & Editing D Swiatek Roles: Conceptualization, Formal Analysis, Investigation, Methodology K Sopidou Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Writing – Review & Editing E Tabilo Roles: Formal Analysis, Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing M Betka Roles: Formal Analysis, Investigation, Methodology, Writing – Review & Editing Iracema Leroi Roles: Conceptualization, Methodology, Supervision, Validation, Writing – Review & Editing T Leon Roles: Formal Analysis, Writing – Original Draft Preparation, Writing – Review & Editing Geeske Peeters Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Supervision, Validation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Coronavirus (COVID-19) collection. Abstract Background COVID-19 control measures have had a unique impact on people with dementia (PWD) and their carers living at home. Yet, uncertainty exists regarding the global impact of such measures, and whether differences exist between countries and global regions. We aimed to synthesize evidence on this topic. Methods We searched Medline, PsycINFO, EMBASE, Web of Science, CINAHL, Latin American and Caribbean Health Literature (Lilacs), Scientific Electronic Library online (Scielo), and EM Premium, from the start of the pandemic to July 2022. At least two researchers independently screened citations and performed quality assessment following recommended criteria for critical appraisal according to study methodology. We analyzed data by country and region, and synthesized results descriptively. Results Sixty-nine studies met inclusion criteria (74% qualitative and 26% quantitative; 22% included PWD, 44% carers of PWD, 4% dyads), with a total of 209,738 participants. Most studies were conducted in Europe (59%), followed by Asia and North America (15% each), South America (7%) and Oceania (1%). Two studies presented data from multiple regions (3%). The quality of the studies varied, with the majority (62%) being of moderate quality. Across the study populations and global regions, COVID-19 control measures had implications for PWD and carers’ access to health services, physical and mental health and daily routine, cognition, behaviour, with accompanying social and economic costs. Conclusion Our results highlight how public health measures impacted PWD and their carers living at home globally, and suggest the need for proactive planning of preventive measures to mitigate the negative impact, in anticipation of future public health threats. Other This work was funded by the JPND Call for Expert Working Groups: The Impact of COVID-19 on Neurodegenerative Diseases in partnership with the CIHR-Institute of Aging; Public Health Agency (CIHR #02342-000). PROSPERO CRD42024554701. READ ALL READ LESS Keywords dementia; prognosis; carers; healthcare access; mental health; SARS-CoV-2 Corresponding Author(s) Yaohua Chen ( [email protected] ) Close Corresponding author: Yaohua Chen Competing interests: No competing interests were disclosed. Grant information: This research was supported by the team grant: JPND Call for Expert Working Groups: The Impact of COVID-19 on Neurodegenerative Diseases in partnership with the CIHR-Institute of Aging; Public Health Agency (CIHR #02342-000). TM was supported by the Canada Research Chairs Program (Neurological Disorders and Brain Health, CRC-2021-00074). This work emerged through liaising with global stakeholders at the GBHI. The funders had no role in the study’s design, data collection and analysis, decision to publish, or preparation of the manuscript. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2025 Chen Y et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Chen Y, Mollayeva T, Fitzpatrick R et al. The global impact of COVID-19 control measures on people with dementia living at home and their carers during the two first waves: A systematic review of quantitative and qualitative research across 27 countries [version 1; peer review: 1 approved with reservations] . HRB Open Res 2025, 8 :99 ( https://doi.org/10.12688/hrbopenres.14202.1 ) First published: 04 Sep 2025, 8 :99 ( https://doi.org/10.12688/hrbopenres.14202.1 ) Latest published: 04 Sep 2025, 8 :99 ( https://doi.org/10.12688/hrbopenres.14202.1 ) Abbreviations used in the text AD = Alzheimer’s disease COVID-19 = Coronavirus disease DEMQOL = Dementia Quality of Life DEMQOL-C = Dementia Quality of Life of Carers EQ-5D = EuroQol Five-Dimensions FTD = frontotemporal dementia MMSE = Mini-Mental State Examination PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses QUALID = Quality of Life in Late-stage Dementia WAIS = Wechsler Adult Intelligence Scale PROSPERO = International prospective register of systematic reviews PWD = Persons with dementia PRISMA = Preferred Reporting Items for Systematic reviews and Meta-Analyses SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2 SF-12 = 12-item Short Form Survey SWEMWBS = Short Warwick-Edinburgh Mental Wellbeing Scale USA = United States of America Key points Control measures for SARS-CoV-2 have had a unique impact on people with dementia living at home and their carers Globally, multiple domains of health, functioning and well-being of people with dementia and their carers were impacted Results call for proactive prevention planning in anticipation of future public health threats Introduction The COVID-19 pandemic and its control measures have had a significant impact on both the physical and mental health of communities across the globe, with up to 50% of the general population reporting increased psychological distress, depression and reduced quality of life 1 , 2 . People with dementia (PWD), including those living at home during the pandemic, were reported to be affected by the lockdowns, physical distancing, and other containment strategies across healthcare systems globally 3 – 6 . It has become apparent that the global response to the pandemic had implications for both PWD and their carers. Research suggests that control measures increased the cognitive and/or physical decline in PWD 7 – 9 , and impacted the health and well-being of carers of PWD 5 , who had to take on care responsibilities previously held by formal care while managing their own stress, anxiety, and other mental health concerns. These implications may be relevant across dementia types and disease stages, affecting PWD and their carers of all ages, sexes, gender identities, ethnicities and places of residence 10 – 13 . As such, the impact of COVID-19 control measures on PWD and their carers living at home during the pandemic require comprehensive evaluation. To date, several studies have systematically reviewed data on the impact of control measures on PWD, predominantly those of quantitative methodologies focusing largely on PWD living in care facilities during the pandemic 14 – 16 . The results suggested decreased infection rates and increased survivorship as a result of control measures 17 – 20 . However, in light of emerging qualitative evidence on the implications of the lockdown on mental health and well-being, there is a need to integrate both qualitative and quantitative evidence on the impact of the COVID-19 control measures on PWD living at home and their carers through a global lens. This is particularly important because COVID-19 control measures varied widely across countries and regions 21 – 23 , reflecting differing public health policies, healthcare infrastructures, and pandemic severities. This variability may have led to different impacts on PWD living in these countries, which require further data synthesis to understand the global scope, identify patterns, gaps, and best practices that may inform future responses to similar crises. Therefore, we conducted a systematic review of qualitative and quantitative evidence with the following aims: (1) to assess the impact of pandemic-related control measures on PWD living at home and their carers; (2) to compare results across countries and regions to identify commonalities and differences; and (3) to offer an evidence-based discussion for policymakers, healthcare providers, and support organizations to improve care for PWD during future emergencies. Methods We registered the review with the International Prospective Register of Systematic Reviews (PROSPERO, CRD42024554701) 24 . We conducted data extraction, analyses, and reporting in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines 25 (Extended data 1). Data source and searches We identified all peer-reviewed studies, irrespective of the country or study setting, published from March 11, 2020, to the last day of July 2022 through Medline, PsycINFO, EMBASE, Web of Science, CINAHL, Latin American and Caribbean Health Literature (Lilacs), Scientific Electronic Library online (Scielo), and EM Premium. The medical subject headings (MeSH) for Medline were “dementia”, “mental health”, “COVID-19”, and “care partners”. We also searched grey literature using Google Scholar (the first 10 pages), and an inventory of existing national surveys and reports in each participant’s country for items published between the start of the pandemic through the end of July 2022. We cross-checked the references list of all included studies. Eligibility criteria based on the PICOS approach P (Participants): people with dementia and/or their carers living at home/community dwelling during COVID-19 pandemic; I (Interventions): not applicable; C (Comparisons): not applicable; O (Outcomes): disease progression, physical/cognitive/daily functioning, mental health, wellbeing, access to care/health services, carer burden or social outcomes in the context of COVID-19 control measures; S (Study design): quantitative observational studies of any design and qualitative studies of lived experiences of dementia and/or their carers living at home. Inclusion and exclusion criteria We considered original peer-reviewed observational or qualitative studies in any language of all designs that: (1) included people with dementia and/or their carers living at home/community dwelling during COVID-19 and (2) assessed their physical/cognitive/daily functioning, mental health, wellbeing, access to care/health services, or other health, social and/or functional outcomes. In addition, the studies were required to have (3) quantified the magnitude of the association between COVID-19 control measures and the outcome of interest or reported on the implications of COVID-19 control measures on PWD and/or their carers living at home. We excluded non-human studies, letters to editors, reviews, conference abstracts, articles without primary data, single case studies, studies that focused on therapeutic interventions, studies that included people living in long-term care facilities or nursing homes, and whose samples were composed largely of people with a diagnosis of mild cognitive impairment or other disorders of neurodegenerative nature. We also excluded studies that focused on investigating the effect of the COVID-19 infection itself on PWD and/or their carers. Data collection and analysis Selection process . We extracted keyword-based searches into an online reference management tool (EndNote ® , version 20, Clarivate, Philadelphia, PA, USA). One researcher (YC) eliminated duplicates and inserted data into collaborative online tool (Covidence ® , Melbourne, Australia). Two researchers per title (DS, KS, ET, MB, ZA, YC, TL, RF) independently assessed the study titles and abstracts for compliance with the inclusion criteria. Differences in opinion were resolved through group discussion. Then, each researcher assessed the selected full texts to determine their compliance with inclusion/exclusion criteria. When information regarding any of the above was unclear, we contacted authors of the reports to provide further details. Data extraction . Two researchers per study (DS, KS, ET, MB, YC, TL, GP, RF, FRF) independently extracted the data into Excel files, consisting of (1) study information (authors, publication year, country, objectives, design, method of recruitment, sample size, measures used, and effects of COVID-19 control measures investigated in the study) and (2) participant information (age, sex, dementia type and severity if PWD, relationship to the participant if care partners). Outcomes were categorized into following themes: physical/daily functioning; cognitive symptoms; mental health; behaviour; wellbeing/loneliness; social cost; access to care; and other. We further collapsed the categories into themes based on conceptual unity emerging from data synthesis: (1) physical health and daily routine; (2) cognitive functioning; (3) behavioural problems, mental health and wellbeing; (4) social and economic consequences; and (5) access to health services. Risk of bias and quality assessment Four researchers (YC, IL, RF, TM) independently assessed study quality using the National Institutes of Health study quality assessment tools 26 that suited each included study design. The researchers involved in the assessment of risk of bias initially met for a calibration review, in which they independently reviewed one study of each type and discussed each item on the list to clarify its meaning and interpretation. Following this, the same three reviewers independently rated the methodological quality of each study across a set of items. In cases of disagreement between the researchers, a team discussion took place, with the aim to reach consensus. Quantitative studies . We appraised quantitative studies in two steps. The first step included rating items related to potential sources of bias according to the most critical criteria for external and internal validity within cohort, cross-sectional, or case-control studies. The second step consisted of summarizing the presence of potential sources of biases as “yes,” “no”, “not reported,” or “cannot determine.” The overall rating of potential bias for each study was summarized in accordance with the Scottish Intercollegiate Guidelines Network methodology 27 , where summarized study quality into three groups: high-quality (“++”), when all or most of the quality were fulfilled (i.e. allowing one “CD” or “NR” based six potential sources of bias); moderate-quality (“+”), when half items of criteria were fulfilled; or low-quality (“-”) when less than half of items of criteria were fulfilled (Extended data 2). Qualitative studies . We evaluated qualitative studies using the Critical Appraisal Skills Programme (CASP) qualitative studies checklist 28 . Assessments were categorized as follows: "yes" indicated that the item was adequately addressed in the study; "no" indicated that the item was not clearly addressed; and "cannot tell" reflected uncertainty. A score was given for each item that was categorized as “yes”. Study quality was then summarized into three groups: high-quality (“++”), when all or most of the criteria were fulfilled; moderate-quality (“+”), when half items of the criteria were fulfilled; or low-quality (“-”), when less than half of the criteria were fulfilled (Extended data 3). Data synthesis We tabulated the study characteristics into a file to evaluate similarities between studies. We observed heterogeneity across all PICOS criteria, confirming that the assumptions for conducting a classical meta-analysis were not met. Further, variations in outcome definition and categorization, and differences in the study samples and characteristics prevented us from performing data conversions. We therefore used a best-evidence synthesis approach, synthesizing findings from included studies through tabulation, data visualization, and qualitative description 29 , 30 . We summarized the evidence and presented an overview of the findings across the studied outcome categories according to quantitative and qualitative data by global region. Sensitivity analysis We carried out sensitivity analysis to test whether critical methodological concerns affected the results. This involved repeating an analysis using combined studies regardless of study quality and separately and informally comparing the findings. We grouped the main results by study design (quantitative and qualitative) and compared the results of studies that focused on the same outcome theme. Publication bias Due to high heterogeneity of study design, population, COVID-19 waves, and outcomes (Extended data 4 Table 1), and variability among studies in the bias domains affecting study quality (Extended data 2 and 3), we did not perform evaluation of the publication bias using statistical tests 30 . To minimize the potential for such bias, we implemented several strategies, including conducting literature searches with attempts to locate grey literature and unpublished studies and assessed reporting bias in outcomes of included studies 31 . Dealing with missing data We contacted study authors to verify key study characteristics, aiming to obtain missing data where possible for inclusion and analysis of select study. The remaining missing data were considered in the risk of bias assessment. Ethical review We did not seek ethical approval, as this study did not involve primary data collection. Results A total of 14,552 citations were abstracted from databases searched. After removal of duplicates and screening of titles and abstracts, a total of 197 records underwent full text review. Of these, 69 studies met the inclusion criteria and were included in data synthesis ( Figure 1 ). Figure 1. PRISMA flow diagram showing the process of study selection. The vast majority of included studies (74%) were quantitative studies, of which 30 were cross-sectional studies, 19 were cohort studies, and two were population-based studies using administrative data. Eighteen of the included studies were qualitative studies. Please see Extended data 3 for specifics. Study characteristics Table 1 (Extended data 4) summarizes the study characteristics pertinent to our research questions, including country/region of study origin, sample characteristics, analysis methods, and study results. Study origin Out of a total of 69 studies, 41 were conducted in Europe (France, Germany, Greece, Hungary, Italy, Netherlands, Norway, Poland, Spain, Turkey, UK), ten in Asia (China, India, Iran, Israel, Japan, Kuwait) and North America (Canada, Cuba, Jamaica, USA) each, five in South America (Argentina, Brazil, Chile) and one in Oceania (Australia). Two studies were cross-country studies, and included participants from multiple regions (Europe, Oceania, North America). No studies were conducted in the African continent (Extended data 4 Table 1). Sample characteristics The studies included a total of 209,738 participants. Fifteen studies engaged strictly PWD, 30 studies carers of PWD, and three PWD-carer dyads. The remaining 21 studies included a mix of PWD, MCI and SCD, carers and healthy older adults (Extended data 4 Table 1). The studies included a total of 194,532 PWD. The study samples consisted of female participant samples ranging between 37% and 80%, with an average of 56% across studies. Seventeen studies did not explicitly state the sex ratio. The mean age of PWD ranged between 59.8 and 83.2 years of age. The studies included a total of 12,883 carers of PWD. The study samples consisted of female participant samples ranging from 48% to 100%, with an average of 74% across studies. Twenty-four studies did not explicitly state the sex ratio. The mean age of carers ranged between 45.7 and 70.1 years of age (Extended data 4 Table 1). Risk of bias and quality of the evidence In this review, the quality of the studies was not part of the inclusion or exclusion criteria, and none of the studies were excluded because of their quality. We rated the majority of the qualitative studies as high-quality (“++”, 11 studies), and the remaining studies as moderate-quality (“+”, 7 studies) (Extended data 3). We rated the majority of the quantitative studies as moderate-quality (“+”, 36 studies), and the remaining studies as low-quality (“-”, 15 studies) (Extended data 2). Figure 2 positions a global region comparison based on identified themes for PWD and carers, and quality assessment, for qualitative (left) and quantitative (right) studies. None of the outcomes was investigated by all the papers from five regions contributing evidence included in this review (Asia, Europe, North America, South America, and Oceania). There were no qualitative studies originating from South America nor studies including participants coming from multiple regions. There were no quantitative studies originating solely from Oceania ( Figure 2 ). Figure 2. Number of included studies investigating outcomes among people with dementia (top) and their carers (bottom). Outcomes were grouped into seven categories: (1) well-being/loneliness; (2) social cost/social participation; (3) physical/daily functioning; (4) mental health; (5) cognitive symptoms; (6) behavioural disorders; and (7) access to care/health services. Studies were grouped by quality (“-”, low-quality; “+”, moderate-quality; “++”, high-quality) and study methodology (qualitative, left; quantitative, right). The colors indicate the region where the study was conducted (yellow, Asia; green, Europe; teal, North America; dark blue, South America; purple, Oceania; grey, multiple regions). Physical health and daily routine In total, 39 studies reported on topics related to physical health and daily routine. These included 15 qualitative studies and 24 quantitative studies (14 cross-sectional studies, nine cohort studies, and one analysis of administrative data). Physical health and daily routine of PWD . The qualitative studies reported that the continuing changes in control measures meant ongoing adaptation in everyday activities for PWD 32 . Inability to go outdoors or meet with others led to changes in diet and (physical) daily activities 33 , 34 . Lack of a regular schedule was perceived as distressing and believed to increase symptom progression 35 , 36 . Daily activities such as grocery shopping became more difficult and a source of stress, as people were worried about bringing the virus home 37 – 39 , and these activities were more often taken over by the carer 32 , 35 . Food packages that were handed out by councils in the UK did not take into account ethnical or dietary preferences (e.g. halal or vegetarian). In contrast, some people reported having more time to make fresh meals or a focus on nutrition to boost the immune system, resulting in positive improvements in their eating habits 34 , 39 . PWD who were able to continue their daily routine seemed to manage well 40 . The results of qualitative findings were complemented by quantitative studies. A Chinese study found that physical activity levels were lower during the pandemic than before the pandemic 41 . A survey among PWD in Turkey found that 9.3% could not carry out their hobbies 42 , and a Brazilian study found that half of PWD ceased performing usual tasks or activities 43 . Several studies reported a decline in daily functioning, either measured as functional dependency/limitations, personal care, or mobility 5 , 42 – 48 . One Chinese study looked at the prevalence of malnutrition and found that only 3.3% of 787 PWD were malnourished, but half were at risk of being malnourished 49 . In the same study, 7.8% stated loss of appetite and 4.1% lost weight, while 2.1% showed an increase in appetite and 6.0% gained weight 49 . Studies were also consistent in that 37–61% of carers reported a decline in the health of the PWD 50 , 51 . Sleep problems were not mentioned in the qualitative studies, but were reported in quantitative studies. Studies in Asia, South America, Europe and Oceania all found that the prevalence of sleep problems was higher during or after lockdown than before 47 , 52 – 54 . In addition, one Chinese study found that sleep quality, sleep efficiency, and sleep duration were poorer after lifting of the lockdown than during the lockdown, while sleep latency, sleep disorder, hypnotic usage, and daytime function remained stable 53 . Physical health and daily routine of carers . In the qualitative studies, carers reported having to adapt their own lives (e.g. quit job or work remotely) to take care of the PWD 34 , 35 , 55 . Reduced work hours led to financial worries 34 , 35 , 55 . A new role for carers was to ensure the PWD was adhering to the control measures 32 , 34 , which was often perceived as challenging 32 , 56 . With the increased care duties and reduced formal home care services, the carers reported stress around coping with day-to-day activities 57 , even limiting their ability to look after themselves (e.g. stopping exercise) 56 . Through its impact on the PWD, lack of a regular schedule also affected the health of the carers (e.g. chest pain) 32 , 58 , 59 . Quantitative studies confirmed the findings of qualitative studies in that the lockdown had a substantial impact on the daily lives of care partners 51 , 60 , 61 . For 52% of Italian carers and 31% of Hungarian carers, the employment circumstances changed during the lockdown (with the most common change being working from home), which had financial consequences in a third of the cases 50 . Due to the closure of services and control measures, new care needs arose 51 . The time spent caring increased for most carers 47 , 50 and there were proportionally more carers spending >10 hours caring per day 62 . The caregiving required more physical effort, and carers felt more tired 47 , consequently increasing the burden of care 5 , 45 , 46 , 53 , 60 , 63 , 64 . Nearly a third of 4913 Italian carers and 12% of 165 German carers reported a reduction in time available for their own activities 60 , 61 . Physical health and daily routine: country differences . While studies conducted in different countries measured different outcomes, overall, the tendency of decline in physical health and changes in daily routine and increased care needs were consistent across countries and regions. No notable differences between countries were found across the studies, apart from some reflections in qualitative studies on services that were specific in a given country (e.g. food packages handed out in the UK). Cognitive functioning In total, 28 studies reported on topics related to cognitive functioning. These included 9 qualitative studies and 19 quantitative studies (12 cross-sectional studies and 7 prospective cohort studies). Cognitive functioning of PWD . In qualitative interviews, care partners expressed that they felt the cognitive functioning of PWD declined more rapidly during the lockdown than before 36 , 40 , 55 – 57 , 65 . Most studies attributed this accelerated decline to a reduction in cognitive, mental, or social activation 36 , 57 , 65 , confusion due to not understanding the control measures 35 , 55 , 66 , and lack of routine 55 . In contrast, in one study, carers argued that the accelerated decline could be explained by the progressive nature of dementia and/or their increased proximity to the PWD, such that they noticed the decline more 40 . Findings from quantitative studies used a variety of study designs to examine (rate of) decline in cognition during lockdown. Most studies were cross-sectional surveys asking PWD or carers about subjective (decline in) cognitive functioning of the PWD 5 , 42 – 45 , 47 , 61 , 67 . They reported subjective worsening of cognition in 35–73% of PWD. Two studies that measured cognitive functioning before and during lockdown, found a similar magnitude of decline in Mini Mental State Examination (MMSE) scores with a mean decline of 1.61 ±3.4 in 105 Chinese people with Alzheimer’s disease (AD) 41 and 1.99 ±0.42 in 38 Italian people with AD 68 . Only two studies measured the rate of decline. In 36 PWD from Kuwait, the mean monthly rate of decline was 0.53 ±0.3 points during lockdown, which was significantly higher than before lockdown (0.2 ±0.1, p<0.001) 69 . In 40 PWD from Italy, the within-group annual rate of decline was greater from 2019–2020 than from 2017–2019 (p<0.05) 70 . In summary, despite differences in study design, findings consistently point toward a decline in cognitive functioning during lockdown. There is sparse evidence suggesting that the rate of decline was more rapid during than before lockdown. Cognitive functioning: country differences . The qualitative studies were all conducted in Europe and North America, with consistent findings across these two regions. Quantitative studies were conducted in all regions except Oceania and Africa. We observed consistency in findings across study designs and countries. Behavioural problems, mental health and wellbeing In total, 66 studies reported on topics related to behavioural problems, mental health and wellbeing. These included 20 qualitative studies and 46 quantitative studies (28 cross-sectional studies and 18 prospective studies). Behavioural problems, mental health and wellbeing of PWD . In qualitative interviews, both PWD and carers indicated that the control measures negatively affected the mental health and wellbeing of PWD and led to increased behavioural problems 33 , 36 , 65 , 66 , 71 . Behavioural problems included increased apathy, anxiety, restlessness, irritability, sleep disturbances, aggression, and agitation 33 , 35 , 38 – 40 , 65 . This was mainly attributed to reduced social contacts, closure of day care services, others wearing masks causing confusion, and worries about their loved one’s health and wellbeing 33 , 35 , 36 , 38 , 39 , 55 , 65 . Social isolation and lack of meaningful activities were often cited as the main causes for increased feelings of loneliness 36 , 58 , 65 and the inability to understand the need for control measures further exacerbated these problems 38 , 39 , 65 . The impact on mental health was even stronger in PWD who were aware of their declining independence 40 . Coping strategies such as using alternate communication methods to maintain social contacts (e.g. video calls), were often not available or feasible 65 . In contrast, some studies reported positive consequences of the pandemic, including time to return to past hobbies, learn new skills, and a welcome break from the busy and therefore stressful normal routine 36 , 39 . Practical support from family in adapting to the situation provided a sense of security and helped maintain wellbeing 34 , 40 . Quantitative studies showed higher prevalence of neuropsychiatric symptoms during the pandemic than before the pandemic 41 , 44 , 52 , 61 , 67 , 72 – 76 and lower prevalence after lifting of quarantine 53 , 73 . Studies that compared prevalence of symptoms later on in the pandemic with pre- or early stages of the pandemic found a decrease in prevalence as the pandemic continued 6 , 77 , although changes were not always statistically significant 78 . In the early stages of the pandemic, 44–65% of PWD reported increases in symptoms, which was fairly consistent across countries given variations in study design 5 , 41 , 44 , 61 , 64 , 67 , 79 . The most commonly reported symptoms included anxiety, depression, apathy, agitation, irritability and sleep problems/night time behaviour 5 , 6 , 41 – 44 , 46 , 47 , 49 , 53 , 54 , 63 , 67 , 72 , 75 , 76 , 80 . During lockdown, a higher percentage of PWD were using benzodiazepines, neuroleptics, or combinations 73 , and doses also increased 64 . Factors associated with symptom prevalence included not living with a carer, awareness of COVID-19, limited COVID-19 understanding, and inability to access support services 54 , 61 , 80 . PWD seemed to experience less worry or stress related to the COVID-19 outbreak itself than healthy controls 81 . In 787 Chinese PWD, only 8.6% worried about the outbreak. However, among those who did worry, the prevalence of anxiety and nervousness was high (83.8%) 49 . In a sample of 38 Italian PWD, stress levels increased from the start of the lockdown to 2 weeks later, then stabilized another 2 weeks later. (p<0.05) 68 . During the lockdown, social contact decreased relative to before the lockdown 41 , 67 . Studies that reported on loneliness all showed increases in loneliness during lockdown relative to before lockdown, but with varying prevalence. In an Iranian study of 21 PWD, 81% had moderate and 14% had severe levels of loneliness 82 . In a Dutch sample of 204 PWD or MCI, 17% reported (more) loneliness 6 . In a sample of 321 carers from Argentina, Brazil, and Chile, the carers reported that 31% of PWD felt more lonely 47 . Two UK studies and one Spanish study found no significant changes in quality of life from pre-lockdown to during lockdown (measured as self-reported and/or proxy-reported Dementia Quality of Life (DEMQOL) or EuroQol Five-Dimensions (EQ-5D)) 75 , 83 , 84 . In contrast, another UK study found that mental wellbeing (measured with the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS)) gradually improved as the lockdown progressed 78 , and an Italian study found that the quality of life (measured with the Quality of Life in Late-stage Dementia (QUALID) scale) first declined during lockdown and then recovered after lockdown to pre-lockdown levels 73 . Behavioural problems, mental health and wellbeing of carers . Stress and concerns were common themes across qualitative studies, for which a number of causes and consequences were cited. Care partners were concerned about themselves or the PWD being infected with COVID-19 and being isolated, hospitalized, or even losing their life, and being unable to provide the required care 33 – 35 , 39 , 56 – 58 , 65 , 66 . They were concerned about the future, specifically related to developments of the pandemic 32 , 35 , 55 , 65 and increased care burden 55 , 58 . These concerns were exacerbated by lack of information from governments or health services 55 , 56 . Carers experienced an increased care burden as support from family or professional care dropped away 56 , 57 , 65 , 66 , 85 . Carers experienced extra stress if they: (a) had to take over tasks previously done by care professionals that they did not feel qualified for 37 , (b) felt forced to move in with the PWD 37 , or (c) feared or experienced unemployment or economic difficulties 57 , 66 . Spending more time together also meant that carers were more aware of the symptoms of the PWD, which increased their concerns about disease progression 35 . Adhering to the control measures, (repeatedly) explaining these to the PWD, and adjusting to the routine of the PWD added to the care burden and subsequently caused stress and fatigue 32 , 38 – 40 , 58 , 66 . The pandemic situation also confronted carers with the need for care-planning conversations with the PWD, family, and medical team. Making such decisions in a time of heightened risk and reduced availability of services exacerbated their stress 39 . Other sources of stress were the lack of social interactions and not having an outlet or time for hobbies 32 , 37 , 39 , 65 , 66 , 71 , 85 . For some carers, the stress led to panic attacks, anxiety, depression, fatigue or feelings of loneliness 32 , 37 , 39 , 65 , 71 . The stress also negatively affected the care relationship, triggering behavioural problems in the PWD 35 , 65 , 66 . This caused a vicious cycle, with more stressed carers leading to more behavioural problems in the PWD leading to more stressed carers, etcetera 38 . Carers also expressed they felt unable to cope on their own 57 , 85 . In contrast, two studies reported that spending more time with the PWD helped strengthen the care relationship 35 , 59 . Some studies discussed coping strategies. Spirituality, meaningful activities (e.g. gardening, exercise), enjoying good weather, and self-care provided relief and sense of purpose 34 , 65 . Maintaining routine/daily structure, creatively adapting to the situation, and hiring paid care helped to cope 34 , 56 , 58 , 65 . Also, other people’s willingness to help and (online) peer support networks aided in reducing negative emotions 56 , 58 . Carers tried to assist the PWD with alternate forms of communication, mainly digital tools, to compensate for the lack of in-person social connections, but this was not satisfactory to the same degree 39 , 40 , 65 , 66 and also not accessible to all 34 , 85 . The quantitative studies confirmed the findings from qualitative studies in that the control measures negatively affected the care partners’ mental health. Studies reported increases in depressive symptoms, anxiety, irritability, and stress 44 , 47 , 48 , 54 , 60 , 61 , 76 , 79 , 86 , 87 , as well as concerns related to the pandemic, health of the PWD and their own health 46 , 51 , 60 . During the pandemic, the mean scores for depression, but not anxiety, were significantly higher in carers than in non-carers 87 . A number of studies examined the prevalence of mental health problems as the pandemic progressed and reported mixed findings. During the first three months of the first lockdown, levels of anxiety and depression remained constant in 377 UK carers 78 . After lifting of the quarantine, one study reported increases in anxiety and depression and a decrease in distress in Chinese carers 53 , while another study reported decreases in anxiety, depression, and stress in Italian carers 73 . Another Italian study reported that the prevalence of a range of mental health problems increased from 6–39% at the start of the first lockdown to 32–60% one year later 87 . Many factors may explain these contrasting findings, including (but not limited to) differences in timing of measurements, measurement instruments, sample characteristics (e.g. differences in disease progression of the PWD), as well as actual country-differences. Factors associated with mental health problems in carers included disease progression, neuropsychiatric symptoms and health of the PWD, perceived care burden, informal support network, paid home care, day care, carer-PWD relationship, pandemic-related concerns, social isolation, and hobbies 6 , 48 , 49 , 51 , 54 , 67 , 74 , 76 , 79 , 87 – 89 . Several studies reported either an increase in levels of loneliness or high levels of loneliness during the pandemic 8 , 47 , 60 , 82 . Factors associated with higher levels of loneliness included anxiety, having more formal activities during the day, relationship to the PWD, co-residing with the PWD, health of the PWD, cognitive functioning of the PWD and caregiving burden 8 , 90 . At the same time, loneliness contributed to increased perceived caregiving burden 8 . A series of UK studies found that approximately half of carers reported high levels of wellbeing 62 , 91 , with no or modest decline in quality of life (measured with the Dementia Quality of Life of Carers (DEMQOL-C) and self-rated quality of life) during the pandemic 83 , 84 , 91 . In contrast, a survey among 84 Italian carers found that, on average, participants scored very low on physical and mental wellbeing (measured with the 12-item Short Form Survey SF-12) 48 . Factors associated with wellbeing included resilience, self-efficacy, coping strategies, employment status, type of dementia, dementia severity, and type of dwelling 84 , 92 . As stated earlier, many studies reported an increase in caregiver burden, which plays a key role in the mental health and wellbeing of carers. The negative impact of the care burden may be mitigated by coping strategies. In a UK study, approximately 70% carers were coping well ‘often’ or ‘always’. However, during the pandemic, more carers shifted from ‘sometimes’ to ‘often’ or from ‘often’ to ‘always’ than in a pre-pandemic control group, suggesting that carers used coping strategies to adjust to the new carer demands during the pandemic 62 . The approximately 30% who reported coping ‘sometimes’ or ‘never’, is in the same range as reported in other studies. In a Chinese sample, 34.5% of carers needed a break and 29.1% could no longer cope 49 and in a Dutch sample, 29% reported a need for more support 67 . Finally, in a Turkish sample of 54 carers, 50.0% felt they could not find time for themselves, 14.8% wished to leave the patient and go away, 38.9% said they were irritable. Of note, an Italian study concluded that participants mostly used maladaptative coping strategies, such as avoidance strategies, but these strategies did not affect the stress level of caregivers 48 . Behavioural problems, mental health and wellbeing: country differences . While individual studies from different countries highlighted different elements, the collection of findings tells a coherent story that illustrates a uniform impact of the control measures on the mental health and wellbeing of both the PWD and their carers. These findings seem consistent across countries and regions. The long-term impact of the control measures on the mental health of the care partners remains unclear. Social and economic consequences In total, 28 studies reported on topics related to social and economic consequences of the control measures. These included 17 qualitative studies and 11 quantitative studies (seven cross-sectional and four cohort studies). Findings from qualitative and quantitative studies consistently indicated that decreased social life and support was a key issue for both PWD and their carers 33 – 35 , 38 , 54 , 64 , 66 . As described above, this had a negative impact on their mental health and wellbeing. For care partners, lack of informal support meant that they had to take on more caregiving tasks, particularly if paid care had also dropped away. The pandemic had financial consequences for many people, but there were some consequences that were specific for PWD and their carers, namely: (1) loss of income due to the need to reduce work hours or even quit their job to care for the PWD 34 , 51 , 66 . Carers, particularly those whose job situation did not allow for remote work, had to choose between care duties and income 34 . And (2) increased costs due to having to hire paid care 34 , 66 and purchasing hygiene products to reduce the risk of infection (e.g. masks, sanitizer) 32 or other products they were already using (e.g. wipes, medication) that went up in price due to scarcity 32 , 33 . These financial consequences particularly affected people with low incomes, therefore increasing already existing inequalities 34 , 55 . Social and economic consequences: country differences . While no notable regional differences could be observed, financial consequences came up more frequently in studies conducted in low- and middle-income countries such as India and Jamaica. A few studies pointed towards differences in people in lower or higher socio-economic positions. The financial consequences were felt more by people with low incomes, while people in higher socio-economic positions had more access to social and other resources to cope with the situation 34 , 55 . Access to health services In total, 39 studies reported on topics related to social and economic consequences of the control measures. These included 16 qualitative studies and 23 quantitative studies (17 cross-sectional studies, 4 prospective cohort studies, and 2 studies analyzing administrative data). Qualitative studies reported that PWD and their carers were greatly affected by the reduced formal health and social care services, such as closure of day care centres, closure of respite care, cessation of physio- and occupational therapy, decrease in domestic and/or home care and peer support groups 32 , 35 , 37 , 39 , 56 , 58 , 65 , 66 . As the entire health care system was focused on controlling the pandemic, even access to basic health care services was limited. For example, it was difficult to get doctors’ appointments or access to medication 33 , 34 , 39 , 58 , 59 , 66 , 93 . Offered solutions such as telemedicine were not always accessible or feasible for PWD 35 , 55 – 59 , 71 . As already alluded to above, this led to (1) disruption of routine and less activation of the PWD, possibly leading to accelerated disease progression and (2) increased care burden, with no prospect of a break in care duties. When home or day care services were available, care partners sometimes chose to stop the care due to difficulties with ensuring care professionals were adhering to the control measures or due to fear of bringing the virus home 37 , 39 , 58 , 66 . A few studies also noted that lack of information on available support was an issue 56 , 85 , with respondents in one study suggesting that word of mouth was crucial in obtaining relevant information 35 . Quantitative studies confirmed the findings in qualitative studies, suggesting care use was lower during the pandemic and therapies stopped 9 , 46 , 60 , 63 , 64 , 72 , 80 , 94 . The only exception is a USA study of 64 PWD, which reported no significant difference in the number of days receiving formal care during versus pre-pandemic 95 . The proportion of respondents that reported discontinuation of care varied greatly, ranging from 10% in French carers 74 to 49% in UK carers 91 , 75% in Dutch PWD 67 and 90% in Argentinian carers 64 . However, these differences are likely explained by variations in how the questions were asked. In time-series analyses of administrative care use data in Canada, the home care visits dropped by 16% at the start of the pandemic (mid-March 2020), but recovered to normal levels by September 2020 94 . Similarly, use of therapies dropped by 50% at the start of the pandemic and exceeded pre-pandemic levels by September 2020 94 . These findings were partly confirmed in a second Canadian study using administrative health services data, which also found a drop in visits per 100 PWD (2.41 in reference period versus 1.20 in pandemic period), but in that study, the number of visits did not return to pre-pandemic levels after the second wave 96 . Two quantitative studies reported contrasting socio-economic differences in access to care. In 73 Israeli carers, those with higher levels of education or higher income were less likely to report forgone care 97 , while in a time-series analysis of administrative data of 131,466 Canadian PWD, the decline in personal care was greater in those living in more affluent areas 94 . Hence the potential modifying effect of socio-economic factors on impact of the control measures on health services use remains unclear, or could potentially reflect differences across countries. Access to health services: country differences . While there is consistent evidence that the control measures had a significant impact on access to health and care services for PWD in all countries (except the US), the magnitude of this impact is likely to differ across countries given the differences in availability of health services for PWD, as well as cultural differences in seeking formal support. However, direct or indirect country comparisons are hampered by the variation in study designs and measurement of services use. Discussion Principal findings Pre-pandemic studies have reported that PWD often experience social isolation and loneliness, physical and mental adversities, challenges with relationship and intimacy, and reduced quality of life 34 , 35 . Therefore, we anticipated exacerbation of adverse outcomes related to the control measures during COVID-19 pandemic. Adverse outcomes were consistently reported in the scientific evidence included in this review, spanning many countries and regions. The impact of the pandemic on carers of PWD was also largely uniform, who often reported living with anxiety and fear, and experiencing difficulties balancing caregiving challenges with their own needs. The experiences of PWD and carers that emerged in the qualitative research were of diverse and personal nature. Some PWD were able to continue regular daily activities at home, such as gardening, doing crosswords, or reading, and seemed to manage the control measures well, especially were not excessively complex. Some carers and PWD reported that their diets had improved or become healthier during the pandemic as they were able to make fresh meals. On the other hand, carers supporting a person with FTD than with AD reported greater burden in the included studies, likely because people with FTD are known to experience more behavioral and psychological symptoms 61 and reduced access to formal care support 74 . In some cases, there was a change in the person delivering the care, from a spouse to an adult child 68 or a lack of family support to the main carer 64 . Synthesis of qualitative research raise important discussions about variability in the impact of control measures and the role of a person’s living environment and social influences (i.e., PROGRESS- Plus parameters) 98 in their experiences. The majority of the studies included in this review came from high income countries. Among included studies, financial consequences came up more frequently in studies conducted in low- and middle-income countries, such as India and Jamaica 33 , 34 . A few studies pointed towards differences in people in lower or higher socio-economic positions 32 , 94 . It is probable that those with lower income were more affected due to increased likelihood of holding jobs that put them in a vulnerable position (unable to work from home; higher risk of losing job; front-line jobs with higher risk of infection), indicating that social capital and socioeconomic status play an important role on brain health. Furthermore, regarding the influence of race and ethnicity, the research conducted by West et al included black, Asian, and minority ethnic groups in the UK 39 . Findings were similar to those in other studies, suggesting little ethnic or cultural differences, or a failure of studies to capture this in their analyses. Research sensitive to the person’s living environment and social capital can enhance our understanding of the needs of PWD and their carers within and between countries, and has the potential to foster complex discussions with research, policy, and practice implications. This is particularly relevant for countries in Africa, since no studies included in this review originated from this region. Strengths and limitations Our review has several strengths. First, we did not limit our searches to English language studies only, rather, we included studies published in multiple languages. This approach allowed for extraction of data collected in non-English-speaking countries with limited resources to disseminate their work with the larger scientific community. Second, we included both quantitative and qualitative research. Our approach took into account the advantages of the two types of research. We collected topics from open-ended questions and qualitative research to better understand the lived experience and the societal impacts of the pandemic, while also synthesizing results from quantitative studies, which used standardized measures to study multiple associations relevant to our research objectives. To the best of our knowledge, this is the first comprehensive systematic review on this topic aggregating data from both qualitative and quantitative studies. This is also the first systematic review that reviewed evidence through a global lens. Finally, our multiple subgroup analyses with a focus on relevant endpoint and visual data presentation allowed for nuanced comparisons across studies, countries, and global regions. We acknowledge several limitations. First, the heterogeneity in included studies prevented us from conducting a formal assessment of publication bias. Heterogeneity was observed at multiple levels (i.e., sample characteristics, clinical settings, spectrum of studied comorbidities, reporting, statistical approaches, and outcome measurements); even within the same country and group of people the strength of association varied. Second, prior to data extraction, we decided on the confounding variables that were considered as important to studied outcomes. However, many of these variables were missing. The type of dementia and severity were not always reported in included studies, despite being important variables that could influence the outcomes for PWD and their carers. A concern inherent to all dementia research is that cognitive impairments of PWD may affect their ability to understand survey questions, and carers who provide care to PWD may have influenced responses of PWD in studies involving dyads, consequently impacting the data collected. Access to and proficiency with technology required to complete self-report surveys during the pandemic may have led to biased samples and limited generalizability to people who are living with more advanced stages of dementia, those facing communication barriers, and those with limited access to or proficiency with technology 99 . The quantitative studies included in this systematic review reported associations while considering various confounding parameters. It is possible that the associations between confounding parameters and the outcomes of interest can be attenuated due to “over-controlled” variables (Extended data 4 Table 1). For instance, since there is a possible causal relationship between age, gender, insomnia, dementia, and studied outcomes, including them in a model might have attenuated the association between them and the studied outcomes because they might be in the causal pathway to many adverse effects 100 , 101 . However, we observed consistency in findings, which strengthens the robustness of results and mitigates this concern to some extent. Finally, we included studies up to July 2022; thus, the results are limited to the earlier stages of the pandemic (wave 1 and 2). The perspectives of PWD and carers may have shifted over time as the pandemic progressed and control measures changed. However, the control measures were most strict in the earlier stages of the pandemic, suggesting that our review captured the major consequences of such measures. Implications of the results for practice, policy, and future research Results from our systematic review have highlighted challenges with access to health services, (exacerbated) deterioration of physical, cognitive and mental function, as well as social and financial adversities faced by PWD and their carers living at home during the COVID-19 pandemic. It is essential that, globally, decision-makers understand the needs of PWD when implementing control measures. People with dementia and their carers represent a heterogeneous group of people across countries and communities; despite that, we did not identify many contradictory results in the included literature. Social equity parameters should be considered and implemented in future studies to identify variables within populations of interest that could be associated with a poorer overall experience during the pandemic, and lead to studies of higher quality to enhance certainty in the results. The impact of COVID-19 should be assessed separately according to various living environments to identify more at-risk groups and regions, particularly those without evidence included in this review (i.e., Africa). Future studies should also analyze different protective and risk factors among PWD and their carers. For example, it would be important to compare the effect of living alone versus living with carer, of being younger in age versus older, or of having greater community support versus less. Moreover, future studies can delve deeper into resilience, regulation of emotions, and coping strategies of PWD and their carers. Micro-, meso-, and macro-level policies should be established to ensure that PWD and their carers are trained on how to use communication technologies to enable them to preserve social links, uphold family bonds, and maintain the ability to give or receive needed care when faced with isolation and protective measures during future pandemic or crises. Conclusions The results of this systematic review highlight the impact of public health measures on the vulnerability of PWD living at home and their carers across 27 countries and five regions globally, and suggest the need for proactive planning of prevention measures to mitigate risks, in anticipation of potential public health threats. Future studies should evaluate the long-term effect of control measures, particularly during the subsequent waves of the pandemic, on PWD living at home and their carers. Statements and declarations Human Ethics and Consent to Participate Declarations: not applicable. Consent to Participate declaration : not applicable. Clinical Trial Number in the manuscript: not applicable. Data availability statement Extended data The data are available from the online repository (Figshare), and include - PRISMA Guidelines (Extended data 1) 102 DOI- https://doi.org/10.6084/m9.figshare.29905853 - Risk of bias and quality assessment for quantitative studies (Extended data 2) 103 DOI- https://doi.org/10.6084/m9.figshare.29954954 - Risk of bias and quality assessment for qualitative studies (Extended data 3) 104 DOI- https://doi.org/10.6084/m9.figshare.29631071 - Description of all included studies (Extended data 4) 105 DOI- https://doi.org/10.6084/m9.figshare.29954966 Data are available under the terms of the Creative Commons Zero “No rights reserved” data waiver ( CC-BY 4.0 license applied ). Acknowledgements We wish to acknowledge the global STRAP consortium for the unwavering commitment, collaborative spirit and ground-breaking initiatives to lead the charge in transforming our understanding of brain health and enhancing the quality of life for people with dementia and their carers. We also wish to express our sincere gratitude to Mrs Zohra Atrafi for her valuable help in the selection stage of the articles. Faculty Opinions recommended References 1. Lee Y, Lui LMW, Chen-Li D, et al. : Government response moderates the mental health impact of COVID-19: a systematic review and meta-analysis of depression outcomes across countries. J Affect Disord. 2021; 290 : 364–377. PubMed Abstract | Publisher Full Text | Free Full Text 2. Ayenigbara IO: Mental Health amid COVID-19 pandemic: appropriate coping strategies. Psychiatr Danub. 2022; 34 (2): 325–333. PubMed Abstract | Publisher Full Text 3. Magklara K, Kyriakopoulos M: The impact of the COVID-19 pandemic on children and young people. Psychiatriki. 2023; 34 (4): 265–268. PubMed Abstract | Publisher Full Text 4. Bianchetti A, Rozzini R, Bianchetti L, et al. : Dementia clinical care in relation to COVID-19. Curr Treat Options Neurol. 2022; 24 (1): 1–15. PubMed Abstract | Publisher Full Text | Free Full Text 5. Barguilla A, Fernández-Lebrero A, Estragués-Gázquez I, et al. : Effects of COVID-19 pandemic confinement in patients with cognitive impairment. Front Neurol. 2020; 11 : 589901. PubMed Abstract | Publisher Full Text | Free Full Text 6. Bakker ED, van Maurik IS, Mank A, et al. : Psychosocial effects of COVID-19 measures on (Pre-)Dementia patients during second lockdown. J Alzheimers Dis. 2022; 86 (2): 931–939. PubMed Abstract | Publisher Full Text 7. Kennedy P, Rogan C, Higgins D, et al. : Changes and interruptions during COVID-19: caregivers of people with brain health challenges-A qualitative analysis. Front Dement. 2024; 3 : 1360112. PubMed Abstract | Publisher Full Text | Free Full Text 8. Grycuk E, Chen Y, Almirall-Sanchez A, et al. : Care burden, loneliness, and social isolation in caregivers of people with physical and brain health conditions in English-speaking regions: before and during the COVID-19 pandemic. Int J Geriatr Psychiatry. 2022; 37 (6). PubMed Abstract | Publisher Full Text | Free Full Text 9. Vislapuu M, Angeles RC, Berge LI, et al. : The consequences of COVID-19 lockdown for formal and informal resource utilization among home-dwelling people with dementia: results from the prospective PAN.DEM study. BMC Health Serv Res. 2021; 21 (1): 1003. PubMed Abstract | Publisher Full Text | Free Full Text 10. Canevelli M, Palmieri L, Raparelli V, et al. : Prevalence and clinical correlates of dementia among COVID-19-related deaths in Italy. Alzheimers Dement (Amst). 2020; 12 (1): e12114. PubMed Abstract | Publisher Full Text | Free Full Text 11. Hanafy S, Colantonio A, Mollayeva T, et al. : Employment and accommodation needs and the effect of COVID-19 on men and women with traumatic brain injury. Work. 2023; 75 (1): 41–58. PubMed Abstract | Publisher Full Text 12. Suárez-González A, Rajagopalan J, Livingston G, et al. : The effect of COVID-19 isolation measures on the cognition and mental health of people living with dementia: a rapid systematic review of one year of quantitative evidence. EClinicalMedicine. 2021; 39 : 101047. PubMed Abstract | Publisher Full Text | Free Full Text 13. Livingston G, Rostamipour H, Gallagher P, et al. : Prevalence, management, and outcomes of SARS-CoV-2 infections in older people and those with dementia in mental health wards in London, UK: a retrospective observational study. Lancet Psychiatry. 2020; 7 (12): 1054–1063. PubMed Abstract | Publisher Full Text | Free Full Text 14. Bicalho MAC, Aliberti MJR, Delfino-Pereira P, et al. : Clinical characteristics and outcomes of COVID-19 patients with preexisting dementia: a large multicenter propensity-matched Brazilian cohort study. BMC Geriatr. 2024; 24 (1): 25. PubMed Abstract | Publisher Full Text | Free Full Text 15. Tavares-Júnior JWL, de Souza ACC, Borges JWP, et al. : COVID-19 associated cognitive impairment: a systematic review. Cortex. 2022; 152 : 77–97. PubMed Abstract | Publisher Full Text | Free Full Text 16. Gaigher JM, Lacerda IB, Dourado MCN: Dementia and mental health during the COVID-19 pandemic: a systematic review. Front Psychiatry. 2022; 13 : 879598. PubMed Abstract | Publisher Full Text | Free Full Text 17. Hariyanto TI, Putri C, Arisa J, et al. : Dementia and outcomes from coronavirus disease 2019 (COVID-19) pneumonia: a systematic review and meta-analysis. Arch Gerontol Geriatr. 2021; 93 : 104299. PubMed Abstract | Publisher Full Text | Free Full Text 18. Talic S, Shah S, Wild H, et al. : Effectiveness of public health measures in reducing the incidence of covid-19, SARS-CoV-2 transmission, and covid-19 mortality: systematic review and meta-analysis. BMJ. 2021; 375 : e068302. PubMed Abstract | Publisher Full Text | Free Full Text 19. Burns J, Movsisyan A, Stratil JM, et al. : International travel-related control measures to contain the COVID-19 pandemic: a rapid review. Cochrane Database Syst Rev. 2021; 3 (3): CD013717. PubMed Abstract | Publisher Full Text | Free Full Text 20. Stratil JM, Biallas RL, Burns J, et al. : Non-pharmacological measures implemented in the setting of long-term care facilities to prevent SARS-CoV-2 infections and their consequences: a rapid review. Cochrane Database Syst Rev. 2021; 9 (9): CD015085. PubMed Abstract | Publisher Full Text | Free Full Text 21. Salanti G, Peter N, Tonia T, et al. : The impact of the COVID-19 pandemic and associated control measures on the mental health of the general population: A systematic review and dose-response meta-analysis. Ann Intern Med. 2022; 175 (11): 1560–1571. PubMed Abstract | Publisher Full Text | Free Full Text 22. Wang Z, Whittington J, Yuan HY, et al. : Evaluating the effectiveness of control measures in multiple regions during the early phase of the COVID-19 pandemic in 2020. Biosaf Health. 2021; 3 (5): 264–275. PubMed Abstract | Publisher Full Text | Free Full Text 23. Alkhaldi G, Aljuraiban GS, Alhurishi S, et al. : Perceptions towards COVID-19 and adoption of preventive measures among the public in Saudi Arabia: a cross sectional study. BMC Public Health. 2021; 21 (1): 1251. PubMed Abstract | Publisher Full Text | Free Full Text 24. Chen Y, LTPGMTFR: Problems perceived by people with dementia and their care partners in response to the COVID-19 control measures. PROSPERO. 25. Page MJ, McKenzie JE, Bossuyt PM, et al. : The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372 : n71. PubMed Abstract | Publisher Full Text | Free Full Text 26. National Institutes of Health: Study quality assessment tools. Reference Source 27. Scottish Intercollegiate Guidelines Network: Methodology checklist. 28. Critical Appraisal Skills Programme: CASP Checklist: CASP Qualitative Studies Checklist. Reference Source 29. Slavin RE: Best evidence synthesis: an intelligent alternative to meta-analysis. J Clin Epidemiol. 1995; 48 (1): 9–18. PubMed Abstract | Publisher Full Text 30. Ayorinde AA, Williams I, Mannion R, et al. : Assessment of publication bias and outcome reporting bias in systematic reviews of health services and delivery research: a meta-epidemiological study. PLoS One. 2020; 15 (1): e0227580. PubMed Abstract | Publisher Full Text | Free Full Text 31. Dwan K, Gamble C, Williamson PR, et al. : Systematic review of the empirical evidence of study publication bias and outcome reporting bias – an updated review. PLoS One. 2013; 8 (7): e66844. PubMed Abstract | Publisher Full Text | Free Full Text 32. Baumbusch J, Cooke HA, Seetharaman K, et al. : Exploring the impacts of COVID-19 public health measures on community-dwelling people living with dementia and their family caregivers: a longitudinal, qualitative study. J Fam Nurs. 2022; 28 (3): 183–194. PubMed Abstract | Publisher Full Text | Free Full Text 33. Vaitheswaran S, Lakshminarayanan M, Ramanujam V, et al. : Experiences and needs of caregivers of persons with dementia in India during the COVID-19 pandemic-a qualitative study. Am J Geriatr Psychiatry. 2020; 28 (11): 1185–1194. PubMed Abstract | Publisher Full Text | Free Full Text 34. Stubbs M, Govia I, Robinson JN, et al. : The experiences of caregivers of persons living with dementia in Jamaica during COVID-19. Gerontol Geriatr Med. 2021; 7 : 23337214211043384. PubMed Abstract | Publisher Full Text | Free Full Text 35. Bannon SM, Wang KE, Grunberg VA, et al. : Couples’ experiences managing young-onset dementia early in the COVID-19 pandemic. Gerontologist. 2022; 62 (8): 1173–1184. PubMed Abstract | Publisher Full Text | Free Full Text 36. Talbot CV, Briggs P: 'Getting back to normality seems as big of a step as going into lockdown': the impact of the COVID-19 pandemic on people with early to middle stage dementia. Age Ageing. 2021; 50 (3): 657–663. PubMed Abstract | Publisher Full Text | Free Full Text 37. Giebel C, Hanna K, Cannon J, et al. : Decision-making for receiving paid home care for dementia in the time of COVID-19: a qualitative study. BMC Geriatr. 2020; 20 (1): 333. PubMed Abstract | Publisher Full Text | Free Full Text 38. Giebel C, Hanna K, Rajagopal M, et al. : The potential dangers of not understanding COVID-19 public health restrictions in dementia: "It’s a groundhog day - every single day she does not understand why she can’t go out for a walk". BMC Public Health. 2021; 21 (1): 762. PubMed Abstract | Publisher Full Text | Free Full Text 39. West E, Nair P, Barrado-Martin Y, et al. : Exploration of the impact of the COVID-19 pandemic on people with dementia and carers from black and minority ethnic groups. BMJ Open. 2021; 11 (5): e050066. PubMed Abstract | Publisher Full Text | Free Full Text 40. Tuijt R, Frost R, Wilcock J, et al. : Life under lockdown and social restrictions - the experiences of people living with dementia and their carers during the COVID-19 pandemic in England. BMC Geriatr. 2021; 21 (1): 301. PubMed Abstract | Publisher Full Text | Free Full Text 41. Chen ZC, Liu S, Gan JH, et al. : The impact of the COVID-19 pandemic and lockdown on mild cognitive impairment, Alzheimer’s disease and dementia with lewy bodies in China: a 1-year follow-up study. Front Psychiatry. 2021; 12 : 711658. PubMed Abstract | Publisher Full Text | Free Full Text 42. Helvaci Yilmaz N, Polat B, Ermis A, et al. : Clinical deterioration of Alzheimer’s disease patients during the COVID-19 pandemic and caregiver burden. J Exp Clin Med (Turkey). 2021; 38 (3): 255–259. Publisher Full Text 43. Penteado CT, Loureiro JC, Pais M V, et al. : Mental health status of psychogeriatric patients during the 2019 new Coronavirus Disease (COVID-19) pandemic and effects on caregiver burden. Front Psychiatry. 2020; 11 : 578672. PubMed Abstract | Publisher Full Text | Free Full Text 44. Manca R, De Marco M, Colston A, et al. : The impact of social isolation due to the COVID-19 pandemic on patients with dementia and caregivers. Acta Neuropsychiatr. 2022; 34 (5): 276–281. PubMed Abstract | Publisher Full Text 45. Tsapanou A, Papatriantafyllou JD, Yiannopoulou K, et al. : The impact of COVID-19 pandemic on people with mild cognitive impairment/dementia and on their caregivers. Int J Geriatr Psychiatry. 2021; 36 (4): 583–587. PubMed Abstract | Publisher Full Text 46. Cohen G, Russo MJ, Campos JA, et al. : COVID-19 epidemic in Argentina: worsening of behavioral symptoms in elderly subjects with dementia living in the community. Front Psychiatry. 2020; 11 : 866. PubMed Abstract | Publisher Full Text | Free Full Text 47. Azevedo LVDS, Calandri IL, Slachevsky A, et al. : Impact of social isolation on people with dementia and their family caregivers. J Alzheimers Dis. 2021; 81 (2): 607–617. PubMed Abstract | Publisher Full Text | Free Full Text 48. Maggio MG, La Rosa G, Calatozzo P, et al. : How COVID-19 has affected caregivers’ burden of patients with dementia: an exploratory study focusing on coping strategies and quality of life during the lockdown. J Clin Med. 2021; 10 (24): 5953. PubMed Abstract | Publisher Full Text | Free Full Text 49. Yuan S, Zhang W, Lü W, et al. : The psychological impact on patients with memory disorders and their caregivers during COVID-19. Aging Clin Exp Res. 2021; 33 (8): 2317–2325. PubMed Abstract | Publisher Full Text | Free Full Text 50. Kostyal LA, Szeman Z, Almasi VE, et al. : The impact of COVID-19 on the health and experience of the carers of older family members living with dementia: an Italian-Hungarian comparative study. Int J Environ Res Public Health. 2022; 19 (9): 5329. PubMed Abstract | Publisher Full Text | Free Full Text 51. Rusowicz J, Pezdek K, Szczepańska-Gieracha J: Needs of Alzheimer’s charges’ caregivers in Poland in the Covid-19 pandemic–an observational study. Int J Environ Res Public Health. 2021; 18 (9): 4493. PubMed Abstract | Publisher Full Text | Free Full Text 52. Gan JH, Liu S, Wu H, et al. : The impact of the COVID-19 pandemic on Alzheimer’s disease and other dementias. Front Psychiatry. 2021; 12 : 703481. PubMed Abstract | Publisher Full Text | Free Full Text 53. Yuan S, Zhang W, Yao Q, et al. : The Neuropsychiatric changes after COVID-19 quarantine in patients with cognitive impairment and their caregivers in chongqing, China: a cohort study. Front Aging Neurosci. 2022; 14 : 762907. PubMed Abstract | Publisher Full Text | Free Full Text 54. Wei G, Diehl-Schmid J, Matias-Guiu JA, et al. : The effects of the COVID-19 pandemic on neuropsychiatric symptoms in dementia and carer mental health: an international multicentre study. Sci Rep. 2022; 12 (1): 2418. PubMed Abstract | Publisher Full Text | Free Full Text 55. Giebel C, Hanna K, Tetlow H, et al. : “A piece of paper is not the same as having someone to talk to”: accessing post-diagnostic dementia care before and since COVID-19 and associated inequalities. Int J Equity Health. 2021; 20 (1): 76. PubMed Abstract | Publisher Full Text | Free Full Text 56. Lion KM, Moyle W, Cations M, et al. : How did the COVID-19 restrictions impact people living with dementia and their informal carers within community and residential aged care settings in Australia? A qualitative study. J Fam Nurs. 2022; 28 (3): 205–218. PubMed Abstract | Publisher Full Text 57. Roach P, Zwiers A, Cox E, et al. : Understanding the impact of the COVID-19 pandemic on well-being and virtual care for people living with dementia and care partners living in the community. Dementia (London). 2021; 20 (6): 2007–2023. PubMed Abstract | Publisher Full Text | Free Full Text 58. Maćkowiak M, Senczyszyn A, Lion K, et al. : The experiences of people with dementia and informal carers related to the closure of social and medical services in Poland during the COVID-19 pandemic-a qualitative study. Healthcare (Basel). 2021; 9 (12): 1677. PubMed Abstract | Publisher Full Text | Free Full Text 59. Sriram V, Jenkinson C, Peters M: Impact of COVID-19 restrictions on carers of persons with dementia in the UK: a qualitative study. Age Ageing. 2021; 50 (6): 1876–1885. PubMed Abstract | Publisher Full Text | Free Full Text 60. Theurer C, Rother D, Pfeiffer K, et al. : [Burden experienced by caregiving relatives during the corona pandemic]. Z Gerontol Geriatr. 2022; 55 (2): 136–142. PubMed Abstract | Publisher Full Text | Free Full Text 61. Rainero I, Bruni AC, Marra C, et al. : The impact of COVID-19 quarantine on patients with dementia and family caregivers: a nation-wide survey. Front Aging Neurosci. 2021; 12 : 625781. PubMed Abstract | Publisher Full Text | Free Full Text 62. Gamble LD, Parker S, Quinn C, et al. : A comparison of well-being of carers of people with dementia and their ability to manage before and during the COVID-19 pandemic: findings from the IDEAL study. J Alzheimers Dis. 2022; 88 (2): 679–692. PubMed Abstract | Publisher Full Text 63. Russo MJ, Cohen G, Campos J, et al. : COVID-19 and older adults with cognitive impairment: how social isolation affects the disease? Neurología Argentina. 2021; 13 (3): 159–169. Publisher Full Text 64. Cohen G, Russo MJ, Campos JA, et al. : Living with dementia: increased level of caregiver stress in times of COVID-19. Int Psychogeriatr. 2020; 32 (11): 1377–1381. PubMed Abstract | Publisher Full Text | Free Full Text 65. Geyer J, Böhm F, Müller J, et al. : Die Lebenssituation von Menschen mit Demenz und pflegenden Angehörigen während der Coronavirus-Pandemie Eine qualitative Studie. Pflege. 2020; 33 (4): 189–197. PubMed Abstract | Publisher Full Text 66. Cipolletta S, Morandini B, Tomaino SCM: Caring for a person with dementia during the COVID-19 pandemic: a qualitative study with family care-givers. Ageing Soc. 2023; 43 (3): 535–555. Publisher Full Text 67. van Maurik IS, Bakker ED, van den Buuse S, et al. : Psychosocial effects of corona measures on patients with dementia, mild cognitive impairment and subjective cognitive decline. Front Psychiatry. 2020; 11 : 585686. PubMed Abstract | Publisher Full Text | Free Full Text 68. Paolini S, Devita M, Epifania OM, et al. : Perception of stress and cognitive efficiency in older adults with mild and moderate dementia during the COVID-19-related lockdown. J Psychosom Res. 2021; 149 : 110584. PubMed Abstract | Publisher Full Text | Free Full Text 69. Ismail II, Kamel WA, Al-Hashel JY: Association of COVID-19 pandemic and rate of cognitive decline in patients with dementia and mild cognitive impairment: a cross-sectional study. Gerontol Geriatr Med. 2021; 7 : 23337214211005223. PubMed Abstract | Publisher Full Text | Free Full Text 70. Tondo G, Sarasso B, Serra P, et al. : The Impact of the COVID-19 pandemic on the cognition of people with dementia. Int J Environ Res Public Health. 2021; 18 (8): 4285. PubMed Abstract | Publisher Full Text | Free Full Text 71. Oliver S, Alexander K, Bennett SG, et al. : Experiences of Black American dementia caregivers during the COVID-19 pandemic. J Fam Nurs. 2022; 28 (3): 195–204. PubMed Abstract | Publisher Full Text | Free Full Text 72. Kuroda Y, Sugimoto T, Matsumoto N, et al. : Prevalence of behavioral and psychological symptoms in patients with cognitive decline before and during the COVID-19 pandemic. Front Psychiatry. 2022; 13 : 839683. PubMed Abstract | Publisher Full Text | Free Full Text 73. Moretti R, Caruso P, Giuffre M, et al. : COVID-19 lockdown effect on not institutionalized patients with dementia and caregivers. Healthcare (Basel). 2021; 9 (7): 893. PubMed Abstract | Publisher Full Text | Free Full Text 74. Boutoleau-Bretonniere C, Pouclet-Courtemanche H, Gillet A, et al. : Impact of confinement on the burden of caregivers of patients with the behavioral variant of frontotemporal dementia and Alzheimer Disease during the COVID-19 crisis in France. Dement Geriatr Cogn Dis Extra. 2020; 10 (3): 127–134. PubMed Abstract | Publisher Full Text | Free Full Text 75. Lara B, Carnes A, Dakterzada F, et al. : Neuropsychiatric symptoms and quality of life in Spanish patients with Alzheimer’s Disease during the COVID-19 lockdown. Eur J Neurol. 2020; 27 (9): 1744–1747. PubMed Abstract | Publisher Full Text | Free Full Text 76. Manini A, Brambilla M, Maggiore L, et al. : The impact of lockdown during SARS-CoV-2 outbreak on behavioral and psychological symptoms of dementia. Neurol Sci. 2021; 42 (3): 825–833. PubMed Abstract | Publisher Full Text | Free Full Text 77. Sabatini S, Bennett HQ, Martyr A, et al. : Minimal impact of COVID-19 pandemic on the mental health and wellbeing of people living with dementia: analysis of matched longitudinal data from the IDEAL study. Front Psychiatry. 2022; 13 : 849808. PubMed Abstract | Publisher Full Text | Free Full Text 78. Giebel C, Pulford D, Cooper C, et al. : COVID-19-related social support service closures and mental well-being in older adults and those affected by dementia: a UK longitudinal survey. BMJ Open. 2021; 11 (1): e045889. PubMed Abstract | Publisher Full Text | Free Full Text 79. Kostyal LA, Szeman Z, Almasi VE, et al. : Impact of the COVID-19 pandemic on family carers of older people living with dementia in Italy and Hungary. Sustainability. 2021; 13 (13): 7107. Publisher Full Text 80. Giebel C, Lord K, Cooper C, et al. : A UK survey of COVID-19 related social support closures and their effects on older people, people with dementia, and carers. Int J Geriatr Psychiatry. 2021; 36 (3): 393–402. PubMed Abstract | Publisher Full Text | Free Full Text 81. Hashimoto M, Suzuki M, Hotta M, et al. : The influence of the COVID-19 outbreak on the lifestyle of older patients with dementia or mild cognitive impairment who live alone. Front Psychiatry. 2020; 11 : 570580. PubMed Abstract | Publisher Full Text | Free Full Text 82. Mohammadian F, Rezaee M, Kalantar A, et al. : Relationship between psychological impacts of COVID-19 and loneliness in patients with dementia: a cross-sectional study from Iran. Front Psychiatry. 2022; 13 : 814676. PubMed Abstract | Publisher Full Text | Free Full Text 83. Hicks B, Read S, Hu B, et al. : A cohort study of the impact of COVID-19 on the quality of life of people newly diagnosed with dementia and their family carers. Alzheimers Dement (N Y). 2022; 8 (1): e12236. PubMed Abstract | Publisher Full Text | Free Full Text 84. Daley S, Farina N, Hughes L, et al. : Covid-19 and the quality of life of people with dementia and their carers-The TFD-C19 study. PLoS One. 2022; 17 (1): e0262475. PubMed Abstract | Publisher Full Text | Free Full Text 85. Flemons K, McGhan G, McCaughey D: Family caregiving for people living with dementia during COVID-19: a thematic analysis. J Fam Nurs. 2022; 28 (3): 219–230. PubMed Abstract | Publisher Full Text | Free Full Text 86. Altieri M, Santangelo G: The psychological impact of COVID-19 pandemic and lockdown on caregivers of people with dementia. Am J Geriatr Psychiatry. 2021; 29 (1): 27–34. PubMed Abstract | Publisher Full Text | Free Full Text 87. Busse C, Barnini T, Zucca M, et al. : Depression, anxiety and sleep alterations in caregivers of persons with dementia after 1-year of COVID-19 pandemic. Front Psychiatry. 2022; 13 : 826371. PubMed Abstract | Publisher Full Text | Free Full Text 88. Alexopoulos P, Soldatos R, Kontogianni E, et al. : COVID-19 crisis effects on caregiver distress in neurocognitive disorder. J Alzheimers Dis. 2021; 79 (1): 459–466. PubMed Abstract | Publisher Full Text 89. Llibre-Rodriguez JJ, Santiesteban IP, Noriega-Fernandez L, et al. : Overburden and correlates among caregivers of people with dementia during the COVID-19 pandemic. Revista Habanera de Ciencias Medicas. 2021; 20 (4): e3944. Reference Source 90. Perach R, Read S, Hicks B, et al. : Predictors of loneliness during the Covid-19 pandemic in people with dementia and their carers in England: findings from the DETERMIND-C19 study. Aging Ment Health. 2022; 27 (3): 521–532. PubMed Abstract | Publisher Full Text 91. Quinn C, Gamble LD, Parker S, et al. : Impact of COVID-19 on carers of people with dementia in the community: findings from the British IDEAL cohort. Int J Geriatr Psychiatry. 2022; 37 (5): 1–11. PubMed Abstract | Publisher Full Text | Free Full Text 92. Sánchez-Teruel D, Robles-Bello MA, Sarhani-Robles M, et al. : Exploring resilience and well-being of family caregivers of people with dementia exposed to mandatory social isolation by COVID-19. Dementia (London). 2022; 21 (2): 410–425. PubMed Abstract | Publisher Full Text | Free Full Text 93. Morkavuk G, Demirkol A, Berber GE, et al. : Comparison of dementia patients admission rates and dementia characteristics before and during the COVID-19 pandemic. Cureus. 2021; 13 (11): e19934. PubMed Abstract | Publisher Full Text | Free Full Text 94. Jones A, Maclagan LC, Schumacher C, et al. : Impact of the COVID-19 pandemic on home care services among community-dwelling adults with dementia. J Am Med Dir Assoc. 2021; 22 (11): 2258–2262.e1. PubMed Abstract | Publisher Full Text | Free Full Text 95. Pickering CEZ, Maxwell CD, Yefimova M, et al. : Early stages of covid-19 pandemic had no discernable impact on risk of elder abuse and neglect among dementia family caregivers: a daily diary study. J Fam Violence. 2022; 11 : 1–11. PubMed Abstract | Publisher Full Text | Free Full Text 96. Maclagan LC, Wang X, Emdin A, et al. : Visits to the emergency department by community-dwelling people with dementia during the first 2 waves of the COVID-19 pandemic in Ontario: a repeated cross-sectional analysis. CMAJ Open. 2022; 10 (3): E610–E621. PubMed Abstract | Publisher Full Text | Free Full Text 97. Werner P, Tur-Sinai A, AboJabel H: Examining dementia family caregivers’ forgone care for general practitioners and medical specialists during a COVID-19 lockdown. Int J Environ Res Public Health. 2021; 18 (7): 3688. PubMed Abstract | Publisher Full Text | Free Full Text 98. Sant’Ana TT, Hanafy S, Fuller-Thomson E, et al. : A PROGRESS-driven approach to cognitive outcomes after traumatic brain injury: a study protocol for advancing equity, diversity, and inclusion through knowledge synthesis and mobilization. PLoS One. 2024; 19 (7): e0307418. PubMed Abstract | Publisher Full Text | Free Full Text 99. Zhang Y, Lee EWJ, Teo WP: Health-seeking behavior and its associated technology use: interview study among community-dwelling older adults. JMIR Aging. 2023; 6 : e43709. PubMed Abstract | Publisher Full Text | Free Full Text 100. Henry A, Katsoulis M, Masi S, et al. : The relationship between sleep duration, cognition and dementia: a mendelian randomization study. Int J Epidemiol. 2019; 48 (3): 849–860. PubMed Abstract | Publisher Full Text | Free Full Text 101. Prather AA, Vogelzangs N, Penninx BWJH: Sleep duration, insomnia, and markers of systemic inflammation: results from the Netherlands Study of Depression and Anxiety (NESDA). J Psychiatr Res. 2015; 60 : 95–102. PubMed Abstract | Publisher Full Text | Free Full Text 102. Chen Y: Extended data 1 PRISMA checklist. Depository Figshare, Dataset, 2025. http://www.doi.org/10.6084/m9.figshare.29905853 103. Chen Y: Extended data 2 quality assessment for quantitative studies. Depository Figshare, Dataset, 2025. http://www.doi.org/10.6084/m9.figshare.29954954 104. Chen Y: Extended data 3 quality assessment for qualitative studies. Depository Figshare, Dataset, 2025. http://www.doi.org/10.6084/m9.figshare.29631071 105. Chen Y: Extended data 4 description of all included studies. Depository Figshare, Dataset, 2025. http://www.doi.org/10.6084/m9.figshare.29954966 Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 04 Sep 2025 ADD YOUR COMMENT Comment Author details Author details 1 CHU Lille, Department of Geriatrics, University of Lille, Lille, Hauts-de-France, France 2 Global Brain Health Institute, County Dublin, County Dublin, Ireland 3 Trinity College Dublin School of Medicine, Dublin, Leinster, Ireland 4 University of California San Francisco, San Francisco, California, USA 5 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada 6 KITE-Toronto Rehab-University Health Network, Toronto, Ontario, Canada 7 The University of Chicago Medicine, Chicago, Illinois, USA 8 Regional Specialist Hospital in Wrocław Research and Development Center, Wroclaw, Poland 9 Neurosciences and Neurodegenerative diseases, Medical School, Faculty of HealthSciences, Aristotle University, Thessaloniki, Greece 10 Memory and Neuropsychiatric Center (CMYN) Neurology Department, Hospital del Salvador & Faculty of Medicine, University of Chile, Santiago, Santiago Metropolitan Region, Chile 11 Gerosciences Center for Brain Health and Metabolism (GERO), Santiago, Chile 12 Mazowiecki Szpital Bródnowski, Warsaw Medical University, Warsaw, Masovian Voivodeship, Poland 13 Radboudumc Alzheimer Center and Department of Geriatric Medicine, Radboud university medical center, Nijmegen, Gelderland, The Netherlands Yaohua Chen Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Supervision, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Tatyana Mollayeva Roles: Conceptualization, Formal Analysis, Funding Acquisition, Investigation, Methodology, Validation, Writing – Review & Editing Rachel Fitzpatrick Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Thaisa Tylinski Sant’Ana Roles: Investigation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Francesca R Farina Roles: Conceptualization, Formal Analysis, Funding Acquisition, Investigation, Methodology, Validation, Writing – Review & Editing D Swiatek Roles: Conceptualization, Formal Analysis, Investigation, Methodology K Sopidou Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Writing – Review & Editing E Tabilo Roles: Formal Analysis, Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing M Betka Roles: Formal Analysis, Investigation, Methodology, Writing – Review & Editing Iracema Leroi Roles: Conceptualization, Methodology, Supervision, Validation, Writing – Review & Editing T Leon Roles: Formal Analysis, Writing – Original Draft Preparation, Writing – Review & Editing Geeske Peeters Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Supervision, Validation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information This research was supported by the team grant: JPND Call for Expert Working Groups: The Impact of COVID-19 on Neurodegenerative Diseases in partnership with the CIHR-Institute of Aging; Public Health Agency (CIHR #02342-000). TM was supported by the Canada Research Chairs Program (Neurological Disorders and Brain Health, CRC-2021-00074). This work emerged through liaising with global stakeholders at the GBHI. The funders had no role in the study’s design, data collection and analysis, decision to publish, or preparation of the manuscript. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Article Versions (1) version 1 Published: 04 Sep 2025, 8:99 https://doi.org/10.12688/hrbopenres.14202.1 Copyright © 2025 Chen Y et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics VIEWS $counts.viewCount downloads Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Chen Y, Mollayeva T, Fitzpatrick R et al. The global impact of COVID-19 control measures on people with dementia living at home and their carers during the two first waves: A systematic review of quantitative and qualitative research across 27 countries [version 1; peer review: 1 approved with reservations] . HRB Open Res 2025, 8 :99 ( https://doi.org/10.12688/hrbopenres.14202.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 04 Sep 2025 Views 0 Cite How to cite this report: Granholm AC. Reviewer Report For: The global impact of COVID-19 control measures on people with dementia living at home and their carers during the two first waves: A systematic review of quantitative and qualitative research across 27 countries [version 1; peer review: 1 approved with reservations] . HRB Open Res 2025, 8 :99 ( https://doi.org/10.21956/hrbopenres.15620.r49694 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-99/v1#referee-response-49694 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 17 Oct 2025 Ann-Charlotte Granholm , University of Colorado Anschutz Medical Campus, Aurora, USA Approved with Reservations VIEWS 0 https://doi.org/10.21956/hrbopenres.15620.r49694 This manuscript focuses on global COVID protective measures effects in terms of patients with Alzheimer’s disease and their caregivers. The manuscript includes both qualitative and quantitative research measures. The unusual topic of this article is that they wanted to examine ... Continue reading READ ALL This manuscript focuses on global COVID protective measures effects in terms of patients with Alzheimer’s disease and their caregivers. The manuscript includes both qualitative and quantitative research measures. The unusual topic of this article is that they wanted to examine global and regional impacts of this, contrary to most manuscripts which focus on one region or one population/cohort. This is interesting and unique. The period examined covered the beginning of the pandemic to July 2022 and included 69 studies (197 publications were screened) with more than 200,000 patients included. Control measures for SARS-CoV-2 include personal protective actions like wearing face masks and source control of contamination, as well as community-level strategies such as promoting good ventilation and providing vaccinations. The manuscript showed that multiple domains of health and well-being were impacted by COVID-19 isolation policies, both for people with dementia and their caregivers and therefore planning for preventative measures should be undertaken now to prevent similar impacts of potential future pandemics. An interesting finding was that control measures themselves, such as isolation, impacted both people with dementia and their caregivers negatively; more isolation and stress were experienced, not unexpectedly. The study was conducted in a systematic and thorough fashion and is unique in its global inclusion. There are some specific concerns or questions; these are listed below. It seems as if the team suggests that the control measures should be evaluated since they caused significant stress and increased burden on caregivers; but would they suggest that less control measures would be recommended and, if so, how would that affect the mortality and morbidity rates of the actual virus, particularly in vulnerable populations? They might have missed some populations, such as special cohorts such as people with Down syndrome and Alzheimer’s disease; this group is especially sensitive to SARS-CoV-2 with increased mortality, and a survey study was recently published (Huls et al; PMID: 33173907). Examining Table 1, it appears that a significant portion of the studies were conducted on European and north American populations; there is a lack of evidence and data from the Middle East and Africa. There are two recommendations regarding this: 1) Adding a map figure showing where populations were located that were included in the study (this would give a better overview of what global means in this context), and 2) making an attempt to find data for African and Middle East populations to complement the already vast work conducted here. In the results section, under the “Physical health and daily routine of PWD” subtitle, it is stated that the lack of a regular schedule was believed to increase symptom progression. Was there any quantitative data supporting this notion? This is important and should be at the center of the total outcomes assessments. Although the study focuses on results of the lock-down itself on dementia progression, it would also be interesting and quite relevant to also include dementia decline in those who contracted COVID-19. There is a wealth of data investigating COVID effects on dementia rating; it would enhance the study to also include these data under the subtitle “Cognitive Functioning”. In addition, it is impossible to know who was infected, especially in the second wave. Some of the reported data could therefore be confused with COVID-infected symptoms. This should at least be mentioned. In the results section about behavioral functioning and mental health, it is reported that there were increases in apathy, anxiety, restlessness, irritability, sleep disturbances, aggression, and agitation. These behavioral problems have also been associated with post-COVID symptoms. Is it possible that some of the reports included those with dementia and post-COVID or long-COVID symptoms as well? This is not mentioned. Although it might be difficult to discern, it may have been mentioned. Or is it clear from the individual studies that these symptoms were reported for non-infected people with dementia only? In the section about behavioral health and caregivers, it is only briefly mentioned that there could be actual country differences. However, this is not deliberated further. There are, indeed, significant cultural differences between all these countries. It would be valuable to develop this idea a little more and include cultural differences that could be involved in the differing results. Such differences in culture could both be differences in expectations for caring for a family member in some cultures, to the need/want for social interactions in another culture. This is likely important from a future planning perspective and should be discussed since cultural differences will play a role in how well a pandemic response is received and complied with. In the Discussion it would be good to include a table showing the most prominent differences and likenesses between countries and regions for the different categories; this could highlight global effects and differences better and provide an overview of the findings here. Are the rationale for, and objectives of, the Systematic Review clearly stated? Yes Are sufficient details of the methods and analysis provided to allow replication by others? Yes Is the statistical analysis and its interpretation appropriate? Not applicable Are the conclusions drawn adequately supported by the results presented in the review? Yes References 1. Hüls A, Costa A, Dierssen M, Baksh R, et al.: An international survey on the impact of COVID-19 in individuals with Down syndrome. medRxiv . 2020. Publisher Full Text 2. Hüls A, Costa A, Dierssen M, Baksh R, et al.: Medical vulnerability of individuals with Down syndrome to severe COVID-19–data from the Trisomy 21 Research Society and the UK ISARIC4C survey. EClinicalMedicine . 2021; 33 . Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: Neuroscience, neuropathology, biomarkers, Alzheimer's disease, Down syndrome I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Granholm AC. Reviewer Report For: The global impact of COVID-19 control measures on people with dementia living at home and their carers during the two first waves: A systematic review of quantitative and qualitative research across 27 countries [version 1; peer review: 1 approved with reservations] . HRB Open Res 2025, 8 :99 ( https://doi.org/10.21956/hrbopenres.15620.r49694 ) The direct URL for this report is: https://hrbopenresearch.org/articles/8-99/v1#referee-response-49694 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 04 Sep 2025 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 Version 1 04 Sep 25 read Ann-Charlotte Granholm , University of Colorado Anschutz Medical Campus, Aurora, USA Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Granholm A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 17 Oct 2025 | for Version 1 Ann-Charlotte Granholm , University of Colorado Anschutz Medical Campus, Aurora, USA 0 Views copyright © 2025 Granholm A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This manuscript focuses on global COVID protective measures effects in terms of patients with Alzheimer’s disease and their caregivers. The manuscript includes both qualitative and quantitative research measures. The unusual topic of this article is that they wanted to examine global and regional impacts of this, contrary to most manuscripts which focus on one region or one population/cohort. This is interesting and unique. The period examined covered the beginning of the pandemic to July 2022 and included 69 studies (197 publications were screened) with more than 200,000 patients included. Control measures for SARS-CoV-2 include personal protective actions like wearing face masks and source control of contamination, as well as community-level strategies such as promoting good ventilation and providing vaccinations. The manuscript showed that multiple domains of health and well-being were impacted by COVID-19 isolation policies, both for people with dementia and their caregivers and therefore planning for preventative measures should be undertaken now to prevent similar impacts of potential future pandemics. An interesting finding was that control measures themselves, such as isolation, impacted both people with dementia and their caregivers negatively; more isolation and stress were experienced, not unexpectedly. The study was conducted in a systematic and thorough fashion and is unique in its global inclusion. There are some specific concerns or questions; these are listed below. It seems as if the team suggests that the control measures should be evaluated since they caused significant stress and increased burden on caregivers; but would they suggest that less control measures would be recommended and, if so, how would that affect the mortality and morbidity rates of the actual virus, particularly in vulnerable populations? They might have missed some populations, such as special cohorts such as people with Down syndrome and Alzheimer’s disease; this group is especially sensitive to SARS-CoV-2 with increased mortality, and a survey study was recently published (Huls et al; PMID: 33173907). Examining Table 1, it appears that a significant portion of the studies were conducted on European and north American populations; there is a lack of evidence and data from the Middle East and Africa. There are two recommendations regarding this: 1) Adding a map figure showing where populations were located that were included in the study (this would give a better overview of what global means in this context), and 2) making an attempt to find data for African and Middle East populations to complement the already vast work conducted here. In the results section, under the “Physical health and daily routine of PWD” subtitle, it is stated that the lack of a regular schedule was believed to increase symptom progression. Was there any quantitative data supporting this notion? This is important and should be at the center of the total outcomes assessments. Although the study focuses on results of the lock-down itself on dementia progression, it would also be interesting and quite relevant to also include dementia decline in those who contracted COVID-19. There is a wealth of data investigating COVID effects on dementia rating; it would enhance the study to also include these data under the subtitle “Cognitive Functioning”. In addition, it is impossible to know who was infected, especially in the second wave. Some of the reported data could therefore be confused with COVID-infected symptoms. This should at least be mentioned. In the results section about behavioral functioning and mental health, it is reported that there were increases in apathy, anxiety, restlessness, irritability, sleep disturbances, aggression, and agitation. These behavioral problems have also been associated with post-COVID symptoms. Is it possible that some of the reports included those with dementia and post-COVID or long-COVID symptoms as well? This is not mentioned. Although it might be difficult to discern, it may have been mentioned. Or is it clear from the individual studies that these symptoms were reported for non-infected people with dementia only? In the section about behavioral health and caregivers, it is only briefly mentioned that there could be actual country differences. However, this is not deliberated further. There are, indeed, significant cultural differences between all these countries. It would be valuable to develop this idea a little more and include cultural differences that could be involved in the differing results. Such differences in culture could both be differences in expectations for caring for a family member in some cultures, to the need/want for social interactions in another culture. This is likely important from a future planning perspective and should be discussed since cultural differences will play a role in how well a pandemic response is received and complied with. In the Discussion it would be good to include a table showing the most prominent differences and likenesses between countries and regions for the different categories; this could highlight global effects and differences better and provide an overview of the findings here. Are the rationale for, and objectives of, the Systematic Review clearly stated? Yes Are sufficient details of the methods and analysis provided to allow replication by others? Yes Is the statistical analysis and its interpretation appropriate? Not applicable Are the conclusions drawn adequately supported by the results presented in the review? Yes References 1. Hüls A, Costa A, Dierssen M, Baksh R, et al.: An international survey on the impact of COVID-19 in individuals with Down syndrome. medRxiv . 2020. Publisher Full Text 2. Hüls A, Costa A, Dierssen M, Baksh R, et al.: Medical vulnerability of individuals with Down syndrome to severe COVID-19–data from the Trisomy 21 Research Society and the UK ISARIC4C survey. EClinicalMedicine . 2021; 33 . Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise Neuroscience, neuropathology, biomarkers, Alzheimer's disease, Down syndrome I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Granholm AC. Peer Review Report For: The global impact of COVID-19 control measures on people with dementia living at home and their carers during the two first waves: A systematic review of quantitative and qualitative research across 27 countries [version 1; peer review: 1 approved with reservations] . HRB Open Res 2025, 8 :99 ( https://doi.org/10.21956/hrbopenres.15620.r49694) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://hrbopenresearch.org/articles/8-99/v1#referee-response-49694 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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