Symptoms, testing and treatment of coronavirus with dementia

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1. What are the symptoms of coronavirus?
2. Tests for coronavirus
3. Treatments for coronavirus
4. Long Covid and dementia

1. What are the symptoms of coronavirus?

For most people, infection with coronavirus causes symptoms that are mild enough to manage at home or, in some cases, no symptoms.

Symptoms of coronavirus in adults can include:

• a high temperature or shivering (chills)
• a new, continuous cough
• a loss or change to sense of smell or taste
• shortness of breath
• feeling tired or exhausted
• an aching body
• a headache
• a sore throat
• a blocked or runny nose
• loss of appetite
• diarrhoea
• feeling sick or being sick.

The NHS has tips for treating mild coronavirus at home. 

Atypical Covid symptoms for people aged over 65

A person aged over 65 may have the common symptoms listed above. But they are more likely to have different (‘atypical’) early symptoms including: 

• delirium – particularly in people with dementia
• weakness
• muscle or joint pain 
• dizziness or falls.

These atypical symptoms are more likely as the person gets get older or frailer. They are also more likely in a person with other conditions such as dementia, heart disease and diabetes.

Atypical Covid is particularly common in people who live in care homes.

In older people, coronavirus may start with what seem to be mild symptoms (for example, diarrhoea and loss of appetite) but get worse quickly. 

Severe Covid

Call 999 and ask for an ambulance if a person with coronavirus:

• is getting confused or agitated
• is becoming very sleepy
• is struggling to breathe
• has symptoms that cannot be managed at home.

2. Tests for coronavirus

Coronavirus tests use a swab taken from the nose and sometimes the back of the throat. The test comes in a kit with instructions on how to use it. You can follow these tips on how to take a swab when the person has dementia.

Coronavirus tests are no longer free for most people. You can buy a test from some pharmacies and retailers, in person or online.

You may be able to access a free test if:

• you have symptoms of coronavirus AND you have a health condition which means you're eligible for Covid treatments from the NHS. You should be sent a Covid test to use if you have symptoms.
• you're due to have surgery or a procedure.
• you work in the NHS or in adult social care.

3. Treatments for coronavirus

The NHS offers treatments to people with Covid who are at the highest risk of becoming seriously ill, and have symptoms that are not getting better. 

The names of the available treatments are:

• nirmatrelvir and ritonavir (Paxlovid)
• sotrovimab (Xevudy)
• remdesivir (Veklury)
• molnupiravir (Lagevrio)

These treatments can help some people manage their Covid symptoms and reduce the risk of becoming seriously ill. 

Not everyone with dementia will be eligible for the above treatments. A doctor or specialist will confirm if you are eligible for treatment.

Going into hospital for Covid treatment

New treatments and vaccination have significantly improved survival rates, but Covid is still a potentially very serious disease. If a person with dementia develops severe Covid, they will need to go into hospital as an emergency.

It is helpful if the person’s preferences about treatment are discussed beforehand when there is time and while they can. For example: 

• the person may or may not want to be put on a ventilator to breathe for them
• they may not want to have cardiopulmonary resuscitation (CPR) if their heart or breathing suddenly stops. 

We have information on making advance decisions and advance statements, and on appointing a Lasting power of attorney (LPA) for someone to make decisions on a person’s behalf.

The medical team will follow a ‘treatment escalation plan’ once the person is admitted. This sets out what will happen if the person’s condition worsens. 

The treatment plan also records whether the person has the ability to make decisions (mental capacity) about their care. Having dementia does not always mean that the person lacks capacity but, as a person’s dementia progresses, they will lose capacity to understand the information they need to decide.

The NHS has information about symptoms a person may experience after being in hospital with Covid.

4. Long Covid and dementia

What is 'long Covid'?

Most people who get Covid start to feel better after a few weeks. Some people still feel unwell weeks or months after the initial illness. This is known as 'long Covid'. Older people are more likely to experience long covid.

More than one in every five people over 70 years old who get Covid, experience long Covid. 

Anyone who thinks they may have long Covid should contact their GP. The NHS website Your Covid Recovery has information and advice about coping with long Covid.

Dementia symptoms and long Covid symptoms

Some of the symptoms of long Covid are similar to symptoms of dementia. 

Day-to-day skills

Dementia makes it harder for someone to remain independent or retain everyday skills (for example, cooking or showering).

If long Covid makes someone’s memory or concentration worse (‘brain fog’), these activities may become even more difficult. 

An occupational therapist can:

• agree realistic goals with the person and then plan how to meet these 
• also advise on equipment and adaptations.

Sometimes the person loses abilities due to the progression of their dementia, and not from long Covid. This can mean that not all treatments will work for them.

Mental health

Anxiety and depression in long Covid may be a reaction to other ongoing symptoms (for example, fatigue) or lost self-confidence.

Our advice on supporting a person with dementia who has anxiety and depression may be useful. A doctor may offer medication or talking therapies, or refer the person to a psychiatrist, clinical psychologist or counsellor.