Pain assessment and treatment in dementia at the time of coronavirus disease covid-19

The infection of severe acute respiratory syndrome coronavirus (SARS-CoV) 2 has raised rapidly from the outbreak in Wuhan within the Chinese Hubei province all over the world resulting in a pandemic emergency, which has remarkably affected the Italian population since February 21, 2020 (1). COVID-19 (COrona VIrus Disease 2019) presents the highest rate of severity and mortality in the elderly, characterized by several comorbidities contributing to a worse prognosis (2). This is exacerbated by the circulation and spread in long-term care facilities (3). Among the concurrent chronic conditions affecting the aged patients and the oldest old, one of the most frequent is represented by cognitive impairment in dementia, known as Alzheimer‘s disease and related dementias (ADRD) (4). It is known that age represents a highest risk factor for pain and dementia (5). In addition, about half of the people suffering with dementia experience regular pain (6). Pain can be encountered in different types of dementia, such as Alzheimer’s disease (AD), vascular dementia (VaD), fronto-temporal dementia (FTD), and Parkinson’s disease (PD), and it could appear in different forms (e.g., nociceptive pain, neuropathic pain, and central pain) (5). Importantly, the occurrence of pain in dementia could lead to further complications in the patients’ healthcare routine. At this moment, due to the COVID-19 emergency, a large amount of old people presenting dementia and pain cannot attend to the hospital to receive their usual healthcare routine to manage pain. In this regard, the introduction of new digital technologies in the field of medicine—commonly known as “telemedicine” or “telehealth” (7)—can pave the way for treating pain in patients with dementia from the comfort of their own home (8).