The Trilemma of Today's Aging Population in the Time of Pandemic: A Case Study of Pre-existing Psychiatric Illness and Cognitive Deficits, COVID-19, and Further Cognitive Decline.

Care for geriatric patients can be difficult due to the complex nature of age-related comorbidities, multiple medications, and cognitive decline; this hardship multiplies when psychiatric illness or dementia are present and often exacerbates existing issues. Millions of lives have been lost in the COVID pandemic, and it has also severely harmed our collective mental health and cognition. The elderly population has felt that this impact the greatest as they are at the highest risk of isolation, cognitive inactivity, loneliness, and depression, all of which are risk factors for dementia. Studies associate loneliness with a 40% increase in the risk of dementia; thus, this pandemic and resulting isolation have likely caused an increase in cognition loss of the elderly. Furthermore, there is a documented bidirectional relationship between COVID-19 and psychiatric illness, both of which increase the likelihood of the other and are associated with worsening mental cognition. We present a case series of two patients with pre-existing psychiatric illness and cognitive decline, both exacerbated by COVID-19 infection, causing further decline in cognition.