LAUSR

The behavioral and psychological symptoms of dementia (BPSD) are well known in patients with major cognitive impairment (Bessey and Walaszek, 2019). The COVID-19 pandemic calls into question the organization of Cognitive and Behavioral Units (CBUs) specialized in the management of BPSD (Bellelli and Trabucchi, 2011; Koskas et al., 2011) to limit the risk of contamination for hospitalized patients and staff. Moderate-to-severe cognitive disorders andBPSDs such as wandering and agitation explain patients’ lack of understanding of the basic protective measures against COVID-19 and their difficulty in implementing them (BMJ Best Practice, 2020). It is also difficult to find the right balance between protective but coercive measures and respect for patients’ dignity. Another difficulty is how to streamline hospital procedures to reduce workload and limit the risk of mental and physical exhaustion. Recently, several expert committees have published guidelines on the treatment and management of patients with COVID-19 in different clinical situations (BMJ Best Practice, 2020; Wang et al., 2020) but to our knowledge, none of them had focused on elderly patients with BPSD. Confronted with the urgent medical need of guidelines, a French geriatric and psychiatric task force developed recommendations based on their clinical experience in CBU. In France, CBU exists in hospitals for the purpose of managing very severe BPSD in older adults living with dementia which are systematically assessed at admission and hospital discharge by using the Neuropsychiatric Inventory. Pathological wandering is a BPSD and consists in being in constant motion, with no precise or reasonable goal. It can lead a patient with advanced dementia to involuntarily leave the hospital without medical authorization with the risk of being harmed. This specific BPSD is systematically screened prior to admission because it is usually associated with aberrant motor behavior which implies incapacity to respect barrier measures such as social distancing, wearing a mask, or sanitizing one’s hands. It is, therefore, associatedwith a high risk of cluster outbreak. Depending on the stage of contamination in the unit, practical proposals are made to better manage patients with BPSD and reduce the risk of contamination for patients and hospital staff during the COVID-19 pandemic. The stages of COVID-19 contamination in a specialized unit and the corresponding recommendations are shown in Figure 1.