A rapid review of the pathoetiology, presentation, and management of delirium in adults with COVID-19

Abstract

Background COVID-19 causes significant morbidity and mortality. Despite the high prevalence of delirium and delirium-related symptoms in COVID-19 patients, data and evidence-based recommendations on the pathophysiology and management of delirium are limited. Objective We conducted a rapid review of COVID-19-related delirium literature to provide a synthesis of literature on the prevalence, pathoetiology, and management of delirium in these patients. Methods Systematic searches of Medline, Embase, PsycInfo, LitCovid, WHO-COVID-19, and Web of Science electronic databases were conducted. Grey literature was also reviewed, including preprint servers, archives, and websites of relevant organizations. Search results were limited to the English language. We included literature focused on adults with COVID-19 and delirium. Papers were excluded if they did not mention signs or symptoms of delirium. Results 229 studies described prevalence, pathoetiology, and/or management of delirium in adults with COVID-19. Delirium was rarely assessed with validated tools. Delirium affected >50% of all patients with COVID-19 admitted to the ICU. The etiology of COVID-19 delirium is likely multifactorial, with some evidence of direct brain effect. Prevention remains the cornerstone of management in these patients. To date, there is no evidence to suggest specific pharmacological strategies. Discussion Delirium is common in COVID-19 and may manifest from both indirect and direct effects on the central nervous system. Further research is required to investigate contributing mechanisms. As there is limited empirical literature on delirium management in COVID-19, management with non-pharmacological measures and judicious use of pharmacotherapy is suggested.

Delirium symptoms duration and mortality in SARS-COV2 elderly: results of a multicenter retrospective cohort study

“…The cause of delirium is often multifactorial (e.g., infections, change in medications, use of restraints) especially in older patients [ 2 ]. In late 2019, a new emerging risk factor for delirium was the infection with SARS-COV2 [ 3 ]. The main hypothesis of the pathogenesis of delirium in patients with SARS-COV2 is a central neuroinflammation along with the worsening of other geriatric syndromes, which can be worsened by the infection itself or by the acute isolation related to the health care policies to reduce the spread of the viral infection [ 3 ].…”

“…Since the occurrence of the SARS-COV2 pandemic, there has been an increasing interest in investigating the epidemiology of delirium. A recent review has reported how delirium affects up to 80% of the patients with SARS-COV2 in the ICU and between 29 and 67% in non-ICU patients [ 3 ]. Delirium in patients with SARS-COV2 is reported to increase the risk of mortality and worsen patients’ functional outcomes [ 11 , 12 ].…”

Delirium is one of the many faces of COVID-19. Literature review

“…Siû lo ma lai ky tis iki pande mi jos eg zis ta vu siø so ma to ge ni nio de ly ro gy dy mo gairiø, jas pri tai kant kon kre èioms kli ni ki nëms si tu a ci joms, ak cen tuo jant kvë pa vi mo sis te mos pa þei di mus, ga li mas var to ja mø vais tø sà vei kas. Toks de ly ro gy dy mas pa pras tai re mia si jo es mi niø su de da mø jø da liø, t. y. su vo ki mo, màsty mo, psi cho mo to ri nio el ge sio, emo ci jø, mie go ir bud rumo cik lo bei ki tø su tri ki mø, ko rek ci ja [21].…”

“…Ma noma, kad imu no sup re suo tiems pa cien tams me la to ni nà reikë tø skir ti at sar giai [23]. Kli ni ki niø ty ri mø, pa tvir ti nan èiø me la to ni no efek ty vu mà de ly rui gy dy ti COVID-19 me tu, në ra [21,24].…”

“…Juos ski riant, svar bu at kreip ti dë me sá á ga li mas vais tø sàvei kas. Kli ni ki niø ty ri mø, pa tvir ti nan èiø val proi nës rûgðties efek ty vu mà de ly rui gy dy ti CO VID-19 me tu, taip pat në ra [21,24].…”