Altered mental status in 71 deaths due to COVID-19

Abstract

Objective: The purpose of this study was to investigate the occurrence of neurologic symptoms with a focus on altered mental status in a sample of deaths due to COVID-19. Methods: We reviewed neurologic symptoms in 71 deaths due to COVID-19 at the first US hospital with reported cases, of which 66 (93%) had medical comorbidities, 47 (66%) came from assisted living facilities or nursing homes and 35 (49%) had baseline dementia. Results: Sixty-one patients (86%) demonstrated neurologic symptoms at hospital admission. Altered mental status was seen in 47 patients (66%) and represented the most common neurologic symptom. Seven patients (10%) were comatose at hospital admission and 5 (7%) presented with altered mental status without respiratory symptoms. Three patients had seizures and two had strokes. Hypertension (61%), cardiovascular disease (59%), and dementia (49%) were the most common comorbidities associated with death due to COVID-19 in our sample. Conclusions: Neurologic symptoms, particularly altered mental status, are very common in COVID-19 patients with high risk of mortality. In a small subset of patients, altered mental status is the defining feature of disease presentation. A mental status examination should be incorporated in the medical assessment of COVID-19.

Neurological manifestations of COVID-19 in confirmed and probable cases: A descriptive study from a large tertiary care center

“…Although COVID-19 was initially considered as a primary potential threat to the respiratory system, it was recognized that many other organ systems could be significantly affected as the pandemic progressed [1,2]. Patients' clinical patterns vary from asymptomatic cases to acute respiratory distress syndrome (ARDS) requiring intensive care and even multiple organ failure resulting in death [3,4].…”

“…In addition to non-specific neurological symptoms such as headache and dizziness at the onset of the pandemic, frequent bidity and mortality. Nevertheless, studies investigating which neurological comorbidities cause poor outcomes are still insufficient [4,7,12].…”

“…The development of mental deterioration increases mortality dramatically. Also, the existence of seizure attacks was associated with a high mortality rate.Ó 2021 Elsevier Ltd. All rights reserved.hyposmia and hypogeusia attracted physicians' attention [4,5].Recent studies focusing on neurological involvement have shown an increase in the frequency and variety of neurological findings. Central and peripheral nervous system findings can develop due to direct effects of the virus, para-infectious or post-infectious immune-related diseases, and systemic effects of 5,6].Published studies reported that the occurrence of neurological complications in COVID-19 patients was associated with factors such as the severity of infection, age, obesity, metabolic problems, and the presence of comorbid diseases [1,7,8].…”

“…The frequency of neurological signs and symptoms was found to be significantly different in various studies [7,9,10].Pre-existing neurological comorbidities can increase both the frequency and severity of neurological manifestations in patients with COVID-19. However, the available data are inadequate to demonstrate this relationship in detail [4,7,11]. Still, some studies have demonstrated that neurological complications developing during COVID-19 worsen the patient's prognosis and increase mor-…”

COVID-19-Associated Acute Brain Dysfunction Related to Sepsis

“…The central nervous system (CNS) manifestations caused by COVID-19 included dizziness (17%), headache (13%), impaired consciousness (7.5%), seizures (0.5%), and acute cerebrovascular disease (5.7%) [8]. Moreover, altered mental status (66.0%) was more likely to represent as the most common neurologic symptom [9]. Actually, according to the new definition of Sepsis-3, all above-mentioned manifestations can generally be called as COVID-19-associated ABD, including various different terms, such as altered mental status, delirium, cerebrovascular disease/stroke, encephalopathy, encephalitis and/or meningitis, and other conditions.…”