Clinical Features and Outcomes of Patients with Dementia Compared to an Aging Cohort Hospitalized During the Initial New York City COVID-19 Wave

Harb, Amro A; Chen, Ruijun; Chase, Herbert; Natarajan, Karthik; Noble, James M.

doi:10.3233/jad-210050

Cited by 19 publications

(22 citation statements)

References 26 publications

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“…Quantifying the burden of neurological events during the acute phase of illness will shed light on potential risk factors and mechanisms of post-COVID-19 neuropsychiatric conditions increasingly reported in survivors. 2,[21][22][23][24] Several questions remain with regards to the implications of the timing and severity of neurological manifestations on post-acute COVID-19 recovery. Well-designed cohorts in the acute COVID-19 period are needed to define risk factors associated with poor outcomes in the post hospitalization period, especially amongst multiethnic cohorts who were impacted significantly by the pandemic.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for New Neurologic Diagnoses in Hospitalized Patients With COVID-19

Thakur

Chu²,

Hughes³

et al. 2022

Neur Clin Pract

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Abstract:Background/Objective: There have been numerous reports of neurological manifestations identified in hospitalized patients infected with SARS-CoV-2, the virus that causes COVID-19. Here, we identify the spectrum of associated neurological symptoms and diagnoses, define the time course of their development, examine readmission rates and mortality risk post-hospitalization in a multiethnic urban cohort.Methods: We identify the occurrence of new neurological diagnoses among patients with laboratory-confirmed SARS-CoV-2 infection in New York City. A retrospective cohort study was performed of 532 cases (hospitalized patients with new neurological diagnoses within 6 weeks of positive SARS-CoV-2 laboratory results between March 1, 2020 and August 31, 2020). We compare demographic and clinical features of the 532 cases to 532 COVID-19 positive controls without neurological diagnoses in a case-control study with 1 to 1 matching; and examine hospital-related data and outcomes of death and readmission up to 6 months after acute hospitalization in a secondary case-only analysis.Results: Among the 532 cases, the most common new neurological diagnoses included encephalopathy (478, 89.8%), stroke (66, 12.4%), and seizures (38, 7.1%). In the case-control study, cases were more likely than controls to be male (58.6% vs. 52.8%, p=0.05), have baseline neurological comorbidities (36.3% vs. 13.0%, p<0.0001) and be treated in an intensive care unit (ICU) (62.0% vs. 9.6%, p < 0.0001). Of the 394 (74.1%) cases that survived the acute hospitalization, more than half (220/394, 55.8%) were readmitted within 6 months, with a mortality rate of 23.2% during readmission.Conclusion: Many patients hospitalized with SARS-CoV-2 have new neurological diagnoses, with significant morbidity and mortality post-discharge. Further research is needed to define the impact of neurological diagnoses during acute hospitalization on longitudinal post-COVID-19 related symptoms including neurocognitive impairment.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for New Neurologic Diagnoses in Hospitalized Patients With COVID-19

Thakur

Chu²,

Hughes³

et al. 2022

Neur Clin Pract

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“… 7 We expect that residents with ADRD generally present with less specific symptoms of COVID‐19 than those without ADRD. 2 , 3 , 4 This could obscure clinical detection and delay diagnosis, resulting in potential exposure of more staff and residents to SARS‐CoV‐2. Our findings demonstrate the critical importance of infection control and underscore the importance of viral testing and vital signs monitoring, especially in facilities with high ADRD prevalence.…”

Section: Discussionmentioning

confidence: 99%

“…1 Retrospective studies of hospitalized older adults with COVID‐19 and Alzheimer's disease and related dementias (ADRD) report alterations in cognition or functional status as the most common symptoms. 2 , 3 , 4 Furthermore, ADRD reduces adherence to infection control measures in NH such as testing, masking and physical distancing. 5 , 6 , 7 Through these multiple mechanisms, the contextual factor of ADRD prevalence could lead to increased risk of SARS‐CoV‐2 in a NH.…”

Section: Introductionmentioning

confidence: 99%

Dementia prevalence, a contextual factor associated with SARS‐CoV‐2 in veterans affairs community living centers

Bayer

DeVone

McConeghy

et al. 2022

J American Geriatrics Society

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Background: Alzheimer's disease and related dementias (ADRD) impact the diagnosis and infection control of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in nursing homes (NH) by influencing the behavior of residents and their caregivers. Health system data show an association between ADRD and SARS-CoV-2. Whether this association is present in NH populations remains unknown. How increased SARS-CoV-2 risk among residents with ADRD impacts the greater NH population also remains unknown.Methods: This retrospective cohort study used electronic health record data on Veterans residing in 133 Veterans Affairs Community Living Centers (CLC) and 15 spinal cord injury units from March 1, 2020 to December 13, 2020. We measured ADRD using diagnostic codes 12 months before an index SARS-CoV-2 test date for each resident. We used Poisson regression to determine the relative risk of SARS-CoV-2 for the highest quartile of facility ADRD prevalence versus the lowest, stratifying by individual ADRD status, and adjusting for covariates, with and without a random intercept to account for facility clustering.Results: Across the study period, 15,043 residents resided in CLCs, 1952 (13.0%) had SARS-CoV-2, and 8067 (53.6%) had ADRD. There was an estimated 60% increased risk of SARS-CoV-2 in facilities with highest dementia prevalence versus lowest (relative risk, 1.6 [95% confidence interval 0.95, 2.7]). Conclusions: CLC residents had a greater likelihood of SARS-CoV-2 infection in facilities with greater ADRD prevalence. Facility characteristics other than ADRD prevalence may account for this association.

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“…The COVID-19 pandemic has presented another challenge to individuals living with dementia and their families as the disease has a disproportionate burden on this group of patients. Multiple studies have shown that, despite attempts to control for other health conditions, dementia is associated with a higher risk of SARS-CoV-2 infection and mortality after COVID-19 disease [38][39][40][41]. One study of community dwelling older adults in the United Kingdom found that neurodegenerative diseases were more strongly associated with COVID-19-related death than the other health conditions and demographic variables they tracked.…”

Section: Prognostication and Hospice Referralmentioning

confidence: 99%

Primary Palliative Care in Dementia

Weisbrod

2022

Neurotherapeutics

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Primary palliative care is a fundamental aspect of high-quality care for patients with a serious illness such as dementia. The clinician caring for a patient and family suffering with dementia can provide primary palliative care in numerous ways. Perhaps the most important aspects are high quality communication while sharing a diagnosis, counseling the patient through progression of illness and prognostication, and referral to hospice when appropriate. COVID-19 presents additional risks of intensive care requirement and mortality which we must help patients and families navigate. Throughout all of these discussions, the astute clinician must monitor the patient's decision making capacity and balance respect for autonomy with protection against uninformed consent. Excellent primary palliative care also involves discussion of deprescribing medications of uncertain benefit such as long term use of cholinesterase inhibitors and memantine and being vigilant in the monitoring of pain with its relationship to behavioral disturbance in patients with dementia. Clinicians should follow a standardized approach to pain management in this vulnerable population. Caregiver burden is high for patients with dementia and comprehensive care should also address this burden and implement reduction strategies. When these aspects of care are particularly complex or initial managements strategies fall short, palliative care specialists can be an important additional resource not only for the patient and family, but for the care team struggling to guide the way through a disease with innumerable challenges.

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Clinical Features and Outcomes of Patients with Dementia Compared to an Aging Cohort Hospitalized During the Initial New York City COVID-19 Wave

Cited by 19 publications

References 26 publications

Risk Factors for New Neurologic Diagnoses in Hospitalized Patients With COVID-19

Risk Factors for New Neurologic Diagnoses in Hospitalized Patients With COVID-19

Dementia prevalence, a contextual factor associated with SARS‐CoV‐2 in veterans affairs community living centers

Primary Palliative Care in Dementia

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