Delirium: Clinical Presentation and Outcomes in Older COVID-19 Patients

Rozzini, Renzo; Bianchetti, Angelo; Mazzeo, F; Cesaroni, Giulia; Bianchetti, Luca; Trabucchi, Marco

doi:10.3389/fpsyt.2020.586686

Cited by 20 publications

(27 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In a review of mortality risk factors among older adults with COVID-19, Sun et al (2020) reported a significantly higher percentage of consciousness disorders among patients who died in comparison to those who were discharged. One of the patients described here presented with altered mental status and lethargy, a manifestation of hypoactive delirium similar to other reported CNS manifestations of COVID-19 ( Rozzini et al, 2020 ). Lethargy is a pathological state of sleepiness or deep unresponsiveness and inactivity in contrast to fatigue which manifests as a lack of energy and motivation and has been described in up to 44% of patients with COVID-19 ( Huang et al, 2020 ; Zhu et al, 2020 ).…”

Section: Discussionsupporting

confidence: 81%

Atypical Presentations among Older Adults with COVID-19 Disease: A Need for Broadening the Differential Diagnosis

Ohuabunwa

Turner

Johnson

2021

Gerontology and Geriatric Medicine

View full text Add to dashboard Cite

Typical presenting symptoms of COVID-19 have been reported to be common in older adults. Current guidelines by the World Health Organization (WHO) and Centers for Disease Control (CDC) for testing and diagnosis are based on the presence of these typical symptoms. Several older adults seen at our hospital have presented atypically with symptoms such as delirium, falls, increasing the need for attention to diagnostic protocols since this has significant implications for early detection and patient outcomes, infection control and promotion of safety among healthcare providers. With the increased risk of fatality among older adults with COVID-19, appropriate diagnostic protocols are needed to ensure early diagnosis and management. Recognizing these atypical presentations in nursing homes would also facilitate early screening and cohorting in these congregate living facilities where older adults have had disproportionately high morbidity and mortality rates. We present two patients who presented with delirium and falls, found to have COVID-19 infection.

show abstract

Section: Discussionsupporting

confidence: 81%

Atypical Presentations among Older Adults with COVID-19 Disease: A Need for Broadening the Differential Diagnosis

Ohuabunwa

Turner

Johnson

2021

Gerontology and Geriatric Medicine

View full text Add to dashboard Cite

show abstract

“…COVID-19 patients with dementia may be hospitalized due to the characteristic symptoms of the infection (pneumonia, fever, respiratory failure). However, deterioration of functional status, behavioural symptoms, and in about two-third of cases, delirium, especially in the hypoactive form, are the most frequent symptoms of COVID-19 among patients affected by dementia [33].…”

Section: Delirium In Covid-19 Patients With Dementiamentioning

confidence: 99%

Dementia Clinical Care in Relation to COVID-19

Bianchetti

Rozzini

Bianchetti³

et al. 2022

Curr Treat Options Neurol

Self Cite

View full text Add to dashboard Cite

Purpose of Review This review discusses the complex relationship between COVID-19 and dementia and how the pandemic has affected the management of patients with dementia. This population resulted particularly susceptible to SARS-CoV-2 infection and its effects and also to the negative effects of the measures taken worldwide to control the spread of the virus. Recent Findings Patients with dementia were at increased risk for COVID-19 compared to patients without dementia, and diagnosis of dementia represents an independent risk factor for hospitalization in COVID-19 patients. Mortality due to SARS-CoV2 infection in subjects with dementia is 2–5 times higher than in the general population. Cognitive impairment and delirium have been described in COVID-19 survivors. SARS-COV2 pandemic exacerbates the vulnerability of dementia patients and their caregivers, due to the morbidity and mortality from COVID-19, the indirect effects of the pandemic on the social supports, and the effects on healthcare system on which they depend. Summary The COVID-19 pandemic requires people with dementia to move from traditional models of health care to innovative models for home care, to support caregivers’ burden, and to improve long term care.

show abstract

“…Some of these manifestations include delirium, cognitive impairments, mood alterations, anxiety disorders, depression, suicidal ideations, post-traumatic stress disorder (PTSD), insomnia, psychosis, and schizophrenia (Brown et al, 2020;Keyhanian et al, 2020;Mazza et al, 2020). In other clinical reports, COVID-19 patients have been shown to develop hypokinetic delirium (Rozzini et al, 2020). Self-rated symptoms in the psychopathological range include 30% for PTSD, 40% for depression, 40% for anxiety, 20% for obsessive-compulsive disorder symptoms, and 40% for insomnia (Mazza et al, 2020).…”

Section: Psychiatric Manifestationsmentioning

confidence: 99%

SARS-CoV-2 Neuronal Invasion and Complications: Potential Mechanisms and Therapeutic Approaches

et al. 2021

View full text Add to dashboard Cite

Clinical reports suggest that the coronavirus disease-19 (COVID-19) pandemic caused by severe acute respiratory syndrome (SARS)-coronavirus-2 (CoV-2) has not only taken millions of lives, but has also created a major crisis of neurologic complications that persist even after recovery from the disease. Autopsies of patients confirm the presence of the coronaviruses in the CNS, especially in the brain. The invasion and transmission of SARS-CoV-2 in the CNS is not clearly defined, but, because the endocytic pathway has become an important target for the development of therapeutic strategies for COVID-19, it is necessary to understand endocytic processes in the CNS. In addition, mitochondria and mechanistic target of rapamycin (mTOR) signaling pathways play a critical role in the antiviral immune response, and may also be critical for endocytic activity. Furthermore, dysfunctions of mitochondria and mTOR signaling pathways have been associated with some high-risk conditions such as diabetes and immunodeficiency for developing severe complications observed in COVID-19 patients. However, the role of these pathways in SARS-CoV-2 infection and spread are largely unknown. In this review, we discuss the potential mechanisms of SARS-CoV-2 entry into the CNS and how mitochondria and mTOR pathways might regulate endocytic vesicle-mitochondria interactions and dynamics during SARS-CoV-2 infection. The mechanisms that plausibly account for severe neurologic complications with COVID-19 and potential treatments with Food and Drug Administration-approved drugs targeting mitochondria and the mTOR pathways are also addressed.

show abstract

Delirium: Clinical Presentation and Outcomes in Older COVID-19 Patients

Cited by 20 publications

References 20 publications

Atypical Presentations among Older Adults with COVID-19 Disease: A Need for Broadening the Differential Diagnosis

Atypical Presentations among Older Adults with COVID-19 Disease: A Need for Broadening the Differential Diagnosis

Dementia Clinical Care in Relation to COVID-19

SARS-CoV-2 Neuronal Invasion and Complications: Potential Mechanisms and Therapeutic Approaches

Contact Info

Product

Resources

About