Delirium in COVID-19: common, distressing and linked with poor outcomes. . . can we do better?

Peterson, Alexandra; Marengoni, Alessandra; Shenkin, Susan D.; MacLullich, Alasdair M.J.

doi:10.1093/ageing/afab153

Cited by 6 publications

(5 citation statements)

References 13 publications

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“…In the cases described in the present study, the mortality rate was 25%, which is a critical indicator of how delirium can play a role in the mortality of hospitalized patients, as demonstrated by other studies (62)(63)(64)(65)(66).…”

Section: Discussionsupporting

confidence: 78%

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Delirium during COVID‑19: A report of eight cases and a review of the literature

et al. 2022

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Delirium is an acute confusional state, often associated with long-term hospitalization, oxygen supplementation, the male sex and an older age. Since the start of the coronavirus disease 2019 (COVID-19) pandemic, there was an abrupt increase in intensive care unit (ICU) admissions and hospitalization in general, as well as in the need for oxygen therapy and enforced isolation due to the contagion risk. This caused a sudden increase in the episodes of delirium. The diagnosis of delirium, however, remains a difficult task, as it can often be misdiagnosed or confused with underlying dementia, particularly among the elderly. The present study describes present eight cases of patients admitted to hospital due to severe acute respiratory syndrome coronavirus 2 infection, who manifested delirium. Notably, only one of the patients had psychiatric comorbidities prior to hospitalization. The most prevalent sex was the male (7:1) one, the mean age of the patients was 81.7±4 years, and the mean duration of hospitalization was 23.6±6 days. In total, 3 patients had a virological recovery and were discharged, 3 had a clinical recovery and were transferred to a lower intensity COVID-19 facility and 2 patients did not survive. In the eight cases described herein, the mortality rate was 25%. Delirium was found to be commonly associated with a higher mortality rate and a longer hospitalization period. Therefore, it is imperative to develop protocols and tools with which to rapidly assess delirium and treat it accordingly. In addition, it is fundamental to improve the quality of life of hospitalized patients, supporting behavioral therapy and the environmental factors that can affect patients, to prevent delirium as well.

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Section: Discussionsupporting

confidence: 78%

“…Delirium has been shown to be associated with a higher mortality rate in patients hospitalized for SARS-CoV-2 infection (62)(63)(64)(65)(66), prolongation in hospital stay (67), an impairment in physical functions (68) and cognitive impairment even after physical recovery from infection (69).…”

Section: Introductionmentioning

confidence: 99%

Delirium during COVID‑19: A report of eight cases and a review of the literature

et al. 2022

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“…Of the more than 500 patients examined in the Tyson study, only about 13% met the diagnostic inclusion criteria for delirium. Thus, this study suggested that delirium is not one of the most common neurological consequences of COVID-19, but one should nonetheless pay attention to this serious condition developing, as delirium correlates with serious outcomes, including mortality [86]. Relatively little attention has been paid to the prevalence or consequences of delirium in patients with severe COVID-19, even though other studies indicated a prevalence of delirium in as much as every third patient with severe COVID-19 [86].…”

Section: Covid-19 and Deliriummentioning

confidence: 81%

Long-Term Effects of SARS-CoV-2 in the Brain: Clinical Consequences and Molecular Mechanisms

Granholm

2023

JCM

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Numerous investigations have demonstrated significant and long-lasting neurological manifestations of COVID-19. It has been suggested that as many as four out of five patients who sustained COVID-19 will show one or several neurological symptoms that can last months after the infection has run its course. Neurological symptoms are most common in people who are less than 60 years of age, while encephalopathy is more common in those over 60. Biological mechanisms for these neurological symptoms need to be investigated and may include both direct and indirect effects of the virus on the brain and spinal cord. Individuals with Alzheimer’s disease (AD) and related dementia, as well as persons with Down syndrome (DS), are especially vulnerable to COVID-19, but the biological reasons for this are not clear. Investigating the neurological consequences of COVID-19 is an urgent emerging medical need, since close to 700 million people worldwide have now had COVID-19 at least once. It is likely that there will be a new burden on healthcare and the economy dealing with the long-term neurological consequences of severe SARS-CoV-2 infections and long COVID, even in younger generations. Interestingly, neurological symptoms after an acute infection are strikingly similar to the symptoms observed after a mild traumatic brain injury (mTBI) or concussion, including dizziness, balance issues, anosmia, and headaches. The possible convergence of biological pathways involved in both will be discussed. The current review is focused on the most commonly described neurological symptoms, as well as the possible molecular mechanisms involved.

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“…Delirium is a syndrome characterized by cognitive impairment, inattention, and decreased awareness 6-8. Clinical manifestations of delirium include inattention, confusion, hallucinations, restlessness, and gait disturbances.…”

Section: Deliriummentioning

confidence: 99%

“…Delirium is a syndrome characterized by cognitive impairment, inattention, and decreased awareness. [6][7][8] Clinical manifestations of delirium include inattention, confusion, hallucinations, restlessness, and gait disturbances. Poorer outcomes, an increase in mortality, and extended lengths of hospitalizations are all associated with delirium.…”

Section: Deliriummentioning

confidence: 99%

Delirium after COVID-19 vaccination in older adults

Armstrong

2023

Nursing

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Case scenarioAn 83-year-old male was admitted to the hospital with weakness and confusion. He had a week-long history of fatigue, malaise, gait instability, and anorexia after starting an antidepressant medication. His wife called 911 when he displayed a "catatonic state" and could no longer stand independently. Upon admission to the ED, he had a serum potassium level of 2.9 mEq/L (normal, 3.5-5.0 mEq/L) and a serum sodium level of 116 mEq/L (normal, 136-145 mEq/L). 1 He was diagnosed with hypokalemia and hyponatremia with associated delirium secondary to hyponatremia and antidepressant use. The delirium slowly resolved as his electrolytes were corrected and his antidepressant medication was discontinued. Imaging studies were performed to rule out other causes for his mental status changes. The results of a chest X-ray and head computerized tomography (CT) scan were normal. While in the hospital, he fell and injured his shoulder. The remainder of his hospi-Abstract: The COVID-19 global pandemic has devastated the older adult population. Like all vaccines, adverse reactions of COVID-19 vaccines are possible. This article discusses the increased incidence of delirium and deliriumassociated symptoms in older adults following COVID-19 vaccinations.

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Delirium in COVID-19: common, distressing and linked with poor outcomes. . . can we do better?

Cited by 6 publications

References 13 publications

Delirium during COVID‑19: A report of eight cases and a review of the literature

Delirium during COVID‑19: A report of eight cases and a review of the literature

Long-Term Effects of SARS-CoV-2 in the Brain: Clinical Consequences and Molecular Mechanisms

Delirium after COVID-19 vaccination in older adults

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