Functional and cognitive outcomes after COVID-19 delirium

Abstract

Purpose To ascertain delirium prevalence and outcomes in COVID-19. Methods We conducted a point-prevalence study in a cohort of COVID-19 inpatients at University College Hospital. Delirium was defined by DSM-IV criteria. The primary outcome was all-cause mortality at 4 weeks; secondary outcomes were physical and cognitive function. Results In 71 patients (mean age 61, 75% men), 31 (42%) had delirium, of which only 12 (39%) had been recognised by the clinical team. At 4 weeks, 20 (28%) had died, 26 (36%) were interviewed by telephone and 21 (30%) remained as inpatients. Physical function was substantially worse in people after delirium − 50 out of 166 points (95% CI − 83 to − 17, p = 0.01). Mean cognitive scores at follow-up were similar and delirium was not associated with mortality in this sample. Conclusions Our findings indicate that delirium is common, yet under-recognised. Delirium is associated with functional impairments in the medium term.

Presenting features of COVID-19 in older people: relationships with frailty, inflammation and mortality

“…Our data indicate that fever and dyspnoea may be important prognostic signs. The clinical significance of delirium has been observed in other COVID-19 cohorts, including from our own hospital [6,7]. However, the inverse relationship between CRP on admission and frailty has not previously been noted in COVID-19.…”

Cognitive and Neuropsychiatric Manifestations of COVID-19 and Effects on Elderly Individuals With Dementia

“…In a case series of 4 severe COVID-19 patients who required ICU admission, cognitive impairment, identified as memory deficit and frontal syndrome, was detected after discharged but remitted after 5 days of immunoglobulin therapy (Chaumont et al, 2020). Besides, in a sample of 71 COVID-19 hospitalized patients, those who were diagnosed with delirium during their hospitalization (42%) had lower cognitive scores on a telephone screening interview after 4 weeks of discharge, although the betweengroup comparison did not reach statistical significance (p = 0.06) (McLoughlin et al, 2020).…”

The One-Two Punch of Delirium and Dementia During the COVID-19 Pandemic and Beyond

“…While quantifying the impact of this pandemic on delirium is in its early stages, COVID-19 has been demonstrated in small studies to be associated with an increased risk of delirium (10,11). This association is likely due to an exacerbation of established risk factors, including the development of hypoxia, metabolic derangements, and infection leading to a heightened inflammatory state, as well as the need for intensive care (12,13).…”

“…This association is likely due to an exacerbation of established risk factors, including the development of hypoxia, metabolic derangements, and infection leading to a heightened inflammatory state, as well as the need for intensive care (12,13). In one point-prevalence cohort study of 71 hospitalized individuals with COVID-19, 31 patients were diagnosed with delirium by DSM-IV criteria (11). Importantly, only 12 of these patients were recognized as being delirious by the primary clinical team (11).…”

“…In one point-prevalence cohort study of 71 hospitalized individuals with COVID-19, 31 patients were diagnosed with delirium by DSM-IV criteria (11). Importantly, only 12 of these patients were recognized as being delirious by the primary clinical team (11). Such a discrepancy is not surprising since, without the use of a targeted screening tool, misidentification of delirium for depression or other psychiatric diagnoses, especially in older patients is not uncommon (14,15).…”