This hospital was among the first to report cases and deaths of COVID-19 patients in the United States. COVID-19 is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Most neurological manifestations of COVID-19 have been reported from non-USA health systems for hospitalized patients [1-3]. All patients had laboratory confirmed SARS-CoV-2 infection. Only new onset neurological manifestations were included. Study data were extracted from electronic medical records, and all neurological manifestations were confirmed via chart review by a neurologist and neuropsychologist. The study was approved by institutional review board and ethics committee. Core presenting symptoms were fever, cough, and shortness of breath. Clinical characteristics and admission laboratory measures are summarized in Table 1. Shapiro's test revealed significant deviations from normal distribution. Therefore, non-parametric alternatives to the t test (Wilcox rank sum test and Hodges-Lehmann estimation) were used, at alpha level of 0.05, adjusted for multiple comparisons using the Benjamini-Hochberg method. Female patients younger than 65 years old were more likely to have neurological symptoms; however, the findings were not statistically significant. Asian patients were 2.02 times more likely to have neurological symptoms than

Objective: This study was designed to replicate previous research on critical item analysis within the Word Choice Test (WCT). Method: Archival data were collected from a mixed clinical sample of 119 consecutively referred adults (Mage = 51.7, Meducation = 14.7). The classification accuracy of the WCT was calculated against psychometrically defined criterion groups. Results: Critical item analysis identified an additional 2%–5% of the sample that passed traditional cutoffs as noncredible. Passing critical items after failing traditional cutoffs was associated with weaker independent evidence of invalid performance, alerting the assessor to the elevated risk for false positives. Failing critical items in addition to failing select traditional cutoffs increased overall specificity. Non-White patients were 2.5 to 3.5 times more likely to Fail traditional WCT cutoffs, but select critical item cutoffs limited the risk to 1.5–2. Conclusions: Results confirmed the clinical utility of critical item analysis. Although the improvement in sensitivity was modest, critical items were effective at containing false positive errors in general, and especially in racially diverse patients. Critical item analysis appears to be a cost-effective and equitable method to improve an instrument’s classification accuracy.

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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.