COVID-19 in adults with dementia: clinical features and risk factors of mortality—a clinical cohort study on 125 patients

Abstract

Background There is limited evidence on the characteristics and outcome of patients with dementia hospitalised for novel coronavirus infection (COVID-19). Method We conducted a prospective study in 2 gerontologic COVID units in Paris, France, from March 14, 2020, to May 7, 2020. Patients with dementia hospitalised for confirmed COVID-19 infection were systematically enrolled. A binary logistic regression analysis was performed to identify factors associated with mortality at 21 days. Results We included 125 patients. Median age was 86 (IQI 82–90); 59.4% were female. Most common causes of dementia were Alzheimer’s disease, mixed dementia and vascular dementia. 67.2% had ≥ 2 comorbidities; 40.2% lived in a long-term care facility. The most common symptoms at COVID-19 onset were confusion and delirium (82.4%), asthenia (76.8%) and fever (72.8%) before polypnea (51.2%) and desaturation (50.4%). Falls were frequent at the initial phase of the disease (35.2%). The fatality rate at 21 days was 22.4%. Chronic kidney disease and CRP at admission were independent factors of death. Persisting confusion, mood and behavioural disorders were observed in survivors (19.2%). Conclusion COVID-19 in demented individuals is associated with severe outcome in SARS-CoV-2 infection and is characterised by specific clinical features and complications, with confusion and delirium at the forefront. COVID-19 testing should be considered in front of any significant change from baseline.

Prediction of COVID-19-related Mortality and 30-Day and 60-Day Survival Probabilities Using a Nomogram

“…Although the reasons underlying this association have not been identified, 2 persistent chronic inflammation in diabetes combined with poor control of blood glucose levels during the COVID-19 illness and combined comorbidities of diabetes in itself can affect the prognosis of COVID-19 in patients with diabetes. 33 Some studies showed that patients with dementia, especially those living in care facilities, had an increased risk of COVID-19 and COVID-19-related mortality, 34 35 36 consistent with our findings. Living in care facilities favors the rapid spread of COVID-19 due to the increased likelihood of exposure to the virus in a closed environment, and furthermore, patients with dementia tend to have other underlying comorbidities.…”

Hyperactivated RAGE in Comorbidities as a Risk Factor for Severe COVID-19—The Role of RAGE-RAS Crosstalk

“…A significantly increased risk for COVID-19 and an association with severe outcomes of the pathology have been observed in patients with dementia, including AD [76,77]. On the other hand, neuronal injury and glial activation have been reported in patients with moderate to severe COVID-19 with or without dementia [78].…”

Can SARS-CoV-2 Infection Lead to Neurodegeneration and Parkinson’s Disease?

“…Dementia was found to be one of the strongest risk factors for COVID-19 and associated with a higher mortality [ 126 , 127 , 128 , 129 , 130 ]. Apparently, patients with dementia have difficulties in following hygiene rules, mask requirements, behavioral instructions and distancing rules due to cognitive deficits [ 124 , 131 ].…”

“…Dementia patients frequently live in nursing homes where a higher risk for infection with the virus was present in many areas [ 124 ]. COVID-19 disease in dementia patients often appeared atypical presenting foremost with delirium/confusion and few infectious symptoms [ 129 , 132 ]. Confusion and mood and behavioral disturbances persisted in 19.2% of survivors [ 129 ].…”

“…COVID-19 disease in dementia patients often appeared atypical presenting foremost with delirium/confusion and few infectious symptoms [ 129 , 132 ]. Confusion and mood and behavioral disturbances persisted in 19.2% of survivors [ 129 ].…”