Delirium and COVID‐19: a narrative review of emerging evidence

Abstract

Delirium is a common condition affecting hospital inpatients, including those having surgery and on the intensive care unit. Delirium is also common in patients with COVID-19 in hospital settings, and the occurrence is higher than expected for similar infections. The short-term outcomes of those with COVID-19 delirium are similar to that of classical delirium and include increased length of stay and increased mortality. Management of delirium in COVID-19 in the context of a global pandemic is limited by the severity of the syndrome and compounded by the environmental constraints. Practical management includes effective screening, early identification and appropriate treatment aimed at minimising complications and timely escalation decisions. The pandemic has played out on the national stage and the effect of delirium on patients, relatives and healthcare workers remains unknown but evidence from the previous SARS outbreak suggests there may be long-lasting psychological damage.

COVID-19 in the perioperative setting: A review of the literature and the clinical landscape

“…Neurocognitive dysfunction and damage after COVID infection are also common. 31 , 32 , 33 , 34 , 35 , 36 Delirium is a well-recognized complication of COVID and is associated with a poor prognosis and increased mortality. While specific post-COVID perioperative neurocognitive complications are not yet reported, we remain highly concerned about the risk of postoperative delirium and other postoperative neurocognitive disorders.…”

Targeting the mammalian target of rapamycin pathway in neurological manifestations of Covid‐19

“…34 As the SARS-CoV-2 demonstrates an ability to invade the CNS and provoke immune responses, the challenge lies in discerning whether the neurological manifestations are primarily a consequence of direct viral effects or an intricate interplay between the virus and the host's immune system. 35,36…”

“…The heterogeneity in neurological manifestations observed in Covid‐19 patients prompts a deeper exploration into the underlying molecular and cellular processes 34 . As the SARS‐CoV‐2 demonstrates an ability to invade the CNS and provoke immune responses, the challenge lies in discerning whether the neurological manifestations are primarily a consequence of direct viral effects or an intricate interplay between the virus and the host's immune system 35,36 …”

Association between COVID-19 and Postoperative Neurological Complications and Antipsychotic Medication Use after Cancer Surgery: A Retrospective Study

“…Patients with postoperative delirium have an increased risk of developing other postoperative complications, hospital readmission, and a higher healthcare-associated cost and mortality rate than those without delirium [ 9 , 10 , 11 ]. Precipitating factors of postoperative delirium include age, duration of surgery, the extent of surgery, and perioperative medication administration, such as high doses of opioids and benzodiazepines [ 12 , 13 , 14 ]. However, patients with a diminished brain reserve, such as those with dementia, also have an increased risk for postoperative delirium [ 7 , 14 , 15 ].…”

“…Precipitating factors of postoperative delirium include age, duration of surgery, the extent of surgery, and perioperative medication administration, such as high doses of opioids and benzodiazepines [ 12 , 13 , 14 ]. However, patients with a diminished brain reserve, such as those with dementia, also have an increased risk for postoperative delirium [ 7 , 14 , 15 ]. Studies have shown Alzheimer’s disease-like features in patients with a history of long COVID, suggesting permanent brain damage [ 16 ].…”