Delirium in Older Patients With COVID-19 Presenting to the Emergency Department

Abstract

IMPORTANCE Delirium is common among older emergency department (ED) patients, is associated with high morbidity and mortality, and frequently goes unrecognized. Anecdotal evidence has described atypical presentations of coronavirus disease 2019 (COVID-19) in older adults; however, the frequency of and outcomes associated with delirium in older ED patients with COVID-19 infection have not been well described. OBJECTIVE To determine how frequently older adults with COVID-19 present to the ED with delirium and their associated hospital outcomes.

COVID-19 im Alter – Die geriatrische Perspektive

“…Bei älteren Menschen kann ein Delir erstes und einziges Symptom einer COVID-19-Erkrankung sein. Patienten mit einem unklaren Verwirrtheitszustand in der Notaufnahme sollten daher immer auf SARS-CoV‑2 getestet werden [ 29 ]. In einer Studie, in die ältere Menschen mit einem Durchschnittsalter von 78 Jahren eingeschlossen wurden, war das Delir das sechsthäufigste Symptom einer COVID-19-Erkrankung, und bei 17 % der Delirpatienten war das Delir primäres Symptom von COVID-19.…”

Double stranded RNA drives innate immune responses, sickness behavior and cognitive impairment dependent on dsRNA length, IFNAR1 expression and age

“…In the largest report on hospitalised cases of SARS-CoV-2 in Europe, the ISARIC consortium report that confusion was the most 5 th most common symptom on admission, representing 25% of all patients (Docherty et al, 2020) (Docherty et al, 2020Varatharaj et al, 2020). It is known that delirium is more prevalent in older age (Cole, 2004) and that older SARS-CoV-2 patients often present with delirium in the absence of even the characteristic COVID19 symptoms (Kennedy et al, 2020;Poloni et al, 2020). There is, quite rightly, significant attention on the evidence that SARS-CoV-2 can enter the brain (Meinhardt et al, 2020) and whether this contributes to the frequent neuropsychiatric features observed, but the current data show that even in the absence viable virus, peripheral dsRNA alone is sufficient to trigger disruption of dynamic cognitive functions relying on attention and working memory, selectively in older individuals.…”

“…Patients with mild symptoms include typical sickness behaviors (Eyre et al, 2020), while more deleterious neurological effects of the novel coronavirus have also been reported (Paterson et al, 2020). In particular, confusion or delirium was present in approximately 25% of all patients in a study of 20K+ patients (Docherty et al, 2020) and older patients more often show delirium as the initial presenting symptom (Kennedy et al, 2020;Poloni et al, 2020). The use of systemic poly I:C in older animals allows interrogation of the extent to which older individuals are more susceptible to CNS effects of systemic anti-viral responses in the absence of viable viral infection of the brain.…”

Encephalopathy with progression to posterior reversible encephalopathy pattern in a patient with COVID-19: clinical, imaging findings and follow-up

“… 6 Delirium pattern appears to be a common feature in the elderly with COVID-19 and was reported to be a primary problem in about 16% of delirium with COVID-19 infection. 7 The patient did present with elevated blood pressure and signs of acute kidney injury, which can also cause PRES in isolation without concomitant COVID-19 infection. Non-adherence to medication was felt unlikely given primary care records of patient adherence, confirmation from the family who visited his household, and patient confirmation on his phone interview post discharge.…”