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, 31 (42%) had delirium, of which only 19 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 (-39 points on functional scale/166, 95% CI -92 to -21, p=0.01) (Table 2). 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.

The ‘third wave’: impending cognitive and functional decline in COVID-19 survivors

“…One third of COVID-19 patients report neurological symptoms, and there have been anecdotal accounts of "COVID-19 delirium", manifesting as paranoid hallucinations, confusion and agitation in over 20% of hospitalised patients 7,8 . A small study from the UK reported delirium in 42% of COVID-19 patients 9 . One of the highest-risk groups for severe manifestations of COVID-19, patients over 65 yr old, often have underlying mild cognitive impairment (MCI) and are already at increased risk of delirium due to underlying "neurocognitive frailty" 10,11 .…”

COVID-19 has hit nursing homes hard

“…Residents suffer from loneliness, depression and anxiety [2,16]. Pausing group activities, especially exercise and outdoor activities, has exacerbated development of sarcopenia, frailty, and disabilities [17]. The consequence is accelerated cognitive decline [2].…”

Common genetic variation in humans impactsin vitrosusceptibility to SARS-CoV-2 infection

“…A subset of COVID-19 patients present with neurological symptoms (Mao et al, 2020), including headaches, dizziness, and defects in smell and taste reported in 12-60% of patients (Chen et al, 2020). COVID-19 has been associated with acute disseminated encephalomyelitis (ADEM) (Pilotto et al, 2020;Zhang et al, 2020), mid-and long-term sequels including classical Guillain-Barré syndrome (Toscano et al, 2020;Zhao et al, 2020a), and COVID-19-associated delirium (McLoughlin et al, 2020). After hospital discharge, an alarmingly high fraction of patients, as high as 33%, suffer from a dysexecutive syndrome consisting of inattention, disorientation, or poorly organized movements in response to command (Helms et al, 2020).…”