Prevention, diagnosis, and treatment of delirium in older adults with COVID-19. Literature review

Abstract

Background. COVID-19 affects several systems in the body, including the central nervous system (CNS), expressed in the form of headaches, hyposmia, cerebrovascular disease, and neuropathy. Older Adults (OA) are vulnerable to this infection, and may also present delirium, which may be the result of the virus directly affecting the CNS or of systemic inflammation during infection. Objective. To determine the clinical characteristics, risk factors, pathophysiology, treatment measures, and prevention of delirium associated with COVID-19 from a review of the literature in times of the SARS-CoV-2 pandemic. Method. A search was conducted in PubMed, SciELO, UpToDate, and Medscape using keywords in English and Spanish. Results. Seventy-two articles were reviewed. We analyzed inclusion and exclusion criteria and 43 articles with relevant information for the narrative description of the review were selected. Twenty to thirty per cent of the COVID-19 patients will present or develop delirium, or changes in mental status during their hospitalization, with rates of 60% to 70% in severe illness. The exact mechanisms are likely to be multifactorial. There is a worrying lack of attention to the implications of identifying and managing delirium in the response to this pandemic. Discussion and conclusion. Delirium is a frequent neurological manifestation in OA with COVID-19 and requires early identification, as well as the implementation of non-pharmacological and pharmacological treatment strategies, which may reduce the associated morbidity and mortality in this age group.

Inflammatory and blood gas markers of COVID-19 delirium compared to non-COVID-19 delirium: a cross-sectional study

“…In our study, the proportion of COVID-19 patients with delirium (25%) is consistent with other values reported for hospitalised COVID-19 patients (30%), despite the fact the small study population was derived from a cohort of psychiatric referrals (Aguilar-Navarro et al, 2020). A significantly lower incidence of delirium in the COVID-19 cohort compared to the non-COVID-19 cohort (25% vs 63% respectively) may be caused by an increase in severity of disease of non-COVID-19 patients attending hospital over this time.…”

Patient Profile and Management of Delirium in Older Adults Hospitalized Due to COVID-19

“…In our study, pharmacological contention measures were usually maintained for at least three days, whilst physical restraints were maintained for up to 10 days in one case. According to O'Hanlon et al [17] and Nikooie et al [29], antipsychotic management of ADOP is not always effective, and it is not without risks [20]. Yet, as demonstrated in our study, pharmacological management of ADOP is still frequent [38].…”

“…Our results are similar to those reported by previous investigations carried out throughout the year 2020. A systematic review by Aguilar et al [29]…”

“…Our results are similar to those reported by previous investigations carried out throughout the year 2020. A systematic review by Aguilar et al [29] comprising 43 articles concluded that prevalence of ADOP in COVID-19 patients ranged from 20 to 30%. Garcez et al [21] and Mendes et al [22] reported similar prevalence rates, 30% and 20.4%, respectively, whilst another study by Ticinesi et al [1] identified a much lower percentage of ADOP amongst patients admitted with COVID-19.…”

“…Later, in 2008, Inouye et al published "The Confusion Assessment Method: A Systematic Review of Current Usage", demonstrating a sensibility of 94% (confidence interval 91-97%) and specificity of 89% (confidence interval 85-94%). Since then, many studies have used this information to justify using the CAM as tool to diagnose delirium [28,29] worldwide [30]. The CAM diagnostic algorithm comprises four features.…”