The Impact of Dementia on the Clinical Outcome of COVID-19: A Systematic Review and Meta-Analysis

Liu, Nanyang; Sun, Jiahui; Wang, Xiyuan; Zhao, Ming; Huang, Qianqian; Li, Hao

doi:10.3233/jad-201016

Cited by 84 publications

(76 citation statements)

References 34 publications

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“…Like others, we found that age, male sex 1 , African-American race 6,11 and obesity 12,13 were associated with greater clinical severity. Associations of liver disease and dementia with COVID-19 severity have also been reported 14,15 . We found that patients with rheumatologic disease had lower clinical severity.…”

Section: Discussionmentioning

confidence: 84%

The National COVID Cohort Collaborative: Clinical Characterization and Early Severity Prediction

Bennett

Moffitt

Hajagos

et al. 2021

Preprint

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BackgroundThe majority of U.S. reports of COVID-19 clinical characteristics, disease course, and treatments are from single health systems or focused on one domain. Here we report the creation of the National COVID Cohort Collaborative (N3C), a centralized, harmonized, high-granularity electronic health record repository that is the largest, most representative U.S. cohort of COVID-19 cases and controls to date. This multi-center dataset supports robust evidence-based development of predictive and diagnostic tools and informs critical care and policy.Methods and FindingsIn a retrospective cohort study of 1,926,526 patients from 34 medical centers nationwide, we stratified patients using a World Health Organization COVID-19 severity scale and demographics; we then evaluated differences between groups over time using multivariable logistic regression. We established vital signs and laboratory values among COVID-19 patients with different severities, providing the foundation for predictive analytics. The cohort included 174,568 adults with severe acute respiratory syndrome associated with SARS-CoV-2 (PCR >99% or antigen <1%) as well as 1,133,848 adult patients that served as lab-negative controls. Among 32,472 hospitalized patients, mortality was 11.6% overall and decreased from 16.4% in March/April 2020 to 8.6% in September/October 2020 (p = 0.002 monthly trend). In a multivariable logistic regression model, age, male sex, liver disease, dementia, African-American and Asian race, and obesity were independently associated with higher clinical severity. To demonstrate the utility of the N3C cohort for analytics, we used machine learning (ML) to predict clinical severity and risk factors over time. Using 64 inputs available on the first hospital day, we predicted a severe clinical course (death, discharge to hospice, invasive ventilation, or extracorporeal membrane oxygenation) using random forest and XGBoost models (AUROC 0.86 and 0.87 respectively) that were stable over time. The most powerful predictors in these models are patient age and widely available vital sign and laboratory values. The established expected trajectories for many vital signs and laboratory values among patients with different clinical severities validates observations from smaller studies, and provides comprehensive insight into COVID-19 characterization in U.S. patients.ConclusionsThis is the first description of an ongoing longitudinal observational study of patients seen in diverse clinical settings and geographical regions and is the largest COVID-19 cohort in the United States. Such data are the foundation for ML models that can be the basis for generalizable clinical decision support tools. The N3C Data Enclave is unique in providing transparent, reproducible, easily shared, versioned, and fully auditable data and analytic provenance for national-scale patient-level EHR data. The N3C is built for intensive ML analyses by academic, industry, and citizen scientists internationally. Many observational correlations can inform trial designs and care guidelines for this new disease.

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Section: Discussionmentioning

confidence: 84%

The National COVID Cohort Collaborative: Clinical Characterization and Early Severity Prediction

Bennett

Moffitt

Hajagos

et al. 2021

Preprint

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“…Hence, as new reviews continue to be published, the estimated numbers of individuals with COVID-19 and dementia might change. The strengths of our study were that it used updated literature regarding mortality among older adults with dementia who have COVID-19 and calculated the pooled odds ratio and pooled prevalence rates, making it of greater value compared to earlier published reports which only reported the prevalence of survival versus death in older adult with dementia who have COVID-19 39 , 40 , 41 .…”

Section: Discussionmentioning

confidence: 99%

Dementia as a mortality predictor among older adults with COVID-19: A systematic review and meta-analysis of observational study

Saragih

Saragih²,

Batubara

et al. 2021

Geriatric Nursing

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The purpose of this study was to systematically examine the association between dementia and mortality among older adults with COVID-19. To do so, we conducted a search of 7 databases for relevant full-text articles. A cohort study and case-control study were included. A meta-analysis was performed to synthesize the pooled odds ratio with a random-effects model. We identified studies that reported mortality among older adults with dementia and non-dementia who have COVID-19. The pooled mortality rates of dementia and non-dementia older adults infected with COVID-19 were 39% (95% CI: 0.23 – 0.54%, I 2 = 83.48%) and 20% (95% CI: 0.16 – 0.25%, I 2 = 83.48%), respectively. Overall, dementia was the main factor influencing poor health outcomes and high rates of mortality in older adults with COVID-19 infection (odds ratio 2.96; 95% CI 2.00 – 4.38, I 2 = 29.7%), respectively. Our results show that older adults with dementia with COVID-19 infection have a higher risk of mortality compared with older adults without dementia. This current study further highlights the need to provide focused care to the older adults with dementia or cognitive impairment who have COVID-19.

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“…A study by Canavelli et al [30] evaluating the prevalence of dementia in a random sample of con rmed COVID-19 infected patients, found that patients with dementia accounted for 15.8% of overall COVID-19 related death. In a meta-analysis of, the mortality of individuals with dementia was increased compared to not demented subjects (OR=5.17) [31].…”

Section: Discussionmentioning

confidence: 99%

COVID-19 in Adults With Dementia: Clinical Features and Predictive Factors of Mortality. A Clinical Cohort Study on 125 Patients

Vrillon

Mhanna

Aveneau

et al. 2021

Preprint

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BACKGROUNDThere is limited evidence on the characteristics and outcome of patients with dementia hospitalized for novel coronavirus infection (COVID-19).METHODWe conducted a prospective study in 2 gerontologic Covid Units in Paris, France, from March 14th 2020 to May 7th 2020. Patients with dementia hospitalized for confirmed COVID-19 infection were systematically enrolled. A binary logistic regression analysis was performed to identify factors associated with mortality at 21 days.RESULTSWe 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 behavioral disorders were observed in survivors (19.2%).CONCLUSIONCOVID-19 in demented individuals is associated with severe outcome in SARS-CoV-2 infection and is characterized 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.

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The Impact of Dementia on the Clinical Outcome of COVID-19: A Systematic Review and Meta-Analysis

Cited by 84 publications

References 34 publications

The National COVID Cohort Collaborative: Clinical Characterization and Early Severity Prediction

The National COVID Cohort Collaborative: Clinical Characterization and Early Severity Prediction

Dementia as a mortality predictor among older adults with COVID-19: A systematic review and meta-analysis of observational study

COVID-19 in Adults With Dementia: Clinical Features and Predictive Factors of Mortality. A Clinical Cohort Study on 125 Patients

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