SARS-CoV-2, the virus that causes COVID-19, became a public health threat in December 2019 and was declared a pandemic by the World Health Organization in March 2020. Significant neurological complications have been observed, including encephalopathy, strokes, seizures, and ataxia.
Delirium appears to be a common complication, with an incidence of approximately 65–80 percent in the intensive care unit in previous studies (ICU).
Delirium may occur as a result of coronavirus infection of the central nervous system directly, and systemic inflammatory responses may exacerbate neurocognitive impairment further.
Multiple delirium risk factors are frequently present in the intensive care unit and can increase risk additively. Delirium is also linked to extended hospitalization, long-term cognitive and functional impairment, and an increased risk of death. As such, there is an urgent need to increase understanding of this syndrome in COVID-19 patients.
A new study of nearly 150 patients hospitalised for COVID at the outbreak’s start discovered that 73percent had delirium, a serious mental disorder in which a patient is confused, agitated, and unable to think clearly.
Patients with delirium were generally sicker, had more comorbid conditions such as hypertension and diabetes, and appeared to have more severe COVID-related illness, according to study author Phillip Vlisides, M.D., of Michigan Medicine’s Department of Anesthesiology.
The study team attempted to identify common threads among patients who developed delirium by reviewing patient medical records and conducting telephone surveys following hospital discharge for a group of patients hospitalised in the intensive care unit between March and May 2020.
The disease itself can result in reduced oxygen supply to the brain, the formation of blood clots, and stroke, all of which can result in cognitive impairment. Additionally, delirium patients had significantly elevated levels of inflammatory markers. Confusion and agitation may be a result of brain inflammation.
To compound the problem, care teams were regularly unable to use standard delirium reduction techniques, such as exercises designed to get a patient moving or allowing visitors or objects from the patient’s home to orient patients while in the hospital.
Additionally, a correlation existed between sedative use and delirium—patients with delirium were sedated more oftenly and commonly at higher doses.
Additionally, the study discovered that cognitive impairment can persist after discharge. Almost a third of patients’ charts were not marked as resolved upon discharge, and 40percent of these patients required skilled nursing care. Almost a quarter of patients tested positive for delirium based on their caregiver’s assessment. These symptoms persisted for months in some patients. This can exacerbate the difficulty of managing the recovery process following hospitalization.
Vlisides accepts that care teams are doing the best they can with the resources available, particularly as hospitals continue to fill up with COVID patients.
And he encourages family members and other caregivers who are struggling to care for loved ones to seek immediate assistance from their primary care physician.
The take-home message is that cognitive impairment—including depression and delirium—is highly likely in patients hospitalized with severe COVID-19, he added.
“Overall, this study highlights another reason why getting vaccinated and preventing severe illness is so important. There can be long term neurological complications that perhaps we don’t talk about as much as we should.”
The results of the study were published in BMJ Open. DOI: 10.1136/bmjopen-2021-050045
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