La confusion comme signe de COVID-19 chez la personne âgée ? Repère bibliographique.

Repère bibliographique

Mots clés et recherche sur PubMed :

• Rebora P, Rozzini R, Bianchetti A, Blangiardo P, Marchegiani A, Piazzoli A, Mazzeo F, Cesaroni G, Chizzoli A, Guerini F, Bonfanti P, Morandi A, Faraci B, Gentile S, Bna C, Savelli G, Citerio G, Valsecchi MG, Mazzola P, Bellelli G, CoViD‐19 Lombardia Team. Delirium in Patients with SARS-CoV-2 Infection: A Multicenter Study. J Am Geriatr Soc. 2020 Nov 27:10.1111/jgs.16969. doi: 10.1111/jgs.16969.
  [PMID: 33411332] [PMCID: 7753490] [DOI: 10.1111/jgs.16969]
  OBJECTIVES: The aims of this study are to report the prevalence of delirium on admission to the unit in patients hospitalized with SARS-CoV-2 infection, to identify the factors associated with delirium, and to evaluate the association between delirium and in-hospital mortality. DESIGN: Multicenter observational cohort study. SETTINGS: Acute medical units in four Italian hospitals. PARTICIPANTS: A total of 516 patients (median age 78 years) admitted to the participating centers with SARS-CoV-2 infection from February 22 to May 17, 2020. MEASUREMENTS: Comprehensive medical assessment with detailed history, physical examinations, functional status, laboratory and imaging procedures. On admission, delirium was determined by the Diagnostic and Statistical Manual of Mental Disorders (5th edition) criteria, 4AT, m-Richmond Agitation Sedation Scale, or clinical impression depending on the site. The primary outcomes were delirium rates and in-hospital mortality. RESULTS: Overall, 73 (14.1%, 95% confidence interval (CI) = 11.0-17.3%) patients presented delirium on admission. Factors significantly associated with delirium were dementia (odds ratio, OR = 4.66, 95% CI = 2.03-10.69), the number of chronic diseases (OR = 1.20, 95% CI = 1.03; 1.40), and chest X-ray or CT opacity (OR = 3.29, 95% CI = 1.12-9.64 and 3.35, 95% CI = 1.07-10.47, for multiple or bilateral opacities and single opacity vs no opacity, respectively). There were 148 (33.4%) in-hospital deaths in the no-delirium group and 43 (58.9%) in the delirium group (P-value assessed using the Gray test <.001). As assessed by a multivariable Cox model, patients with delirium on admission showed an almost twofold increased hazard ratio for in-hospital mortality with respect to patients without delirium (hazard ratio = 1.88, 95% CI = 1.25-2.83). CONCLUSION: Delirium is prevalent and associated with in-hospital mortality among older patients hospitalized with SARS-CoV-2 infection.

  Traduction automatique en Français sur Google Translate

  Twitter cet article (lien vers l'article)
  Twitter cet article (lien vers ce site)
• Hawkins M, Sockalingam S, Bonato S, Rajaratnam T, Ravindran M, Gosse P, Sheehan KA. A rapid review of the pathoetiology, presentation, and management of delirium in adults with COVID-19. J Psychosom Res. 2020 Dec 25;141:110350. doi: 10.1016/j.jpsychores.2020.110350.
  [PMID: 33401078] [PMCID: 7762623] [DOI: 10.1016/j.jpsychores.2020.110350]
  Background COVID-19 causes significant morbidity and mortality. Despite the high prevalence of delirium and delirium-related symptoms in COVID-19 patients, data and evidence-based recommendations on the pathophysiology and management of delirium are limited. Objective We conducted a rapid review of COVID-19-related delirium literature to provide a synthesis of literature on the prevalence, pathoetiology, and management of delirium in these patients. Methods Systematic searches of Medline, Embase, PsycInfo, LitCovid, WHO-COVID-19, and Web of Science electronic databases were conducted. Grey literature was also reviewed, including preprint servers, archives, and websites of relevant organizations. Search results were limited to the English language. We included literature focused on adults with COVID-19 and delirium. Papers were excluded if they did not mention signs or symptoms of delirium. Results 229 studies described prevalence, pathoetiology, and/or management of delirium in adults with COVID-19. Delirium was rarely assessed with validated tools. Delirium affected >50% of all patients with COVID-19 admitted to the ICU. The etiology of COVID-19 delirium is likely multifactorial, with some evidence of direct brain effect. Prevention remains the cornerstone of management in these patients. To date, there is no evidence to suggest specific pharmacological strategies. Discussion Delirium is common in COVID-19 and may manifest from both indirect and direct effects on the central nervous system. Further research is required to investigate contributing mechanisms. As there is limited empirical literature on delirium management in COVID-19, management with non-pharmacological measures and judicious use of pharmacotherapy is suggested.

  Traduction automatique en Français sur Google Translate

  Twitter cet article (lien vers l'article)
  Twitter cet article (lien vers ce site)
• Ng Cheong Chung KJ. The frailty and mortality relationship in patients with COVID-19. Eur Geriatr Med. 2021 Jan 3:1-2. doi: 10.1007/s41999-020-00391-2.
  [PMID: 33393061] [PMCID: 7779082] [DOI: 10.1007/s41999-020-00391-2]
  

  Traduction automatique en Français sur Google Translate

  Twitter cet article (lien vers l'article)
  Twitter cet article (lien vers ce site)
• Rawle MJ, Bertfield DL, Brill SE. Atypical presentations of COVID-19 in care home residents presenting to secondary care: A UK single centre study. Aging Med (Milton). 2020 Sep 17;3(4):237-244. doi: 10.1002/agm2.12126. eCollection 2020 Dec.
  [PMID: 33392429] [PMCID: 7771562] [DOI: 10.1002/agm2.12126]
  BACKGROUND: Atypical presentations of COVID-19 pose difficulties for early isolation and treatment, particularly in institutional care settings. We aimed to characterize the presenting symptoms and associated mortality of COVID-19 in older adults, focusing on care home residents admitted to secondary care. METHODS: A retrospective cohort study of 134 consecutive inpatients over 80 years old hospitalized with PCR confirmed COVID-19 in the United Kingdom. Symptoms at presentation and frailty were analysed. Differences between community dwelling and care home residents, and associations with mortality, were assessed using between-group comparisons and logistic regression. RESULTS: Care home residents were less likely to experience cough (46.9% vs 72.9%, P = .002) but more likely to present with delirium (51.6% vs 31.4%, P = .018), particularly hypoactive delirium (40.6% vs 24.3%, P = .043). Mortality was more likely with increasing frailty (OR 1.25, 95% CI 1.00, 1.58, P = .049) and those presenting with anorexia (OR 3.20, 95% CI 1.21, 10.09, P = .028). There were no differences in mortality or length of stay based on residential status. CONCLUSION: COVID-19 in older adults often presents with atypical symptoms, particularly in those admitted from institutional care. These individuals have a reduced incidence of cough and increased hypoactive delirium. Individuals presenting atypically, especially with anorexia, have higher mortality.

  Traduction automatique en Français sur Google Translate

  Twitter cet article (lien vers l'article)
  Twitter cet article (lien vers ce site)
• Mattace-Raso F, Polinder-Bos H, Oosterwijk B, van Bruchem-Visser R, Goudzwaard J, Oudshoorn C, Ziere G, Egberts A. Delirium: A Frequent Manifestation in COVID-19 Older Patients. Clin Interv Aging. 2020 Dec 1;15:2245-2247. doi: 10.2147/CIA.S280189. eCollection 2020.
  [PMID: 33293801] [PMCID: 7718860] [DOI: 10.2147/CIA.S280189]
  The authors report a high prevalence of delirium in COVID-19 old patients admitted in an academic hospital. During the recent COVID-19 period, delirium was present in 38% of old patients admitted with delirium at the COVID ward of the Erasmus MC University Medical Center of Rotterdam. We do not know in which patients COVID-19 can cause delirium; however, considering the high prevalence of delirium in COVID-19 old patients and the potential serious consequences, attention is needed in order to reduce disability and mortality in this vulnerable category of patients.

  Traduction automatique en Français sur Google Translate

  Twitter cet article (lien vers l'article)
  Twitter cet article (lien vers ce site)
• Arnold C. Could COVID delirium bring on dementia?. Nature. 2020 Dec;588(7836):22-24. doi: 10.1038/d41586-020-03360-8.
  [PMID: 33268868] [DOI: 10.1038/d41586-020-03360-8]
  

  Traduction automatique en Français sur Google Translate

  Twitter cet article (lien vers l'article)
  Twitter cet article (lien vers ce site)
• Rozzini R, Bianchetti A, Mazzeo F, Cesaroni G, Bianchetti L, Trabucchi M. Delirium: Clinical Presentation and Outcomes in Older COVID-19 Patients. Front Psychiatry. 2020 Nov 12;11:586686. doi: 10.3389/fpsyt.2020.586686. eCollection 2020.
  [PMID: 33262713] [PMCID: 7688465] [DOI: 10.3389/fpsyt.2020.586686]
  The aim of the study is to describe the clinical characteristics and outcomes of a series of older patients consecutively admitted into a non-ICU ward due to SARS-CoV-2 infection (14, males 11), developing delirium. Hypokinetic delirium with lethargy and confusion was observed in 43% of cases (6/14 patients). A total of eight patients exhibited hyperkinetic delirium and 50% of these patients (4/8) died. The overall mortality rate was 71% (10/14 patients). Among the four survivors we observed two different clinical patterns: two patients exhibited dementia and no ARDS (acute respiratory distress syndrome), while the remaining two patients exhibited ARDS and no dementia. The observed different clinical patterns of delirium (hypokinetic delirium; hyperkinetic delirium with or without dementia; hyperkinetic delirium with or without ARDS) identified patients with different prognosis: we believe these observations may have an impact on the management of older subjects with delirium due to COVID-19.

  Traduction automatique en Français sur Google Translate

  Twitter cet article (lien vers l'article)
  Twitter cet article (lien vers ce site)
• Castagna A, Manzo C, Ruotolo G. Comprensive Geriatric Assessment in hospitalized older patients with COVID-19. Geriatr Gerontol Int. 2021 Jan;21(1):118-119. doi: 10.1111/ggi.14103. Epub 2020 Dec 1.
  [PMID: 33260256] [PMCID: 7753837] [DOI: 10.1111/ggi.14103]
  

  Traduction automatique en Français sur Google Translate

  Twitter cet article (lien vers l'article)
  Twitter cet article (lien vers ce site)
• Radhakrishnan NS, Mufti M, Ortiz D, Maye ST, Melara J, Lim D, Rosenberg EI, Price CC. Implementing Delirium Prevention in the Era of COVID-19. J Alzheimers Dis. 2021;79(1):31-36. doi: 10.3233/JAD-200696.
  [PMID: 33252073] [DOI: 10.3233/JAD-200696]
  Patients admitted with COVID-19 can develop delirium due to predisposing factors, isolation, and the illness itself. Standard delirium prevention methods focus on interaction and stimulation. It can be challenging to deliver these methods of care in COVID settings where it is necessary to increase patient isolation. This paper presents a typical clinical vignette of representative patients in a tertiary care hospital and how a medical team modified an evidence-based delirium prevention model to deliver high-quality care to COVID-19 patients. The implemented model focuses on four areas of delirium-prevention: Mobility, Sleep, Cognitive Stimulation, and Nutrition. Future studies will be needed to track quantitative outcome measures.

  Traduction automatique en Français sur Google Translate

  Twitter cet article (lien vers l'article)
  Twitter cet article (lien vers ce site)
• LaHue SC, Douglas VC, Miller BL. The One-Two Punch of Delirium and Dementia During the COVID-19 Pandemic and Beyond. Front Neurol. 2020 Nov 5;11:596218. doi: 10.3389/fneur.2020.596218. eCollection 2020.
  [PMID: 33224102] [PMCID: 7674550] [DOI: 10.3389/fneur.2020.596218]
  

  Traduction automatique en Français sur Google Translate

  Twitter cet article (lien vers l'article)
  Twitter cet article (lien vers ce site)
• Kennedy M, Helfand BKI, Gou RY, Gartaganis SL, Webb M, Moccia JM, Bruursema SN, Dokic B, McCulloch B, Ring H, Margolin JD, Zhang E, Anderson R, Babine RL, Hshieh T, Wong AH, Taylor RA, Davenport K, Teresi B, Fong TG, Inouye SK. Delirium in Older Patients With COVID-19 Presenting to the Emergency Department. JAMA Netw Open. 2020 Nov 2;3(11):e2029540. doi: 10.1001/jamanetworkopen.2020.29540.
  [PMID: 33211114] [PMCID: 7677760] [DOI: 10.1001/jamanetworkopen.2020.29540]
  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. DESIGN, SETTING, AND PARTICIPANTS: This multicenter cohort study was conducted at 7 sites in the US. Participants included consecutive older adults with COVID-19 presenting to the ED on or after March 13, 2020. EXPOSURE: COVID-19 was diagnosed by positive nasal swab for severe acute respiratory syndrome coronavirus 2 (99% of cases) or classic radiological findings (1% of cases). MAIN OUTCOMES AND MEASURES: The primary outcome was delirium as identified from the medical record according to a validated record review approach. RESULTS: A total of 817 older patients with COVID-19 were included, of whom 386 (47%) were male, 493 (62%) were White, 215 (27%) were Black, and 54 (7%) were Hispanic or Latinx. The mean (SD) age of patients was 77.7 (8.2) years. Of included patients, 226 (28%) had delirium at presentation, and delirium was the sixth most common of all presenting symptoms and signs. Among the patients with delirium, 37 (16%) had delirium as a primary symptom and 84 (37%) had no typical COVID-19 symptoms or signs, such as fever or shortness of breath. Factors associated with delirium were age older than 75 years (adjusted relative risk [aRR], 1.51; 95% CI, 1.17-1.95), living in a nursing home or assisted living (aRR, 1.23; 95% CI, 0.98-1.55), prior use of psychoactive medication (aRR, 1.42; 95% CI, 1.11-1.81), vision impairment (aRR, 1.98; 95% CI, 1.54-2.54), hearing impairment (aRR, 1.10; 95% CI 0.78-1.55), stroke (aRR, 1.47; 95% CI, 1.15-1.88), and Parkinson disease (aRR, 1.88; 95% CI, 1.30-2.58). Delirium was associated with intensive care unit stay (aRR, 1.67; 95% CI, 1.30-2.15) and death (aRR, 1.24; 95% CI, 1.00-1.55). CONCLUSIONS AND RELEVANCE: In this cohort study of 817 older adults with COVID-19 presenting to US emergency departments, delirium was common and often was seen without other typical symptoms or signs. In addition, delirium was associated with poor hospital outcomes and death. These findings suggest the clinical importance of including delirium on checklists of presenting signs and symptoms of COVID-19 that guide screening, testing, and evaluation.

  Traduction automatique en Français sur Google Translate

  Twitter cet article (lien vers l'article)
  Twitter cet article (lien vers ce site)
• Duggan MC, Van J, Ely EW. Delirium Assessment in Critically Ill Older Adults: Considerations During the COVID-19 Pandemic. Crit Care Clin. 2021 Jan;37(1):175-190. doi: 10.1016/j.ccc.2020.08.009. Epub 2020 Aug 14.
  [PMID: 33190768] [PMCID: 7427547] [DOI: 10.1016/j.ccc.2020.08.009]
  Older adults are particularly vulnerable during the Coronavirus disease 2019 (COVID-19) pandemic, because higher age increases risk for both delirium and COVID-19-related death. Despite the health care system limitations and the clinical challenges of the pandemic, delirium screening and management remains an evidence-based cornerstone of critical care. This article discusses practical recommendations for delirium screening in the COVID-19 pandemic era, tips for training health care workers in delirium screening, validated tools for detecting delirium in critically ill older adults, and approaches to special populations of older adults (eg, sensory impairment, dementia, acute neurologic injury).

  Traduction automatique en Français sur Google Translate

  Twitter cet article (lien vers l'article)
  Twitter cet article (lien vers ce site)
• Baker HA, Safavynia SA, Evered LA. The 'third wave': impending cognitive and functional decline in COVID-19 survivors. Br J Anaesth. 2020 Oct 21:S0007-0912(20)30849-7. doi: 10.1016/j.bja.2020.09.045.
  [PMID: 33187638] [PMCID: 7577658] [DOI: 10.1016/j.bja.2020.09.045]
  

  Traduction automatique en Français sur Google Translate

  Twitter cet article (lien vers l'article)
  Twitter cet article (lien vers ce site)
• Shi J, Gao Y, Zhao L, Li Y, Yan M, Niu MM, Chen Y, Song Z, Zhang R, Zhang L, Tian J. Prevalence of delirium, depression, anxiety, and post-traumatic stress disorder among COVID-19 patients: protocol for a living systematic review. Syst Rev. 2020 Nov 6;9(1):258. doi: 10.1186/s13643-020-01507-2.
  [PMID: 33158456] [PMCID: 7646715] [DOI: 10.1186/s13643-020-01507-2]
  BACKGROUND: Previous studies on the impact of corona virus disease 2019 (COVID-19) on the mental health of the patients has been limited by the lack of relevant data. With the rapid and sustained growth of the publications on COVID-19 research, we will perform a living systematic review (LSR) to provide comprehensive and continuously updated data to explore the prevalence of delirium, depression, anxiety, and post-traumatic stress disorder (PTSD) among COVID-19 patients. METHODS: We will perform a comprehensive search of the following databases: Cochrane Library, PubMed, Web of Science, EMBASE, and Chinese Biomedicine Literature to identify relevant studies. We will include peer-reviewed cross-sectional studies published in English and Chinese. Two reviewers will independently assess the methodological quality of included studies using the Joanna Briggs Institute Prevalence Critical Appraisal tool and perform data extraction. In the absence of clinical heterogeneity, the prevalence estimates with a 95% confidence interval (CI) of delirium, depression, anxiety, and post-traumatic stress disorder (PTSD) will be calculated by using random-effects model to minimize the effect of between-study heterogeneity separately. The literature searches will be updated every 3 months. We will perform meta-analysis if any new eligible studies or data are obtained. We will resubmit an updated review when there were relevant changes in the results, i.e., when outcomes became statistically significant (or not statistically significant anymore) or when heterogeneity became substantial (or not substantial anymore). DISCUSSION: This LSR will provide an in-depth and up-to-date summary of whether the common neuropsychiatric conditions observed in patients hospitalized for severe acute respiratory syndrome (SARS-CoV) and Middle East respiratory syndrome (MERS) are also prevalent in a different stage of COVID-19 patients. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020196610.

  Traduction automatique en Français sur Google Translate

  Twitter cet article (lien vers l'article)
  Twitter cet article (lien vers ce site)
• Helfand BKI, D'Aquila ML, Tabloski P, Erickson K, Yue J, Fong TG, Hshieh TT, Metzger ED, Schmitt EM, Boudreaux ED, Inouye SK, Jones RN. Detecting Delirium: A Systematic Review of Identification Instruments for Non-ICU Settings. J Am Geriatr Soc. 2020 Nov 2. doi: 10.1111/jgs.16879.
  [PMID: 33135780] [DOI: 10.1111/jgs.16879]
  BACKGROUND/OBJECTIVES: Delirium manifests clinically in varying ways across settings. More than 40 instruments currently exist for characterizing the different manifestations of delirium. We evaluated all delirium identification instruments according to their psychometric properties and frequency of citation in published research. DESIGN: We conducted the systematic review by searching Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Excerpta Medica Database (Embase), PsycINFO, PubMed, and Web of Science from January 1, 1974, to January 31, 2020, with the keywords "delirium" and "instruments," along with their known synonyms. We selected only systematic reviews, meta-analyses, or narrative literature reviews including multiple delirium identification instruments. MEASUREMENTS: Two reviewers assessed the eligibility of articles and extracted data on all potential delirium identification instruments. Using the original publication on each instrument, the psychometric properties were examined using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) framework. RESULTS: Of 2,542 articles identified, 75 met eligibility criteria, yielding 30 different delirium identification instruments. A count of citations was determined using Scopus for the original publication for each instrument. Each instrument underwent methodological quality review of psychometric properties using COSMIN definitions. An expert panel categorized key domains for delirium identification based on criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM)-III through DSM-5. Four instruments were notable for having at least two of three of the following: citation count of 200 or more, strong validation methodology in their original publication, and fulfillment of DSM-5 criteria. These were, alphabetically, Confusion Assessment Method, Delirium Observation Screening Scale, Delirium Rating Scale-Revised-98, and Memorial Delirium Assessment Scale. CONCLUSION: Four commonly used and well-validated instruments can be recommended for clinical and research use. An important area for future investigation is to harmonize these measures to compare and combine studies on delirium.

  Traduction automatique en Français sur Google Translate

  Twitter cet article (lien vers l'article)
  Twitter cet article (lien vers ce site)
• Vrillon A, Hourregue C, Azuar J, Grosset L, Boutelier A, Tan S, Roger M, Mourman V, Mouly S, Sène D, François V, Dumurgier J, Paquet C, for LRB COVID Group. COVID-19 in Older Adults: A Series of 76 Patients Aged 85 Years and Older with COVID-19. J Am Geriatr Soc. 2020 Dec;68(12):2735-2743. doi: 10.1111/jgs.16894. Epub 2020 Oct 28.
  [PMID: 33045106] [PMCID: 7675559] [DOI: 10.1111/jgs.16894]
  BACKGROUND: Clinical presentation and risk factors of death in COVID-19 in oldest adults have not been well characterized. OBJECTIVES: To describe clinical features and outcome of COVID-19 in patients older than 85 years and study risk factors for mortality. DESIGN: Prospective cohort. PARTICIPANTS AND SETTING: Patients aged 85 years and older, admitted in noncritical care units at the University Hospital Lariboisière Fernand-Widal (Paris, France) for confirmed severe acute respiratory syndrome coronavirus 2 infection were included and followed up for 21 days. MEASUREMENTS: Clinical and laboratory findings were collected. Cox survival analysis was performed to explore factors associated with death. RESULTS: From March 14 to April 11, 2020, 76 patients (median age = 90 (86-92) years; women = 55.3%) were admitted for confirmed COVID-19. Of the patients, 64.5% presented with three or more comorbidities. Most common symptoms were asthenia (76.3%), fever (75.0%) and confusion and delirium (71.1%). An initial fall was reported in 25.0% of cases, and digestive symptoms were reported in 22.4% of cases. COVID-19 was severe in 51.3% of cases, moderate in 32.9%, and mild in 15.8%. Complications included acute respiratory syndrome (28.9%), cardiac decompensation (14.5%), and hypotensive shock (9.0%). Fatality at 21 days was 28.9%, after a median course of disease of 13 (8-17) days. Males were overrepresented in nonsurvivors (68.2%). In survivors, median length of stay was 12 (9-19.5) days. Independent predictive factors of death were C-reactive protein level at admission and lymphocyte count at nadir. CONCLUSION: Specific clinical features, multiorgan injury, and high case fatality rate are observed in older adults with COVID-19. However, rapid diagnosis, appropriate care, and monitoring seem to improve prognosis.

  Traduction automatique en Français sur Google Translate

  Twitter cet article (lien vers l'article)
  Twitter cet article (lien vers ce site)
• Steinmeyer Z, Vienne-Noyes S, Bernard M, Steinmeyer A, Balardy L, Piau A, Sourdet S. Acute Care of Older Patients with COVID-19: Clinical Characteristics and Outcomes. Geriatrics (Basel). 2020 Sep 27;5(4):65. doi: 10.3390/geriatrics5040065.
  [PMID: 32992602] [PMCID: 7709587] [DOI: 10.3390/geriatrics5040065]
  (1) Background: COVID-19 has become a global pandemic and older patients present higher mortality rates. However, studies on the characteristics of this population set are limited. The objective of this study is to describe clinical characteristics and outcomes of older patients hospitalized with COVID-19. (2) Methods: This retrospective cohort study was conducted from March to May 2020 and took place in three acute geriatric wards in France. Older patients hospitalized for COVID-19 infections were included. We collected clinical, radiological, and laboratory outcomes. (3) Results: Ninety-four patients were hospitalized and included in the final analysis. Mean age was 85.5 years and 55% were female. Sixty-four (68%) patients were confirmed COVID-19 cases and 30 (32%) were probable. A majority of patients were dependent (77%), 45% were malnourished, and the mean number of comorbidities was high in accordance with the CIRS-G score (12.3 ± 25.6). The leading causes of hospitalization were fever (30%), dyspnea (28%), and geriatric syndromes (falls, delirium, malaise) (18%). Upon follow-up, 32% presented acute respiratory failure and 30% a geriatric complication. Frailty and geriatric characteristics were not correlated with mortality. Acute respiratory failure (p = 0.03) and lymphopenia (p = 0.02) were significantly associated with mortality. (4) Conclusions: Among older patients hospitalized with COVID-19, clinical presentations were frequently atypical and complications occurred frequently. Frailty and geriatric characteristics were not correlated with mortality.

  Traduction automatique en Français sur Google Translate

  Twitter cet article (lien vers l'article)
  Twitter cet article (lien vers ce site)
• Zazzara MB, Penfold RS, Roberts AL, Lee KA, Dooley H, Sudre CH, Welch C, Bowyer RCE, Visconti A, Mangino M, Freidin MB, El-Sayed Moustafa JS, Small KS, Murray B, Modat M, Graham MS, Wolf J, Ourselin S, Martin FC, Steves CJ, Lochlainn MN. Probable delirium is a presenting symptom of COVID-19 in frail, older adults: a cohort study of 322 hospitalised and 535 community-based older adults. Age Ageing. 2021 Jan 8;50(1):40-48. doi: 10.1093/ageing/afaa223.
  [PMID: 32986799] [PMCID: 7543251] [DOI: 10.1093/ageing/afaa223]
  BACKGROUND: Frailty, increased vulnerability to physiological stressors, is associated with adverse outcomes. COVID-19 exhibits a more severe disease course in older, comorbid adults. Awareness of atypical presentations is critical to facilitate early identification. OBJECTIVE: To assess how frailty affects presenting COVID-19 symptoms in older adults. DESIGN: Observational cohort study of hospitalised older patients and self-report data for community-based older adults. SETTING: Admissions to St Thomas' Hospital, London with laboratory-confirmed COVID-19. Community-based data for older adults using the COVID Symptom Study mobile application. SUBJECTS: Hospital cohort: patients aged 65 and over (n = 322); unscheduled hospital admission between 1 March 2020 and 5 May 2020; COVID-19 confirmed by RT-PCR of nasopharyngeal swab. Community-based cohort: participants aged 65 and over enrolled in the COVID Symptom Study (n = 535); reported test-positive for COVID-19 from 24 March (application launch) to 8 May 2020. METHODS: Multivariable logistic regression analysis performed on age-matched samples from hospital and community-based cohorts to ascertain association of frailty with symptoms of confirmed COVID-19. RESULTS: Hospital cohort: significantly higher prevalence of probable delirium in the frail sample, with no difference in fever or cough. Community-based cohort: significantly higher prevalence of possible delirium in frailer, older adults and fatigue and shortness of breath. CONCLUSIONS: This is the first study demonstrating higher prevalence of probable delirium as a COVID-19 symptom in older adults with frailty compared to other older adults. This emphasises need for systematic frailty assessment and screening for delirium in acutely ill older patients in hospital and community settings. Clinicians should suspect COVID-19 in frail adults with delirium.

  Traduction automatique en Français sur Google Translate

  Twitter cet article (lien vers l'article)
  Twitter cet article (lien vers ce site)
• Ticinesi A, Cerundolo N, Parise A, Nouvenne A, Prati B, Guerra A, Lauretani F, Maggio M, Meschi T. Delirium in COVID-19: epidemiology and clinical correlations in a large group of patients admitted to an academic hospital. Aging Clin Exp Res. 2020 Oct;32(10):2159-2166. doi: 10.1007/s40520-020-01699-6. Epub 2020 Sep 18.
  [PMID: 32946031] [PMCID: 7498987] [DOI: 10.1007/s40520-020-01699-6]
  BACKGROUND: Delirium incidence and clinical correlates in coronavirus disease-19 (COVID-19) pneumonia are still poorly investigated. AIM: To describe the epidemiology of delirium in patients hospitalized for suspect COVID-19 pneumonia during the pandemic peak in an academic hospital of Northern Italy, identify its clinical correlations and evaluate the association with mortality. METHODS: The clinical records of 852 patients admitted for suspect COVID-19 pneumonia, defined as respiratory symptoms or fever or certain history of contact with COVID-19 patients, plus chest CT imaging compatible with alveolar-interstitial pneumonia, were retrospectively analyzed. Delirium was defined after careful revision of daily clinical reports in accordance with the Confusion Assessment Method criteria. Data on age, clinical presentation, comorbidities, drugs, baseline lab tests and outcome were collected. The factors associated with delirium, and the association of delirium with mortality, were evaluated through binary logistic regression models. RESULTS: Ninety-four patients (11%) developed delirium during stay. They were older (median age 82, interquartile range, IQR 78-89, vs 75, IQR 63-84, p < 0.001), had more neuropsychiatric comorbidities and worse respiratory exchanges at baseline. At multivariate models, delirium was independently and positively associated with age [odds ratio (OR) 1.093, 95% confidence interval (CI) 1.046-1.143, p < 0.001], use of antipsychotic drugs (OR 4.529, 95% CI 1.204-17.027, p = 0.025), serum urea and lactate-dehydrogenase at admission. Despite a higher mortality in patients with delirium (57% vs 30%), this association was not independent of age and respiratory parameters. CONCLUSIONS: Delirium represents a common complication of COVID-19 and a marker of severe disease course, especially in older patients with neuropsychiatric comorbidity.

  Traduction automatique en Français sur Google Translate

  Twitter cet article (lien vers l'article)
  Twitter cet article (lien vers ce site)
• Emmerton D, Abdelhafiz A. Delirium in Older People with COVID-19: Clinical Scenario and Literature Review. SN Compr Clin Med. 2020 Aug 29:1-8. doi: 10.1007/s42399-020-00474-y.
  [PMID: 32904497] [PMCID: 7455775] [DOI: 10.1007/s42399-020-00474-y]
  Delirium is a potentially fatal acute brain dysfunction that is characterised by inattention and fluctuating mental changes. It is indicative of an acute serious organ failure or acute infection. Delirium is also associated with undesirable health outcomes that include prolonged hospital stay, long-term cognitive decline and increased mortality. The new SARS-CoV-2 shows, not only pulmonary tropism but also, neurotropism which results in delirium in the acute phase illness particularly in the older age groups. The current assessment for COVID-19 in older people does not routinely include screening for delirium. Implementation of a rapid delirium screening tool is necessary because, without screening, up to 75% of cases can be missed. Delirium can also be exaggerated by health care policies that recommend social isolation and wearing personal protective equipment in addition to less interaction with patients. Non-pharmacological intervention for delirium prevention and management may be helpful if implemented as early and as often as possible in hospitalised older people with COVID-19. A holistic approach that includes psychological support in addition to medical care is needed for older people admitted to hospital with COVID-19.

  Traduction automatique en Français sur Google Translate

  Twitter cet article (lien vers l'article)
  Twitter cet article (lien vers ce site)
• Darvall JN, Bellomo R, Bailey M, Paul E, Young PJ, Rockwood K, Pilcher D. Frailty and outcomes from pneumonia in critical illness: a population-based cohort study. Br J Anaesth. 2020 Nov;125(5):730-738. doi: 10.1016/j.bja.2020.07.049. Epub 2020 Sep 3.
  [PMID: 32891413] [PMCID: 7467940] [DOI: 10.1016/j.bja.2020.07.049]
  BACKGROUND: A threshold Clinical Frailty Scale (CFS) of 5 (indicating mild frailty) has been proposed to guide ICU admission for UK patients with coronavirus disease 2019 (COVID-19) pneumonia. However, the impact of frailty on mortality with (non-COVID-19) pneumonia in critical illness is unknown. We examined the triage utility of the CFS in patients with pneumonia requiring ICU. METHODS: We conducted a retrospective cohort study of adult patients admitted with pneumonia to 170 ICUs in Australia and New Zealand from January 1, 2018 to September 31, 2019. We classified patients as: non-frail (CFS 1-4) frail (CFS 5-8), mild/moderately frail (CFS 5-6),and severe/very severely frail (CFS 7-8). We evaluated mortality (primary outcome) adjusting for site, age, sex, mechanical ventilation, pneumonia type and illness severity. We also compared the proportion of ICU bed-days occupied between frailty categories. RESULTS: 1852/5607 (33%) patients were classified as frail, including1291/3056 (42%) of patients aged >65 yr, who would potentially be excluded from ICU admission under UK-based COVID-19 triage guidelines. Only severe/very severe frailty scores were associated with mortality (adjusted odds ratio [aOR] for CFS=7: 3.2; 95% confidence interval [CI]: 1.3-7.8; CFS=8 [aOR: 7.2; 95% CI: 2.6-20.0]). These patients accounted for 7% of ICU bed days. Vulnerability (CFS=4) and mild frailty (CFS=5) were associated with a similar mortality risk (CFS=4 [OR: 1.6; 95% CI: 0.7-3.8]; CFS=5 [OR: 1.6; 95% CI: 0.7-3.9]). CONCLUSIONS: Patients with severe and very severe frailty account for relatively few ICU bed days as a result of pneumonia, whilst adjusted mortality analysis indicated little difference in risk between patients in vulnerable, mild, and moderate frailty categories. These data do not support CFS ≥5 to guide ICU admission for pneumonia.

  Traduction automatique en Français sur Google Translate

  Twitter cet article (lien vers l'article)
  Twitter cet article (lien vers ce site)
• Wang H. Delirium: A suggestive sign of COVID-19 in dementia. EClinicalMedicine. 2020 Sep;26:100524. doi: 10.1016/j.eclinm.2020.100524. Epub 2020 Aug 24.
  [PMID: 32864594] [PMCID: 7444936] [DOI: 10.1016/j.eclinm.2020.100524]
  

  Traduction automatique en Français sur Google Translate

  Twitter cet article (lien vers l'article)
  Twitter cet article (lien vers ce site)
• Poloni TE, Carlos AF, Cairati M, Cutaia C, Medici V, Marelli E, Ferrari D, Galli A, Bognetti P, Davin A, Cirrincione A, Ceretti A, Cereda C, Ceroni M, Tronconi L, Vitali S, Guaita A. Prevalence and prognostic value of Delirium as the initial presentation of COVID-19 in the elderly with dementia: An Italian retrospective study. EClinicalMedicine. 2020 Sep;26:100490. doi: 10.1016/j.eclinm.2020.100490. Epub 2020 Jul 30.
  [PMID: 32838241] [PMCID: 7392565] [DOI: 10.1016/j.eclinm.2020.100490]
  BACKGROUND: Delirium may be one of the presenting symptoms of COVID-19, complicating diagnosis and care of elderly patients with dementia. We aim to identify the prevalence and prognostic significance of delirium as the sole onset manifestation of COVID-19. METHODS: This is a retrospective single-centre study based on review of medical charts, conducted during the outbreak peak (March 27-April 18, 2020) in a Lombard dementia facility, including 59 elderly subjects with dementia and laboratory-confirmed COVID-19. FINDINGS: Of the 59 residents, 57 (96⋅6%) tested positive (mean age: 82⋅8; women: 66⋅7%). Comorbidities were present in all participants, with 18/57 (31⋅6%) having three or more concomitant diseases. Delirium-Onset COVID-19 (DOC) was observed in 21/57 (36⋅8%) subjects who were chiefly older (mean age: 85⋅4 y/o) and with multiple comorbidities. Eleven/21 DOC patients (52⋅4%) had hypoactive delirium, while hyperactive delirium occurred in ten/21 (47⋅6%). Lymphopenia was present in almost all subjects (median: 1⋅3 × 10(9)/L). Overall mortality rate was 24⋅6% (14/57) and dementia severity per se had no impact on short-term mortality due to COVID-19. DOC was strongly associated with higher mortality (p<0⋅001). Also, DOC and male gender were independently associated with increased risk of mortality (OR: 17⋅0, 95% CI: 2⋅8-102⋅7, p = 0⋅002 and 13⋅6, 95% CI: 2⋅3-79⋅2, p = 0⋅001 respectively). INTERPRETATION: Delirium occurrence in the elderly with dementia may represent a prodromal phase of COVID-19, and thus deserves special attention, especially in the presence of lymphopenia. Hypoxia and a severe inflammatory state may develop subsequently. DOC cases have higher short-term mortality rate. FUNDING: None.

  Traduction automatique en Français sur Google Translate

  Twitter cet article (lien vers l'article)
  Twitter cet article (lien vers ce site)
• Marengoni A, Zucchelli A, Grande G, Fratiglioni L, Rizzuto D. The impact of delirium on outcomes for older adults hospitalised with COVID-19. Age Ageing. 2020 Oct 23;49(6):923-926. doi: 10.1093/ageing/afaa189.
  [PMID: 32821901] [PMCID: 7499475] [DOI: 10.1093/ageing/afaa189]
  INTRODUCTION: Delirium is a frequent condition in hospitalized older patients and it usually has a negative prognostic value. A direct effect of SARS-COV-2 on the central nervous system (CNS) has been hypothesized. OBJECTIVE: To evaluate the presence of delirium in older patients admitted for a suspected diagnosis of COVID-19 and its impact on in-hospital mortality. SETTING AND SUBJECTS: 91 patients, aged 70-years and older, admitted to an acute geriatric ward in Northern Italy from March 8th to April 17th, 2020. METHODS: COVID-19 cases were confirmed by reverse transcriptase-polymerase chain reaction assay for SARS-Cov-2 RNA from nasal and pharyngeal swabs. Delirium was diagnosed by two geriatricians according to the Diagnostic and Statistical Manual of Mental Disorders V (DMS V) criteria. The number of chronic diseases was calculated among a pre-defined list of 60. The pre-disease Clinical Frailty Scale (CFS) was assessed at hospital admission. RESULTS: Of the total sample, 39 patients died, 49 were discharged and 3 were transferred to ICU. Twenty-five patients (27.5%) had delirium. Seventy-two percent of patients with delirium died during hospitalization compared to 31.8% of those without delirium. In a multivariate logistic regression model adjusted for potential confounders, patients with delirium were four times more likely to die during hospital stay compared to those without delirium (OR = 3.98;95%CI = 1.05-17.28; p = 0.047). CONCLUSIONS: Delirium is common in older patients with COVID-19 and strongly associated with in-hospital mortality. Regardless of causation, either due to a direct effect of SARS-COV-2 on the CNS or to a multifactorial cause, delirium should be interpreted as an alarming prognostic indicator in older people.

  Traduction automatique en Français sur Google Translate

  Twitter cet article (lien vers l'article)
  Twitter cet article (lien vers ce site)
• Aw D, Woodrow L, Ogliari G, Harwood R. Association of frailty with mortality in older inpatients with Covid-19: a cohort study. Age Ageing. 2020 Oct 23;49(6):915-922. doi: 10.1093/ageing/afaa184.
  [PMID: 32778870] [PMCID: 7454254] [DOI: 10.1093/ageing/afaa184]
  BACKGROUND: COVID-19 has disproportionately affected older people. OBJECTIVE: The objective of this paper to investigate whether frailty is associated with all-cause mortality in older hospital inpatients, with COVID-19. DESIGN: Cohort study. SETTING: Secondary care acute hospital. PARTICIPANTS: Participants included are 677 consecutive inpatients aged 65 years and over. METHODS: Cox proportional hazards models were used to examine the association of frailty with mortality. Frailty was assessed at baseline, according to the Clinical Frailty Scale (CFS), where higher categories indicate worse frailty. Analyses were adjusted for age, sex, deprivation, ethnicity, previous admissions and acute illness severity. RESULTS: Six hundred and sixty-four patients were classified according to CFS. Two hundred and seventy-one died, during a mean follow-up of 34.3 days. Worse frailty at baseline was associated with increased mortality risk, even after full adjustment (P = 0.004). Patients with CFS 4 and CFS 5 had non-significant increased mortality risks, compared to those with CFS 1-3. Patients with CFS 6 had a 2.13-fold (95% CI 1.34-3.38) and those with CFS 7-9 had a 1.79-fold (95% CI 1.12-2.88) increased mortality risk, compared to those with CFS 1-3 (P = 0.001 and 0.016, respectively). Older age, male sex and acute illness severity were also associated with increased mortality risk. CONCLUSIONS: Frailty is associated with all-cause mortality risk in older inpatients with COVID-19.

  Traduction automatique en Français sur Google Translate

  Twitter cet article (lien vers l'article)
  Twitter cet article (lien vers ce site)
• Helms J, Kremer S, Merdji H, Schenck M, Severac F, Clere-Jehl R, Studer A, Radosavljevic M, Kummerlen C, Monnier A, Boulay C, Fafi-Kremer S, Castelain V, Ohana M, Anheim M, Schneider F, Meziani F. Delirium and encephalopathy in severe COVID-19: a cohort analysis of ICU patients. Crit Care. 2020 Aug 8;24(1):491. doi: 10.1186/s13054-020-03200-1.
  [PMID: 32771053] [PMCID: 7414289] [DOI: 10.1186/s13054-020-03200-1]
  BACKGROUND: Neurotropism of SARS-CoV-2 and its neurological manifestations have now been confirmed. We aimed at describing delirium and neurological symptoms of COVID-19 in ICU patients. METHODS: We conducted a bicentric cohort study in two French ICUs of Strasbourg University Hospital. All the 150 patients referred for acute respiratory distress syndrome due to SARS-CoV-2 between March 3 and May 5, 2020, were included at their admission. Ten patients (6.7%) were excluded because they remained under neuromuscular blockers during their entire ICU stay. Neurological examination, including CAM-ICU, and cerebrospinal fluid analysis, electroencephalography, and magnetic resonance imaging (MRI) were performed in some of the patients with delirium and/or abnormal neurological examination. The primary endpoint was to describe the incidence of delirium and/or abnormal neurological examination. The secondary endpoints were to describe the characteristics of delirium, to compare the duration of invasive mechanical ventilation and ICU length of stay in patients with and without delirium and/or abnormal neurological symptoms. RESULTS: The 140 patients were aged in median of 62 [IQR 52; 70] years old, with a median SAPSII of 49 [IQR 37; 64] points. Neurological examination was normal in 22 patients (15.7%). One hundred eighteen patients (84.3%) developed a delirium with a combination of acute attention, awareness, and cognition disturbances. Eighty-eight patients (69.3%) presented an unexpected state of agitation despite high infusion rates of sedative treatments and neuroleptics, and 89 (63.6%) patients had corticospinal tract signs. Brain MRI performed in 28 patients demonstrated enhancement of subarachnoid spaces in 17/28 patients (60.7%), intraparenchymal, predominantly white matter abnormalities in 8 patients, and perfusion abnormalities in 17/26 patients (65.4%). The 42 electroencephalograms mostly revealed unspecific abnormalities or diffuse, especially bifrontal, slow activity. Cerebrospinal fluid examination revealed inflammatory disturbances in 18/28 patients, including oligoclonal bands with mirror pattern and elevated IL-6. The CSF RT-PCR SARS-CoV-2 was positive in one patient. The delirium/neurological symptoms in COVID-19 patients were responsible for longer mechanical ventilation compared to the patients without delirium/neurological symptoms. Delirium/neurological symptoms could be secondary to systemic inflammatory reaction to SARS-CoV-2. CONCLUSIONS AND RELEVANCE: Delirium/neurological symptoms in COVID-19 patients are a major issue in ICUs, especially in the context of insufficient human and material resources. TRIAL REGISTRATION: NA.

  Traduction automatique en Français sur Google Translate

  Twitter cet article (lien vers l'article)
  Twitter cet article (lien vers ce site)
• Knopp P, Miles A, Webb TE, Mcloughlin BC, Mannan I, Raja N, Wan B, Davis D. Presenting features of COVID-19 in older people: relationships with frailty, inflammation and mortality. Eur Geriatr Med. 2020 Dec;11(6):1089-1094. doi: 10.1007/s41999-020-00373-4. Epub 2020 Jul 30.
  [PMID: 32734464] [PMCID: 7391232] [DOI: 10.1007/s41999-020-00373-4]
  PURPOSE: To describe the clinical features of COVID-19 in older adults, and relate these to outcomes. METHODS: A cohort study of 217 individuals (median age 80, IQR 74-85 years; 62% men) hospitalised with COVID-19, followed up for all-cause mortality, was conducted. Secondary outcomes included cognitive and physical function at discharge. C-reactive protein and neutrophil:lymphocyte ratio were used as measures of immune activity. RESULTS: Cardinal COVID-19 symptoms (fever, dyspnoea, cough) were common but not universal. Inflammation on hospitalisation was lower in frail older adults. Fever, dyspnoea, delirium and inflammation were associated with mortality. Delirium at presentation was an independent risk factor for cognitive decline at discharge. CONCLUSIONS: COVID-19 may present without cardinal symptoms as well as implicate a possible role for age-related changes in immunity in mediating the relationship between frailty and mortality.

  Traduction automatique en Français sur Google Translate

  Twitter cet article (lien vers l'article)
  Twitter cet article (lien vers ce site)
• Miles A, Webb TE, Mcloughlin BC, Mannan I, Rather A, Knopp P, Davis D. Outcomes from COVID-19 across the range of frailty: excess mortality in fitter older people. Eur Geriatr Med. 2020 Oct;11(5):851-855. doi: 10.1007/s41999-020-00354-7. Epub 2020 Jul 18.
  [PMID: 32683576] [PMCID: 7368630] [DOI: 10.1007/s41999-020-00354-7]
  PURPOSE: Our aim was to quantify the mortality from COVID-19 and identify any interactions with frailty and other demographic factors. METHODS: Hospitalised patients aged ≥ 70 were included, comparing COVID-19 cases with non-COVID-19 controls admitted over the same period. Frailty was prospectively measured and mortality ascertained through linkage with national and local statutory reports. RESULTS: In 217 COVID-19 cases and 160 controls, older age and South Asian ethnicity, though not socioeconomic position, were associated with higher mortality. For frailty, differences in effect size were evident between cases (HR 1.02, 95% CI 0.93-1.12) and controls (HR 1.99, 95% CI 1.46-2.72), with an interaction term (HR 0.51, 95% CI 0.37-0.71) in multivariable models. CONCLUSIONS: Our findings suggest that (1) frailty is not a good discriminator of prognosis in COVID-19 and (2) pathways to mortality may differ in fitter compared with frailer older patients.

  Traduction automatique en Français sur Google Translate

  Twitter cet article (lien vers l'article)
  Twitter cet article (lien vers ce site)
• De Smet R, Mellaerts B, Vandewinckele H, Lybeert P, Frans E, Ombelet S, Lemahieu W, Symons R, Ho E, Frans J, Smismans A, Laurent MR. Frailty and Mortality in Hospitalized Older Adults With COVID-19: Retrospective Observational Study. J Am Med Dir Assoc. 2020 Jul;21(7):928-932.e1. doi: 10.1016/j.jamda.2020.06.008. Epub 2020 Jun 9.
  [PMID: 32674821] [PMCID: 7280137] [DOI: 10.1016/j.jamda.2020.06.008]
  OBJECTIVES: To determine the association between frailty and short-term mortality in older adults hospitalized for coronavirus disease 2019 (COVID-19). DESIGN: Retrospective single-center observational study. SETTING AND PARTICIPANTS: Eighty-one patients with COVID-19 confirmed by reverse-transcriptase polymerase chain reaction (RT-PCR), at the Geriatrics department of a general hospital in Belgium. MEASUREMENTS: Frailty was graded according to the Rockwood Clinical Frailty Scale (CFS). Demographic, biochemical, and radiologic variables, comorbidities, symptoms, and treatment were extracted from electronic medical records. RESULTS: Participants (N = 48 women, 59%) had a median age of 85 years (range 65-97 years) and a median CFS score of 7 (range 2-9); 42 (52%) were long-term care residents. Within 6 weeks, 18 patients died. Mortality was significantly but weakly associated with age (Spearman r = 0.241, P = .03) and CFS score (r = 0.282, P = .011), baseline lactate dehydrogenase (LDH; r = 0.301, P = .009), lymphocyte count (r = -0.262, P = .02), and RT-PCR cycle threshold (Ct, r = -0.285, P = .015). Mortality was not associated with long-term care residence, dementia, delirium, or polypharmacy. In multivariable logistic regression analyses, CFS, LDH, and RT-PCR Ct (but not age) remained independently associated with mortality. Both age and frailty had poor specificity to predict survival. A multivariable model combining age, CFS, LDH, and viral load significantly predicted survival. CONCLUSIONS AND IMPLICATIONS: Although their prognosis is worse, even the oldest and most severely frail patients may benefit from hospitalization for COVID-19, if sufficient resources are available.

  Traduction automatique en Français sur Google Translate

  Twitter cet article (lien vers l'article)
  Twitter cet article (lien vers ce site)
• Mcloughlin BC, Miles A, Webb TE, Knopp P, Eyres C, Fabbri A, Humphries F, Davis D. Functional and cognitive outcomes after COVID-19 delirium. Eur Geriatr Med. 2020 Oct;11(5):857-862. doi: 10.1007/s41999-020-00353-8. Epub 2020 Jul 14.
  [PMID: 32666303] [PMCID: 7358317] [DOI: 10.1007/s41999-020-00353-8]
  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 (mean age 61, 75% men), 31 (42%) had delirium, of which only 12 (39%) 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 - 50 out of 166 points (95% CI - 83 to - 17, p = 0.01). 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.

  Traduction automatique en Français sur Google Translate

  Twitter cet article (lien vers l'article)
  Twitter cet article (lien vers ce site)
• Maltese G, Corsonello A, Di Rosa M, Soraci L, Vitale C, Corica F, Lattanzio F. Frailty and COVID-19: A Systematic Scoping Review. J Clin Med. 2020 Jul 4;9(7):2106. doi: 10.3390/jcm9072106.
  [PMID: 32635468] [PMCID: 7408623] [DOI: 10.3390/jcm9072106]
  Older people have paid a huge toll in terms of mortality during the coronavirus disease-19 (COVID-19) pandemic. Frailty may have contributed to the vulnerability of older people to more severe clinical presentation. We aimed at reviewing available evidence about frailty and COVID-19. We searched PUBMED, Web of Science, and EMBASE from 1 December 2019 to 29 May 2020. Study selection and data extraction were performed by three independent reviewers. Qualitative synthesis was conducted and quantitative data extracted when available. Forty papers were included: 13 editorials, 15 recommendations/guidelines, 3 reviews, 1 clinical trial, 6 observational studies, 2 case reports. Editorials and reviews underlined the potential clinical relevance of assessing frailty among older patients with COVID-19. However, frailty was only investigated in regards to its association with overall mortality, hospital contagion, intensive care unit admission rates, and disease phenotypes in the few observational studies retrieved. Specific interventions in relation to frailty or its impact on COVID-19 treatments have not been evaluated yet. Even with such limited evidence, clinical recommendations on the use of frailty tools have been proposed to support decision making about escalation plan. Ongoing initiatives are expected to improve knowledge of COVID-19 interaction with frailty and to promote patient-centered approaches.

  Traduction automatique en Français sur Google Translate

  Twitter cet article (lien vers l'article)
  Twitter cet article (lien vers ce site)
• Beach SR, Praschan NC, Hogan C, Dotson S, Merideth F, Kontos N, Fricchione GL, Smith FA. Delirium in COVID-19: A case series and exploration of potential mechanisms for central nervous system involvement. Gen Hosp Psychiatry. 2020 Jul-Aug;65:47-53. doi: 10.1016/j.genhosppsych.2020.05.008. Epub 2020 May 22.
  [PMID: 32470824] [PMCID: 7242189] [DOI: 10.1016/j.genhosppsych.2020.05.008]
  INTRODUCTION: Neuropsychiatric manifestations of the coronavirus disease 2019 (COVID-19) have been described, including anosmia, ageusia, headache, paresthesia, encephalitis and encephalopathy. Little is known about the mechanisms by which the virus causes central nervous system (CNS) symptoms, and therefore little guidance is available regarding potential workup or management options. CASES: We present a series of four consecutive cases, seen by our psychiatry consultation service over a one-week period, each of which manifested delirium as a result of infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). DISCUSSION: The four cases highlighted here all occurred in older patients with premorbid evidence of cognitive decline. Unique features seen in multiple cases included rigidity, alogia, abulia, and elevated inflammatory markers. In all four cases, a change in mental status was the presenting symptom, and three of the four cases lacked significant respiratory symptoms. In addition to discussing unique features of the cases, we discuss possible pathophysiologic explanations for COVID-19 delirium. CONCLUSIONS: Delirium should be recognized as a potential feature of infection with SARS-CoV-2 and may be the only presenting symptom. Based on the high rates of delirium demonstrated in prior studies, hospitals should consider adding mental status changes to the list of testing criteria. Further research is needed to determine if delirium in COVID-19 represents a primary encephalopathy heralding invasion of the CNS by the virus, or a secondary encephalopathy related to systemic inflammatory response or other factors.

  Traduction automatique en Français sur Google Translate

  Twitter cet article (lien vers l'article)
  Twitter cet article (lien vers ce site)
• Benussi A, Pilotto A, Premi E, Libri I, Giunta M, Agosti C, Alberici A, Baldelli E, Benini M, Bonacina S, Brambilla L, Caratozzolo S, Cortinovis M, Costa A, Cotti Piccinelli S, Cottini E, Cristillo V, Delrio I, Filosto M, Gamba M, Gazzina S, Gilberti N, Gipponi S, Imarisio A, Invernizzi P, Leggio U, Leonardi M, Liberini P, Locatelli M, Masciocchi S, Poli L, Rao R, Risi B, Rozzini L, Scalvini A, Schiano di Cola F, Spezi R, Vergani V, Volonghi I, Zoppi N, Borroni B, Magoni M, Pezzini A, Padovani A. Clinical characteristics and outcomes of inpatients with neurologic disease and COVID-19 in Brescia, Lombardy, Italy. Neurology. 2020 Aug 18;95(7):e910-e920. doi: 10.1212/WNL.0000000000009848. Epub 2020 May 22.
  [PMID: 32444493] [DOI: 10.1212/WNL.0000000000009848]
  OBJECTIVE: To report clinical and laboratory characteristics, treatment, and clinical outcomes of patients admitted for neurologic diseases with and without coronavirus disease 2019 (COVID-19). METHODS: In this retrospective, single-center cohort study, we included all adult inpatients with confirmed COVID-19 admitted to a neuro-COVID unit beginning February 21, 2020, who had been discharged or died by April 5, 2020. Demographic, clinical, treatment, and laboratory data were extracted from medical records and compared (false discovery rate corrected) to those of neurologic patients without COVID-19 admitted in the same period. RESULTS: One hundred seventy-three patients were included in this study, of whom 56 were positive and 117 were negative for COVID-19. Patients with COVID-19 were older (77.0 years, interquartile range [IQR] 67.0-83.8 years vs 70.1 years, IQR 52.9-78.6 years, p = 0.006), had a different distribution regarding admission diagnoses, including cerebrovascular disorders (n = 43, 76.8% vs n = 68, 58.1%), and had a higher quick Sequential Organ Failure Assessment (qSOFA) score on admission (0.9, IQR 0.7-1.1 vs 0.5, IQR 0.4-0.6, p = 0.006). In-hospital mortality rates (n = 21, 37.5% vs n = 5, 4.3%, p < 0.001) and incident delirium (n = 15, 26.8% vs n = 9, 7.7%, p = 0.003) were significantly higher in the COVID-19 group. Patients with COVID-19 and without COVID with stroke had similar baseline characteristics, but patients with COVID-19 had higher modified Rankin Scale scores at discharge (5.0, IQR 2.0-6.0 vs 2.0, IQR 1.0-3.0, p < 0.001), with a significantly lower number of patients with a good outcome (n = 11, 25.6% vs n = 48, 70.6%, p < 0.001). In patients with COVID-19, multivariable regressions showed increasing odds of in-hospital death associated with higher qSOFA scores (odds ratio [OR] 4.47, 95% confidence interval [CI] 1.21-16.5, p = 0.025), lower platelet count (OR 0.98, 95% CI 0.97-0.99, p = 0.005), and higher lactate dehydrogenase (OR 1.01, 95% CI 1.00-1.03, p = 0.009) on admission. CONCLUSIONS: Patients with COVID-19 admitted with neurologic disease, including stroke, have a significantly higher in-hospital mortality and incident delirium and higher disability than patients without COVID-19.

  Traduction automatique en Français sur Google Translate

  Twitter cet article (lien vers l'article)
  Twitter cet article (lien vers ce site)
• Rogers JP, Chesney E, Oliver D, Pollak TA, McGuire P, Fusar-Poli P, Zandi MS, Lewis G, David AS. Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic. Lancet Psychiatry. 2020 Jul;7(7):611-627. doi: 10.1016/S2215-0366(20)30203-0. Epub 2020 May 18.
  [PMID: 32437679] [PMCID: 7234781] [DOI: 10.1016/S2215-0366(20)30203-0]
  BACKGROUND: Before the COVID-19 pandemic, coronaviruses caused two noteworthy outbreaks: severe acute respiratory syndrome (SARS), starting in 2002, and Middle East respiratory syndrome (MERS), starting in 2012. We aimed to assess the psychiatric and neuropsychiatric presentations of SARS, MERS, and COVID-19. METHODS: In this systematic review and meta-analysis, MEDLINE, Embase, PsycINFO, and the Cumulative Index to Nursing and Allied Health Literature databases (from their inception until March 18, 2020), and medRxiv, bioRxiv, and PsyArXiv (between Jan 1, 2020, and April 10, 2020) were searched by two independent researchers for all English-language studies or preprints reporting data on the psychiatric and neuropsychiatric presentations of individuals with suspected or laboratory-confirmed coronavirus infection (SARS coronavirus, MERS coronavirus, or SARS coronavirus 2). We excluded studies limited to neurological complications without specified neuropsychiatric presentations and those investigating the indirect effects of coronavirus infections on the mental health of people who are not infected, such as those mediated through physical distancing measures such as self-isolation or quarantine. Outcomes were psychiatric signs or symptoms; symptom severity; diagnoses based on ICD-10, DSM-IV, or the Chinese Classification of Mental Disorders (third edition) or psychometric scales; quality of life; and employment. Both the systematic review and the meta-analysis stratified outcomes across illness stages (acute vs post-illness) for SARS and MERS. We used a random-effects model for the meta-analysis, and the meta-analytical effect size was prevalence for relevant outcomes, I(2) statistics, and assessment of study quality. FINDINGS: 1963 studies and 87 preprints were identified by the systematic search, of which 65 peer-reviewed studies and seven preprints met inclusion criteria. The number of coronavirus cases of the included studies was 3559, ranging from 1 to 997, and the mean age of participants in studies ranged from 12·2 years (SD 4·1) to 68·0 years (single case report). Studies were from China, Hong Kong, South Korea, Canada, Saudi Arabia, France, Japan, Singapore, the UK, and the USA. Follow-up time for the post-illness studies varied between 60 days and 12 years. The systematic review revealed that during the acute illness, common symptoms among patients admitted to hospital for SARS or MERS included confusion (36 [27·9%; 95% CI 20·5-36·0] of 129 patients), depressed mood (42 [32·6%; 24·7-40·9] of 129), anxiety (46 [35·7%; 27·6-44·2] of 129), impaired memory (44 [34·1%; 26·2-42·5] of 129), and insomnia (54 [41·9%; 22·5-50·5] of 129). Steroid-induced mania and psychosis were reported in 13 (0·7%) of 1744 patients with SARS in the acute stage in one study. In the post-illness stage, depressed mood (35 [10·5%; 95% CI 7·5-14·1] of 332 patients), insomnia (34 [12·1%; 8·6-16·3] of 280), anxiety (21 [12·3%; 7·7-17·7] of 171), irritability (28 [12·8%; 8·7-17·6] of 218), memory impairment (44 [18·9%; 14·1-24·2] of 233), fatigue (61 [19·3%; 15·1-23·9] of 316), and in one study traumatic memories (55 [30·4%; 23·9-37·3] of 181) and sleep disorder (14 [100·0%; 88·0-100·0] of 14) were frequently reported. The meta-analysis indicated that in the post-illness stage the point prevalence of post-traumatic stress disorder was 32·2% (95% CI 23·7-42·0; 121 of 402 cases from four studies), that of depression was 14·9% (12·1-18·2; 77 of 517 cases from five studies), and that of anxiety disorders was 14·8% (11·1-19·4; 42 of 284 cases from three studies). 446 (76·9%; 95% CI 68·1-84·6) of 580 patients from six studies had returned to work at a mean follow-up time of 35·3 months (SD 40·1). When data for patients with COVID-19 were examined (including preprint data), there was evidence for delirium (confusion in 26 [65%] of 40 intensive care unit patients and agitation in 40 [69%] of 58 intensive care unit patients in one study, and altered consciousness in 17 [21%] of 82 patients who subsequently died in another study). At discharge, 15 (33%) of 45 patients with COVID-19 who were assessed had a dysexecutive syndrome in one study. At the time of writing, there were two reports of hypoxic encephalopathy and one report of encephalitis. 68 (94%) of the 72 studies were of either low or medium quality. INTERPRETATION: If infection with SARS-CoV-2 follows a similar course to that with SARS-CoV or MERS-CoV, most patients should recover without experiencing mental illness. SARS-CoV-2 might cause delirium in a significant proportion of patients in the acute stage. Clinicians should be aware of the possibility of depression, anxiety, fatigue, post-traumatic stress disorder, and rarer neuropsychiatric syndromes in the longer term. FUNDING: Wellcome Trust, UK National Institute for Health Research (NIHR), UK Medical Research Council, NIHR Biomedical Research Centre at University College London Hospitals NHS Foundation Trust and University College London.

  Traduction automatique en Français sur Google Translate

  Twitter cet article (lien vers l'article)
  Twitter cet article (lien vers ce site)
• O'Hanlon S, Inouye SK. Delirium: a missing piece in the COVID-19 pandemic puzzle. Age Ageing. 2020 Jul 1;49(4):497-498. doi: 10.1093/ageing/afaa094.
  [PMID: 32374367] [PMCID: 7239228] [DOI: 10.1093/ageing/afaa094]
  

  Traduction automatique en Français sur Google Translate

  Twitter cet article (lien vers l'article)
  Twitter cet article (lien vers ce site)
• Kotfis K, Williams Roberson S, Wilson JE, Dabrowski W, Pun BT, Ely EW. COVID-19: ICU delirium management during SARS-CoV-2 pandemic. Crit Care. 2020 Apr 28;24(1):176. doi: 10.1186/s13054-020-02882-x.
  [PMID: 32345343] [PMCID: 7186945] [DOI: 10.1186/s13054-020-02882-x]
  The novel coronavirus, SARS-CoV-2-causing Coronavirus Disease 19 (COVID-19), emerged as a public health threat in December 2019 and was declared a pandemic by the World Health Organization in March 2020. Delirium, a dangerous untoward prognostic development, serves as a barometer of systemic injury in critical illness. The early reports of 25% encephalopathy from China are likely a gross underestimation, which we know occurs whenever delirium is not monitored with a valid tool. Indeed, patients with COVID-19 are at accelerated risk for delirium due to at least seven factors including (1) direct central nervous system (CNS) invasion, (2) induction of CNS inflammatory mediators, (3) secondary effect of other organ system failure, (4) effect of sedative strategies, (5) prolonged mechanical ventilation time, (6) immobilization, and (7) other needed but unfortunate environmental factors including social isolation and quarantine without family. Given early insights into the pathobiology of the virus, as well as the emerging interventions utilized to treat the critically ill patients, delirium prevention and management will prove exceedingly challenging, especially in the intensive care unit (ICU). The main focus during the COVID-19 pandemic lies within organizational issues, i.e., lack of ventilators, shortage of personal protection equipment, resource allocation, prioritization of limited mechanical ventilation options, and end-of-life care. However, the standard of care for ICU patients, including delirium management, must remain the highest quality possible with an eye towards long-term survival and minimization of issues related to post-intensive care syndrome (PICS). This article discusses how ICU professionals (e.g., physicians, nurses, physiotherapists, pharmacologists) can use our knowledge and resources to limit the burden of delirium on patients by reducing modifiable risk factors despite the imposed heavy workload and difficult clinical challenges posed by the pandemic.

  Traduction automatique en Français sur Google Translate

  Twitter cet article (lien vers l'article)
  Twitter cet article (lien vers ce site)
• LaHue SC, James TC, Newman JC, Esmaili AM, Ormseth CH, Ely EW. Collaborative Delirium Prevention in the Age of COVID-19. J Am Geriatr Soc. 2020 May;68(5):947-949. doi: 10.1111/jgs.16480.
  [PMID: 32277467] [PMCID: 7262233] [DOI: 10.1111/jgs.16480]
  

  Traduction automatique en Français sur Google Translate

  Twitter cet article (lien vers l'article)
  Twitter cet article (lien vers ce site)