Delirium a possible early warning sign in Covid-19

Delirium can be an early warning sign of Covid-19 in older patients

Dr. Mary Ní Lochlainn

Doctors should be aware of delirium as a possible early warning sign in Covid-19, as research in the hospitals of Guy and St. Thomas in London has shown.

A co-lead on the research team at King & # 39; s College University, a graduate of Trinity College Dublin, Dr. Mary Ní Lochlainn This finding is of particular importance in nursing homes where staff may look for confusion or behavioral changes among residents.

“The current guidelines in Ireland do not contain confusion as a symptom of immediate testing. Doctors and nurses should look out for signs of confusion or strange behavior in the frail elderly as this could be an early warning sign of Covid-19. "

"Even if they don't have a cough or a fever, delirium is more common in vulnerable people over 65 than other, fitter people of the same age."

The researchers said this was the first study to show a higher prevalence of probable delirium as a Covid-19 symptom in older adults with frailty compared to other older adults.

“This emphasized the need for systematic vulnerability assessment and screening for delirium in acutely ill elderly patients in hospitals and communities. Doctors should suspect Covid-19 in frail adults with delirium. "

The researchers studied more than 800 people over 65 in two different cohorts, one in the hospital and one in the community.

Dr. Ní Lochlainn led the team that collected the hospital data. In the community cohort of 535 people, the confusion was reported by patients or their families, with an application used to record symptoms or record health reports on behalf of friends and family. All had received a positive test result.

In the hospital cohort, all 322 patients were examined by a doctor.

Remarkably, almost a fifth of the hospital patients studied had confusion as the only presenting characteristic of the disease.

Older adults with frailty who were hospitalized with Covid-19 were more likely to have likely delirium than non-frail adults of the same age.

The pathophysiology was not fully understood, but Dr. Ní Lochlainn told the Irish Medical Times that it was possible that neuroinflammation was contributing to confusion or inflammation in general.

There was some evidence from a research group in Birmingham, UK, that inflammatory responses were dysfunctional in people with delirium.

"We don't know for sure, however, and more research is needed to determine this," she added.

Her research team carried out further work in this area and other aspects of Covid-19.

The study published in Age and Aging, "Probable Delirium Is A Presenting Symptom Of Covid-19 In Frail Elderly Adults: A Cohort Study Of 322 Hospitalized and 535 Elderly Adults in the Community" is available here.

valerie.ryan@imt.ie