Prevalence and prognostic value of Delirium as the initial presentation of COVID-19 in the elderly with dementia: An Italian retrospective study. (September 2020)

• Record Type: Journal Article
• Authors: Poloni, Tino Emanuele; Carlos, Arenn Faye; Cairati, Marco; Cutaia, Chiara; Medici, Valentina; Marelli, Eleonora; Ferrari, Danila; Galli, Alberto; Bognetti, Paola; Davin, Annalisa; Cirrincione, Alice; Ceretti, Arcangelo; Cereda, Cristina; Ceroni, Mauro; Tronconi, Livio; Vitali, Silvia; Guaita, Antonio
• Is Part Of: EClinicalMedicine. Volume 26(2020)
• Publication Date: 2020-09
• Subjects: Medicine -- Research -- Periodicals; Medical policy -- Periodicals; Clinical Medicine; Health Policy; Public Health; Medical policy; Medicine -- Research; Periodical; Electronic journals; Periodicals; 613
• DOI: 10.1016/j.eclinm.2020.100490
• Languages: English
• ISSNs: 2589-5370

Abstract

Abstract: 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.