Prevalence and prognostic value of Delirium as the initial presentation of COVID-19 in the elderly with dementia: An Italian retrospective study.
EClinicalMedicine
; 26: 100490, 2020 Sep.
Article
in En
| MEDLINE
| ID: mdl-32838241
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 (96â 6%) tested positive (mean age 82â 8; women 66â 7%). Comorbidities were present in all participants, with 18/57 (31â 6%) having three or more concomitant diseases. Delirium-Onset COVID-19 (DOC) was observed in 21/57 (36â 8%) subjects who were chiefly older (mean age 85â 4 y/o) and with multiple comorbidities. Eleven/21 DOC patients (52â 4%) had hypoactive delirium, while hyperactive delirium occurred in ten/21 (47â 6%). Lymphopenia was present in almost all subjects (median 1â 3 × 109/L). Overall mortality rate was 24â 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<0â 001). Also, DOC and male gender were independently associated with increased risk of mortality (OR 17â 0, 95% CI 2â 8-102â 7, p = 0â 002 and 13â 6, 95% CI 2â 3-79â 2, p = 0â 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.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Type of study:
Observational_studies
/
Prevalence_studies
/
Prognostic_studies
/
Risk_factors_studies
Language:
En
Journal:
EClinicalMedicine
Year:
2020
Document type:
Article
Affiliation country:
Italy