Delirium a possible early warning sign in Covid-19

Delirium may provide early warning sign for Covid-19 in elderly patients

Dr Mary Ní Lochlainn

Doctors should be aware of delirium as a possible early warning sign in Covid-19, research carried out at Guy’s and St Thomas’ Hospitals in London has highlighted.

A Co-Lead on the King’s College university research team, Trinity College Dublin graduate, Dr Mary Ní Lochlainn said this finding would be of particular importance in nursing homes where the staff could look out for confusion or changes in behaviour amongst residents.

“Current guidance in Ireland does not include confusion as a symptom to prompt testing. Doctors and carers should look out for signs of confusion or strange behaviour in frail older people because it could be an early warning sign of Covid-19.”

“Even if they have no cough or fever, delirium is more common in vulnerable over-65s than other, fitter people of the same age.”

The researchers said this was 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 emphasised 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.”

The researchers looked at more than 800 people older than 65 in two different cohorts, one hospitalised and one based in the community.

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

In the hospital cohort, all 322 patients were assessed by a physician.

Notably, of the hospital patients studied, almost one-fifth had confusion as the only presenting feature of the disease.

Older adults with frailty hospitalised with Covid-19 were more likely to present with probable delirium than non-frail adults of the same age.

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

There was some evidence from a research group in Birmingham in the United Kingdom that inflammatory responses in people with delirium were dysfunctional.

“However, we do not know for sure, and more research is needed to establish that,” she added.

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

The study, ‘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’, published in Age and Ageing, can be accessed here.

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