Delirium in COVID-19: a case series and exploration of potential mechanisms for central nervous system involvement
Open accessAbstract
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.
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At hospitalisation, all patients with dementia in the case series presented with agitation and 7 out of 8 with delirium.
“At hospitalisation, all patients presented with agitation and 7 out of 8 with delirium.”
From The impact of COVID-19 infection and enforced prolonged social isolation on neuropsychiatric symptoms in older adults with and without dementia: A review (2020) · cites this paper as [16]
In all cases of dementia with COVID-19, the neuropsychiatric manifestations were clinician-reported.
“In all cases, the neuropsychiatric manifestations of COVID-19 were clinician-reported.”
From The impact of COVID-19 infection and enforced prolonged social isolation on neuropsychiatric symptoms in older adults with and without dementia: A review (2020) · cites this paper as [16]
People with dementia who contracted COVID-19 often presented with agitation and altered consciousness.
“Particularly affected were people with dementia, who presented often with agitation (16, 18–20) and altered consciousness (15, 18).”
From The impact of COVID-19 infection and enforced prolonged social isolation on neuropsychiatric symptoms in older adults with and without dementia: A review (2020) · cites this paper as [16]
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Brain dysfunction in COVID‐19 and CAR‐T therapy: cytokine storm‐associated encephalopathy
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“Spontaneous clinical recovery has been reported for various patients with COVID-19-related encephalopathy.(10,29,30) However, a subgroup of patients may develop severe neurological manifestations (e.”
BackgroundHawkins, M., Sockalingam, S., Bonato, S., Rajaratnam, T., Ravindran, M., Gosse, P. J., & Sheehan, K. (2020) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2020.110350 · Cited by 79 · see citing works
“derlying and contributory etiologies, while concomitantly implementing non-pharmacological and pharmacological interventions [71].”
InfluentialParker, C., Shalev, D., Hsu, I., Shenoy, A., Cheung, S., Nash, S. S., Wiener, I., Fedoronko, D. A., Allen, N., & Shapiro, P. A. (2020) · Journal of the Academy of Consultation-Liaison Psychiatry · doi:10.1016/j.psym.2020.10.001 · Cited by 73 · see citing works
Moreira, J. L. D. S., Barbosa, S. M. B., Vieira, J. G., Chaves, N. C. B., Felix, E. B. G., Feitosa, P. W. G., da Cruz, Í. S., da Silva, C. G. L., & Neto, M. L. R. (2020) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2020.110159 · Cited by 75 · see citing works
“Although COVID-19 is largely responsible for the clinical worsening of the infectious condition, atypical presentations are being increasingly recognized (Beach et al., 2020).”
InfluentialEffects of COVID-19 Pandemic on Health and Wellbeing of Older People: A Comprehensive Review
Lekamwasam, R., & Lekamwasam, S. (2020) · Annals of Geriatric Medicine and Research · doi:10.4235/agmr.20.0027 · Cited by 69 · see citing works
Is the Frontal Lobe the Primary Target of SARS-CoV-2?
Toniolo, S., Lorenzo, F. D., Scarioni, M., Frederiksen, K. S., & Nobili, F. M. (2021) · Journal of Alzheimer s Disease · doi:10.3233/jad-210008 · Cited by 68 · see citing works
Elucidating the Neuropathologic Mechanisms of SARS-CoV-2 Infection
Pacheco‐Herrero, M., Soto-Rojas, L. O., Harrington, C. R., Flores-Martinez, Y. M., Villegas-Rojas, M. M., León-Aguilar, A. M., Martínez-Gómez, P. A., Campa-Córdoba, B. B., Apátiga-Pérez, R., Corniel-Taveras, C. N., et al. (2021) · Frontiers in Neurology · doi:10.3389/fneur.2021.660087 · Cited by 69 · see citing works
Emamikhah, M., Babadi, M., Mehrabani, M., Jalili, M., Pouranian, M., Daraie, P., Mohaghegh, F., Aghavali, S., Zaribafian, M., & Rohani, M. (2021) · Journal of NeuroVirology · doi:10.1007/s13365-020-00941-1 · Cited by 66 · see citing works
Neurological manifestations in COVID-19: A narrative review
Rahman, A., Niloofa, R., Zoysa, I. D., Cooray, A., Kariyawasam, J., & Seneviratne, S. L. (2020) · SAGE Open Medicine · doi:10.1177/2050312120957925 · Cited by 64 · see citing works
COVID-19 causes neuronal degeneration and reduces neurogenesis in human hippocampus
Bayat, A., Azimi, H., Moghaddam, M. H., Ebrahimi, V., Fathi, M., Vakili, K. G., Mahmoudiasl, G., Forouzesh, M., Boroujeni, M. E., Nariman, Z., et al. (2022) · APOPTOSIS · doi:10.1007/s10495-022-01754-9 · Cited by 64 · see citing works
Costas‐Carrera, A., Sánchez‐Rodríguez, M. M., Cañizares, S., Ojeda, A., Martín‐Villalba, I., Primé‐Tous, M., Rodríguez-Rey, A., Segú, X., Valdesoiro‐Pulido, F., Borràs, R., et al. (2022) · Brain Behavior & Immunity - Health · doi:10.1016/j.bbih.2022.100425 · Cited by 59 · see citing works
“Sustained attention (Filatov et al., 2020; Zhou et al., 2020), processing speed, verbal memory (Almeria et al., 2020; Mazza et al., 2021), language (Beaud et al., 2020) and executive function (Beach et al., 2020; Zhou et al., 2020; Almeria et al., 2020) were the most affected.”
Eser, H. Y., Köroğlu, Y. E., Çakmak, Ö. Ö., Keskin, Ö., Gürsoy, A., & Özdemir, Y. (2021) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2021.656313 · Cited by 54 · see citing works
Myoclonus and Cerebellar Ataxia Following COVID‐19
Dijkstra, F., den Bossche, T. V., Willekens, B. M. P., Cras, P. P., & Crosiers, D. (2020) · Movement Disorders Clinical Practice · doi:10.1002/mdc3.13049 · Cited by 52 · see citing works
Catatonia in older adults: A systematic review
Jaimes-Albornoz, W., de Pellón-Santamaría, Á. R., Nizama‐Vía, A., Isetta, M., Albájar, I., & Mestres, J. S. (2022) · World Journal of Psychiatry · doi:10.5498/wjp.v12.i2.348 · Cited by 50 · see citing works
The Social Brain and Emotional Contagion: COVID-19 Effects
Valenzano, A. A., Scarinci, A., Monda, V., Sessa, F., Messina, A., Monda, M., Precenzano, F., Mollica, M. P., Carotenuto, M., Messina, G., et al. (2020) · Medicina · doi:10.3390/medicina56120640 · Cited by 49 · see citing works
“Neurocognitive symptoms associated with COVID-19 include delirium, both acute and chronic attention and memory impairment related to hippocampal and cortical dam g , as well s learning deficits in both adults and children [2,61].”
BackgroundDolatshahi, M., Sabahi, M., & Aarabi, M. H. (2021) · Molecular Neurobiology · doi:10.1007/s12035-020-02236-2 · Cited by 49 · see citing works
Kulaga, S. S., & Miller, C. W. T. (2021) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2021.05.008 · Cited by 51 · see citing works
Intravenous immunoglobulin therapy in COVID-19-related encephalopathy
Muccioli, L., Pensato, U., Bernabè, G., Ferri, L., Tappatà, M., Volpi, L., Cani, I., Henry, O. J., Ceccaroni, F., Cevoli, S., et al. (2020) · Journal of Neurology · doi:10.1007/s00415-020-10248-0 · Cited by 44 · see citing works
COVID-19-related encephalopathy presenting with aphasia resolving following tocilizumab treatment
Muccioli, L., Pensato, U., Cani, I., Guerra, L., Provini, F., Bordin, G., Riccioli, L. A., Lodi, R., Tinuper, P., & Bisulli, F. (2020) · Journal of Neuroimmunology · doi:10.1016/j.jneuroim.2020.577400 · Cited by 42 · see citing works
“Even though these findings cannot rule out CNS viral invasion with certainty, we believe more likely an immuno-mediated para-infectious pathogenic mechanism underlying the neurological manifestations of our patient, also according to the emerging evidence supporting an inflammatory, cytokine-mediated, pathogenesis in…”
Vergara, J., Skoretz, S. A., Brodsky, M. B., Miles, A., Langmore, S. E., Wallace, S., Seedat, J., Starmer, H. M., Bolton, L., Clavé, P., et al. (2020) · American Journal of Speech-Language Pathology · doi:10.1044/2020_ajslp-20-00163 · Cited by 42 · see citing works
Parker, C., Slan, A. R., Shalev, D., & CRITCHFIELD, A. (2021) · Journal of Psychiatric Practice · doi:10.1097/pra.0000000000000533 · Cited by 40 · see citing works
Sobrino-Relaño, S., Balboa-Bandeira, Y., Peña, J., Ibarretxe‐Bilbao, N., Zubiaurre‐Elorza, L., & Ojeda, N. (2023) · Scientific Reports · doi:10.1038/s41598-023-37420-6 · Cited by 42 · see citing works
Hamm, B., & Rosenthal, L. J. (2020) · Psychosomatics · doi:10.1016/j.psym.2020.06.022 · Cited by 40 · see citing works
COVID-19 and Catatonia: A Case Series and Systematic Review of Existing Literature
Scheiner, N. S., Smith, A. K., Wohlleber, M., Malone, C., & Schwartz, A. C. (2021) · Journal of the Academy of Consultation-Liaison Psychiatry · doi:10.1016/j.jaclp.2021.04.003 · Cited by 38 · see citing works
“delirium seen in COVID-19 targets subcortical structures or if it indicates a severe systemic illness in a vulnerable patient.(29)”
The potential impact of Covid-19 on CNS and psychiatric sequels
Dehghani, A., Zokaei, E., Kahani, S. M., Alavinejad, E., Dehghani, M., Meftahi, G. H., & Afarinesh, M. R. (2022) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2022.103097 · Cited by 37 · see citing works
“According to Kenny and his colleagues’ survey, there are various types of inflammatory factors in the cerebrospinal fluid of dementia patients, which show an association between immune system activity and memory decline (Kinney et al., 2018).. Upregulation of pro-inflammatory cytokines increases the production of cycl…”
InfluentialPouga, L. (2020) · Journal of Medical Virology · doi:10.1002/jmv.26309 · Cited by 36 · see citing works
Incidence, Predictors and Outcomes of Delirium in Critically Ill Patients With COVID-19
Williamson, C. A., Faiver, L., Nguyen, A., Ottenhoff, L., & Rajajee, V. (2021) · The Neurohospitalist · doi:10.1177/19418744211034815 · Cited by 30 · see citing works
Riordan, P., Stika, M. M., Goldberg, J., & Drzewiecki, M. (2020) · The Clinical Neuropsychologist · doi:10.1080/13854046.2020.1810325 · Cited by 30 · see citing works
Ojeahere, M. I., de Filippis, R., Ransing, R. S., Karaliūnienė, R., Ullah, I., Bytyçi, D. G., Abbass, Z., Kılıç, Ö., Nahidi, M., Hayatudeen, N., et al. (2020) · Brain Behavior & Immunity - Health · doi:10.1016/j.bbih.2020.100147 · Cited by 30 · see citing works
Potential neurological manifestations of COVID-19: a narrative review
Pergolizzi, J. V., Raffa, R. B., Varrassi, G., Magnusson, P., LeQuang, J. A., Paladini, A., Taylor, R., Wollmuth, C. E., Breve, F., Chopra, M., et al. (2020) · Postgraduate Medicine · doi:10.1080/00325481.2020.1837503 · Cited by 31 · see citing works
“Case studies of COVID-19-associated delirium appear in the literature [83,84].”
BackgroundPsychiatric Manifestations of COVID-19 and Their Social Significance
Ptáček, R., Ptáčková, H., Anders, M., & Stefano, G. B. (2020) · Medical Science Monitor · doi:10.12659/msm.930340 · Cited by 29 · see citing works
“Reports indicate that the virus can induce psychosis [7,8], mania [9], delirium [10], depression and anxiety [11], as well as confusion [12,13].”
BackgroundSleep disturbance and cognition in the elderly: a narrative review
Ni, Y., Yu, M., & Liu, C. (2024) · Anesthesiology and Perioperative Science · doi:10.1007/s44254-024-00066-2 · Cited by 27 · see citing works
“Other mechanisms include cerebral vascular dysregulation, mitochondrial dysfunction caused by COVID-19 and traumatic changes secondary to acute respiratory distress syndrome [48, 51, 52].”
A Case of Concurrent Delirium and Catatonia in a Woman With Coronavirus Disease 2019
Amouri, J., Andrews, P., Heckers, S., Ely, E. W., & Wilson, J. E. (2020) · Journal of the Academy of Consultation-Liaison Psychiatry · doi:10.1016/j.psym.2020.09.002 · Cited by 26 · see citing works
“The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causes the coronavirus disease 2019 (COVID-19), which is primarily characterized by acute pneumonia; however, central nervous system insults have been described.(12,13)”
Verhoef, P. A., Kannan, S., Sturgill, J., Tucker, E. W., Morris, P. E., Miller, A. C., Sexton, T. R., Koyner, J. L., Hejal, R. B., Brakenridge, S. C., et al. (2021) · Critical Care Explorations · doi:10.1097/cce.0000000000000374 · Cited by 25 · see citing works
COVID-19-Associated Neurological Manifestations: An Emerging Electroencephalographic Literature
Vellieux, G., Sonneville, R., Vledouts, S., Jaquet, P., Rouvel-Tallec, A., & d’Ortho, M. (2021) · Frontiers in Physiology · doi:10.3389/fphys.2020.622466 · Cited by 24 · see citing works
Subcortical Myoclonus in Coronavirus Disease 2019: Comprehensive Evaluation of a Patient
Muccioli, L., Rondelli, F., Ferri, L., Rossini, G., Cortelli, P., & Guarino, M. (2020) · Movement Disorders Clinical Practice · doi:10.1002/mdc3.13046 · Cited by 23 · see citing works
Encephalopathy in COVID-19 Presenting With Acute Aphasia Mimicking Stroke
Pensato, U., Muccioli, L., Pasini, E., Tappatà, M., Ferri, L., Volpi, L., Licchetta, L., Battaglia, S., Rossini, G., Bon, I., et al. (2020) · Frontiers in Neurology · doi:10.3389/fneur.2020.587226 · Cited by 21 · see citing works
Toxicity of psychotropic drugs in patients with COVID-19: A systematic review
Sabé, M., Dorsaz, O., Huguelet, P., & Kaiser, S. (2021) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2021.02.006 · Cited by 21 · see citing works
“Other severe neurological consequences, such as cerebrovascular events and encephalopathy, have also been reported [8,9].”
Mental Health in Patients with Coronavirus Disease-19 and the Quarantined People
Park, H. Y. (2021) · 신경정신의학 · doi:10.4306/jknpa.2021.60.1.11 · Cited by 20 · see citing works
Akinetic Mutism and Coronavirus Disease 2019: A Narrative Review
Fusunyan, M. A., Praschan, N. C., Fricchione, G. L., & Beach, S. R. (2021) · Journal of the Academy of Consultation-Liaison Psychiatry · doi:10.1016/j.jaclp.2021.08.009 · Cited by 19 · see citing works
“In our own COVID-associated delirium case series, 3 patients aged 68 to 76 years with pre-existing neuropsychiatric vulnerability and signs of systemic hyperinflammation presented with acute-onset behavioral changes and progressed from hyperactive delirium to abulia and mutism within the course of a week.(5)”
MethodCOVID-19 neuropsychiatric repercussions: Current evidence on the subject
Júnior, R. T. D. S., Apolonio, J. S., Cuzzuol, B. R., da Costa, B. T., Silva, C. S., Araújo, G. R. L., Luz, M. S., Marques, H. S., Santos, L. K. D. S., Pinheiro, S. L. R., et al. (2022) · World Journal of Methodology · doi:10.5662/wjm.v12.i5.365 · Cited by 19 · see citing works
Tirado, J. D. V., Trzepacz, P. T., & Franco, J. G. (2021) · Journal of Neuropsychiatry · doi:10.1176/appi.neuropsych.20100251 · Cited by 19 · see citing works
Behavioral interventions in acute COVID-19 recovery: A new opportunity for integrated care
Jaywant, A., Vanderlind, W. M., Boas, S. J., & Dickerman, A. L. (2020) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2020.07.001 · Cited by 18 · see citing works
“Many patients have residual symptoms of hypoactive delirium [5] that can be misinterpreted as depression or apathy.”
Goldberg, E. M., Southerland, L. T., Meltzer, A. C., Pagenhardt, J., Hoopes, R., Camargo, C. A., & Kline, J. A. (2022) · Journal of the American Geriatrics Society · doi:10.1111/jgs.17816 · Cited by 17 · see citing works
“10–12 However, older adults with COVID-19 can present “atypically” or with alternate presentations such as falls or syncope,(13) drowsiness,(14) or acute mental status changes.(15,16) While the link between age andworse clinical outcomes in older patients with SARS-CoV-2 infection has been wellestablished,(2,17) few s…”
BackgroundNewhouse, A. L., Kritzer, M. D., Eryilmaz, H., Praschan, N. C., Camprodon, J. A., Fricchione, G. L., & Chemali, Z. N. (2022) · Journal of the Academy of Consultation-Liaison Psychiatry · doi:10.1016/j.jaclp.2022.08.007 · Cited by 17 · see citing works
Early attention impairment in a patient with COVID‐19
Tolentino, J. C., Gjorup, A. L. T., Schmidt, G. J., & Schmidt, S. L. (2020) · Psychiatry and Clinical Neurosciences · doi:10.1111/pcn.13178 · Cited by 17 · see citing works
“1 ACE2 receptors are found in the central nervous system and angiotensin II is an active product of the renin-angiotensin system (RAS).2 Previous studies have implicated the brain RAS in cognitive functions.3 Recently, neurologic events and delirium have been described in COVID-19.”
Backgroundon behalf of the “Cognitive and Behavioral Neurology” Study Group of the Italian Neurological Society, Stracciari, A., Bottini, G., Guarino, M., Magni, E., & Pantoni, L. (2021) · Neurological Sciences · doi:10.1007/s10072-021-05231-0 · Cited by 19 · see citing works
“[15], three patients presented speech disturbances and akinetic mutism as prominent signs of COVID-related encephalopaty.”
BackgroundMunawar, N., Syed, R., Costello, M. M., Robinson, D. W., Bergin, C. J., & Greene, E. (2023) · Aging and Health Research · doi:10.1016/j.ahr.2023.100125 · Cited by 17 · see citing works
COVID-19 Catatonia—Would We Even Know?
Cooper, J. J., & Ross, D. A. (2020) · Biological Psychiatry · doi:10.1016/j.biopsych.2020.07.001 · Cited by 16 · see citing works
“Yet there is also room for hope: a recent paper on delirium in COVID-19 highlights the overlap and differences between catatonia and akinetic mutism, reinforcing the importance of accurate diagnosis (10).”
BackgroundAlzheimer’s disease in elderly COVID-19 patients: potential mechanisms and preventive measures
Wang, H., Lü, J., Zhao, X., Qin, R., Song, K., Xu, Y. Q., Zhang, J., & Chen, Y. (2021) · Neurological Sciences · doi:10.1007/s10072-021-05616-1 · Cited by 15 · see citing works
Fabrazzo, M., Russo, A., Camerlengo, A., Tucci, C., Luciano, M., Santis, V. D., Perris, F., Catapano, F., & Coppola, N. (2021) · Medicina · doi:10.3390/medicina57111244 · Cited by 15 · see citing works
“[102] had a premorbid cognitive impairment.”
BackgroundSasidharan, S., Singh, V. A., Singh, J., Madan, G. S., Dhillon, H. S., Dash, P. K., Shibu, B., & Dhillon, G. K. (2021) · Journal of Anaesthesiology Clinical Pharmacology · doi:10.4103/joacp.joacp_14_21 · Cited by 15 · see citing works
Coronavirus Disease-2019 and Mental Health
Darmadi, D., & Ruslie, R. H. (2020) · Open Access Macedonian Journal of Medical Sciences · doi:10.3889/oamjms.2020.5304 · Cited by 14 · see citing works
“Medications used to manage mental health problems in COVID-19 patients are antipsychotic agents (olanzapine and chlorpromazine), haloperidol, antidepressants, benzodiazepines, and amantadine [8], [11].”
BackgroundInfluentialThe effect of SARS-CoV-2 on the development of Parkinson's disease: the role of α-synuclein
Iravanpour, F., Farrokhi, M. R., Jafarinia, M., & Oliaee, R. T. (2023) · Human Cell · doi:10.1007/s13577-023-00988-2 · Cited by 14 · see citing works
“While no similar cases have been recorded so far, several investigations have documented a condition known as "akinetic mutism" in the context of encephalitis, with the nature of this condition remaining unknown [25, 26].”
Dementia and COVID-19: A Case Report and Literature Review on Pain Management
Scuteri, D., Contrada, M., Tonin, P., Corasaniti, M. T., Nicotera, P., & Bagetta, G. (2022) · Pharmaceuticals · doi:10.3390/ph15020199 · Cited by 14 · see citing works
“As for AD, anosmia is a frequent symptom and NPSs, delirium and a change in mental health can be the presentation of symptoms of the infection [29].”
BackgroundZielińska-Turek, J., Jasińska, A., Kołakowska, J., Szadurska, J., KOSIOR, D. A., & Dorobek, M. (2021) · Neurologia i Neurochirurgia Polska · doi:10.5603/pjnns.a2021.0011 · Cited by 13 · see citing works
“Considering the severity of the basic disease, COVID-19, and the fact that these patients usually have many comorbidities, this explains the severity of consciousness disorders and delirium [9].”
BackgroundAcute and long‑term psychiatric symptoms associated with COVID‑19 (Review)
Paunescu, R., Micluția, I., Verișezan-Roșu, O., & Crecan-Suciu, B. D. (2022) · Biomedical Reports · doi:10.3892/br.2022.1586 · Cited by 13 · see citing works
Smith, C. J., Renshaw, P. F., Yurgelun-Todd, D. A., & Sheth, C. S. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.772335 · Cited by 12 · see citing works
Delirium in Patients with COVID-19 in Japan
Kurahara, Y., Matsuda, Y., Tsuyuguchi, K., & Tokoro, A. (2022) · Internal Medicine · doi:10.2169/internalmedicine.9013-21 · Cited by 11 · see citing works
“COVID-19-associated pneumonia and hypoxia, as well as direct infection of the central nervous system by SARSCoV-2, are particularly effective in unmasking the deliriogenic potential of dementia (11).”
BackgroundActive elasticity drives the formation of periodic beading in damaged axons
Riccobelli, D. (2021) · Physical review. E · doi:10.1103/physreve.104.024417 · Cited by 11 · see citing works
Delirium occurrence and association with outcomes in hospitalized COVID-19 patients
Pagali, S. R., Fu, S., Lindroth, H. L., Sohn, S., Burton, M. C., & Lapid, M. I. (2021) · International Psychogeriatrics · doi:10.1017/s104161022100106x · Cited by 11 · see citing works
Sharma, S., Jagadeesh, H., Saxena, A., Chakravarthy, H., & Devanathan, V. (2021) · Journal of Biosciences · doi:10.1007/s12038-021-00232-9 · Cited by 11 · see citing works
Fernández-Jiménez, E., Muñoz‐Sanjosé, A., Mediavilla, R., Martínez‐Alés, G., Rojas, I. I. L., Andreo-Jover, J., Cebolla, S., Bravo‐Ortiz, M. F., & Bayón, C. (2021) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2021.764334 · Cited by 11 · see citing works
“Moreover, among the most severe cases with COVID-19, delirium is often the only sign of the infection (Beach et al., 2020; O’Hanlon and Inouye, 2020).”
BackgroundShapiro, P. A., Brahmbhatt, K., Caravella, R. A., Erickson, J. M., Everly, G. S., Giles, K., Gopalan, P. R., Greenspan, H. N., Huijon, R. M., Key, R. G., et al. (2021) · Journal of the Academy of Consultation-Liaison Psychiatry · doi:10.1016/j.jaclp.2021.05.001 · Cited by 12 · see citing works
Clinical Manifestations of Corona Virus Disease
Srivastava, P., & Gupta, N. (2020) · Springer eBooks · doi:10.1007/978-981-15-8681-1_3 · Cited by 9 · see citing works
COVID-19 Infection: A Neuropsychiatric Perspective
Manolis, T. A., Apostolopoulos, E. J., Manolis, A. S., Melita, H., & Manolis, A. S. (2021) · Journal of Neuropsychiatry · doi:10.1176/appi.neuropsych.20110277 · Cited by 10 · see citing works
Garcı́a, S., Cuatepotzo-Burgos, F. M., Toledo-Lozano, C. G., Balderrama-Soto, A., Alcaráz‐Estrada, S. L., Montiel-López, L., de la Vega-Bravo, A. H., Mondragón‐Terán, P., Santosbeña-Lagunes, M., Escarela-Serrano, M., et al. (2021) · Healthcare · doi:10.3390/healthcare9111501 · Cited by 9 · see citing works
“The pathway of SARS-CoV-2 arrival at the CNS could be transsynaptic by the infected cells, the olfactory nerve across the vascular endothelium, and/or leukocyte migration through the blood–brain barrier [74,77,78].”
Backgroundvan Reekum, E. A., Rosic, T., Sergeant, A., Sanger, N., Rodrigues, M., Rebinsky, R., Panesar, B., Deck, E., Kim, N., Woo, J., et al. (2021) · Journal of Medical Case Reports · doi:10.1186/s13256-021-03140-6 · Cited by 8 · see citing works
“All but one study provided alternative explanations for the neuropsychiatric outcomes or ruled out differential etiologies (for example, using neuroimaging or laboratory investigation), as such these were at low risk of bias for this domain [35, 37, 38].”
ResultCOVID-19 in Assisted Living: Protecting a Critical Long-Term Care Resource
Schwartz, L. B., Lieblich, C., Laxton, C. E., Kaes, L., Barnett, D. P., Port, C. L., & Pace, D. D. (2022) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2022.12.012 · Cited by 8 · see citing works
Encefalite e encefalopatia em pacientes acometidos pela COVID-19
Costa, D. A., Dias, B. N., Pereira, B. M. D. C., Coelho, F. A. D. R., dos Santos, G. A., Silva, J. D. V., Aguiar, M. R. F., Fernandes, T. R. S., Prado, E., Carmo, R. R. D. S., et al. (2021) · Research Society and Development · doi:10.33448/rsd-v10i12.20764 · Cited by 7 · see citing works
Pacnejer, A.-M., Butucă, A., Dobrea, C. M., Arseniu, A. M., Frum, A., Gligor, F. G., Arseniu, R., Vonica, R. C., Vonica-Țincu, A. L., Oancea, C. I., et al. (2024) · Viruses · doi:10.3390/v16121811 · Cited by 8 · see citing works
“Case reports have also documented the presence of manic and psychotic symptoms in patients with COVID-19 who had no prior psychiatric diagnosis [170,171].”
Spectrum of Neurological Manifestations in COVID-19: A Review
Quraishi, F. A., Rahman, A., & Twinkle, F. Q. (2021) · Bangladesh Journal of Medicine · doi:10.3329/bjm.v32i2.53790 · Cited by 7 · see citing works
COVID-19 and its impact on the brain and Mind- A conceptual model and supporting evidence
Saeed, S. A., Pastis, I., & Santos, M. G. (2022) · Psychiatric Quarterly · doi:10.1007/s11126-022-09980-9 · Cited by 7 · see citing works
“It has almost been two years since the pandemic started and the extent of the COVID19 impact has not yet been fully appreciated although it will likely be consequential with 208 million cases and 4.38 millions of deaths [63], [64].”
BackgroundInfluentialLuccarelli, J., Kalinich, M., McCoy, T. H., Fricchione, G. L., Smith, F. A., & Beach, S. R. (2022) · Journal of the Academy of Consultation-Liaison Psychiatry · doi:10.1016/j.jaclp.2022.12.010 · Cited by 7 · see citing works
Treatment of Patients with Mental Illness Amid A Global COVID-19 Pandemic
Jain, A., Sahu, K. K., & Mitra, P. (2021) · Advances in experimental medicine and biology · doi:10.1007/978-3-030-63761-3_42 · Cited by 6 · see citing works
Psychotropics and COVID-19: An analysis of safety and prophylaxis
Javelot, H., Straczek, C., Meyer, G., Faria, C. G. F., Weiner, L., Drapier, D., Fakra, É., Fossati, P., Weibel, S., Dizet, S., et al. (2021) · L Encéphale · doi:10.1016/j.encep.2021.08.002 · Cited by 6 · see citing works
“[85] Beach SR, Praschan NC, Hogan C, et al.”
- Authors
- Beach, S. R., Praschan, N. C., Hogan, C., Dotson, S., Merideth, F., Kontos, N., Fricchione, G. L., & Smith, F. A.
- Affiliations
- Harvard University (US)
- Corresponding author
- Beach, Scott R.
- ORCID
- Venue
- General Hospital Psychiatry
- Publisher
- Elsevier BV
- Published
- 2020-07
- Volume
- 65
- Pages
- 47-53
- ISSN
- 0163-8343 (ISSN-L)
- PMC
- PMC7242189
- OpenAlex
- W3026414252
- Cited by
- 199
- References
- 48
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 14 · 2023: 22 · 2022: 47 · 2021: 70 · 2020: 40
- FWCI
- 19.36
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- General Hospital Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Keywords
- COVID-19 pandemic, SARS-CoV-2, delirium, central nervous system involvement, neuropsychiatric symptoms, cognitive decline, older adults, rigidity, alogia, abulia, inflammatory markers, systemic inflammatory response, encephalopathy, psychiatric consultation
- MeSH terms
- COVID-19, Aged, Aged, 80 and over, Brain Diseases, Delirium, Female, Humans, Male, Pneumonia, Viral, Coronavirus Infections, Pandemics, Cognitive Dysfunction
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