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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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“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]
Experimental — accuracy not yet measuredIn the citing paper
“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]
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“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]
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Cites
Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China
Mao, L., Jin, H., Wang, M., Hu, Y., Chen, S., He, Q., Chang, J., Hong, C., Zhou, Y., Wang, D., et al. (2020) · JAMA Neurology · doi:10.1001/jamaneurol.2020.1127 · Cited by 7,166 · cited 1×
“turbed consciousness, and neuropsychiatric symptoms seem to be associated with more severe disease [1].”
Endothelial cell infection and endotheliitis in COVID-19
Varga, Z., Flammer, A. J., Steiger, P., Haberecker, M., Andermatt, R., Zinkernagel, A. S., Mehra, M. R., Schuepbach, R. A., Ruschitzka, F., & Moch, H. (2020) · The Lancet · doi:10.1016/s0140-6736(20)30937-5 · Cited by 6,358 · cited 1×
“ACE2 receptors are also expressed by endothelial cells, and endotheliitis has also been implicated in the pathology of the virus as a result of both direct and indirect mechanisms [29].”
A SARS-CoV-2 protein interaction map reveals targets for drug repurposing
Gordon, D. E., Jang, G. M., Bouhaddou, M., Xu, J., Obernier, K., White, K. M., O’Meara, M. J., Rezelj, V. V., Guo, J. Z., Swaney, D. L., et al. (2020) · Nature · doi:10.1038/s41586-020-2286-9 · Cited by 4,405 · cited 1×
“While haloperidol carries theoretical risk of EPS, it is worth noting that the IV form is rarely associated with EPS, add haloperidol is now on the list of medications being studied as a treatment for SARS-CoV-2 because of its effects on sigma receptors [33].”
Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study
Chen, T., Wu, D., Chen, H., Yan, W., Yang, D., Chen, G., Ma, K., Xu, D., Yu, H., Wang, H., et al. (2020) · BMJ · doi:10.1136/bmj.m1091 · Cited by 3,903 · cited 2×
“Prior case series have determined that 20–65% of patients with SARS-CoV-2 display features consistent with delirium, and our cases illustrate that mental status changes can occur as the presenting feature [2,6].”
Neurologic features in severe SARS-CoV-2 infection
Helms, J., Kremer, S., Merdji, H., Clere-Jehl, R., Schenck, M., Kummerlen, C., Collange, O., Boulay, C., Fafi-Kremer, S., Ohana, M., et al. (2020) · New England Journal of Medicine · doi:10.1056/nejmc2008597 · Cited by 2,674 · cited 6×
“thermore, while a test for detecting virus in the CSF has been described in other countries [2,7], such a test is not yet available in the United States.”
InfluentialLechien, J. R., Chiesa-Estomba, C. M., De Siati, D. R., Horoi, M., Le Bon, S. D., Rodriguez, A., Dequanter, D., Blecic, S., El Afia, F., Distinguin, L., et al. (2020) · European Archives of Oto-Rhino-Laryngology · doi:10.1007/s00405-020-05965-1 · Cited by 2,668 · cited 2×
“It is also known that up to 88% of patients develop anosmia or ageusia, thought to be secondary to invasion of the olfactory bulb by the virus, suggesting brain involvement [3].”
Li, Y., Bai, W., & Hashikawa, T. (2020) · Journal of Medical Virology · doi:10.1002/jmv.25728 · Cited by 2,266 · cited 1×
“It is known that some coronaviruses, like SARS-CoV, appear capable of invading the brain via a synapse-connected chain extending from receptors in the lung to the medullary cardiorespiratory center [13].”
Baig, A. M., Khaleeq, A., Ali, U., & Syeda, H. (2020) · ACS Chemical Neuroscience · doi:10.1021/acschemneuro.0c00122 · Cited by 2,207 · cited 1×
“The brain has been reported to express ACE2 receptors that have been detected in both neurons and glial cells [27], which makes them vulnerable to SARS-CoV-2 invasion [28].”
Nervous system involvement after infection with COVID-19 and other coronaviruses
Wu, Y., Xu, X., Chen, Z., Duan, J., Hashimoto, K., Yang, L., Liu, C., & Yang, C. (2020) · Brain, Behavior, and Immunity · doi:10.1016/j.bbi.2020.03.031 · Cited by 2,046 · cited 1×
“While some authors suggest these as elements of a workup for all patients [31], this may not be practical due to tenuous clinical status, cost, exposure of staff, and resource availability (i.”
A first case of meningitis/encephalitis associated with SARS-Coronavirus-2
Moriguchi, T., Harii, N., Goto, J., Harada, D., Sugawara, H., Takamino, J., Ueno, M., Sakata, H., Kondo, K., Myose, N., et al. (2020) · International Journal of Infectious Diseases · doi:10.1016/j.ijid.2020.03.062 · Cited by 2,024 · cited 4×
“While the preceding accompaniments of the virus may be interpreted as indirect CNS effects, a report from China describes the first case of viral encephalitis with COVID-19, confirmed by cerebrospinal fluid (CSF) analysis [7].”
Influential
Cited by
Sorted by citations
Guillain Barre syndrome associated with COVID-19 infection: A case report
Sedaghat, Z., & Karimi, N. (2020) · Journal of Clinical Neuroscience · doi:10.1016/j.jocn.2020.04.062 · Cited by 600
Harapan, B. N., & Yoo, H. J. (2021) · Journal of Neurology · doi:10.1007/s00415-021-10406-y · Cited by 360
“Independent of the etiology of delirium, hospitals should consider adding mental status changes to the list of testing criteria since delirium may be the only presenting symptom [48].”
BackgroundDelirium in Older Patients With COVID-19 Presenting to the Emergency Department
Kennedy, M., Helfand, B., Gou, R. Y., Gartaganis, S. L., Webb, M. A., Moccia, J. M., Bruursema, S., Dokic, B., McCulloch, B., Ring, H., et al. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.29540 · Cited by 288
“00) Rehabilitation 111 (14) 41 (18) 70 (12) 1.”
BackgroundInfluentialImpact of COVID-19 in the Mental Health in Elderly: Psychological and Biological Updates
Grolli, R. E., Mingoti, M. E. D., Bertollo, A. G., Luzardo, A. R., Quevedo, J., Réus, G. Z., & Ignácio, Z. M. (2021) · Molecular Neurobiology · doi:10.1007/s12035-020-02249-x · Cited by 286
Frequency of Neurologic Manifestations in COVID-19
Misra, S., Kolappa, K., Prasad, M., Radhakrishnan, D. M., Thakur, K. T., Solomon, T., Michael, B. D., Winkler, A. S., Beghi, E., Guekht, A. B., et al. (2021) · Neurology · doi:10.1212/wnl.0000000000012930 · Cited by 255
Jaywant, A., Vanderlind, W. M., Alexopoulos, G. S., Fridman, C. B., Perlis, R. H., & Gunning, F. M. (2021) · Neuropsychopharmacology · doi:10.1038/s41386-021-00978-8 · Cited by 248
Manca, R., De Marco, M., & Venneri, A. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.585540 · Cited by 227
Encephalopathy in patients with COVID‐19: A review
Garg, R. K., Paliwal, V. K., & Gupta, A. (2021) · Journal of Medical Virology · doi:10.1002/jmv.26207 · Cited by 224
“4 | CLINICAL FEATURES COVID‐19 associated encephalitis/encephalopathies, like other encephalopathies, clinically presents with confusion, agitation, delirium, and coma.(55) According to a retrospective review of 841 hospitalized patients with COVID‐19 (mean age: 66.”
BackgroundNeurological manifestations of COVID-19: a systematic review and meta-analysis of proportions
Favas, T. T., Dev, P., Chaurasia, R. N., Chakravarty, K., Mishra, R., Joshi, D., Mishra, V. N., Kumar, A., Singh, V. K., Pandey, M., et al. (2020) · Neurological Sciences · doi:10.1007/s10072-020-04801-y · Cited by 218
“[202] reported four cases of elderly COVID-19 patients, who presented to the hospital with altered mental status without any respiratory complaints, and only one among them developed respiratory complaints during the hospital stay.”
BackgroundVanderlind, W. M., Rabinovitz, B. B., Miao, I. Y., Oberlin, L. E., Castellano, C. B., Fridman, C. B., Jaywant, A., & Kanellopoulos, D. (2021) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000713 · Cited by 201
de Erausquin, G. A., Snyder, H. M., Carrillo, M. C., Hosseini, A. A., Brugha, T. S., & Seshadri, S. S. (2021) · Alzheimer s & Dementia · doi:10.1002/alz.12255 · Cited by 204
Agitation and Dementia: Prevention and Treatment Strategies in Acute and Chronic Conditions
Carrarini, C., Russo, M., Dono, F., Barbone, F., Rispoli, M. G., Ferri, L., Pietro, M. D., Digiovanni, A., Ajdinaj, P., Speranza, R., et al. (2021) · Frontiers in Neurology · doi:10.3389/fneur.2021.644317 · Cited by 177
“Finally, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be a precipitating factor for agitation because of the related long-term hospitalization and quarantine (42–44) or the ensuing viral encephalitis, critical illness encephalopathy, and systemic inflammation (45).”
BackgroundThe SARS-CoV-2 and mental health: From biological mechanisms to social consequences
Szcześniak, D. M., Gładka, A., Misiak, B., Cyran, A., & Rymaszewska, J. (2020) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2020.110046 · Cited by 157
Mutiawati, E., Fahriani, M., Mamada, S. S., Fajar, J. K., Frediansyah, A., Maliga, H. A., Ilmawan, M., Emran, T. B., Ophinni, Y., Ichsan, I., et al. (2021) · F1000Research · doi:10.12688/f1000research.28393.1 · Cited by 127
Poloni, T. E., Carlos, A. F., Cairati, M., Cutaia, C., Medici, V., Marelli, E., Ferrari, D., Galli, A., Bognetti, P., Davin, A., et al. (2020) · EClinicalMedicine · doi:10.1016/j.eclinm.2020.100490 · Cited by 124
Ticinesi, A., Cerundolo, N., Parise, A., Nouvenne, A., Prati, B., Guerra, A., Lauretani, F., Maggio, M. G., & Meschi, T. (2020) · Aging Clinical and Experimental Research · doi:10.1007/s40520-020-01699-6 · Cited by 115
Guerrero, J. I., Barragán, L. A., Martínez, J. D., Montoya, J. P., Peña, A., Sobrino, F., Tovar-Spinoza, Z. S., & Ghotme, K. A. (2021) · BMC Infectious Diseases · doi:10.1186/s12879-021-06185-6 · Cited by 112
“Endothelial ACE2 receptors’ use to attach to the cell can initiate a coagulation cascade, potentially predisposing patients to microthrombi, acute clots, and stroke [18, 88].”
BackgroundInfluentialCan SARS-CoV-2 infect the central nervous system via the olfactory bulb or the blood-brain barrier?
Burks, S. M., Rosas-Hernandez, H., Alejandro Ramirez-Lee, M., Cuevas, E., & Talpos, J. C. (2021) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2020.12.031 · Cited by 97
“, 2020), strengthening the concern that immune cells may act as reservoirs of latent SARS-CoV-2 infection (Beach et al., 2020; Troyer et al., 2020).”
Banerjee, D., & Viswanath, B. (2020) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2020.102350 · Cited by 100
Kubota, T., & Kuroda, N. (2020) · Clinical Neurology and Neurosurgery · doi:10.1016/j.clineuro.2020.106349 · Cited by 92
Parkinson’s Disease and the COVID-19 Pandemic
Fearon, C., & Fasano, A. A. (2021) · Journal of Parkinson s Disease · doi:10.3233/jpd-202320 · Cited by 92
“, 2020 [88] Oculomotor Convergent spasm 2 Khoo et al.”
BackgroundInfluentialNeurocovid: Pharmacological Recommendations for Delirium Associated With COVID-19
Baller, E. B., Hogan, C. S., Fusunyan, M. A., Ivkovic, A., Luccarelli, J., Madva, E. N., Nisavic, M., Praschan, N. C., Quijije, N. V., Beach, S. R., et al. (2020) · Psychosomatics · doi:10.1016/j.psym.2020.05.013 · Cited by 93
Pranata, R., Huang, I., Lim, M. A., Yonas, E., Vania, R., & Kuswardhani, R. A. T. (2021) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2021.104388 · Cited by 90
Dementia and COVID-19, a Bidirectional Liaison: Risk Factors, Biomarkers, and Optimal Health Care
Toniolo, S., the Management Group of the EAN Dementia and Cognitive Disorders Scientific Panel, Scarioni, M., Lorenzo, F. D., Hort, J., Georges, J., Tomić, S., Nobili, F. M., & Frederiksen, K. S. (2021) · Journal of Alzheimer s Disease · doi:10.3233/jad-210335 · Cited by 86
Brain dysfunction in COVID‐19 and CAR‐T therapy: cytokine storm‐associated encephalopathy
Pensato, U., Muccioli, L., Cani, I., Janigro, D., Zinzani, P. L., Guarino, M., Cortelli, P., & Bisulli, F. (2021) · Annals of Clinical and Translational Neurology · doi:10.1002/acn3.51348 · Cited by 86
“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
“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
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
“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
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 73
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 71
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
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
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 67
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 62
“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 55
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
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
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 51
“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 51
Kulaga, S. S., & Miller, C. W. T. (2021) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2021.05.008 · Cited by 51
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
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 49
“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
Parker, C., Slan, A. R., Shalev, D., & CRITCHFIELD, A. (2021) · Journal of Psychiatric Practice · doi:10.1097/pra.0000000000000533 · Cited by 40
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 45
Hamm, B., & Rosenthal, L. J. (2020) · Psychosomatics · doi:10.1016/j.psym.2020.06.022 · Cited by 40
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
“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 38
“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 34
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 31
Riordan, P., Stika, M. M., Goldberg, J., & Drzewiecki, M. (2020) · The Clinical Neuropsychologist · doi:10.1080/13854046.2020.1810325 · Cited by 34
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
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 32
“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
“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 28
“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
“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
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 25
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
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 27
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 22
“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 19
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 20
“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
Tirado, J. D. V., Trzepacz, P. T., & Franco, J. G. (2021) · Journal of Neuropsychiatry · doi:10.1176/appi.neuropsych.20100251 · Cited by 19
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
“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
“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
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
“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 20
“[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
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
“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
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
“[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
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
“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
“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
“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
“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 17
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
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
“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
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
Sharma, S., Jagadeesh, H., Saxena, A., Chakravarthy, H., & Devanathan, V. (2021) · Journal of Biosciences · doi:10.1007/s12038-021-00232-9 · Cited by 11
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
“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
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
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 11
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
“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
“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
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
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
“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
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
“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
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
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
“[85] Beach SR, Praschan NC, Hogan C, et al.”
Metadata
- 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 › Clinical 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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