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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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“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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“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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Cited by
Sorted by citations
Guillain Barre syndrome associated with COVID-19 infection: A case report
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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
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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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