Altered mental status as a novel initial clinical presentation for COVID-19 infection in the elderly
Open accessAbstract
The coronavirus disease of 2019 or COVID-19 was first identified in Hubei Province in China in November of 2019 and quickly spread to become a global pandemic. The virus, SARS-Coronavirus-2, is particularly virulent in the elderly who can develop symptoms and become mortally ill within days of contracting the virus. The virus is easily transmitted by droplets (e.g., sneezing and coughing) and communal living settings such as personal care homes can be vulnerable to the spread of the virus. Identifying patients early in the disease process is important to providing appropriate medical interventions. To date, most of the medical literature, including Center for Disease Control guidelines, has relied on three necessary symptoms in making the diagnosis of COVID-19: fever, cough, and shortness of breath. We present four cases of elderly patients who developed altered mental status as their presenting symptom without associated fever or respiratory symptoms.
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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 [20]
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 [20]
In 2 cases of severe delirium, disorientation and loss of appetite were also reported.
“In 2 cases of severe delirium, disorientation and loss of appetite were also reported (20).”
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 [20]
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 [20]
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References 17 · Cited by 54
Research works printed but not linked: 1
- [3]Team C.C.-R. Severe outcomes among patients with coronavirus disease 2019 (COVID-19) — United States MMWR Morb Mortal Wkly Rep 2020 PMC7725513 32214079
- Authors
- Ward, C. F., Figiel, G. S., & McDonald, W. M.
- Affiliations
- Emory University (US)
- Corresponding author
- McDonald, William M.
- ORCID
- McDonald, William M.
- Venue
- The American Journal of Geriatric Psychiatry
- Publisher
- Elsevier BV
- Published
- 2020-08
- Volume
- 28
- Issue
- 8
- Pages
- 808-811
- ISSN
- 1064-7481 (ISSN-L)
- PMC
- PMC7227566
- OpenAlex
- W3024188296
- Cited by
- 54
- References
- 17
- Citations by year
- 2025: 2 · 2024: 1 · 2023: 7 · 2022: 7 · 2021: 22 · 2020: 15
- FWCI
- 1.67
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- American Journal of Geriatric Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Keywords
- COVID-19 pandemic, SARS-CoV-2, altered mental status, elderly patients, atypical presentation, non-respiratory symptoms, early diagnosis, geriatric psychiatry, long COVID
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, Aged, 80 and over, Mental Disorders, Female, Humans, Male, Pneumonia, Viral, Coronavirus Infections, Early Diagnosis, Pandemics
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