Delirium Can Signal Presence of COVID-19 in Asymptomatic Older Patients

November 20, 2020

A study published in JAMA Network Open supports evidence that older persons admitted to emergency departments (ED), and subsequently test positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), often present with delirium when they show no other typical coronavirus disease 2019 (COVID-19) symptoms, such as fever and cough.

“In this cohort study of 817 older patients with COVID-19, 28% had delirium at presentation, and delirium was the sixth most common of all presenting symptoms and signs,” wrote Sharon K. Inouye, MD, Hebrew SeniorLife, and Harvard Medical School, Boston Massachusetts, and colleagues. “Among delirious patients, 16% presented with delirium as a primary symptom and 37% had no typical COVID-19 symptoms or signs, such as cough or fever.”

All patients were aged 65 years and older and had presented to emergency departments across 7 sites in the United States on or after March 13, 2020, and subsequently tested positive for SARS-CoV-2 by nasal swab (99% of cases) or classic radiological findings (1%).

These findings suggest the clinical importance of including delirium on checklists of presenting signs and symptoms of COVID-19 that guide screening, testing, and evaluation.

“This study demonstrates that delirium is not only a common symptom of COVID-19, but also may be the leading and possibly sole symptom in older persons,” said Dr. Inouye. “Thus, delirium should be considered an important presenting symptom of COVID-19.”

Of the patients, 386 (47%) were male, 493 (62%) were White, 215 (27%) were Black, and 54 (7%) were Latino. The mean age of the patients was 77.7 years.

Factors associated with delirium were age older than 75 years (adjusted relative risk [aRR] = 1.51; 95% confidence interval [CI], 1.17-1.95), living in a nursing home or assisted living (aRR = 1.23; 95% CI, 0.98-1.55), prior use of psychoactive medication (aRR = 1.42; 95% CI, 1.11-1.81), vision impairment (aRR = 1.98; 95% CI, 1.54-2.54), hearing impairment (aRR = 1.10; 95% CI 0.78-1.55), stroke (aRR = 1.47; 95% CI, 1.15-1.88), and Parkinson disease (aRR = 1.88; 95% CI, 1.30-2.58).

Delirium was associated with intensive care unit stay (aRR = 1.67; 95% CI, 1.30-2.15) and death (aRR = 1.24; 95% CI, 1.00-1.55).

Reference: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2773106

SOURCE: Hebrew SeniorLife