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Delirium Is a Common Consequence of Severe COVID-19 – Cognitive Impairment Could Be Lasting

After more than a year of investigation into the COVID-19 pandemic, researchers are beginning to uncover the numerous and potentially devastating consequences that patients can experience both during and after hospitalisation.

A new study of nearly 150 COVID patients admitted to the hospital at the start of the pandemic discovered that 73 percent of them had delirium, a serious disturbance in mental state in which a patient is confused, agitated, and unable to think clearly.

Those suffering from delirium tended to be sicker, with more comorbid conditions such as hypertension and diabetes, and they also appeared to be suffering from more severe COVID-related illness, according to study author Phillip Vlisides, M.D., of the Department of Anesthesiology at the University of Michigan.

The researcher went on to say that COVID is associated with a number of other negative outcomes that tend to prolong hospitalization and make recovery more difficult.

An attempt was made by the research team to identify common threads among patients who developed delirium between March and May 2020, based on patient medical records and telephone surveys conducted after hospital discharge for a group of patients who were admitted to the intensive care unit between March and May 2020. According to Vlisides, a number of factors are at play.

The disease itself can result in decreased oxygenation of the brain, as well as the development of blood clots and stroke, all of which can result in cognitive impairment. In addition, inflammatory markers were found to be significantly elevated in patients suffering from delirium. An inflammatory response in the brain may manifest itself as confusion and agitation.

In addition, care teams were frequently unable to perform standard delirium reduction techniques, such as exercises designed to get a patient moving or allowing visitors or objects from the patient's home to orient them while in the hospital.

"Early on in the pandemic, we weren't following standard delirium prevention protocols in the way that we normally would," Vlisides explained. The fact that we had limited personal protective equipment and were attempting to limit COVID exposure and disease transmission was a significant factor in this."

Patients with delirium were sedated more frequently and frequently at higher doses, which was found to be associated with the use of sedatives in the study as well. "IV sedatives are commonly used in the intensive care unit, particularly for patients who are on a ventilator." However, after speaking with nurses, we discovered that patients with severe COVID were inherently more delirious and agitated at the outset, which may have resulted in the use of more sedatives."

The researchers also discovered that cognitive impairment can persist even after a patient has been discharged. Almost a third of patients did not have their delirium marked as resolved in their chart when they were discharged from the hospital, and 40 percent of these patients required skilled nursing care after discharge. According to the caretaker's assessment, nearly a quarter of the patients tested positive for delirium. Some patients experienced these symptoms for several months. The management of the recovery process following hospitalization can be made even more difficult in this situation.

"A family member who is confused will have limited ability to care for themselves and will require additional caretaking support, which will undoubtedly be a significant undertaking."

Care teams are doing the best they can with the resources they have, and Vlisides acknowledges that this is especially true as hospitals continue to fill with patients suffering from COVID.

"Any innovative approaches we can come up with to implement delirium prevention protocols are likely to be very beneficial," he said. "This includes maintaining consistent communication with family members, bringing in pictures and objects from home, and video visits if family members are unable to physically visit."

And he encourages family members and other caregivers who are having difficulty caring for loved ones to seek assistance from their primary care physician as soon as possible.

The take-home message is that cognitive impairment, including depression and delirium, is highly likely in patients admitted to the hospital with severe COVID-19, according to the researchers.

"Overall, this study demonstrates yet another reason why getting vaccinated and avoiding severe illness is so critical. We don't talk about long-term neurological complications as much as we should, and this is something we should do more of."

Additionally, Jacqueline Ragheb, Amy McKinney, Mackenzie Zierau, Joseph Brooks and Maria Hill-Caruthers contributed to the study as well as Mina Iskander and Yusuf Ahmed. Graciela Mentz was also one of the study's authors, along with Amy McKinney and Joseph Brooks.

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