More than a year into the COVID-19 pandemic, researchers are revealing the many devastating consequences that patients can face both during and after hospitalization.
In a recent study published in BMJ Open, researchers found among nearly 150 patients hospitalized for COVID at the beginning of the pandemic, 73% had delirium, a serious disturbance in mental state wherein a patient is confused, agitated and unable to think clearly.
Patients with delirium tended to be sicker, with more comorbidities like hypertension and diabetes and appeared to have more severe COVID-related illness as well.
The study is from Michigan Medicine. One author is Phillip Vlisides, M.D.
In the study, the team used patient medical records and telephone surveys following hospital discharge for a group of patients hospitalized in the intensive care unit between March and May 2020.
COVID-19 can lead to reduced oxygen to the brain as well as the development of blood clots and stroke, resulting in cognitive impairment.
In addition, inflammatory markers were greatly increased in patients with delirium. Confusion and agitation could be a result of inflammation of the brain.
Adding insult to injury, care teams often were unable to perform standard delirium reduction techniques, such as exercises designed to get a patient moving or allowing visitors or objects from home to orient patients while in the hospital.
Furthermore, there was a correlation between the use of sedatives and delirium—patients with delirium were sedated more often and frequently at higher doses.
The team found that patients with severe COVID were inherently more delirious and agitated at baseline, perhaps prompting more sedative use.
The study also found that cognitive impairment can persist even after discharge. Almost a third of patients did not have their delirium marked as resolved in their chart upon leaving the hospital and 40% of these patients required skilled nursing care.
Almost a quarter of patients screened positive for delirium based on the assessment by their caretaker. For some patients, these symptoms lasted for months.
This can make managing the recovery process after hospitalization that much more difficult.
The team says whatever creative ways doctors can implement delirium prevention protocols is likely to be very helpful.
That includes consistent communication with family members, bringing in pictures and objects from home, and video visits if a family cannot safely visit.
And for family and other caregivers struggling to care for loved ones, the team urges them to get help from their primary care physician as soon as possible.
The take-home message is that for patients hospitalized with severe COVID-19, cognitive impairment—including depression and delirium—is highly likely.
If you care about cognitive decline, please read studies about scientists solve a big puzzle of Alzheimer’s disease and findings of this eye test could show your risk of Alzheimer’s disease.
For more information about dementia, please see recent studies about a cause of dementia in some people and results showing that unstable blood pressure may mean big dementia risk.
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