July 31, 2020

Confusion as the Presenting Symptom of COVID-19 in Elderly Patients
Matthew E. Peters, MD reviewing Ward CF et al. Am J Geriatr Psychiatry 2020 Aug

A case series of four patients who did not have early symptoms of fever, cough, or shortness of breath

Elderly individuals with chronic medical conditions are at particular risk for COVID-19, intensive care unit admission, and death. The authors of this single-site case series describe four elderly patients (mean age, 83; 3 women) diagnosed with COVID-19 whose initial symptom was altered mental status (AMS) and not fever, cough, or respiratory distress.

All patients had chronic medical conditions and dementia and were living in a communal setting. They were each transferred to an emergency department following onset of AMS, where they tested positive for SARS-CoV-2. Chest x-rays were positive for pneumonia in all four patients. At the time that the authors wrote, two patients were admitted to hospice, and the other two remained dependent on oxygen.

COMMENT
At times, individuals with dementia cannot sufficiently communicate symptoms, pains, or complaints. Given the communal nature (e.g., nursing homes, locked memory units) in which many individuals with dementia live, early identification of COVID-19 is essential. Currently, SARS-CoV-2 infection should be considered in all patients with dementia who present with new-onset AMS.

The authors also discuss the potential neuroinvasive nature of COVID-19. Hypotheses include neuroinflammation, an autoimmune response, and synapse-connected spread from the lungs to the medullary cardiorespiratory center. I also note that the autoimmune hypothesis is further fueled by the multisystem inflammatory syndrome, which is associated with inflammation in multiple organ systems in children with COVID-19. Larger sample sizes and longer postexposure follow-ups will help illuminate these more complicated COVID-19–related syndromes.

EDITOR DISCLOSURES AT TIME OF PUBLICATION
Disclosures for Matthew E. Peters, MD at time of publication
Consultant/Advisory Board   emvitals, Inc.
Equity   Rose: Smarter Mental Health
Grant/Research Support   Department of Defense, National Institute on Aging
CITATION(S):
Ward CF et al. Altered mental status as a novel initial clinical presentation for COVID-19 infection in the elderly. Am J Geriatr Psychiatry 2020 Aug; 28:808. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος