Delirium very common among severe COVID-19 cases

ANN ARBOR, Mich. — Delirium is a serious disturbance in one’s mental state with symptoms including confusion, agitation, and the inability to think clearly. Now, a new study reveals it’s becoming a troublingly common condition among hospitalized patients with a severe case of COVID-19. University of Michigan researchers report that among 150 people hospitalized for COVID-19, 73 percent had delirium.

The research also concludes that COVID-19 patients with delirium tend to be sicker, have more intense COVID-19-related symptoms, and deal with more pre-existing conditions such as high blood pressure or diabetes.

“COVID is also associated with a number of other adverse outcomes that tend to prolong hospitalization and make recovery difficult,” notes study author Phillip Vlisides, M.D., of the Department of Anesthesiology at Michigan Medicine, in a university release.

Several factors may be causing delirium

The patients in this study entered the hospital during the early days of the pandemic, between March and May 2020. After leaving the hospital, study authors kept tabs on the patients’ health via medical records and telephone surveys. The team looked to identify any common patterns or similarities among patients with delirium.

The researchers can’t say for certain what’s causing delirium in so many COVID-19 patients, but explain that multiple factors are likely at play. To start, studies show COVID-19 can reduce the flow of oxygen to the brain, which can result in cognitive issues. Also, patients dealing with delirium showed much higher levels of inflammation. So, the confusion and agitation seen in so many patients may be the result of inflammation in the brain.

The infectious nature of COVID-19 also made it difficult for doctors to adequately treat delirium among the patient group. Usually, doctors treat delirium using guided exercise or exposing the patient to familiar objects or people in their lives.

“Early on in the pandemic, we weren’t performing standard delirium prevention protocols like we usually do. A big reason for that is early on in the pandemic in the pre-vaccine era, we had limited personal protective equipment and were trying to limit COVID exposure and disease transmission,” Dr. Vlisides explains.

Notably, the team also recorded a connection between delirium and the use of sedatives as well. Physicians also had to sedate COVID-19 patients with delirium more often and with higher doses.

“It is common to use IV sedatives in the ICU, particular for patients on a ventilator. However, from talking to nurses, we found that patients with severe COVID were inherently more delirious and agitated at baseline, perhaps prompting more sedative use,” Dr. Vlisides comments.

Long COVID may also mean long delirium

Troublingly, cognitive issues lingered in many COVID-19 patients with delirium even after leaving the hospital. Close to a third of patients did not have their delirium marked down as resolved at the time of their discharge and 40 percent needed further nursing care at home following their release. Similarly, close to a quarter of patients still displayed signs of delirium, according to their home caregiver, and some remained in such a state for months.

“A family member who is confused has limited ability to care for themselves and will require additional care taking support, which is certainly a big challenge,” Dr. Vlisides continues. “Whatever creative ways we 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 family cannot safely visit.”

If a family member is struggling to adequately care for a loved one at home following hospitalization for COVID-19, study authors stress the importance of reaching out to their primary care physician for help as soon as possible. Ultimately, Dr. Vlisides concludes that this work strongly suggests that cognitive issues are highly likely for patients with severe COVID-19 symptoms.

“Overall, this study highlights another reason why getting vaccinated and preventing severe illness is so important. There can be long term neurological complications that perhaps we don’t talk about as much as we should,” he concludes.

The findings appear in the journal BMJ Open.