Incidence and Long-term Functional Outcome of Neurologic Disorders in Hospitalized Patients With COVID-19 Infected With Pre-Omicron Variants

Neurology, Journal Year: 2023, Volume and Issue: 101(9)

Published: July 6, 2023

Background and Objective

A variety of neurological disorders has been reported as presentations or complications COVID-19 infection. The objective this study was to determine their incidence dynamics long-term functional outcome.

Methods

Neuro-COVID Italy a multicentre, observational, cohort with ambispective recruitment prospective follow-up. Consecutive hospitalized patients presenting new associated infection (neuro-COVID), independently from respiratory severity, were systematically screened actively recruited by neurology specialists in 38 centers the Republic San Marino. primary outcomes neuro-COVID cases during first 70 weeks pandemic (March 2020 June 2021) outcome at 6 months, categorized full recovery, mild symptoms, disabling symptoms death.

Results

Among 52759 COVID patients, 1865 2881 (neuro-COVID) recruited. Incidence significantly declined over time, comparing three waves (8.4%, 95% CI [7.9, 8.9]; 5.0%, [4.7, 5.3]; 3.3%, [3.0, 3.6], respectively; p = 0.027). most frequent acute encephalopathy (25.2%), hyposmia-hypogeusia (20.2%), ischemic stroke (18.4%) cognitive impairment (13.7%). onset more common prodromic phase (44.3%) illness (40.9%), except for whose prevailed recovery (48.4%). good achieved majority (64.6%) follow-up (median 6.7 months) proportion increased throughout period (r 0.29, [0.05, 0.50]; 0.019). Mild residual frequently (28.1%), while only survivors (47.6%).

Discussion

COVID-associated neurologic decreased pre-vaccination pandemic. Long-term favourable disorders, although commonly lasted months after

Language: Английский

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Delirium is frequently underdiagnosed among older hospitalised patients despite available information in hospital medical records

Age and Ageing, Journal Year: 2024, Volume and Issue: 53(2)

Published: Feb. 1, 2024

Abstract Background In-hospital delirium is associated with adverse outcomes and underdiagnosed, limiting research clinical follow-up. Objective To compare the incidence of in-hospital determined by chart-based review electronic medical records (D-CBR) discharge diagnoses (D-DD). Furthermore, to identify differences in symptoms, treatments triggers between D-CBR D-DD. Method The community-based cohort included 2,115 participants Hordaland Health Study born 1925 1927. Between 2018 2022, we retrospectively reviewed hospital from baseline (1997–99) until death prior 2023. D-DD were validated using Diagnostic Statistical Manual Mental Disorders, Fifth Edition, criteria for delirium. Results Of participants, 638 had rate (IR) was 29.8 [95% confidence interval 28, 32] per 1,000 person-years, whereas IR 3.4 [2.8, 4.2]. ratio 9.14 (P < 0.001). Patients who received pharmacological treatment (n = 121, odds (OR) 3.4, [2.1, 5.4], P 0.001), affected acute memory impairment 149, OR 2.8, [1.8, 4.5], or change perception 137, 2.9, 4.6] 0.001) higher In contrast, post-operative cases (OR 0.2, [0.1, 0.4], lower Conclusion Underdiagnosis a major issue our study, especially less severe cases. Our findings emphasise need integrating systematic diagnostics documentation into admission routines.

Language: Английский

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Delirium‐related psychiatric and neurocognitive impairment and the association with post‐intensive care syndrome—A narrative review

Acta Psychiatrica Scandinavica, Journal Year: 2023, Volume and Issue: 147(5), P. 460 - 474

Published: Feb. 6, 2023

Delirium is common among patients admitted to the intensive care unit (ICU) and its impact on neurocognitive psychiatric state of survivors great interest. These new-onset or worsening conditions, together with physical alterations, are called post-intensive syndrome (PICS). Our aim update latest screening follow-up options for psychological cognitive sequelae PICS.This narrative review discusses occurrence delirium in ICU settings relatively new concept PICS. Psychiatric morbidities that may occur critical illness following addressed. Future perspectives practice research discussed.There no "gold standard" diagnosing ICU, but two extensively validated tools, confusion assessment method checklist, often used. PICS complaints frequent who have suffered been recognized as an important public health socio-economic problem worldwide. Depression, anxiety, post-traumatic stress disorder, long-term impairment recurrently exhibited. Screening tools these deficits discussed, well suggestion early after discharge at 3 12 months.Delirium a complex phenomenon risk factor Its diagnosis challenging potential adverse outcomes, including difficulties. The implementation protocols warranted ensure detection appropriate management.

Language: Английский

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Delirium is under-reported in discharge summaries and in hospital administrative systems: a systematic review

Delirium, Journal Year: 2023, Volume and Issue: unknown

Published: May 15, 2023

Accurate recording of delirium in discharge summaries (DS) and hospital administrative systems (HAS) is critical for patient care.

Language: Английский

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Risk Factors and 120-Day Functional Outcomes of Delirium After Hip Fracture Surgery: A Prospective Cohort Study Using the UK National Hip Fracture Database (NHFD)

Journal of the American Medical Directors Association, Journal Year: 2023, Volume and Issue: 24(5), P. 694 - 701.e7

Published: March 15, 2023

Language: Английский

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Small vessel disease contributions to acute delirium: a pilot feasibility MRI study

Age and Ageing, Journal Year: 2025, Volume and Issue: 54(4)

Published: March 28, 2025

Abstract Background and aims Delirium carries an eight-fold risk of future dementia. Small vessel disease (SVD), best seen on magnetic resonance imaging (MRI), increases delirium risk, yet is understudied in MRI research. We aimed to determine feasibility, tolerability, image usability prevalence SVD lesions delirium. Methods This case–control feasibility study performed (3D T1/T2-weighted), fluid-attenuated inversion recovery, susceptibility-weighted diffusion-weighted (DWI) 20 medical inpatients >65 years: 10 with ≥3 weeks without delirium, matched for vascular Clinical Frailty Scale (CFS) cognition. excluded acute stroke, agitation necessitating sedation, mobility assistance >2 contraindications. measured scan duration, usability, infarcts features. Six months later, we recorded CFS cognitive diagnoses. Results Mean age was 83.5 years (delirium 78.7 vs non-delirium 88.4); 13/20 were female; 17/20 had premorbid decline/impairment or Acquisition took mean 26.8 min. well tolerated 16/20 (7/10 arm; 9/10 arm). Also, 4/20 early termination, but 20/20 clinically interpretable images. detected DWI-hyperintense 3/10 (30%) (2/10 small subcortical 1/10 cortical) subcortical; cortical). white matter hyperintensity Fazekas score 6 versus 4.5 without. Conclusions feasible, usable tolerable one-third all participants, regardless status. indicates contributions, including SVD, both delirium- non-delirium–related presentations, supporting the need larger studies.

Language: Английский

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Developing a set of emergency department performance measures to evaluate delirium care quality for older adults: a modified e-Delphi study

BMC Emergency Medicine, Journal Year: 2024, Volume and Issue: 24(1)

Published: Feb. 15, 2024

Abstract Background Older adults are at high risk of developing delirium in the emergency department (ED); however, it is under-recognized routine clinical care. Lack detection and treatment associated with poor outcomes, such as mortality. Performance measures (PMs) needed to identify variations quality care help guide improvement strategies. The purpose this study gain consensus on a set statements PMs that can be used evaluate for older ED patients. Methods A 3-round modified e-Delphi was conducted experts. In each round, participants rated according concepts importance actionability, then their concept necessity (1–9 Likert scales), ability comment each. Consensus stability were evaluated using priori criteria descriptive statistics. Qualitative data examined themes within across PMs, which went through participant validation exercise final round. Results Twenty-two experts participated, 95.5% from west or central Canada. From 10 24 achieved six 22 PMs. supported justification including three one PM slightly below criteria. Three overarching emerged qualitative related statement actionability. Nine statements, nine structure 14 process included set, addressing four areas care: screening, diagnosis, reduction management. Conclusion provide important, actionable, necessary diverse group To our knowledge, first known develop de novo guideline-based receive setting.

Language: Английский

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Extremes of baseline cognitive function determine the severity of delirium: a population study

Brain, Journal Year: 2023, Volume and Issue: 146(5), P. 2132 - 2141

Published: Feb. 28, 2023

Although delirium is a significant clinical and public health problem, little understood about how specific vulnerabilities underlie the severity of its presentation. Our objective was to quantify relationship between baseline cognition subsequent severity. We prospectively investigated population-representative sample 1510 individuals aged ≥70 years, whom 209 (13.6%) were hospitalized across 371 episodes (1999 person-days assessment). Baseline cognitive function assessed using modified Telephone Interview for Cognitive Status, supplemented by verbal fluency measures. estimated [Memorial Delirium Assessment Scale (MDAS)] abnormal arousal (Observational Level Arousal), adjusted age, sex, frailty illness conducted further analyses examining presentations hospital settings common precipitating aetiologies. The median time from assessment admission 289 days (interquartile range 130 47 days). In admitted patients, present on at least 1 day in 45% episodes. average number with (consecutively positive assessments) 3.9 days. Elective admissions accounted 88 bed (4.4%). emergency (but not elective) admissions, we found non-linear U-shaped global restricted cubic splines. Participants 2 standard deviations below (z-score = -2) had mean MDAS score 14 points (95% CI 10 19). Similarly, those z-score + 7.9 4.9 11). Individuals lowest scores. association followed comparable pattern. C-reactive protein ≥20 mg/l serum sodium <125 mM/l associated more severe delirium. critical determinant changes arousal. Emergency highest who develop should receive enhanced attention.

Language: Английский

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Associations of sex, Alzheimer's disease and related dementias, and days alive and at home among older Medicare beneficiaries recovering from hip fracture

Journal of the American Geriatrics Society, Journal Year: 2023, Volume and Issue: 71(10), P. 3134 - 3142

Published: July 4, 2023

Abstract Background Males constitute 25% of older adults who experience hip fractures in the United States; a concerning upward trend given poorer health and outcomes among male survivors. Male sex is associated with worse cognitive performance after fracture, impacting participation rehabilitation long‐term especially for those Alzheimer's disease or related dementias (ADRD). However, little research has evaluated whether differences post‐fracture recovery are greater living ADRD. Methods Data were drawn from 2010 to 2017 Medicare fee‐for‐service beneficiaries aged 65 years survived hospitalization fracture ( n = 69,581). The primary outcome was days alive at home (DAAH), validated patient‐centered claims‐based calculated as 365 minus hospital, nursing home, facility, emergency department, time death. Multivariable Poisson regressions an interaction term between ADRD status model association DAAH 12 months post adjusting demographics, injury severity, chronic burden, hospital‐level fixed effects. Results Compared females, males younger had more comorbidities fracture. Among survivors, spent mean 160.7 compared 228.4 without ADRD, 177.8 females 248.0 In adjusted analyses, 8.2% fewer (rate ratio [RR] 0.92, 95% CI 0.92–0.92). This relative difference increased significantly when comparing spending additional 3.3% (interaction RR 0.96, 0.96–0.97). Conclusions spend than this increases modestly females. suggests that impairment may be small but significant contributor sex‐based observed during recovery.

Language: Английский

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Postoperative delirium: more risk scores or more action?

Age and Ageing, Journal Year: 2024, Volume and Issue: 53(5)

Published: May 1, 2024

Language: Английский

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