Functional and cognitive outcomes after COVID-19 delirium
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BRIEF REPORT
Functional and cognitive outcomes after COVID‑19 delirium Benjamin C. Mcloughlin1 · Amy Miles1 · Thomas E. Webb1 · Paul Knopp1 · Clodagh Eyres1 · Ambra Fabbri1 · Fiona Humphries1 · Daniel Davis1,2 Received: 27 May 2020 / Accepted: 2 July 2020 © The Author(s) 2020
Key summary points Aim To investigate functional and cognitive outcomes among patients with delirium in COVID-19. Findings Delirium in COVID-19 was prevalent (42%), but only a minority had been recognised by the clinical team. At 4-week follow-up, delirium was significantly associated with worse functional outcomes, independent of pre-morbid frailty. Cognitive outcomes were not appreciably worse. Message The presence of delirium is a significant factor in predicting worse functional outcomes in patients with COVID-19. Abstract Purpose To ascertain delirium prevalence and outcomes in COVID-19. Methods We conducted a point-prevalence study in a cohort of COVID-19 inpatients at University College Hospital. Delirium was defined by DSM-IV criteria. The primary outcome was all-cause mortality at 4 weeks; secondary outcomes were physical and cognitive function. Results In 71 patients (mean age 61, 75% men), 31 (42%) had delirium, of which only 12 (39%) had been recognised by the clinical team. At 4 weeks, 20 (28%) had died, 26 (36%) were interviewed by telephone and 21 (30%) remained as inpatients. Physical function was substantially worse in people after delirium − 50 out of 166 points (95% CI − 83 to − 17, p = 0.01). Mean cognitive scores at follow-up were similar and delirium was not associated with mortality in this sample. Conclusions Our findings indicate that delirium is common, yet under-recognised. Delirium is associated with functional impairments in the medium term. Keywords COVID-19 · Delirium · Telephone interview for cognitive status · Barthel Index · Nottingham extended activities of daily living
Introduction Delirium is one of the most common acute disorders in general hospitals, affecting around 25% of older patients [1]. Delirium is closely linked with adverse outcomes, including Electronic supplementary material The online version of this article (https://doi.org/10.1007/s41999-020-00353-8) contains supplementary material, which is available to authorized users. * Daniel Davis [email protected] 1
Department of Medicine for the Elderly, University College London Hospitals NHS Foundation Trust, London, UK
Department of Population Science and Experimental Medicine, MRC Unit for Lifelong Health and Ageing at UCL, 1‑19 Torrington Place, London WC1E 7HB, UK
2
higher mortality, increased length of stay, long-term cognitive and functional decline, and risk of institutionalisation [2, 3]. Many screening instruments are available and the 4AT is the one best established within the UK National Health Service [4, 5]. Missed diagnoses may contribute to the excess mortality observed [6, 7], making systematic detection of delirium essential in any setting, no less so in the context of COVID-19 infection. To d
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