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Gray MC, Traube C, Sewell TB, Geneslaw AS. Delirium Associated with COVID-19 in Critically ill Children: An Observational Cohort Study. J Intensive Care Med 2024; 39:1002-1011. [PMID: 38689485 DOI: 10.1177/08850666241249169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
OBJECTIVE Delirium is an under-recognized problem in critically ill children. Although delirium is common in adults hospitalized with COVID-19, the relationship between pediatric COVID-19 and delirium has not been described. To address this gap, we characterized delirium in critically ill children with different manifestations of COVID-19 and investigated associations among demographic, disease, and treatment factors. We hypothesized that multisystem inflammatory syndrome in children (MIS-C) would be associated with a higher incidence of delirium given its underlying pathophysiology of hyperinflammation. DESIGN Retrospective, single-center cohort study. SETTING Quaternary-care pediatric intensive care unit (PICU). PATIENTS Children less than 18 years of age hospitalized in the PICU between March 2020 and March 2023 with either active SARS-CoV-2 infection or serological evidence of prior infection. MEASUREMENTS AND MAIN RESULTS The cohort included 149 PICU hospitalizations among children with evidence of COVID-19. Patients were categorized by reason for PICU admission: 75 (50%) for COVID-19 respiratory disease, 36 (24%) MIS-C, and 38 (26%) any other primary reason with positive COVID-19 testing. Delirium was diagnosed in 43 (29%) patients. Delirium incidence was highest in patients requiring invasive mechanical ventilation (IMV) (56% vs 7.5% in patients who did not require IMV, p < .001). Patients who were exposed to opioids, dexmedetomidine, paralytics or benzodiazepines more frequently experienced delirium compared to those unexposed (p < .001, p < .001, p < .001 and p = .001, respectively). After multivariable adjustment, delirium was associated with IMV (HR 3 [95% CI 1.5-5.7]), female sex (HR 2.4 [1.2-4.7]), and developmental disability (HR 3.4 [95% CI 1-11.1]). There was no association between delirium and reason for PICU hospitalization. CONCLUSIONS Delirium was common among children hospitalized with COVID-19. The overall incidence was much less than has been reported in adults with COVID-19. Delirium reduction efforts should focus on children with developmental disability and minimizing ongoing risks during IMV.
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Affiliation(s)
- Meghan C Gray
- Division of Pediatric Critical Care & Hospital Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Chani Traube
- Division of Pediatric Critical Care Medicine, New York-Presbyterian Weill Cornell Medical College, New York, NY, USA
| | - Taylor B Sewell
- Division of Pediatric Critical Care & Hospital Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Andrew S Geneslaw
- Division of Pediatric Critical Care & Hospital Medicine, Columbia University Irving Medical Center, New York, NY, USA
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Schallom M, Tymkew H, Taylor B, Prentice D, Vyers K, Duensing E, Brougham N, Licare J, Arroyo C. Changes in Interprofessional Practice During the COVID-19 Pandemic and the Effect on Patient Outcomes: A Retrospective Observational Study. Dimens Crit Care Nurs 2024; 43:184-193. [PMID: 38787773 DOI: 10.1097/dcc.0000000000000646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Changes in healthcare delivery were required during the first year of the COVID-19 pandemic. OBJECTIVE The purpose of this study was to determine the impact of the approach to care of the COVID-19 patient on nursing sensitive indicators and nutrition therapy and the utilization of rehabilitation services during the first year of the pandemic in the acute care setting. METHOD A retrospective study of 894 patients admitted with a COVID-19 diagnosis was conducted between March 2020 and February 2021 in 3-month cohorts. All charts were reviewed for general demographics and hospital data, nursing quality indicators, and nutritional and rehabilitation services for the first 30 days of admission. RESULTS Differences in patient characteristics were noted among the cohorts. Variations were observed between time points in hospital-acquired pressure injury occurrence, with mechanical ventilation and proning being independent predictors of hospital-acquired pressure injuries. There were differences noted in the percentage of patients with a central line-associated bloodstream infection among the time points (P < .001), but there were no differences noted in catheter-associated urinary tract infections (P = .20). Overall, 15.5% had a malnutrition diagnosis, with most patients receiving 50% of prescribed calorie and protein needs. Rehabilitation services increased over time with these services being initiated earlier in the later cohorts (P < .001). DISCUSSION The results of this study demonstrated the impact of the pandemic on outcomes in the areas of nursing, nutrition, and rehabilitation, which varied across quarterly cohorts as we learned and developed new practices and adapted to a novel pandemic.
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Viegas A, Araújo R, Ramalhete L, Von Rekowski C, Fonseca TAH, Bento L, Calado CRC. Discovery of Delirium Biomarkers through Minimally Invasive Serum Molecular Fingerprinting. Metabolites 2024; 14:301. [PMID: 38921436 PMCID: PMC11205956 DOI: 10.3390/metabo14060301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/21/2024] [Accepted: 05/24/2024] [Indexed: 06/27/2024] Open
Abstract
Delirium presents a significant clinical challenge, primarily due to its profound impact on patient outcomes and the limitations of the current diagnostic methods, which are largely subjective. During the COVID-19 pandemic, this challenge was intensified as the frequency of delirium assessments decreased in Intensive Care Units (ICUs), even as the prevalence of delirium among critically ill patients increased. The present study evaluated how the serum molecular fingerprint, as acquired by Fourier-Transform InfraRed (FTIR) spectroscopy, can enable the development of predictive models for delirium. A preliminary univariate analysis of serum FTIR spectra indicated significantly different bands between 26 ICU patients with delirium and 26 patients without, all of whom were admitted with COVID-19. However, these bands resulted in a poorly performing Naïve-Bayes predictive model. Considering the use of a Fast-Correlation-Based Filter for feature selection, it was possible to define a new set of spectral bands with a wider coverage of molecular functional groups. These bands ensured an excellent Naïve-Bayes predictive model, with an AUC, a sensitivity, and a specificity all exceeding 0.92. These spectral bands, acquired through a minimally invasive analysis and obtained rapidly, economically, and in a high-throughput mode, therefore offer significant potential for managing delirium in critically ill patients.
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Affiliation(s)
- Ana Viegas
- ESTeSL—Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Avenida D. João II, Lote 4.58.01, 1990-096 Lisbon, Portugal;
- Neurosciences Area, Clinical Neurophysiology Unit, ULSSJ—Unidade Local de Saúde São José, Rua José António Serrano, 1150-199 Lisbon, Portugal
- CHRC—Comprehensive Health Research Centre, Universidade NOVA de Lisboa, 1150-082 Lisbon, Portugal; (R.A.)
- NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal
| | - Rúben Araújo
- CHRC—Comprehensive Health Research Centre, Universidade NOVA de Lisboa, 1150-082 Lisbon, Portugal; (R.A.)
- NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal
- ISEL—Instituto Superior de Engenharia de Lisboa, Instituto Politécnico de Lisboa, R. Conselheiro Emídio Navarro 1, 1959-007 Lisbon, Portugal
| | - Luís Ramalhete
- NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal
- Blood and Transplantation Center of Lisbon, Instituto Português do Sangue e da Transplantação, Alameda das Linhas de Torres, n° 117, 1769-001 Lisboa, Portugal
- iNOVA4Health—Advancing Precision Medicine, RG11: Reno-Vascular Diseases Group, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal
| | - Cristiana Von Rekowski
- CHRC—Comprehensive Health Research Centre, Universidade NOVA de Lisboa, 1150-082 Lisbon, Portugal; (R.A.)
- NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal
- ISEL—Instituto Superior de Engenharia de Lisboa, Instituto Politécnico de Lisboa, R. Conselheiro Emídio Navarro 1, 1959-007 Lisbon, Portugal
| | - Tiago A. H. Fonseca
- CHRC—Comprehensive Health Research Centre, Universidade NOVA de Lisboa, 1150-082 Lisbon, Portugal; (R.A.)
- NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal
- ISEL—Instituto Superior de Engenharia de Lisboa, Instituto Politécnico de Lisboa, R. Conselheiro Emídio Navarro 1, 1959-007 Lisbon, Portugal
| | - Luís Bento
- NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056 Lisbon, Portugal
- Intensive Care Department, ULSSJ—Unidade Local de Saúde São José, Rua José António Serrano, 1150-199 Lisbon, Portugal
- Integrated Pathophysiological Mechanisms, CHRC—Comprehensive Health Research Centre, NMS—NOVA Medical School, FCM—Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Campo Mártires da Pátria 130, 1169-056 Lisbon, Portugal
| | - Cecília R. C. Calado
- ISEL—Instituto Superior de Engenharia de Lisboa, Instituto Politécnico de Lisboa, R. Conselheiro Emídio Navarro 1, 1959-007 Lisbon, Portugal
- iBB—Institute for Bioengineering and Biosciences, The Associate Laboratory Institute for Health and Bioeconomy (i4HB), Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisbon, Portugal
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Rittmannsberger H, Barth M, Lamprecht B, Malik P, Yazdi-Zorn K. [Interaction of somatic findings and psychiatric symptoms in COVID-19. A scoping review]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2024; 38:1-23. [PMID: 38055146 DOI: 10.1007/s40211-023-00487-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/24/2023] [Indexed: 12/07/2023]
Abstract
An infection with SARS-CoV‑2 can affect the central nervous system, leading to neurological as well as psychiatric symptoms. In this respect, mechanisms of inflammation seem to be of much greater importance than the virus itself. This paper deals with the possible contributions of organic changes to psychiatric symptomatology and deals especially with delirium, cognitive symptoms, depression, anxiety, posttraumatic stress disorder and psychosis. Processes of neuroinflammation with infection of capillary endothelial cells and activation of microglia and astrocytes releasing high amounts of cytokines seem to be of key importance in all kinds of disturbances. They can lead to damage in grey and white matter, impairment of cerebral metabolism and loss of connectivity. Such neuroimmunological processes have been described as a organic basis for many psychiatric disorders, as affective disorders, psychoses and dementia. As the activation of the glia cells can persist for a long time after the offending agent has been cleared, this can contribute to long term sequalae of the infection.
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Affiliation(s)
- Hans Rittmannsberger
- Abteilung Psychiatrie und psychotherapeutische Medizin, Pyhrn-Eisenwurzen Klinikum Steyr, Steyr, Österreich.
| | - Martin Barth
- Abteilung Psychiatrie und psychotherapeutische Medizin, Pyhrn-Eisenwurzen Klinikum Steyr, Steyr, Österreich
| | - Bernd Lamprecht
- Med Campus III, Universitätsklinik für Innere Medizin mit Schwerpunkt Pneumologie, Kepler Universitätsklinikum GmbH, Linz, Österreich
- Medizinische Fakultät, Johannes Kepler Universität Linz, Linz, Österreich
| | - Peter Malik
- Abteilung Psychiatrie und psychotherapeutische Medizin, Pyhrn-Eisenwurzen Klinikum Steyr, Steyr, Österreich
| | - Kurosch Yazdi-Zorn
- Neuromed Campus, Klinik für Psychiatrie mit Schwerpunkt Suchtmedizin, Kepler Universitätsklinikum GmbH, Linz, Österreich
- Medizinische Fakultät, Johannes Kepler Universität Linz, Linz, Österreich
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Li H, Terrando N, Gelbard HA. Infectious Diseases. ADVANCES IN NEUROBIOLOGY 2024; 37:423-444. [PMID: 39207706 DOI: 10.1007/978-3-031-55529-9_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Microglia, brain-resident innate immune cells, have been extensively studied in neurodegenerative contexts like Alzheimer's disease. The Coronavirus disease 2019 (COVID-19) pandemic highlighted how peripheral infection and inflammation can be detrimental to the neuroimmune milieu and initiate microgliosis driven by peripheral inflammation. Microglia can remain deleterious to brain health by sustaining inflammation in the central nervous system even after the clearance of the original immunogenic agents. In this chapter, we discuss how pulmonary infection with Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) can lead to neurovascular and neuroimmune inflammation causing the neurological syndrome of post-acute sequelae of COVID-19 (PASC). Further, we incorporate lessons from the Human Immunodeficiency Virus' (HIV's) effects on microglial functioning in the era of combined antiretroviral therapies (cART) that contribute to HIV-1 associated neurocognitive disorders (HAND). Finally, we describe roles for mixed lineage kinase 3 (MLK3) and leucine-rich repeat kinase (LRRK2) as key regulators of multiple inflammatory and apoptotic pathways important to the pathogenesis of PASC and HAND. Inhibition of these pathways provides a therapeutically synergistic method of treating both PASC and HAND.
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Affiliation(s)
- Herman Li
- Center for Neurotherapeutics Discovery, Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
- Medical Scientist Training Program, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Niccolò Terrando
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA
- Department of Immunology, Duke University School of Medicine, Durham, NC, USA
- Department of Cell Biology, Duke University School of Medicine, Durham, NC, USA
| | - Harris A Gelbard
- Center for Neurotherapeutics Discovery, Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA.
- Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, USA.
- Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA.
- Department of Microbiology and Immunology, University of Rochester Medical Center, Rochester, NY, USA.
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Westphal GA, Fernandes RP, Pereira AB, Moerschberger MS, Pereira MR, Gonçalves ARR. Incidence of Delirium in Critically Ill Patients With and Without COVID-19. J Intensive Care Med 2023; 38:751-759. [PMID: 36939479 PMCID: PMC10030890 DOI: 10.1177/08850666231162805] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
BACKGROUND It is known that patients with COVID-19 are at high risk of developing delirium. The aim of the study was to compare the incidence of delirium between critically ill patients with and without a diagnosis of COVID-19. METHODS This is a retrospective study conducted in a southern Brazilian hospital from March 2020 to January 2021. Patients were divided into two groups: the COVID-19 group consisted of patients with a diagnosis of COVID-19 confirmed by reverse transcription-polymerase chain reaction (RT-PCR) or serological tests who were admitted to specific ICUs. The non-COVID-19 group consisted of patients with other surgical and medical diagnoses who were admitted to non-COVID ICUs. All patients were evaluated daily using the Intensive Care Delirium Screening Checklist (ICDSC). The two cohorts were compared in terms of the diagnosis of delirium. RESULTS Of the 649 patients who remained more than 48 h in the ICU, 523 were eligible for the study (COVID-19 group: 292, non-COVID-19 group: 231). There were 119 (22.7%) patients who had at least one episode of delirium, including 96 (32.9%) in the COVID-19 group and 23 (10.0%) in the non-COVID-19 group (odds ratio [OR] 4.42; 95% confidence interval [CI], 2.69 to 7.26; p < 0.001). Among patients mechanically ventilated for two days or more, the incidence of delirium did not differ between groups (COVID-19: 89/211, 42.1% vs non-COVID-19: 19/47, 40.4%; p = 0.82). Logistic regression showed that the duration of mechanical ventilation was the only independent factor associated with delirium (p = 0.001). CONCLUSION COVID-19 can be associated with a higher incidence of delirium among critically ill patients, but there was no difference in this incidence between groups when mechanical ventilation lasted two days or more.
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Affiliation(s)
- Glauco Adrieno Westphal
- Department of Intensive Care, Centro Hospitalar Unimed de Joinville, Santa Catarina, Brazil
- Brazilian Research in Intensive Care Network, São Paulo, Brazil
| | | | - Aline Braz Pereira
- Department of Intensive Care, Centro Hospitalar Unimed de Joinville, Santa Catarina, Brazil
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Ikramuddin F, Melnik T, Ingraham NE, Nguyen N, Siegel L, Usher MG, Tignanelli CJ, Morse L. Predictors of discharge disposition and mortality following hospitalization with SARS-CoV-2 infection. PLoS One 2023; 18:e0283326. [PMID: 37053224 PMCID: PMC10101512 DOI: 10.1371/journal.pone.0283326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 03/07/2023] [Indexed: 04/14/2023] Open
Abstract
IMPORTANCE The SARS-CoV-2 pandemic has overwhelmed hospital capacity, prioritizing the need to understand factors associated with type of discharge disposition. OBJECTIVE Characterization of disposition associated factors following SARS-CoV-2. DESIGN Retrospective study of SARS-CoV-2 positive patients from March 7th, 2020, to May 4th, 2022, requiring hospitalization. SETTING Midwest academic health-system. PARTICIPANTS Patients above the age 18 years admitted with PCR + SARS-CoV-2. INTERVENTION None. MAIN OUTCOMES Discharge to home versus PAC (inpatient rehabilitation facility (IRF), skilled-nursing facility (SNF), long-term acute care (LTACH)), or died/hospice while hospitalized (DH). RESULTS We identified 62,279 SARS-CoV-2 PCR+ patients; 6,248 required hospitalizations, of whom 4611(73.8%) were discharged home, 985 (15.8%) to PAC and 652 (10.4%) died in hospital (DH). Patients discharged to PAC had a higher median age (75.7 years, IQR: 65.6-85.1) compared to those discharged home (57.0 years, IQR: 38.2-69.9), and had longer mean length of stay (LOS) 14.7 days, SD: 14.0) compared to discharge home (5.8 days, SD: 5.9). Older age (RRR:1.04, 95% CI:1.041-1.055), and higher Elixhauser comorbidity index [EI] (RRR:1.19, 95% CI:1.168-1.218) were associated with higher rate of discharge to PAC versus home. Older age (RRR:1.069, 95% CI:1.060-1.077) and higher EI (RRR:1.09, 95% CI:1.071-1.126) were associated with more frequent DH versus home. Blacks, Asians, and Hispanics were less likely to be discharged to PAC (RRR, 0.64 CI 0.47-0.88), (RRR 0.48 CI 0.34-0.67) and (RRR 0.586 CI 0.352-0.975). Having alpha variant was associated with less frequent PAC discharge versus home (RRR 0.589 CI 0.444-780). The relative risks for DH were lower with a higher platelet count 0.998 (CI 0.99-0.99) and albumin levels 0.342 (CI 0.26-0.45), and higher with increased CRP (RRR 1.006 CI 1.004-1.007) and D-Dimer (RRR 1.070 CI 1.039-1.101). Increased albumin had lower risk to PAC discharge (RRR 0.630 CI 0.497-0.798. An increase in D-Dimer (RRR1.033 CI 1.002-1.064) and CRP (RRR1.002 CI1.001-1.004) was associated with higher risk of PAC discharge. A breakthrough (BT) infection was associated with lower likelihood of DH and PAC. CONCLUSION Older age, higher EI, CRP and D-Dimer are associated with PAC and DH discharges following hospitalization with COVID-19 infection. BT infection reduces the likelihood of being discharged to PAC and DH.
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Affiliation(s)
- Farha Ikramuddin
- Department of Rehabilitation Medicine, Division of PM&R, University of Minnesota, Minneapolis, MN, United States of America
| | - Tanya Melnik
- Department of Medicine, Division of Pulmonary and Critical Care, University of Minnesota, Minneapolis, MN, United States of America
| | - Nicholas E. Ingraham
- Department of Medicine, Division of Pulmonary and Critical Care, University of Minnesota, Minneapolis, MN, United States of America
| | - Nguyen Nguyen
- Department of Rehabilitation Medicine, Division of PM&R, University of Minnesota, Minneapolis, MN, United States of America
| | - Lianne Siegel
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, United States of America
| | - Michael G. Usher
- Department of Medicine, Division of General Internal Medicine, University of Minnesota, Minneapolis, MN, United States of America
| | - Christopher J. Tignanelli
- Department of Surgery, University of Minnesota Division of Acute Care Surgery, Minneapolis, MN, United States of America
| | - Leslie Morse
- Department of Rehabilitation Medicine, Division of PM&R, University of Minnesota, Minneapolis, MN, United States of America
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Kumar PR, Shilpa B, Jha RK. Brain Disorders: Impact of Mild SARS-CoV-2 May Shrink Several Parts of the Brain. Neurosci Biobehav Rev 2023; 149:105150. [PMID: 37004892 PMCID: PMC10063523 DOI: 10.1016/j.neubiorev.2023.105150] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023]
Abstract
Coronavirus (COVID-19) is a highly infectious respiratory infection discovered in Wuhan, China, in December 2019. As a result of the pandemic, several individuals have experienced life-threatening diseases, the loss of loved ones, lockdowns, isolation, an increase in unemployment, and household conflict. Moreover, COVID-19 may cause direct brain injury via encephalopathy. The long-term impacts of this virus on mental health and brain function need to be analysed by researchers in the coming years. This article aims to describe the prolonged neurological clinical consequences related to brain changes in people with mild COVID-19 infection. When compared to a control group, people those who tested positive for COVID-19 had more brain shrinkage, grey matter shrinkage, and tissue damage. The damage occurs predominantly in areas of the brain that are associated with odour, ambiguity, strokes, reduced attention, headaches, sensory abnormalities, depression, and mental abilities for few months after the first infection. Therefore, in patients after a severe clinical condition of COVID-19, a deepening of persistent neurological signs is necessary.
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Affiliation(s)
- Puranam Revanth Kumar
- Department of Electronics and Communication Engineering, IcfaiTech (Faculty of Science and Technology), IFHE University, Hyderabad, India
| | - B Shilpa
- Department of Electronics and Communication Engineering, IcfaiTech (Faculty of Science and Technology), IFHE University, Hyderabad, India
| | - Rajesh Kumar Jha
- Department of Electronics and Communication Engineering, IcfaiTech (Faculty of Science and Technology), IFHE University, Hyderabad, India
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Relationship Among Clinically Obtained Biomarkers of Inflammation, Hypercoagulability, and Macrophage Activation, and Delirium in Critically Ill Patients With COVID-19. Crit Care Explor 2023; 5:e0851. [PMID: 36699256 PMCID: PMC9851691 DOI: 10.1097/cce.0000000000000851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Critically ill patients with COVID-19 experience high rates of delirium and coma. Whether delirium occurs through novel mechanisms in COVID-19 is not known. We analyzed the relationship among biomarkers of inflammation (C-reactive protein [CRP]), hypercoagulability (d-dimer), and lung macrophage activation (ferritin), and the primary composite outcome of delirium/coma next day. We also measured associations between biomarkers and next day delirium and coma independently, and delirium severity. DESIGN Retrospective, observational cohort study. SETTING ICUs at two large, urban, academic referral hospitals. PATIENTS All consecutive adult patients admitted to the ICU from March 1, 2020, to June 7, 2020, with COVID-19 with clinical biomarkers and delirium assessments performed. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Daily concentrations of CRP, d-dimer, and ferritin were obtained. Coma (assessed by Richmond Agitation-Sedation Scale) and delirium (assessed by Confusion Assessment Method for the ICU/Confusion Assessment Method for the ICU-7) were measured bid. A cohort of 197 ICU patients with COVID-19 were included. Higher d-dimer (odds ratio [OR], 1.57; 95% CI, 1.17-2.12; p < 0.01) and ferritin quartiles (OR, 1.36; 95% CI, 1.02-1.81; p < 0.01) were associated with greater odds of the composite outcome of delirium/coma next day. d-dimer was associated with greater odds of next day delirium (OR, 1.49; 95% CI, 1.14-1.94; p < 0.01) and coma independently (OR, 1.52; 95% CI, 1.08-2.14; p = 0.017). Higher ferritin quartiles were associated with greater odds of next day delirium (OR, 1.33; 95% CI, 1.04-1.70; p = 0.026) and coma independently (OR, 1.59; 95% CI, 1.14-2.23; p < 0.01). Higher CRP quartiles were associated with coma (OR, 1.36; 95% CI, 1.03-1.79; p = 0.030) and delirium severity the next day (β = 0.30; se, 0.07; p ≤ 0.01). CONCLUSIONS Our hypothesis-generating study found d-dimer and ferritin were associated with delirium/coma the following day, as well as delirium and coma independently. CRP was associated with next day coma and delirium severity. Larger studies to validate these results are needed.
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Watne LO, Pollmann CT, Neerland BE, Quist-Paulsen E, Halaas NB, Idland AV, Hassel B, Henjum K, Knapskog AB, Frihagen F, Raeder J, Godø A, Ueland PM, McCann A, Figved W, Selbæk G, Zetterberg H, Fang EF, Myrstad M, Giil LM. Cerebrospinal fluid quinolinic acid is strongly associated with delirium and mortality in hip-fracture patients. J Clin Invest 2023; 133:163472. [PMID: 36409557 PMCID: PMC9843060 DOI: 10.1172/jci163472] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/15/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUNDThe kynurenine pathway (KP) has been identified as a potential mediator linking acute illness to cognitive dysfunction by generating neuroactive metabolites in response to inflammation. Delirium (acute confusion) is a common complication of acute illness and is associated with increased risk of dementia and mortality. However, the molecular mechanisms underlying delirium, particularly in relation to the KP, remain elusive.METHODSWe undertook a multicenter observational study with 586 hospitalized patients (248 with delirium) and investigated associations between delirium and KP metabolites measured in cerebrospinal fluid (CSF) and serum by targeted metabolomics. We also explored associations between KP metabolites and markers of neuronal damage and 1-year mortality.RESULTSIn delirium, we found concentrations of the neurotoxic metabolite quinolinic acid in CSF (CSF-QA) (OR 2.26 [1.78, 2.87], P < 0.001) to be increased and also found increases in several other KP metabolites in serum and CSF. In addition, CSF-QA was associated with the neuronal damage marker neurofilament light chain (NfL) (β 0.43, P < 0.001) and was a strong predictor of 1-year mortality (HR 4.35 [2.93, 6.45] for CSF-QA ≥ 100 nmol/L, P < 0.001). The associations between CSF-QA and delirium, neuronal damage, and mortality remained highly significant following adjustment for confounders and multiple comparisons.CONCLUSIONOur data identified how systemic inflammation, neurotoxicity, and delirium are strongly linked via the KP and should inform future delirium prevention and treatment clinical trials that target enzymes of the KP.FUNDINGNorwegian Health Association and South-Eastern Norway Regional Health Authorities.
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Affiliation(s)
- Leiv Otto Watne
- Oslo Delirium Research Group, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway.,Department of Geriatric Medicine and
| | | | | | | | | | - Ane-Victoria Idland
- Oslo Delirium Research Group, Oslo University Hospital, Oslo, Norway.,Department of Anesthesiology, Akershus University Hospital, Lørenskog, Norway
| | - Bjørnar Hassel
- Department of Neurohabilitation, Oslo University Hospital, Oslo, Norway
| | - Kristi Henjum
- Oslo Delirium Research Group, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Frede Frihagen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Orthopaedic Surgery, Østfold Hospital Trust, Grålum, Norway
| | - Johan Raeder
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Anesthesiology, Oslo University Hospital, Oslo, Norway
| | - Aasmund Godø
- Department of Anesthesiology, Diakonhjemmet Hospital, Oslo, Norway
| | | | | | - Wender Figved
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Orthopaedic Department, Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Geir Selbæk
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, United Kingdom.,UK Dementia Research Institute at UCL, London, United Kingdom.,Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
| | - Evandro F. Fang
- Department of Clinical Molecular Biology, University of Oslo, and Akershus University Hospital, Lørenskog, Norway.,The Norwegian Centre on Healthy Ageing (NO-Age), Oslo, Norway
| | - Marius Myrstad
- Department of Internal Medicine, Bærum Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Lasse M. Giil
- Neuro-SysMed, Department of Internal Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
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11
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Frailty and hyperactive delirium in hospitalized older patients with COVID-19: an insight from GeroCovid registry. Aging Clin Exp Res 2023; 35:433-442. [PMID: 36600029 PMCID: PMC9812736 DOI: 10.1007/s40520-022-02328-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 12/13/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Delirium is an acute neuropsychiatric condition associated with unfavourable outcomes, frequent in older hospitalized people. In the context of the SARS-CoV-2 pandemic, few studies have specifically focused on the inflammatory status of older, frail patients with hyperactive delirium (HD) hospitalized for COVID-19. AIM To identify biological correlates of HD at hospital admission and to assess the independent effect of delirium and physical frailty on in-hospital mortality. METHODS Data were retrospectively extracted by the multicenter registry GeroCovid Observational Study. Individuals aged ≥ 60 years were included if the information on the presence of HD, frailty based on the modified Fried criteria and inflammatory status had been collected. The risk of mortality was evaluated using a Kaplan-Meier estimator, according to frailty and delirium. Logistic and restricted cubic-spline regressions were employed to assess the relationship between inflammatory markers and HD. RESULTS Three-hundred-thirty-seven older adults were included in the analysis [mean age (SD) 77.1 (9.5) years, 50.1% females], and 11.5% presented with HD. A significant association of both PaO2/FiO2 ratio (p = 0.015) and serum lactate dehydrogenase (p = 0.04) with delirium was observed. By Cox multivariable regression, frail and non-frail patients with HD had a 4.42 and 2.85 higher mortality risk compared with non-frail, non-delirious patients. CONCLUSIONS Hyperactive delirium at hospital admission is related with markers of lung failure among older adults, especially when physical frailty coexists. Delirium is associated with increased in-hospital mortality risk, which is doubled by the coexistence of physical frailty.
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12
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Chaudhary P, Bhagora R, Ramar D, Mehta P. Clinical presentations and prognosis of delirium in patients with coronavirus disease 2019: A prospective cohort analysis. TAIWANESE JOURNAL OF PSYCHIATRY 2023. [DOI: 10.4103/tpsy.tpsy_4_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
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13
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Das S, Melgar P, Rasool AA, Adhikari A, Patel R, Adre LAB, Lopez MJ. Delirium in a Relatively Young Person due to COVID-19 Infection. Case Rep Psychiatry 2023; 2023:6215386. [PMID: 37006446 PMCID: PMC10063355 DOI: 10.1155/2023/6215386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/11/2023] [Accepted: 03/16/2023] [Indexed: 04/04/2023] Open
Abstract
The coronavirus disease (COVID-19) pandemic, caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2 virus), has significantly impacted global health. It can present a range of complications, from asymptomatic to severe respiratory distress syndrome. It has also been linked to complications in multiple organ systems, including neurological symptoms such as headaches and encephalopathy. Delirium, characterized by acute confusion, is common in older adults and associated with prolonged hospital stays and elevated mortality rates. We present a case study of a young mother with a prior medical history of mild to moderate depression who experienced an episode of delirium consequent to a COVID-19 infection. The initial manifestation of her illness was mild diarrhea, but as her condition worsened, she began exhibiting symptoms of delirium. These symptoms include confusion, agitation, sleep disturbance, and disordered behavior. The delirious episode was brief and effectively managed with small doses of psychotropic medications to control aggressive behavior. Upon resolution, no additional treatment was deemed necessary. This case underscores the wide-ranging effects of COVID-19 on physical and psychological well-being and highlights the importance of considering symptoms beyond those associated with respiratory distress.
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Affiliation(s)
| | | | | | | | - Rudresh Patel
- Nova Southeastern University Kiran C. Patel College of Osteopathic Medicine, Florida, USA
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14
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Wilke V, Sulyok M, Stefanou MI, Richter V, Bender B, Ernemann U, Ziemann U, Malek N, Kienzle K, Klein C, Bunk S, Goepel S, Mengel A. Delirium in hospitalized COVID-19 patients: Predictors and implications for patient outcome. PLoS One 2022; 17:e0278214. [PMID: 36548347 PMCID: PMC9778494 DOI: 10.1371/journal.pone.0278214] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 11/11/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Delirium is recognized as a severe complication of coronavirus-disease-2019 (COVID-19). COVID-19-associated delirium has been linked to worse patient outcomes and is considered to be of multifactorial origin. Here we sought to evaluate the incidence and risk factors of delirium in hospitalized COVID-19 patients, along with its impact on clinical outcome. METHODS Consecutive adult COVID-19 patients admitted to a tertiary academic referral hospital between March 1st and December 31st, 2020 were included. Potential risk factors for delirium were evaluated, including: age, gender, disease severity (as per the highest WHO grading reached during admission), laboratory parameters for infection and renal function (as per their most extreme values), and presence of comorbidities. To assess the relative strength of risk factors for predicting the occurrence of delirium, we performed a random-forest survival analysis. RESULTS 347 patients with positive COVID-19 PCR test and median age 68.2 [IQR 55.5, 80.5] years were included. Of those, 79 patients (22.8%) developed delirium, 81 (23.3%) were transferred to ICU, 58 (16.7%) died. 163 (73.8%) patients were discharged home, 13 (5.9%) to another hospital, 32 (14.5%) to nursing homes, 13 (5.9%) to rehabilitation with an overall median admission-to-discharge time of 53 [IQR 14, 195] days. The strongest predictors for the occurrence of delirium were blood urea nitrogen (minimal depth value (MD): 3.33), age (MD: 3.75), disease severity (as captured by WHO grading; MD: 3.93), leukocyte count (MD: 4.22), the presence of a neurodegenerative history (MD: 4.43), ferritin (MD: 4.46) and creatinine (MD: 4.59) levels. CONCLUSION The risk of delirium in COVID-19 can be stratified based on COVID-19 disease severity and-similar to delirium associated with other respiratory infections-the factors advanced age, neurodegenerative disease history, and presence of elevated infection and renal-retention parameters. Screening for these risk factors may facilitate early identification of patients at high-risk for COVID-19-associated delirium.
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Affiliation(s)
- Vera Wilke
- Department of Neurology and Stroke, University Hospital Tuebingen, Tuebingen, Germany
- Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Mihaly Sulyok
- Department of Pathology and Neuropathology, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Maria-Ioanna Stefanou
- Second Department of Neurology, Medical School, National and Kapodistrian University of Athens, ’Attikon’ University General Hospital, Athens, Greece
| | - Vivien Richter
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Benjamin Bender
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Ulrike Ernemann
- Department of Diagnostic and Interventional Neuroradiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Ulf Ziemann
- Department of Neurology and Stroke, University Hospital Tuebingen, Tuebingen, Germany
- Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Nisar Malek
- Department of Internal Medicine I, University Hospital of Tuebingen, Tuebingen, Germany
| | - Katharina Kienzle
- Clinical Research Unit Tuebingen, German Center of Infectious Diseases (DZIF), Brunswick, Germany
| | - Constantin Klein
- Department of Internal Medicine I, University Hospital of Tuebingen, Tuebingen, Germany
| | - Stefanie Bunk
- Department of Internal Medicine I, University Hospital of Tuebingen, Tuebingen, Germany
| | - Siri Goepel
- Department of Internal Medicine I, University Hospital of Tuebingen, Tuebingen, Germany
- Clinical Research Unit Tuebingen, German Center of Infectious Diseases (DZIF), Brunswick, Germany
| | - Annerose Mengel
- Department of Neurology and Stroke, University Hospital Tuebingen, Tuebingen, Germany
- Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
- * E-mail:
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15
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Valdivieso-Jiménez G, Valencia-Mesias G, Paucar-Alfaro J. [Factors Associated With Delirium In Patients Hospitalized During The COVID-19 Pandemic]. REVISTA COLOMBIANA DE PSIQUIATRIA 2022:S0034-7450(22)00117-2. [PMID: 36311344 PMCID: PMC9595373 DOI: 10.1016/j.rcp.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 10/07/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To determine the risk factors associated with delirium in patients admitted to a COVID-19 Hospitalization of a general hospital during the first year of the COVID-19 pandemic. METHODS An observational, analytical, case-control study was conducted. We analyzed 50 medical records of patients who presented delirium and 50 who did not present delirium in a COVID Hospitalization area during the period from March 2020 to March 2021. The Odd Ratio of sociodemographic and clinical factors for presenting delirium was evaluated. The logistic regression statistical test was performed using STATA 17.0 software. The protocol was approved by the Research Ethics Committee of the Villa El Salvador Emergency Hospital. RESULTS Ventilatory support (p=0.04), especially the use of a reservoir mask (OR=0.34, CI 0.12-0.88) and the presence of systemic complications (p=0.03) such as metabolic acidosis (OR=12.9, CI 1.45-115.58) were statistically significant variables associated with a higher risk of presenting delirium. CONCLUSIONS The type of ventilatory support and the presence of systemic complications were significant risk factors for delirium in patients hospitalized in a COVID area. Further studies are required in this field to obtain more evidence in this regard.
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16
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Sojka M, Drelich-Zbroja A, Kuczyńska M, Cheda M, Dąbrowska I, Kopyto E, Halczuk I, Zbroja M, Cyranka W, Jargiełło T. Ischemic and Hemorrhagic Cerebrovascular Events Related to COVID-19 Coagulopathy and Hypoxemia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11823. [PMID: 36142094 PMCID: PMC9517511 DOI: 10.3390/ijerph191811823] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
Since the very beginning of the COVID-19 pandemic, numerous researchers have made an effort to determine the molecular composition of the SARS-CoV-2 virus, and the exact pathomechanism through which the virus exerts such a devastating effect on the host/infected organism. Recent scientific evidence highlights the affinity of the virus towards ACE2 receptors, which are widespread in multiple human systems, including the central nervous system (CNS) and cerebral vessels. Such an affinity may explain endothelial dysfunction and damage that is observed in COVID-positive patients in histopathological studies, with subsequent dysregulation of the cerebral circulation leading to transient or acute cerebrovascular accidents. In this paper, we aimed to evaluate the effects of COVID-related hypoxemia and direct viral invasion on the cerebral circulation, with special respect to the postulated pathomechanism, vulnerable groups of patients, clinical course and outcomes, as well as diagnostic imaging findings.
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Affiliation(s)
- Michał Sojka
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Anna Drelich-Zbroja
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Maryla Kuczyńska
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Mateusz Cheda
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Izabela Dąbrowska
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Ewa Kopyto
- Students’ Scientific Society at the Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Izabela Halczuk
- Students’ Scientific Society at the Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Monika Zbroja
- Students’ Scientific Society at the Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Weronika Cyranka
- Students’ Scientific Society at the Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, 20-090 Lublin, Poland
| | - Tomasz Jargiełło
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, 20-090 Lublin, Poland
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17
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Graham EL, Koralnik IJ, Liotta EM. Therapeutic Approaches to the Neurologic Manifestations of COVID-19. Neurotherapeutics 2022; 19:1435-1466. [PMID: 35861926 PMCID: PMC9302225 DOI: 10.1007/s13311-022-01267-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 02/07/2023] Open
Abstract
As of May 2022, there have been more than 527 million infections with severe acute respiratory disease coronavirus type 2 (SARS-CoV-2) and over 6.2 million deaths from Coronavirus Disease 2019 (COVID-19) worldwide. COVID-19 is a multisystem illness with important neurologic consequences that impact long-term morbidity and mortality. In the acutely ill, the neurologic manifestations of COVID-19 can include distressing but relatively benign symptoms such as headache, myalgias, and anosmia; however, entities such as encephalopathy, stroke, seizures, encephalitis, and Guillain-Barre Syndrome can cause neurologic injury and resulting disability that persists long after the acute pulmonary illness. Furthermore, as many as one-third of patients may experience persistent neurologic symptoms as part of a Post-Acute Sequelae of SARS-CoV-2 infection (Neuro-PASC) syndrome. This Neuro-PASC syndrome can affect patients who required hospitalization for COVID-19 or patients who did not require hospitalization and who may have had minor or no pulmonary symptoms. Given the large number of individuals affected and the ability of neurologic complications to impair quality of life and productivity, the neurologic manifestations of COVID-19 are likely to have major and long-lasting personal, public health, and economic consequences. While knowledge of disease mechanisms and therapies acquired prior to the pandemic can inform us on how to manage patients with the neurologic manifestations of COVID-19, there is a critical need for improved understanding of specific COVID-19 disease mechanisms and development of therapies that target the neurologic morbidities of COVID-19. This current perspective reviews evidence for proposed disease mechanisms as they inform the neurologic management of COVID-19 in adult patients while also identifying areas in need of further research.
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Affiliation(s)
- Edith L Graham
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave Suite 1150, Chicago, IL, 60611, USA
| | - Igor J Koralnik
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave Suite 1150, Chicago, IL, 60611, USA
| | - Eric M Liotta
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave Suite 1150, Chicago, IL, 60611, USA.
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18
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Abstract
The measures put in place to contain the rapid spread of COVID-19 infection, such as quarantine, self-isolation, and lockdown, were supportive but have significantly affected the mental wellbeing of individuals. The primary goal of this study was to review the impact of COVID-19 on mental health. An intensive literature search was conducted using PsycINFO, PsyciatryOnline, PubMed, and the China National Knowledge Infrastructure (CNKI) databases. Articles published between January 2020 and June 2022 were retrieved and appraised. Reviews and retrospective studies were excluded. One hundred and twenty-two (122) relevant articles that fulfilled the inclusion criteria were finally selected. A high prevalence of anxiety, depression, insomnia, and post-traumatic stress disorders was reported. Alcohol and substance abuse, domestic violence, stigmatization, and suicidal tendencies have all been identified as direct consequences of lockdown. The eminent risk factors for mental health disorders identified during COVID-19 include fear of infection, history of mental illness, poor financial status, female gender, and alcohol drinking. The protective factors for mental health include higher income levels, public awareness, psychological counseling, social and government support. Overall, the COVID-19 pandemic has caused a number of mental disorders in addition to economic hardship. This strongly suggests the need to monitor the long-term impact of the COVID-19 pandemic on mental health.
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19
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Flinspach AN, Zinn S, Zacharowski K, Balaban Ü, Herrmann E, Adam EH. Electroencephalogram-Based Evaluation of Impaired Sedation in Patients with Moderate to Severe COVID-19 ARDS. J Clin Med 2022; 11:jcm11123494. [PMID: 35743572 PMCID: PMC9224742 DOI: 10.3390/jcm11123494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 06/02/2022] [Accepted: 06/10/2022] [Indexed: 02/01/2023] Open
Abstract
The sedation management of patients with severe COVID-19 is challenging. Processed electroencephalography (pEEG) has already been used for sedation management before COVID-19 in critical care, but its applicability in COVID-19 has not yet been investigated. We performed this prospective observational study to evaluate whether the patient sedation index (PSI) obtained via pEEG may adequately reflect sedation in ventilated COVID-19 patients. Statistical analysis was performed by linear regression analysis with mixed effects. We included data from 49 consecutive patients. None of the patients received neuromuscular blocking agents by the time of the measurement. The mean value of the PSI was 20 (±23). The suppression rate was determined to be 14% (±24%). A deep sedation equivalent to the Richmond Agitation and Sedation Scale of −3 to −4 (correlation expected PSI 25−50) in bedside examination was noted in 79.4% of the recordings. Linear regression analysis revealed a significant correlation between the sedative dosages of propofol, midazolam, clonidine, and sufentanil (p < 0.01) and the sedation index. Our results showed a distinct discrepancy between the RASS and the determined PSI. However, it remains unclear to what extent any discrepancy is due to the electrophysiological effects of neuroinflammation in terms of pEEG alteration, to the misinterpretation of spinal or vegetative reflexes during bedside evaluation, or to other causes.
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Affiliation(s)
- Armin Niklas Flinspach
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe-University Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt, Germany; (S.Z.); (K.Z.); (E.H.A.)
- Correspondence: ; Tel.: +49-69-6301-5868
| | - Sebastian Zinn
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe-University Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt, Germany; (S.Z.); (K.Z.); (E.H.A.)
| | - Kai Zacharowski
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe-University Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt, Germany; (S.Z.); (K.Z.); (E.H.A.)
| | - Ümniye Balaban
- Department of Biostatistics and Mathematical Modelling, Goethe-University Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt, Germany; (Ü.B.); (E.H.)
| | - Eva Herrmann
- Department of Biostatistics and Mathematical Modelling, Goethe-University Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt, Germany; (Ü.B.); (E.H.)
| | - Elisabeth Hannah Adam
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe-University Frankfurt, Theodor-Stern Kai 7, 60590 Frankfurt, Germany; (S.Z.); (K.Z.); (E.H.A.)
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20
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Huang Y, Ling Q, Manyande A, Wu D, Xiang B. Brain Imaging Changes in Patients Recovered From COVID-19: A Narrative Review. Front Neurosci 2022; 16:855868. [PMID: 35527821 PMCID: PMC9072792 DOI: 10.3389/fnins.2022.855868] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 03/21/2022] [Indexed: 12/12/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has caused several outbreaks of highly contagious respiratory diseases worldwide. The respiratory symptoms of Coronavirus Disease-19 (COVID-19) have been closely monitored and studied, while the central nervous system (CNS) and peripheral system (PNS) lesions induced by COVID-19 have not received much attention. Currently, patients with COVID-19-associated encephalopathy present with dizziness, headache, anxiety and depression, stroke, epileptic seizures, the Guillain-Barre syndrome (GBS), and demyelinating disease. The exact pathologic basis for these neurological symptoms is currently not known. Rapid mutation of the SARS-CoV-2 genome leads to the appearance of SARS-CoV-2 variants of concern (VOCs), which have higher infectivity and virulence. Therefore, this narrative review will focus on the imaging assessment of COVID-19 and its VOC. There has been an increase in technologies, such as [18F]fluorodeoxyglucose positron emission tomography (18F-FDG-PET) and functional magnetic resonance imaging (fMRI), that have been used to observe changes in brain microstructure over time in patients with COVID-19 recovery. Medical imaging and pathological approaches aimed at exploring the associations between COVID-19 and its VOC, with cranial nerve and abnormal nerve discharge will shed light on the rehabilitation process of brain microstructural changes related to SARS-CoV-2, and aid future research in our understanding of the treatment and prognosis of COVID-19 encephalopathy.
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Affiliation(s)
- Yan Huang
- Department of Interventional Therapy, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Qiong Ling
- Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Anne Manyande
- School of Human and Social Sciences, University of West London, London, United Kingdom
| | - Duozhi Wu
- Department of Anesthesiology, Hainan general Hospital, Haikou, China
- *Correspondence: Duozhi Wu,
| | - Boqi Xiang
- School of Public Health, Rutgers University, New Brunswick, NJ, United States
- Boqi Xiang,
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21
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Carmassi C, Pacciardi B, Gravina D, Fantasia S, De Pascale G, Cutuli SL, Bertelloni CA, Dell’Osso L. Pharmacological Treatment of Acute Psychiatric Symptoms in COVID-19 Patients: A Systematic Review and a Case Series. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4978. [PMID: 35564372 PMCID: PMC9099660 DOI: 10.3390/ijerph19094978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/10/2022] [Accepted: 04/12/2022] [Indexed: 02/04/2023]
Abstract
Delirium and psychomotor agitation are relevant clinical conditions that may develop during COVID-19 infection, especially in intensive care unit (ICU) settings. The psychopharmacological management of these conditions is receiving increasing interest in psychiatry, considering hyperkinetic delirium as one of the most common neuropsychiatries acute consequences in COVID-19 recovery patients. However, there are no actual internationally validated guidelines about this topic, due to the relatively newly introduced clinical condition; in addition, a standardized psychopharmacologic treatment of these cases is a complex goal to achieve due to the risk of both drug-drug interactions and the vulnerable conditions of those patients. The aim of this systematic review and case series is to evaluate and gather the scientific evidence on pharmacologic handling during delirium in COVID-19 patients to provide practical recommendations on the optimal management of psychotropic medication in these kinds of patients. The electronic databases PubMed, Embase and Web of Science were reviewed to identify studies, in accordance with the PRISMA guidelines. At the end of the selection process, a total of 21 studies (n = 2063) were included. We also collected a case series of acute psychomotor agitation in COVID-19 patients hospitalized in ICU. Our results showed how the symptom-based choice of the psychotropic medication is crucial, and even most of the psychotropic drug classes showed good safety, one must not underestimate the possible drug interactions and also the possible decrease in vital functions which need to be strictly monitored especially during treatment with some kinds of molecules. We believe that the evidence-based recommendations highlighted in the present research will enhance the current knowledge and could provide better management of these patients.
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Affiliation(s)
- Claudia Carmassi
- Psychiatric Unit, Department of Clinical and Experimental Medicine, AOUP, University of Pisa, 56126 Pisa, Italy; (C.C.); (B.P.); (S.F.); (C.A.B.); (L.D.)
| | - Bruno Pacciardi
- Psychiatric Unit, Department of Clinical and Experimental Medicine, AOUP, University of Pisa, 56126 Pisa, Italy; (C.C.); (B.P.); (S.F.); (C.A.B.); (L.D.)
| | - Davide Gravina
- Psychiatric Unit, Department of Clinical and Experimental Medicine, AOUP, University of Pisa, 56126 Pisa, Italy; (C.C.); (B.P.); (S.F.); (C.A.B.); (L.D.)
| | - Sara Fantasia
- Psychiatric Unit, Department of Clinical and Experimental Medicine, AOUP, University of Pisa, 56126 Pisa, Italy; (C.C.); (B.P.); (S.F.); (C.A.B.); (L.D.)
| | - Gennaro De Pascale
- Department of Emergency, Catholic University of the Sacred Heart, 00168 Rome, Italy; (G.D.P.); (S.L.C.)
| | - Salvatore Lucio Cutuli
- Department of Emergency, Catholic University of the Sacred Heart, 00168 Rome, Italy; (G.D.P.); (S.L.C.)
| | - Carlo Antonio Bertelloni
- Psychiatric Unit, Department of Clinical and Experimental Medicine, AOUP, University of Pisa, 56126 Pisa, Italy; (C.C.); (B.P.); (S.F.); (C.A.B.); (L.D.)
| | - Liliana Dell’Osso
- Psychiatric Unit, Department of Clinical and Experimental Medicine, AOUP, University of Pisa, 56126 Pisa, Italy; (C.C.); (B.P.); (S.F.); (C.A.B.); (L.D.)
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22
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Miller AC. What's New in Critical Illness and Injury Science? Delirium, COVID-19, and critical illness. Int J Crit Illn Inj Sci 2022; 12:59-60. [PMID: 35845126 PMCID: PMC9285128 DOI: 10.4103/ijciis.ijciis_44_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 06/12/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Andrew C. Miller
- Department of Emergency Medicine, Alton Memorial Hospital, Alton, IL, USA
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23
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Madonna D, Enrico P, Ciappolino V, Boscutti A, Colombo E, Turtulici N, Cantù F, Cereda G, Delvecchio G, De Falco S, Chierichetti M, Savioli M, Grasselli G, Brambilla P. Factors Associated With Severity of Delirium Complicating COVID-19 in Intensive Care Units. Front Neurol 2022; 13:774953. [PMID: 35401416 PMCID: PMC8987982 DOI: 10.3389/fneur.2022.774953] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 02/07/2022] [Indexed: 12/12/2022] Open
Abstract
The clinical outcome of the disease provoked by the SARS-CoV-2 infection, COVID-19, is largely due to the development of interstitial pneumonia accompanied by an Acute Respiratory Distress Syndrome (ARDS), often requiring ventilatory support therapy in Intensive Care Units (ICUs). Current epidemiologic evidence is demonstrating that the COVID-19 prognosis is significantly influenced by its acute complications. Among these, delirium figures as one of the most frequent and severe, especially in the emergency setting, where it shows a significantly negative prognostic impact. In this regard, the aim of our study is to identify clinical severity factors of delirium complicating COVID-19 related-ARDS. We performed a comparative and correlation analysis using demographics, comorbidities, multisystemic and delirium severity scores and anti-delirium therapy in two cohorts of ARDS patients with delirium, respectively, due to COVID-19 (n = 40) or other medical conditions (n = 39). Our results indicate that delirium in COVID-19-related ARDS is more severe since its onset despite a relatively less severe systemic condition at the point of ICU admission and required higher dosages of antipsychotic and non-benzodiazepinic sedative therapy respect to non-COVID patients. Finally, the correlation analysis showed a direct association between the male gender and maximum dosage of anti-delirium medications needed within the COVID-19 group, which was taken as a surrogate of delirium severity. Overall, our results seem to indicate that pathogenetic factors specifically associated to severe COVID-19 are responsible for the high severity of delirium, paving the way for future research focused on the mechanisms of the cognitive alterations associated with COVID-19.
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Affiliation(s)
- Domenico Madonna
- Department of Neurosciences and Mental Health, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Enrico
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Valentina Ciappolino
- Department of Neurosciences and Mental Health, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Boscutti
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Elisa Colombo
- Department of Neurosciences and Mental Health, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nunzio Turtulici
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Filippo Cantù
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Guido Cereda
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giuseppe Delvecchio
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Stefano De Falco
- Department of Anesthesia, Intensive Care and Emergency, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Monica Chierichetti
- Department of Anesthesia, Intensive Care and Emergency, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Monica Savioli
- Department of Anesthesia, Intensive Care and Emergency, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Giacomo Grasselli
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Department of Anesthesia, Intensive Care and Emergency, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- *Correspondence: Paolo Brambilla
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24
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Cholinergic blockade of neuroinflammation – from tissue to RNA regulators. Neuronal Signal 2022; 6:NS20210035. [PMID: 35211331 PMCID: PMC8837817 DOI: 10.1042/ns20210035] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/06/2022] [Accepted: 01/06/2022] [Indexed: 11/17/2022] Open
Abstract
Inflammatory stimuli and consequent pro-inflammatory immune responses may facilitate neurodegeneration and threaten survival following pathogen infection or trauma, but potential controllers preventing these risks are incompletely understood. Here, we argue that small RNA regulators of acetylcholine (ACh) signaling, including microRNAs (miRs) and transfer RNA fragments (tRFs) may tilt the balance between innate and adaptive immunity, avoid chronic inflammation and prevent the neuroinflammation-mediated exacerbation of many neurological diseases. While the restrictive permeability of the blood–brain barrier (BBB) protects the brain from peripheral immune events, this barrier can be disrupted by inflammation and is weakened with age. The consequently dysregulated balance between pro- and anti-inflammatory processes may modify the immune activities of brain microglia, astrocytes, perivascular macrophages, oligodendrocytes and dendritic cells, leading to neuronal damage. Notably, the vagus nerve mediates the peripheral cholinergic anti-inflammatory reflex and underlines the consistent control of body–brain inflammation by pro-inflammatory cytokines, which affect cholinergic functions; therefore, the disruption of this reflex can exacerbate cognitive impairments such as attention deficits and delirium. RNA regulators can contribute to re-balancing the cholinergic network and avoiding its chronic deterioration, and their activities may differ between men and women and/or wear off with age. This can lead to hypersensitivity of aged patients to inflammation and higher risks of neuroinflammation-driven cholinergic impairments such as delirium and dementia following COVID-19 infection. The age- and sex-driven differences in post-transcriptional RNA regulators of cholinergic elements may hence indicate new personalized therapeutic options for neuroinflammatory diseases.
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25
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Omar AKAE, Dahesh SMA, Ellakwa DES, Gomaa MK, Abdulsamad B, Hanafy R, Al Metwally HG, Mohammad RNEM, Badawy SS, El Saleh RM, Abdelhafiz ME, Gouda AM, Seada SAS, Amr MM, Asar Y, Alamrawy RG. Cognitive impairment in health care workers recovering from COVID-19 infection: a cross-sectional comparative study. MIDDLE EAST CURRENT PSYCHIATRY 2022; 29:79. [PMCID: PMC9573797 DOI: 10.1186/s43045-022-00245-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/05/2022] [Indexed: 06/01/2023] Open
Abstract
Background The COVID-19 outbreak has infected people all over the world where many clinics are being constructed to diagnose and treat lingering symptoms or long COVID. Neurological and long-term cognitive consequences are very worrisome. Many of COVID-19’s neurological symptoms are likely the result of the body’s extensive immunological response to infection rather than the virus attacking the brain or nervous system directly. At the same time, the extent and type of COVID-19’s cognitive consequences are unknown. The goal of this study was to assess the cognitive functions of healthcare workers 2 weeks to 3 months after COVID-19 infection. Ninety-two healthcare workers participated in the study; 32 were post-COVID-19 cases, and 60 were healthy people (the comparison group). The cognitive functions of the participants were assessed using the Addenbrooke’s Cognitive Examination (ACE-III) test, which evaluated attention, memory, language, and visuospatial skills, as well as the Arabic version of the Patient Health Questionnaire Anxiety GAD-7 and Depression Assessments PHQ-9. Results The study revealed that there was a highly significant direct correlation between post-infection with COVID-19 and scores of both anxiety and depression and an inverse correlation in the case of attention and memory. On the other hand, there is no statistical effect of post-COVID-19 on verbal fluency, language scores, and visio-spatial abilities. Using multiple linear regression, there was a powerful significant decrease effect of post-COVID-19 on memory scores controlling both anxiety and depression degrees (Beta = − 0.745, P < 0.001). Also, there was a strong negative correlation post-COVID-19 on attention scores controlling both anxiety and depression degrees (Beta = − 0.745, P < 0.001). Conclusions The study showed a strong negative effect of post-COVID-19 on the attention and memory of patients. Furthermore, both anxiety and depression scores increased significantly among the post-COVID-19 patients.
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Affiliation(s)
| | - Salwa M. A. Dahesh
- Research Institute of Medical Entomology, General Organization for Teaching Hospitals and Institutes, Ministry of Health and Population, Cairo, Egypt
| | - Doha El-Sayed Ellakwa
- Biochemistry and Molecular Biology Department, Faculty of Pharmacy, Al-Azhar University, Cairo, Egypt
| | | | | | - Rana Hanafy
- Ministry of Health and Population, Cairo, Egypt
| | | | | | | | | | | | | | | | | | - Yomna Asar
- Mamoura Psychiatric Hospital, General Secretariat of Mental Health and Addiction Treatment, Ministry of Health and Population, Alexandria, Egypt
- Neuroscience Research Master Candidate, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Roa Gamal Alamrawy
- Mamoura Psychiatric Hospital, General Secretariat of Mental Health and Addiction Treatment, Ministry of Health and Population, Alexandria, Egypt
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26
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The Influence of Covid-19 Infection on Neurocognitive Disorders. CURRENT HEALTH SCIENCES JOURNAL 2021; 47:590-594. [PMID: 35444832 PMCID: PMC8987473 DOI: 10.12865/chsj.47.04.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/11/2021] [Indexed: 11/30/2022]
Abstract
Neurocognitive disorders are a group of disorders characterized by an impaired cognition which has not been present since birth or very early life and represents a decline from a previous attained level of functioning. The case we studied is M.E., a 62 years female, married, from rural area, working as a tailor, without any psychiatric history. She develops psychiatric symptoms during Covid-19 infection and treatment, in November 2020. The patient has been admitted in psychiatric care, in that time, for about one month, for a persistent confusion state during and after this event. These symptoms diminish the patient's level of functioning and seemed to be related with the Covid-19 infection or treatment. Psychological investigation underlines a MMSE 14, severe impairment in attention, short-term and long-term memory. CT evaluation presents normal relation except a moderate general atrophy, according with patient's age. Differential diagnosis will be discussed. The treatment has proven its effectiveness, the patient regaining her ability to orientate, could do housework, good improvement in attention and short-term memory. We emphasize that there is correlation between the Covid-19 infection and confusive state and delirium in patients, as a comorbidity, followed in many cases by chronic progressive neurocognitive disorder, especially in elderly.
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