Severe outcomes of COVID-19 in patients with dementia

In patients with dementia, COVID-19 frequently revealed itself by confusion and asthenia, and was associated with a high fatality rate. A group of French researchers recommend SARS-CoV-2 testing after any significant change in frequency of confusion and delirium in patients with dementia.

Dementia appears independently associated with higher mortality in COVID-19 patients. However, large cohort studies of patients with dementia have been lacking so far. Dr Agathe Vrillon (Hôpital Lariboisière Fernand-Widal, France) reported on the outcomes of 125 patients with dementia hospitalised for confirmed COVID-19 [1]. Median age was 86 years; 67.2% had ≥2 comorbidities. Male sex (41.6%) was associated with mortality (P=0.029).

The most common symptoms at COVID-19 onset were confusion and delirium (82.4%) and asthenia (76.8%). Signs of infection were frequent: fever (72.8%), cough (49.6%), and expectorations (21.6%). Falling was an initial symptom in 35.2% of patients. Dyspnoea (P<0.001) and desaturation (P=0.002) were associated with mortality. Complications significantly associated with death were acute respiratory distress syndrome, cardiac injury, and acute kidney injury (see Table). The most frequently applied treatment was antibiotics (61.6%). Oxygen support was given in 60% of cases, more often in non-survivors (P<0.0001). Steroids were prescribed in only 8%.

Table: Complications of COVID-19 and their relation to survival [1]



The fatality rate at 21 days was 22.4% (n=28). “This is a significant rate, but lower than was reported in similar studies,” according to Dr Vrillon. Median delay between admission and death was 8.5 days. Median length of hospital stay for survivors was 16 days; 40.2% were discharged before end of follow-up. There were 2 independent risk factors of death: chronic renal disease (ExpB=4.631) and CRP at admission (ExpB=1.013).

1. Vrillon A, et al. COVID-19 in patients with dementia: clinical features and predictive factors of mortality in a cohort of 125 patients. OPR-144, EAN 2021 Virtual Congress, 19–22 June.

 

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Posted on 18 August 202118 August 2021