Nearly a third of hospitalised COVID-19 patients experienced some type of altered mental function — ranging from confusion to delirium to unresponsiveness — in the largest study to date of neurological symptoms among coronavirus patients in a U.S. hospital system.

And patients with altered mental function had significantly worse medical outcomes, according to the study, published Monday in Annals of Clinical and Translational Neurology. The study looked at the records of the first 509 coronavirus patients hospitalized, from March 5 to April 6, at 10 hospitals in the Northwestern Medicine health system in the Chicago area.

These patients stayed three times as long in the hospital as patients without altered mental function.

After they were discharged, only 32 percent of the patients with altered mental function were able to handle routine daily activities like cooking and paying bills, said Dr. Igor Koralnik, senior author of the study and chief of neuro-infectious disease and global neurology at Northwestern Medicine. In contrast, 89 percent of patients without altered mental function were able to manage such activities without assistance.

Patients with altered mental function — the medical term is encephalopathy — were also nearly seven times as likely to die as those who did not have that type of problem.

The researchers did not identify a cause for the encephalopathy, which can occur with other diseases, especially in older patients, and can be triggered by several different factors including inflammation and effects on blood circulation, said Koralnik, who also oversees the Neuro COVID-19 Clinic at Northwestern Memorial Hospital. There is very little evidence so far that the virus directly attacks brain cells, and most experts say neurological effects are probably triggered by inflammatory and immune system responses that often affect other organs, as well as the brain.

This paper indicates, importantly, that in-hospital encephalopathy may be a predictor for poorer outcomes. That finding would also suggest that patients with altered mental function in the hospital might benefit from closer post-discharge monitoring or rehabilitation
Dr. Serena Spudich, chief of neurological infections and global neurology at Yale School of Medicine, who was not involved in the study.

Altered mental function was not the only neurological complication the Northwestern study found. Overall, 82 percent of the hospitalised patients had neurological symptoms at some point in the course of the disease from symptom onset through hospitalisation, the study found. That is a higher rate than what has been reported in studies from China and Spain, but the researchers say that may be because of genetic factors or that the Northwestern hospitals may have had more time to identify neurological issues because they were not as overwhelmed with patients as the other hospitals.

This is an important study, since the neurological complications of the infection seem to be frequent and in many cases long-lasting, but yet have not received much attention.
Dr. Avindra Nath, chief of the section on infections of the nervous system at the National Institute of Neurological Disorders and Stroke, who was not involved in the study.

 

 

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The Japan Times