• A recent study published in JAMA Neurology found that neurological symptoms were present in almost 40 percent of people with COVID-19 in Wuhan, China.
  • Studies suggest one-third to more than 80 percent of ICU patients experience delirium during their stay.
  • People with ICU delirium are also more likely to have long-term cognitive damage and are less likely to survive.

Although COVID-19 specifically targets the lungs, the damage it causes can include other major organs, especially the brain.

“Many COVID-19 patients have been reported to have neurological symptoms, such as headache, confusion, seizures, and even strokes,” Dr. Halim Fadil, a neurologist and movement disorders specialist at Texas Health Arlington Memorial Hospital, told Healthline.

A recent study published in JAMA Neurology found that neurological symptoms were present in almost 40 percent of people with COVID-19 in Wuhan, China, where the pandemic is believed to have originated.

Treatment for people with severe COVID-19 symptoms often relies on ventilators to assist with breathing and powerful, long-term sedation to minimize the pain and discomfort associated with intubation.

However, these lifesaving measures also come with side effects that include confusion, inability to comprehend what’s happening around you, and inability to focus.

Commonly affecting people in intensive care units (ICUs) placed on ventilators, these symptoms indicate an acute brain condition called “ICU delirium.”

“Delirium is an acute and fluctuating alteration of consciousness and cognition,” Fadil explained.

“Patients with delirium may have auditory hallucinations, visual hallucinations, disorientation of time and space, agitation, aggression, fluctuating level of consciousness, and impairment of sleep-wake cycle,” said Dr. Kevin Conner, a neurologist at Texas Health Arlington Memorial Hospital and Texas Health Physicians Group.

He explains that “pulmonary fatigue can cause poor ventilation,” which leads to a buildup of carbon dioxide. That can cause “metabolic derangements, confusion, and somnolence.”

According to Conner, patients with delirium can also experience memory difficulties and speech that’s “tangential, disorganized, or incoherent.”

Studies suggest that one-third to more than 80 percent of ICU patients experience delirium during their stay. People with ICU delirium are also more likely to have long-term cognitive damage and are less likely to survive.

Conner says the majority of patients in the ICU will experience some level of delirium during their treatment, and that “delirium can be brought on by any severe illness, such as sepsis, fever, infection, organ failure, and so forth.”

He adds that while COVID-19 can cause delirium by affecting the lungs and reducing oxygen to the brain, high fevers caused by the virus are also a risk factor.

Fadil says the virus likely has “neuro-invasive capabilities, because other coronaviruses have been found to invade the brain.”

Many COVID-19 patients have been reported to have neurological symptoms, such as headache, confusion, seizures, and even strokes.

Dr. Sharon K. Inouye, a professor of medicine at Harvard Medical School, created the world’s most widely used checklist to identify delirium. She developed a program used by hundreds of hospitals to reduce cases of delirium by almost 50 percent.

Called the Hospital Elder Life Program (HELP), the goals of the checklist include:

  • maintaining physical and cognitive functioning throughout hospitalization
  • maximizing independence at discharge
  • assisting with the transition from hospital to home

Conner confirms that the risk of delirium “can be reduced by early treatment of the underlying causes.” He says this includes maintaining adequate oxygen levels, reducing fever, and “evaluating medications that may contribute to delirium.”

Additionally, avoiding benzodiazepine drugs and antipsychotic medications, like haloperidol (Haldol), can help.

“We’re seeing an epidemic of delirium in COVID-19 patients globally, and it’s getting very mismanaged,” Inouye said in a statement.

She believes more should be done to prevent delirium.

“A lot of that may be unavoidable — when you’re trying to keep someone alive, you may not follow the best practices for delirium prevention, so we can understand that — but I do think from talking to colleagues that some of it is avoidable,” she said.

Conner emphasizes it’s important to “minimize disturbances of the sleep-wake cycle,” and that patients should be kept in a calm environment with “frequent reassurances, touch, and reorientation.”

But studies also find walking can reduce delirium risk, and that patients can exercise even when they’re on a ventilator, significantly reducing ICU-acquired weakness and neuropsychiatric disease.

“Some ICUs are doing that because studies show that walking raises oxygen saturation and gets patients off ventilators faster, which frees up the machines for other patients,” said Inouye in the statement. “It takes three staff members to help with the walking, but it can be done.”

Although primarily affecting the lungs, COVID-19 can also influence the brain. This, and being placed in the ICU for severe COVID-19 symptoms, may cause a condition called delirium.

Symptoms of delirium include confusion, memory problems, and disorientation. However, experts say it can be prevented and treated.

Exercise, even while on a ventilator, is shown to reduce the risk of delirium. The risk can also be reduced by minimizing disturbance to the patient’s sleep cycle and keeping them in a calm, reassuring environment.

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