What We Know about Delirium and COVID-19

A Neuro-ICU doctor talks about an uptick in COVID-19 patients experiencing delirium and what doctors know about the condition.

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CLEVELAND – We’re starting to learn more about how COVID-19 affects the brain, as reports of neurologic complications are surfacing worldwide.

Cleveland Clinic’s Pravin George, DO, said he’s noticed an uptick in the number of COVID-19 patients experiencing delirium.

“Some are having this hyperactive delirium where you can get very agitated and start to have these paranoid delusions,” he said. “Some of them are having this thing called hypoactive, where they have these internalized visions and then they start to have this very bad confusion.”

Dr. George said ICU delirium isn’t uncommon, especially in older patients and people who have many medical problems.

But research suggests COVID-19 delirium is trending younger.

He adds that it’s unusual because interventions that typically reduce delirium don’t seem to help coronavirus patients much, and some patients are actually arriving at the hospital with complaints of delirium and hallucinations.

Sedating medications given in the ICU to relax patients may contribute to delirium, because they can have long-lasting effects on receptors in the brain.

Doctors also suspect the disease itself may impact brain tissue and cause delirium, but more research is needed to be sure.

Early studies suggest some COVID-19 delirium may be linked to prolonged periods of low oxygen in the brain.

“The brain is not getting enough oxygen in some of these patients just because of the severe respiratory issues and, for an extended amount of time, that can cause some of the individual brain cells to die and over time that death of some of these brain cells could be permanent and that could cause delirium in itself,” said Dr. George.

Dr. George said delirium is a little different for everybody and that most people recover.

He adds that we’re just starting to learn about the long-term consequences of the condition and that it’s important for researchers to study people as they recover.

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