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Altered Mental Status Not Uncommon in Severe COVID-19

MONDAY, June 29, 2020 -- Altered mental status is the second most common neurological presentation for patients with COVID-19, according to a study published online June 25 in The Lancet Psychiatry.

Aravinthan Varatharaj, B.M.B.Ch., from the University Hospital Southampton NHS Foundation Trust in the United Kingdom, and colleagues examined the breadth of COVID-19 complications that affect the brain. Broad clinical syndromes associated with COVID-19 were classified as a cerebrovascular event, altered mental status, peripheral neurology, or other. Data were included for 153 patients, and complete clinical datasets were available for 125 patients.

The researchers found that 62 percent of the patients presented with a cerebrovascular event, of whom 74, 12, and 1 percent had ischemic stroke, intracerebral hemorrhage, and central nervous system vasculitis, respectively. Altered mental status was reported at presentation in 39 patients (31 percent), including nine and seven with unspecified encephalopathy and encephalitis, respectively; the remaining 23 fulfilled the clinical case definitions for psychiatric diagnoses, and 21 of these were new diagnoses. Ten of 23 patients with neuropsychiatric disorders had new-onset psychosis, while six and four had a neurocognitive syndrome and an affective disorder. Of the patients with altered mental status, 49 and 51 percent were younger and older than 60 years, respectively; among patients with cerebrovascular events, 18 and 82 percent were younger and older than 60 years, respectively.

"Our nationwide, clinician-reported cohort approach provides valuable and timely information that is urgently needed by clinicians, researchers, and funders to inform the immediate next steps in COVID-19 neuroscience-related research and health policy planning," the authors write.

Several authors disclosed financial ties to the pharmaceutical industry.

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