Is Confusion a Symptom of COVID-19?

Brain fog might be a bigger deal than you think.

COVID-19 can present with many different symptoms and affect different people in different ways. But, could confusion be a sign of COVID-19?

A February 2021 literature review of 229 studies from the Journal of Psychosomatic Research suggests that just might be the case. Researchers found that the studies named delirium a commonly-seen symptom of COVID-19 regardless of the severity level of the illness among patients.

A July 2021 study published in the Journal of Clinical Neurology adds another layer to individuals experiencing confusion as a symptom of COVID-19. The findings suggested that, for elderly patients, acute confusion could be the primary symptom indicating COVID-19 for those individuals—especially if the confusion precedes other signs of the illness.

What Is Delirium (Confusion) and How Can It Be a Potential COVID-19 Symptom?

According to MedlinePlus, when an individual experiences delirium, they experience "a mental state in which [they] are confused." This condition might begin all of a sudden but usually does not last long. A person with delirium may appear disoriented or distracted, and they may have difficulty thinking clearly or paying attention.

Delirium can also manifest in different ways within a day's time. Symptoms might range from slight mental status alterations to complete obtundation (a combined state of slow responses, increased sleep, and low environmental interest). Also, while it's perfectly normal to have occasional awareness and memory issues as you get older, delirium is much more serious, requiring treatment and even hospitalization.

Delirium shouldn't be confused with dementia—although there is a certain amount of overlap and dementia is a risk factor for delirium. Delirium can be caused by a number of factors or situations, such as electrolyte imbalances, sleep deprivation, or infections. On the other hand, dementia is usually caused by anatomic changes in the brain, has a slower onset, and is generally chronic or progressive.

Ultimately, delirium is rooted in the central nervous system, which involves the brain and the spinal cord. The National Institute of Neurological Disorders and Stroke notes that individuals who become hospitalized due to COVID-19 initially present with symptoms related to brain or nervous system issues. These issues can occur as the result of your immune system's response to COVID-19 infection, presenting in the form of conditions such as headaches, strokes, dizziness, or delirium.

Confusion as a COVID-19 Symptom Seems To Strike Elderly Adults More Often

The findings from a January 2021 study published in Age and Ageing noted that in older, hospitalized COVID-19 patients who presented with frailty, delirium was likely to be present at the initial stages of infection. This connection didn't come as a huge surprise to Charulatha Nagar, MD, a neurologist at Northwestern Medicine Lake Forest Hospital in Lake Forest, Illinois.

Confusion can be a sign of COVID-19, particularly in elderly people, Dr. Nagar told Health. Dr. Nagar also pointed out that reports of neurological symptoms during previous COVID-19 epidemics can provide a roadmap for potential neurological complications, due to many shared characteristics in this family of viruses.

A growing body of research has reported that COVID-19 patients are presenting various neurological issues. A February 2021 systematic review from the Journal of Neurology found that COVID-19 patients dealt with symptoms of dizziness, headaches, impaired consciousness, and a loss of taste and smell. Researchers of a January 2022 study in The Journal of Headache and Pain found that, along with headaches and loss of taste and smell, COVID-19 patients also presented more often with myalgia (muscle pain).

However, Dr. Nagar noted that potential neurological symptoms of COVID-19 and the disordered physiological processes behind them haven't been fully establ ished. In other words, we still don't know what the exact connection is.

"COVID-19 can present itself in many different forms, which is the challenge," said Dr. Nagar. "Plus, being elderly or immunocompromised, or having various other medical conditions, are risk factors in themselves."

What To Do if You Detect Confusion in Someone Who Might Have COVID-19

The Centers for Disease Control (CDC) doesn't include delirium or confusion in its list of reported COVID-19 symptoms. However, as of January 2022, it has included delirium as a possible COVID-19 symptom for older and immunosuppressed individuals on its "Identifying Sick Workers & Inpatients" page for non-US healthcare facilities.

Additionally, the CDC does cite "new confusion" as an emergency warning sign for COVID-19. It is crucial to remember that delirium can be due to factors beyond COVID-19 infection like hypoxia, severe dehydration, or stroke. In any case, if you detect new confusion in someone, you should call 911 or call ahead to your local emergency facility, noting if you are seeking care for someone who may have COVID-19 when applicable.

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDC, WHO, and their local public health department as resources.

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