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Observational Study
. 2022 Dec;12(12):e2787.
doi: 10.1002/brb3.2787. Epub 2022 Nov 10.

Older patients with COVID-19 and neuropsychiatric conditions: A study of risk factors for mortality

Vi-Huong Nguyen-Michel  1   2 , Marion Houot  3   4   5 , Cécile Delorme  3   6 , Aude Sangaré  1   3 , Ana Gales  7 , Valerio Frazzini  1   2   3 , Aurélie Hanin  1   2   3 , Djamal Aissani  8 , Thanh Trân  9 , Bruno Oquendo  10 , Flora Ketz  10 , Carmelo Lafuente-Lafuente  10 , Christel Oasi  10 , Kiyoka Kinugawa  1   11 , Gaëlle Ouvrard  12 , Renata Ursu  13 , Bertrand Degos  14 , Benjamin Rohaut  3   15 , Sophie Demeret  15 , Virginie Lambrecq  1   2   3 , Vincent Navarro  1   2   3 , Emmanuel Fournier  1   3 , Jean-Christophe Corvol  3   6 , Alaina Borden  1
Affiliations
Observational Study

Older patients with COVID-19 and neuropsychiatric conditions: A study of risk factors for mortality

Vi-Huong Nguyen-Michel et al. Brain Behav. 2022 Dec.

Abstract

Background: Little is known about risk factors for mortality in older patients with COVID-19 and neuropsychiatric conditions.

Methods: We conducted a multicentric retrospective observational study at Assistance Publique-Hôpitaux de Paris. We selected inpatients aged 70 years or older, with COVID-19 and preexisting neuropsychiatric comorbidities and/or new neuropsychiatric manifestations. We examined demographics, comorbidities, functional status, and presentation including neuropsychiatric symptoms and disorders, as well as paraclinical data. Cox survival analysis was conducted to determine risk factors for mortality at 40 days after the first symptoms of COVID-19.

Results: Out of 191 patients included (median age 80 [interquartile range 74-87]), 135 (71%) had neuropsychiatric comorbidities including cognitive impairment (39%), cerebrovascular disease (22%), Parkinsonism (6%), and brain tumors (6%). A total of 152 (79%) patients presented new-onset neuropsychiatric manifestations including sensory symptoms (6%), motor deficit (11%), behavioral (18%) and cognitive (23%) disturbances, gait impairment (11%), and impaired consciousness (18%). The mortality rate at 40 days was 19.4%. A history of brain tumor or Parkinsonism or the occurrence of impaired consciousness were neurological factors associated with a higher risk of mortality. A lower Activities of Daily Living score (hazard ratio [HR] 0.69, 95% confidence interval [CI] 0.58-0.82), a neutrophil-to-lymphocyte ratio ≥ 9.9 (HR 5.69, 95% CI 2.69-12.0), and thrombocytopenia (HR 5.70, 95% CI 2.75-11.8) independently increased the risk of mortality (all p < .001).

Conclusion: Understanding mortality risk factors in older inpatients with COVID-19 and neuropsychiatric conditions may be helpful to neurologists and geriatricians who manage these patients in clinical practice.

Keywords: COVID-19; mortality; neurology psychiatric; older people.

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Conflict of interest statement

Cécile Delorme received a research grant from the FIA for the support of this work, travel funding from Merz Pharma, Boston Scientific and Medtronic, outside of this work. Vincent Navarro served as board member for UCB pharma, LivaNova, GW pharma et EISAI, outside of this work. Jean‐Christophe Corvol received a grant from the Fondation de France (#00113315) for the support of this study, and served on the scientific advisory boards for Biogen, UCB, Prevail Therapeutic, Idorsia, Ever Pharma, Denali, and has received grants from the Michael J Fox Foundation and Sanofi outside of this work. Bertrand Degos has received research support from Orkyn, Elivie, Merz, honoraria for speeches from Ipsen, and travail grant from Orkyn outside of this work. The other authors report no disclosures.

Figures

FIGURE 1
FIGURE 1
Patient inclusion flowchart. Abbreviations: AP‐HP, Assistance Publique‐Hôpitaux de Paris; COVID‐19, coronavirus disease 2019; CT, computed tomography; RT‐PCR, real time‐polymerase chain reaction
FIGURE 2
FIGURE 2
The Kaplan‐Meier survival estimate for the 191 older patients with COVID‐19 and neuropsychiatric conditions. Note: Number of deaths in parentheses
See this image and copyright information in PMC

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