Salud Mental

Prevention, diagnosis, and treatment of delirium in older adults with COVID-19. Literature review

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Sara Gloria Aguilar-Navarro
José Octavio Duarte-Flores
Mary Cruz Granados-Valdéz
María José Suing-Ortega
Alberto José Mimenza-Alvarado

Resumen

Antecedentes. La COVID-19 afecta múltiples sistemas del organismo. Uno de ellos es el sistema nervioso central (SNC), cuya afección se manifiesta con cefalea, hiposmia, enfermedad vascular cerebral y neuropatía. Además de que los adultos mayores (AM) son vulnerables a esta infección, pueden presentar delirium, el cual puede ser resultado de una afección directa del virus al SNC o resultado de la inflamación sistémica durante la infección.

Objetivo. Conocer las características clínicas, factores de riesgo, fisiopatología, medidas de tratamiento y prevención del delirium asociados a COVID-19 a partir de la revisión de la literatura en tiempos de la pandemia por SARS-CoV-2.

Método. Se realizó una búsqueda en PubMed, SciELO, UpToDate y Medscape utilizando palabras clave en inglés y español.

Resultados. Se revisaron 72 artículos, se analizaron criterios de inclusión y exclusión y se seleccionaron 43 artículos con información relevante para la descripción narrativa de la revisión. El 20-30% de los pacientes con COVID-19 presentarán o desarrollarán delirium, o cambios en su estado mental durante el curso de su hospitalización, con tasas del 60-70% en enfermedad grave. Es probable que los mecanismos exactos sean multifactoriales. Existe una preocupante falta de atención a las implicaciones de la identificación y el manejo del delirium en la respuesta a esta pandemia.

Discusión y conclusión. El delirium es una manifestación neurológica frecuente en los AM con COVID-19 y requiere su identificación temprana, así como la implementación de estrategias de tratamiento no farmacológico y farmacológico, lo que puede disminuir la morbimortalidad asociada en este grupo etario.
Palabras clave:
COVID-19, SARS-CoV-2, delirium, adulto mayor

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