Confusion as the Presenting Symptom of COVID-19 in Elderly Patients

Elderly individuals with chronic medical conditions are at particular risk for COVID-19, intensive care unit admission, and death. The authors of this single-site case series describe four elderly patients (mean age, 83; 3 women) diagnosed with COVID-19 whose initial symptom was altered mental status (AMS) and not fever, cough, or respiratory distress.

All patients had chronic medical conditions and dementia and were living in a communal setting. They were each transferred to an emergency department following onset of AMS, where they tested positive for SARS-CoV-2. Chest x-rays were positive for pneumonia in all four patients. At the time that the authors wrote, two patients were admitted to hospice, and the other two remained dependent on o…