The Two-Way Route between Delirium Disorder and Dementia: Insights from COVID-19

Giulia Bommarito; Valentina Garibotto; Giovanni B Frisoni; Frédéric Assal; Patrice H Lalive; Gilles Allali

doi:10.1159/000530566

The Two-Way Route between Delirium Disorder and Dementia: Insights from COVID-19

Neurodegener Dis. 2022;22(3-4):91-103. doi: 10.1159/000530566. Epub 2023 Apr 13.

Authors

Giulia Bommarito¹, Valentina Garibotto², Giovanni B Frisoni³, Frédéric Assal⁴, Patrice H Lalive^{4

5

6}, Gilles Allali^{4

7

8}

Affiliations

¹ Department of Clinical Neurosciences, Lausanne University Hospitals and University of Lausanne, Lausanne, Switzerland.
² Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals and NIMTlab, University of Geneva, Geneva, Switzerland.
³ Memory Center and LANVIE-Laboratory of Neuroimaging of Aging, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
⁴ Department of Clinical Neurosciences, Geneva University Hospitals and University of Geneva, Geneva, Switzerland.
⁵ Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
⁶ Division of Laboratory Medicine, Diagnostic Department, Geneva University Hospitals, Geneva, Switzerland.
⁷ Division of Cognitive and Motor Aging, Department of Neurology, Albert Einstein College of Medicine, Yeshiva University, Bronx, New York, USA.
⁸ Leenaards Memory Center, Lausanne University Hospitals and University of Lausanne, Lausanne, Switzerland.

PMID: 37054684
DOI: 10.1159/000530566

Abstract

Background: Delirium disorder is a frequent neurological complication of SARS-CoV-2 infection and associated with increased disease severity and mortality. Cognitive impairment is a major risk factor for developing delirium disorder during COVID-19, which, in turn, increases the risk of subsequent neurological complications and cognitive decline.

Summary: The bidirectional connection between delirium disorder and dementia likely resides at multiple levels, and its pathophysiological mechanisms during COVID-19 include endothelial damage, blood-brain barrier dysfunction, and local inflammation, with activation of microglia and astrocytes. Here, we describe the putative pathogenic pathways underlying delirium disorder during COVID-19 and highlight how they cross with the ones leading to neurodegenerative dementia.

Key messages: The analysis of the two-sided link can offer useful insights for confronting with long-term neurological consequences of COVID-19 and framing future prevention and early treatment strategies.

Keywords: Acute encephalopathy; COVID-19; Delirium; Dementia; Neurodegeneration; Neurovascular unit; SARS-CoV-2.

Publication types

Review