Psychotropic Medication Use Is Associated With Greater 1-Year Incidence of Dementia After COVID-19 Hospitalization.

Background: COVID-19 has been associated with an increased risk of incident dementia (post-COVID dementia). Establishing additional risk markers may help identify at-risk individuals and guide clinical decision-making. Methods: We investigated pre-COVID psychotropic medication use (exposure) and 1-year incidence of dementia (outcome) in 1,755 patients (≥65 years) hospitalized with COVID-19. Logistic regression models were used to examine the association, adjusting for demographic and clinical variables. For further confirmation, we applied the Least Absolute Shrinkage and Selection Operator (LASSO) regression and a machine learning (Random Forest) algorithm. Results: One-year incidence rate of post-COVID dementia was 12.7% (N = 223). Pre-COVID psychotropic medications (OR = 2.7, 95% CI: 1.8-4.0, P < 0.001) and delirium (OR = 3.0, 95% CI: 1.9-4.6, P < 0.001) were significantly associated with greater 1-year incidence of post-COVID dementia. The association between psychotropic medications and incident dementia remained robust when the analysis was restricted to the 423 patients with at least one documented neurological or psychiatric diagnosis at the time of COVID-19 admission (OR = 3.09, 95% CI: 1.5-6.6, P = 0.002). Across different drug classes, antipsychotics (OR = 2.8, 95% CI: 1.7-4.4, P < 0.001) and mood stabilizers/anticonvulsants (OR = 2.4, 95% CI: 1.39-4.02, P = 0.001) displayed the greatest association with post-COVID dementia. The association of psychotropic medication with dementia was further confirmed with Random Forest and LASSO analysis. Conclusion: Confirming prior studies we observed a high dementia incidence in older patients after COVID-19 hospitalization. Pre-COVID psychotropic medications were associated with higher risk of incident dementia. Psychotropic medications may be risk markers that signify neuropsychiatric symptoms during prodromal dementia, and not mutually exclusive, contribute to post-COVID dementia.

Mortality in association with antipsychotic medication use and clinical outcomes among geriatric psychiatry outpatients with COVID-19.

OBJECTIVES: Older adults are particularly vulnerable to the negative consequences of antipsychotic exposure and are disproportionally affected by higher mortality from coronavirus disease 2019 (COVID-19). Our goal was to determine whether concurrent antipsychotic medication use was associated with increased COVID-19 mortality in older patients with preexisting behavioral health problems. We also report on findings from post-COVID follow-ups. DESIGN: Retrospective observational study. PARTICIPANTS: Outpatients at a geriatric psychiatric clinic in New York City. MEASUREMENTS: Demographic and clinical data including medication, diagnosis and Clinical Global Impression Severity (CGI-S) scales on outpatients who had COVID-19 between February 28th and October 1st 2020 were extracted from the electronic health records (EHR) from the hospital. RESULTS: A total of 56 patients were diagnosed with COVID-19 (mean age 76 years; median age 75 years) and 13 (23.2%) died. We found an increased mortality risk for patients who were prescribed at least one antipsychotic medication at the time of COVID-19 infection (Fisher's exact test P = 0.009, OR = 11.1, 95% confidence interval: 1.4-96.0). This result remains significant after adjusting for age, gender, housing context and dementia (Logistic regression P = 0.035, Beta = 2.4). Furthermore, we found that most patients who survived COVID-19 (88.4%) recovered to pre-COVID baseline in terms of psychiatric symptoms. Comparison of pre- and post-COVID assessments of CGI-S for 33 patients who recovered from COVID-19 were not significantly different. CONCLUSION: We observed a higher COVID-19 mortality associated with concurrent antipsychotics use in older patients receiving behavioral health services. The majority of patients in our geriatric clinic who recovered from COVID-19 appeared to return to their pre-COVID psychiatric function. More precise estimates of the risk associated with antipsychotic treatment in older patients with COVID-19 and other underlying factors will come from larger datasets and meta-analyses.

Presentation and Outcome of Coronavirus Disease (COVID-19) in Patients at a Geriatric Psychiatric Outpatient Clinic

Introduction The novel coronavirus disease 2019 (COVID-19) disproportionally affects elderly patients leading to particularly high morbidity and mortality rates in this population. Age, gender, comorbidities, and housing context have been reported to be among the risk factors for mortality. Exposure to antipsychotics have been discussed to potentially impact the immune response and may pose additional risks. Furthermore, neuropsychiatric presentations are common among older patients and it is unclear how geriatric patients with preexisting psychiatric and neuropsychiatric problems recover from COVID-19. Methods In this retrospective observational study, we describe demographic characteristics of patients at a large geriatric psychiatric outpatient clinic in the New York metropolitan area, who had COVID-19. Our aim is to identify factors that may be associated with increased mortality and to evaluate whether those who survived returned to pre-COVID baseline function. We combined information provided by the treating psychiatrists with data that could be extracted from the electronic health records. Results Between February and September 2020, we identified 56 patients who were diagnosed with COVID-19 (mean age 76 years old). Thirteen patients (23.2%) died and we found that antipsychotics use at the time of COVID-19 infection is associated with increased risk of death (Fisher's exact test P= 0.009, odds ratio = 11.5, 95% confidence interval: 1.4 – 96.0). The result remains significant after adjusting for age, gender, housing context and presence of neurocognitive disorder (Logistic regression P=0.037, Beta=2.4). Furthermore, we found that most patients who survived COVID-19 recovered to baseline (88.4%) as indicated by the ratio of pre- and post-COVID Clinical Global Impressions Severity scale (mean ratio= 0.98, median=1.0, One-sample t-test P=0.48) in 33 patients. Conclusions In conclusion, antipsychotics appear to be associated with higher mortality in our geriatric psychiatry outpatient cohort. However, it is encouraging to find that the majority of elderly patients who survived COVID-19 seems to recover to their baseline neuropsychiatric function. Future larger studies are needed to put these observations into a broader context as well as to explore underlying mechanisms of risk factors. Funding NIH K08 AG054727