LAUSR

While the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is an unprecedented threat to all of us, older adults are especially at risk for serious complications from coronavirus disease 2019 (COVID-19) that necessitate hospitalization (1, 2). Significant attention has rightfully been given to the respiratory and cardiovascular consequences of COVID-19. Less is understood about the neurologic complications associated with this virus, especially its potential impact on delirium and cognitive decline. The prevalence of delirium is expected to increase during this pandemic due to several factors detailed below (3). Delirium is independently associated with accelerated cognitive decline for those with and without preexisting dementia (4). Adults with Alzheimer’s disease and related dementias (ADRD) are particularly vulnerable during this pandemic due to dependence on others and increased likelihood of living in assisted living facilities (5). Further, 30% of all COVID-19 deaths in the United States occur in patients living in nursing homes; a high percentage of these individuals also suffer from mild cognitive impairment or dementia (6). If hospitalized, those with ADRD are more likely to become delirious (7). Our goals are to highlight the heightened risk of this neurologic “one-two punch” as well as provide pragmatic, evidence-based management recommendations for a several clinical environments during the COVID-19 pandemic and subsequent recovery period.