The current pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), or coronavirus disease (COVID-19), has dramatically impacted global society. Globally ~5.5 million cases have been reported with ~350,000 deaths to date. More than 100,000 deaths have occurred in the USA alone. SARS-CoV-2 in particular affects older adults (>60yrs); those with diabetes, hypertension, obesity, heart and/or lung disease, are in nursing home facilities or are immunocompromised. Patients with cognitive impairment and/or age associated neurodegenerative diseases are a particularly vulnerable population. Among this older adult population altered mental status or delirium is much more likely to be presenting clinical manifestations. This is in contrast to the more typical COVID-19 symptoms of fever, cough and dyspnea.

Neurological complications, are common with more severe infection, that disproportionately affect older adults, including impaired consciousness, stroke, and seizures. Though the pathogenesis of neurological complications in COVID-19 are still being elucidated, possibilities include direct neuronal invasion, thrombosis and/or microangiopathy with subsequent stroke or intracranial hemorrhage, sequelae of critical illness including hypoxic brain injury, critical illness neuropathy or myopathy, or post-infectious molecular mimicry syndromes such as Guillain Barre Syndrome or necrotizing encephalomyelitis. This is likely due, in part, to the fact that the COVID-19 virus is now known to target the central nervous system (CNS).

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