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Guo Z, Sun S, Xiao S, Chen G, Chen P, Yang Z, Tang X, Huang L, Wang Y. COVID-19 is associated with changes in brain function and structure: A multimodal meta-analysis of neuroimaging studies. Neurosci Biobehav Rev 2024; 164:105792. [PMID: 38969310 DOI: 10.1016/j.neubiorev.2024.105792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/23/2024] [Accepted: 06/27/2024] [Indexed: 07/07/2024]
Abstract
The actual role of coronavirus disease 2019 (COVID-19) in brain damage has been increasingly reported, necessitating a meta-analysis to collate and summarize the inconsistent findings from functional imaging and voxel-based morphometry (VBM) studies. A comprehensive voxel-wise meta-analysis of the whole brain was conducted to identify alterations in functional activity and gray matter volume (GMV) between COVID-19 patients and healthy controls (HCs) by using Seed-based d Mapping software. We included 15 functional imaging studies (484 patients with COVID-19, 534 HCs) and 9 VBM studies (449 patients with COVID-19, 388 HCs) in the analysis. Overall, patients with COVID-19 exhibited decreased functional activity in the right superior temporal gyrus (STG) (extending to the right middle and inferior temporal gyrus, insula, and temporal pole [TP]), left insula, right orbitofrontal cortex (OFC) (extending to the right olfactory cortex), and left cerebellum compared to HCs. For VBM, patients with COVID-19, relative to HCs, showed decreased GMV in the bilateral anterior cingulate cortex/medial prefrontal cortex (extending to the bilateral OFC), and left cerebellum, and increased GMV in the bilateral amygdala (extending to the bilateral hippocampus, STG, TP, MTG, and right striatum). Moreover, overlapping analysis revealed that patients with COVID-19 exhibited both decreased functional activity and increased GMV in the right TP (extending to the right STG). The multimodal meta-analysis suggests that brain changes of function and structure in the temporal lobe, OFC and cerebellum, and functional or structural alterations in the insula and the limbic system in COVID-19. These findings contribute to a better understanding of the pathophysiology of brain alterations in COVID-19. SIGNIFICANCE STATEMENT: This first large-scale multimodal meta-analysis collates existing neuroimaging studies and provides voxel-wise functional and structural whole-brain abnormalities in COVID-19. Findings of this meta-analysis provide valuable insights into the dynamic brain changes (from infection to recovery) and offer further explanations for the pathophysiological basis of brain alterations in COVID-19.
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Affiliation(s)
- Zixuan Guo
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China; Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China
| | - Shilin Sun
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China; Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China
| | - Shu Xiao
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China; Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China
| | - Guanmao Chen
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China; Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China
| | - Pan Chen
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China; Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China
| | - Zibin Yang
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China; Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China
| | - Xinyue Tang
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China; Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China
| | - Li Huang
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China; Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China
| | - Ying Wang
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, China; Institute of Molecular and Functional Imaging, Jinan University, Guangzhou, China.
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McClelland AC, Benitez SJ, Burns J. COVID-19 Neuroimaging Update: Pathophysiology, Acute Findings, and Post-Acute Developments. Semin Ultrasound CT MR 2024; 45:318-331. [PMID: 38518814 DOI: 10.1053/j.sult.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
COVID-19 has prominent effects on the nervous system with important manifestations on neuroimaging. In this review, we discuss the neuroimaging appearance of acute COVID-19 that became evident during the early stages of the pandemic. We highlight the underlying pathophysiology mediating nervous system effects and neuroimaging appearances including systemic inflammatory response such as cytokine storm, coagulopathy, and para/post-infections immune mediated phenomena. We also discuss the nervous system manifestations of COVID-19 and the role of imaging as the pandemic has evolved over time, including related to the development of vaccines and the emergence of post-acute sequalae such as long COVID.
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Affiliation(s)
| | - Steven J Benitez
- Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Judah Burns
- Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
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Sun D, Shi Z, Chen H, Du Q, Zhang Y, Wang R, Kong L, Luo W, Lang Y, Wang X, Zhou H. COVID-19 susceptibility, hospitalization and severity and the risk of brain cortical structure: a Mendelian randomization study. QJM 2024; 117:413-421. [PMID: 38195890 DOI: 10.1093/qjmed/hcad291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 12/18/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Observational studies have reported structural changes in the brains of patients with coronavirus disease 2019 (COVID-19); it remains unclear whether these associations are causal. AIM We evaluated the causal effects of COVID-19 susceptibility, hospitalization and severity on cortical structures. DESIGN Mendelian randomization (MR) study. METHODS Data on the different COVID-19 phenotypes were obtained from the latest large-scale genome-wide association study (R7) of the COVID-19 Host Genetics Initiative. Brain structure data, including cortical thickness (TH) and surface area (SA), were obtained from the ENIGMA Consortium. Additionally, we employed the round 5 dataset released in January 2021 as the validation cohort. The inverse-variance weighted (IVW) method was used as the primary analysis in MR. Sensitivity analyses were conducted to evaluate heterogeneity and pleiotropy. We performed enrichment analysis on the MR analyses that passed the sensitivity analysis filtering. RESULTS After IVW and sensitivity analyses, we observed causal associations between COVID-19 susceptibility and rostral middle frontal SAw (P = 0.0308, β = -39.1236), cuneus THw (P = 0.0170, β = -0.0121), medial orbitofrontal THw (P = 0.0002, β = 0.0225), postcentral THw (P = 0.0217, β = -0.0106), temporal pole THw (P = 0.0077, β = 0.0359), medial orbitofrontal SAnw (P = 0.0106, β = -24.0397), medial orbitofrontal THnw (P = 0.0007, β = 0.0232), paracentral SAnw (P = 0.0483, β = -20.1442), rostral middle frontal SAnw (P = 0.0368, β = -81.9719) and temporal pole THnw (P = 0.0429, β = 0.0353). COVID-19 hospitalization had causal effects on medial orbitofrontal THw (P = 0.0053, β = 0.0063), postcentral THw (P = 0.0143, β = -0.0042), entorhinal THnw (P = 0.0142, β = 0.0142), medial orbitofrontal THnw (P = 0.0147, β = 0.0065) and paracentral SAnw (P = 0.0119, β = -7.9970). COVID-19 severity had causal effects on rostral middle frontal SAw (P = 0.0122, β = -11.8296), medial orbitofrontal THw (P = 0.0155, β = 0.0038), superior parietal THw (P = 0.0291, β = -0.0021), lingual SAnw (P = 0.0202, β = -11.5270), medial orbitofrontal THnw (P = 0.0290, β = 0.0039), paracentral SAnw (P = 0.0180, β = -5.7744) and pars triangularis SAnw (P = 0.0151, β = -5.4520). CONCLUSION Our MR results demonstrate a causal relationship between different COVID-19 phenotypes and cortical structures.
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Affiliation(s)
- D Sun
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Z Shi
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - H Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Q Du
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Y Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - R Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - L Kong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - W Luo
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Y Lang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - X Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - H Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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Sharma AA, Nenert R, Goodman AM, Szaflarski JP. Brain temperature and free water increases after mild COVID-19 infection. Sci Rep 2024; 14:7450. [PMID: 38548815 PMCID: PMC10978935 DOI: 10.1038/s41598-024-57561-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 03/19/2024] [Indexed: 04/01/2024] Open
Abstract
The pathophysiology underlying the post-acute sequelae of COVID-19 remains understudied and poorly understood, particularly in healthy adults with a history of mild infection. Chronic neuroinflammation may underlie these enduring symptoms, but studying neuroinflammatory phenomena in vivo is challenging, especially without a comparable pre-COVID-19 dataset. In this study, we present a unique dataset of 10 otherwise healthy individuals scanned before and after experiencing mild COVID-19. Two emerging MR-based methods were used to map pre- to post-COVID-19 brain temperature and free water changes. Post-COVID-19 brain temperature and free water increases, which are indirect biomarkers of neuroinflammation, were found in structures functionally associated with olfactory, cognitive, and memory processing. The largest pre- to post-COVID brain temperature increase was observed in the left olfactory tubercle (p = 0.007, 95% CI [0.48, 3.01]), with a mean increase of 1.75 °C. Notably, the olfactory tubercle is also the region of the primary olfactory cortex where participants with chronic olfactory dysfunction showed the most pronounced increases as compared to those without lingering olfactory dysfunction (adjusted pFDR = 0.0189, 95% CI [1.42, 5.27]). These preliminary insights suggest a potential link between neuroinflammation and chronic cognitive and olfactory dysfunction following mild COVID-19, although further investigations are needed to improve our understanding of what underlies these phenomena.
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Affiliation(s)
- Ayushe A Sharma
- Department of Neurology, UAB Epilepsy Center, University of Alabama at Birmingham (UAB), 1719 6th Avenue South, CIRC 312, Birmingham, AL, 35294-0021, USA.
- Department of Neurobiology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.
| | - Rodolphe Nenert
- Department of Neurology, UAB Epilepsy Center, University of Alabama at Birmingham (UAB), 1719 6th Avenue South, CIRC 312, Birmingham, AL, 35294-0021, USA
| | - Adam M Goodman
- Department of Neurology, UAB Epilepsy Center, University of Alabama at Birmingham (UAB), 1719 6th Avenue South, CIRC 312, Birmingham, AL, 35294-0021, USA
| | - Jerzy P Szaflarski
- Department of Neurology, UAB Epilepsy Center, University of Alabama at Birmingham (UAB), 1719 6th Avenue South, CIRC 312, Birmingham, AL, 35294-0021, USA.
- Department of Neurobiology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.
- Department of Neurosurgery, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.
- University of Alabama at Birmingham Epilepsy Center (UABEC), Birmingham, AL, USA.
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Deuter D, Hense K, Kunkel K, Vollmayr J, Schachinger S, Wendl C, Schicho A, Fellner C, Salzberger B, Hitzenbichler F, Zeller J, Vielsmeier V, Dodoo-Schittko F, Schmidt NO, Rosengarth K. SARS-CoV2 evokes structural brain changes resulting in declined executive function. PLoS One 2024; 19:e0298837. [PMID: 38470899 DOI: 10.1371/journal.pone.0298837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/30/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Several research has underlined the multi-system character of COVID-19. Though effects on the Central Nervous System are mainly discussed as disease-specific affections due to the virus' neurotropism, no comprehensive disease model of COVID-19 exists on a neurofunctional base by now. We aimed to investigate neuroplastic grey- and white matter changes related to COVID-19 and to link these changes to neurocognitive testings leading towards a multi-dimensional disease model. METHODS Groups of acutely ill COVID-19 patients (n = 16), recovered COVID-19 patients (n = 21) and healthy controls (n = 13) were prospectively included into this study. MR-imaging included T1-weighted sequences for analysis of grey matter using voxel-based morphometry and diffusion-weighted sequences to investigate white matter tracts using probabilistic tractography. Comprehensive neurocognitive testing for verbal and non-verbal domains was performed. RESULTS Alterations strongly focused on grey matter of the frontal-basal ganglia-thalamus network and temporal areas, as well as fiber tracts connecting these areas. In acute COVID-19 patients, a decline of grey matter volume was found with an accompanying diminution of white matter tracts. A decline in executive function and especially verbal fluency was found in acute patients, partially persisting in recovered. CONCLUSION Changes in gray matter volume and white matter tracts included mainly areas involved in networks of executive control and language. Deeper understanding of these alterations is necessary especially with respect to long-term impairments, often referred to as 'Post-COVID'.
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Affiliation(s)
- Daniel Deuter
- Klinik und Poliklinik für Neurochirurgie, University Hospital Regensburg, Regensburg, Germany
| | - Katharina Hense
- Klinik und Poliklinik für Neurochirurgie, University Hospital Regensburg, Regensburg, Germany
| | - Kevin Kunkel
- Klinik und Poliklinik für Neurochirurgie, University Hospital Regensburg, Regensburg, Germany
| | - Johanna Vollmayr
- Klinik und Poliklinik für Neurochirurgie, University Hospital Regensburg, Regensburg, Germany
| | - Sebastian Schachinger
- Klinik und Poliklinik für Neurochirurgie, University Hospital Regensburg, Regensburg, Germany
| | - Christina Wendl
- Institut für Röntgendiagnostik, University Hospital Regensburg, Regensburg, Germany
- Institut für Neuroradiologie, Medbo Bezirksklinikum Regensburg, Regensburg, Germany
| | - Andreas Schicho
- Institut für Röntgendiagnostik, University Hospital Regensburg, Regensburg, Germany
| | - Claudia Fellner
- Institut für Röntgendiagnostik, University Hospital Regensburg, Regensburg, Germany
| | - Bernd Salzberger
- Abteilung für Krankenhaushygiene und Infektiologie, University Hospital Regensburg, Regensburg, Germany
| | - Florian Hitzenbichler
- Abteilung für Krankenhaushygiene und Infektiologie, University Hospital Regensburg, Regensburg, Germany
| | - Judith Zeller
- Klinik und Poliklinik für Innere Medizin II, University Hospital Regensburg, Regensburg, Germany
| | - Veronika Vielsmeier
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, University Hospital Regensburg, Regensburg, Germany
| | - Frank Dodoo-Schittko
- Institut für Sozialmedizin und Gesundheitsforschung, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Nils Ole Schmidt
- Klinik und Poliklinik für Neurochirurgie, University Hospital Regensburg, Regensburg, Germany
| | - Katharina Rosengarth
- Klinik und Poliklinik für Neurochirurgie, University Hospital Regensburg, Regensburg, Germany
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Kiyak C, Ijezie OA, Ackah JA, Armstrong M, Cowen J, Cetinkaya D, Burianová H, Akudjedu TN. Topographical Distribution of Neuroanatomical Abnormalities Following COVID-19 Invasion : A Systematic Literature Review. Clin Neuroradiol 2024; 34:13-31. [PMID: 37697012 PMCID: PMC10881816 DOI: 10.1007/s00062-023-01344-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/14/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE This systematic review is aimed at synthesising the literature base to date on the frequency and topographical distribution of neuroanatomical changes seen on imaging following COVID-19 invasion with a focus on both the acute and chronic phases of the disease. METHODS In this study, 8 databases were systematically searched to identify relevant articles published from December 2019 to March 2022 and supplemented with a manual reference search. Data were extracted from the included studies and narrative synthesis was employed to integrate the findings. RESULTS A total of 110 studies met the inclusion criteria and comprised 119,307 participants (including 31,073 acute and 143 long COVID-19 patients manifesting neurological alterations) and controls. Considerable variability in both the localisation and nature of neuroanatomical abnormalities are noted along the continuum with a wide range of neuropathologies relating to the cerebrovascular/neurovascular system, (sub)cortical structures (including deep grey and white matter structures), brainstem, and predominant regional and/or global alterations in the cerebellum with varying degrees of spinal involvement. CONCLUSION Structural regional alterations on neuroimaging are frequently demonstrated in both the acute and chronic phases of SARS-CoV‑2 infection, particularly prevalent across subcortical, prefrontal/frontal and cortico-limbic brain areas as well as the cerebrovascular/neurovascular system. These findings contribute to our understanding of the acute and chronic effects of the virus on the nervous system and has the potential to provide information on acute and long-term treatment and neurorehabilitation decisions.
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Affiliation(s)
- Ceyda Kiyak
- Faculty of Science and Technology, Bournemouth University, Bournemouth, UK
- School of Psychology, University of East Anglia, Norwich, UK
| | | | - Joseph A Ackah
- Institute of Medical Imaging and Visualisation, Faculty of Health and Social Sciences, Bournemouth University, 8 8GP, Bournemouth, UK
| | - Matthew Armstrong
- Department of Rehabilitation & Sports Sciences, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Jake Cowen
- Department of Radiology, Queen Alexandra Hospital, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Deniz Cetinkaya
- Faculty of Science and Technology, Bournemouth University, Bournemouth, UK
| | - Hana Burianová
- Faculty of Science and Technology, Bournemouth University, Bournemouth, UK
| | - Theophilus N Akudjedu
- Institute of Medical Imaging and Visualisation, Faculty of Health and Social Sciences, Bournemouth University, 8 8GP, Bournemouth, UK.
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Besteher B, Rocktäschel T, Garza AP, Machnik M, Ballez J, Helbing DL, Finke K, Reuken P, Güllmar D, Gaser C, Walter M, Opel N, Rita Dunay I. Cortical thickness alterations and systemic inflammation define long-COVID patients with cognitive impairment. Brain Behav Immun 2024; 116:175-184. [PMID: 38036270 DOI: 10.1016/j.bbi.2023.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/26/2023] [Accepted: 11/23/2023] [Indexed: 12/02/2023] Open
Abstract
As the heterogeneity of symptoms is increasingly recognized among long-COVID patients, it appears highly relevant to study potential pathophysiological differences along the different subtypes. Preliminary evidence suggests distinct alterations in brain structure and systemic inflammatory patterns in specific groups of long-COVID patients. To this end, we analyzed differences in cortical thickness and peripheral immune signature between clinical subgroups based on 3 T-MRI scans and signature inflammatory markers in n = 120 participants comprising healthy never-infected controls (n = 30), healthy COVID-19 survivors (n = 29), and subgroups of long-COVID patients with (n = 26) and without (n = 35) cognitive impairment according to screening with Montreal Cognitive Assessment. Whole-brain comparison of cortical thickness between the 4 groups was conducted by surface-based morphometry. We identified distinct cortical areas showing a progressive increase in cortical thickness across different groups, starting from healthy individuals who had never been infected with COVID-19, followed by healthy COVID-19 survivors, long-COVID patients without cognitive deficits (MoCA ≥ 26), and finally, long-COVID patients exhibiting significant cognitive deficits (MoCA < 26). These findings highlight the continuum of cortical thickness alterations associated with COVID-19, with more pronounced changes observed in individuals experiencing cognitive impairment (p < 0.05, FWE-corrected). Affected cortical regions covered prefrontal and temporal gyri, insula, posterior cingulate, parahippocampal gyrus, and parietal areas. Additionally, we discovered a distinct immunophenotype, with elevated levels of IL-10, IFNγ, and sTREM2 in long-COVID patients, especially in the group suffering from cognitive impairment. We demonstrate lingering cortical and immunological alterations in healthy and impaired subgroups of COVID-19 survivors. This implies a complex underlying pathomechanism in long-COVID and emphasizes the necessity to investigate the whole spectrum of post-COVID biology to determine targeted treatment strategies targeting specific sub-groups.
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Affiliation(s)
- Bianca Besteher
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Germany; German Center for Mental Health (DZPG), Germany; Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health (C-I-R-C), Halle-Jena-Magdeburg, Germany.
| | - Tonia Rocktäschel
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Germany; German Center for Mental Health (DZPG), Germany; Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health (C-I-R-C), Halle-Jena-Magdeburg, Germany
| | - Alejandra P Garza
- Institute of Inflammation and Neurodegeneration, Otto-von-Guericke-University, Magdeburg, Germany
| | - Marlene Machnik
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Germany
| | - Johanna Ballez
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Germany
| | - Dario-Lucas Helbing
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Germany; German Center for Mental Health (DZPG), Germany; Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health (C-I-R-C), Halle-Jena-Magdeburg, Germany
| | - Kathrin Finke
- Department of Neurology, Jena University Hospital, Germany
| | - Philipp Reuken
- Department of Internal Medicine IV, Gastroenterology, Hepatology and Infectious Diseases, Jena University Hospital, Germany
| | - Daniel Güllmar
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital - Friedrich Schiller University Jena, Germany
| | - Christian Gaser
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Germany; German Center for Mental Health (DZPG), Germany; Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health (C-I-R-C), Halle-Jena-Magdeburg, Germany; Department of Neurology, Jena University Hospital, Germany
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Germany; German Center for Mental Health (DZPG), Germany; Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health (C-I-R-C), Halle-Jena-Magdeburg, Germany
| | - Nils Opel
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Germany; German Center for Mental Health (DZPG), Germany; Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health (C-I-R-C), Halle-Jena-Magdeburg, Germany
| | - Ildiko Rita Dunay
- German Center for Mental Health (DZPG), Germany; Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health (C-I-R-C), Halle-Jena-Magdeburg, Germany; Institute of Inflammation and Neurodegeneration, Otto-von-Guericke-University, Magdeburg, Germany
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8
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Giussani G, Westenberg E, Garcia-Azorin D, Bianchi E, Yusof Khan AHK, Allegri RF, Atalar AÇ, Baykan B, Crivelli L, Fornari A, Frontera JA, Guekht A, Helbok R, Hoo FK, Kivipelto M, Leonardi M, Lopez Rocha AS, Mangialasche F, Marcassoli A, Özdag Acarli AN, Ozge A, Prasad K, Prasad M, Sviatskaia E, Thakur K, Vogrig A, Leone M, Winkler AS. Prevalence and Trajectories of Post-COVID-19 Neurological Manifestations: A Systematic Review and Meta-Analysis. Neuroepidemiology 2024; 58:120-133. [PMID: 38272015 DOI: 10.1159/000536352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 01/03/2024] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION The aim of this systematic review and meta-analysis was to evaluate the prevalence of thirteen neurological manifestations in people affected by COVID-19 during the acute phase and at 3, 6, 9 and 12-month follow-up time points. METHODS The study protocol was registered with PROSPERO (CRD42022325505). MEDLINE (PubMed), Embase, and the Cochrane Library were used as information sources. Eligible studies included original articles of cohort studies, case-control studies, cross-sectional studies, and case series with ≥5 subjects that reported the prevalence and type of neurological manifestations, with a minimum follow-up of 3 months after the acute phase of COVID-19 disease. Two independent reviewers screened studies from January 1, 2020, to June 16, 2022. The following manifestations were assessed: neuromuscular disorders, encephalopathy/altered mental status/delirium, movement disorders, dysautonomia, cerebrovascular disorders, cognitive impairment/dementia, sleep disorders, seizures, syncope/transient loss of consciousness, fatigue, gait disturbances, anosmia/hyposmia, and headache. The pooled prevalence and their 95% confidence intervals were calculated at the six pre-specified times. RESULTS 126 of 6,565 screened studies fulfilled the eligibility criteria, accounting for 1,542,300 subjects with COVID-19 disease. Of these, four studies only reported data on neurological conditions other than the 13 selected. The neurological disorders with the highest pooled prevalence estimates (per 100 subjects) during the acute phase of COVID-19 were anosmia/hyposmia, fatigue, headache, encephalopathy, cognitive impairment, and cerebrovascular disease. At 3-month follow-up, the pooled prevalence of fatigue, cognitive impairment, and sleep disorders was still 20% and higher. At six- and 9-month follow-up, there was a tendency for fatigue, cognitive impairment, sleep disorders, anosmia/hyposmia, and headache to further increase in prevalence. At 12-month follow-up, prevalence estimates decreased but remained high for some disorders, such as fatigue and anosmia/hyposmia. Other neurological disorders had a more fluctuating occurrence. DISCUSSION Neurological manifestations were prevalent during the acute phase of COVID-19 and over the 1-year follow-up period, with the highest overall prevalence estimates for fatigue, cognitive impairment, sleep disorders, anosmia/hyposmia, and headache. There was a downward trend over time, suggesting that neurological manifestations in the early post-COVID-19 phase may be long-lasting but not permanent. However, especially for the 12-month follow-up time point, more robust data are needed to confirm this trend.
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Affiliation(s)
- Giorgia Giussani
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Erica Westenberg
- Department of Neurology, Center for Global Health, School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - David Garcia-Azorin
- Department of Neurology, Hospital Clínico Universitario Valladolid, Valladolid, Spain
| | - Elisa Bianchi
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Abdul Hanif Khan Yusof Khan
- Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | | | - Arife Çimen Atalar
- Department of Neurology, Kanuni Sultan Süleyman Education and Research Hospital, Istanbul, Turkey
| | - Betul Baykan
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Lucia Crivelli
- Department of Cognitive Neurology, Fleni, Buenos Aires, Argentina
| | - Arianna Fornari
- Neurology, Public Health, Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Jennifer A Frontera
- Department of Neurology, NYU Grossman School of Medicine, New York, New York, USA
| | - Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry and Russian National Research Medical University, Moscow, Russian Federation
| | - Raimund Helbok
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
- Department of Neurology, Kepler University Hospital, Johannes Kepler University Linz, Linz, Austria
| | - Fan Kee Hoo
- Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Miia Kivipelto
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
| | - Matilde Leonardi
- Neurology, Public Health, Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Ana Sabsil Lopez Rocha
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
| | - Francesca Mangialasche
- Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
| | - Alessia Marcassoli
- Neurology, Public Health, Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Aynur Ozge
- Mersin University School of Medicine, Mersin, Turkey
| | | | - Manya Prasad
- Clinical Research and Epidemiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Ekaterina Sviatskaia
- Suicide Research and Prevention Department, Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russian Federation
| | - Kiran Thakur
- Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, New York, USA
| | - Alberto Vogrig
- Clinical Neurology, Santa Maria Della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
- Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Maurizio Leone
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Andrea Sylvia Winkler
- Department of Neurology, Center for Global Health, School of Medicine and Health, Technical University of Munich, Munich, Germany
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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9
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Helbing DL, Dommaschk EM, Danyeli LV, Liepinsh E, Refisch A, Sen ZD, Zvejniece L, Rocktäschel T, Stabenow LK, Schiöth HB, Walter M, Dambrova M, Besteher B. Conceptual foundations of acetylcarnitine supplementation in neuropsychiatric long COVID syndrome: a narrative review. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-023-01734-3. [PMID: 38172332 DOI: 10.1007/s00406-023-01734-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/21/2023] [Indexed: 01/05/2024]
Abstract
Post-acute sequelae of COVID-19 can present as multi-organ pathology, with neuropsychiatric symptoms being the most common symptom complex, characterizing long COVID as a syndrome with a significant disease burden for affected individuals. Several typical symptoms of long COVID, such as fatigue, depressive symptoms and cognitive impairment, are also key features of other psychiatric disorders such as myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and major depressive disorder (MDD). However, clinically successful treatment strategies are still lacking and are often inspired by treatment options for diseases with similar clinical presentations, such as ME/CFS. Acetylcarnitine, the shortest metabolite of a class of fatty acid metabolites called acylcarnitines and one of the most abundant blood metabolites in humans can be used as a dietary/nutritional supplement with proven clinical efficacy in the treatment of MDD, ME/CFS and other neuropsychiatric disorders. Basic research in recent decades has established acylcarnitines in general, and acetylcarnitine in particular, as important regulators and indicators of mitochondrial function and other physiological processes such as neuroinflammation and energy production pathways. In this review, we will compare the clinical basis of neuropsychiatric long COVID with other fatigue-associated diseases. We will also review common molecular disease mechanisms associated with altered acetylcarnitine metabolism and the potential of acetylcarnitine to interfere with these as a therapeutic agent. Finally, we will review the current evidence for acetylcarnitine as a supplement in the treatment of fatigue-associated diseases and propose future research strategies to investigate the potential of acetylcarnitine as a treatment option for long COVID.
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Affiliation(s)
- Dario Lucas Helbing
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Philosophenweg 3, 07743, Jena, Germany
- Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits, Underlying Mental Health (C-I-R-C), Jena, Magdeburg, Halle, Germany
- German Center for Mental Health (DZPG), Site Halle, Jena, Magdeburg, Germany
- Leibniz Institute on Aging, Fritz Lipmann Institute, Jena, Germany
- Institute of Molecular Cell Biology, Jena University Hospital, Friedrich Schiller University Jena, 07745, Jena, Germany
| | - Eva-Maria Dommaschk
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Philosophenweg 3, 07743, Jena, Germany
| | - Lena Vera Danyeli
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Philosophenweg 3, 07743, Jena, Germany
- Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits, Underlying Mental Health (C-I-R-C), Jena, Magdeburg, Halle, Germany
- Department of Psychiatry and Psychotherapy, University Tübingen, Tübingen, Germany
| | - Edgars Liepinsh
- Laboratory of Pharmaceutical Pharmacology, Latvian Institute of Organic Synthesis, Riga, Latvia
- Faculty of Pharmacy, Riga Stradins University, Riga, Latvia
| | - Alexander Refisch
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Philosophenweg 3, 07743, Jena, Germany
- Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits, Underlying Mental Health (C-I-R-C), Jena, Magdeburg, Halle, Germany
| | - Zümrüt Duygu Sen
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Philosophenweg 3, 07743, Jena, Germany
- Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits, Underlying Mental Health (C-I-R-C), Jena, Magdeburg, Halle, Germany
| | - Liga Zvejniece
- Laboratory of Pharmaceutical Pharmacology, Latvian Institute of Organic Synthesis, Riga, Latvia
| | - Tonia Rocktäschel
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Philosophenweg 3, 07743, Jena, Germany
- Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits, Underlying Mental Health (C-I-R-C), Jena, Magdeburg, Halle, Germany
- German Center for Mental Health (DZPG), Site Halle, Jena, Magdeburg, Germany
| | - Leonie Karoline Stabenow
- Institute of Molecular Cell Biology, Jena University Hospital, Friedrich Schiller University Jena, 07745, Jena, Germany
- Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - Helgi B Schiöth
- Department of Surgical Sciences, Functional Pharmacology and Neuroscience, Uppsala University, 751 24, Uppsala, Sweden
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Philosophenweg 3, 07743, Jena, Germany
- Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits, Underlying Mental Health (C-I-R-C), Jena, Magdeburg, Halle, Germany
- German Center for Mental Health (DZPG), Site Halle, Jena, Magdeburg, Germany
- Center for Behavioral Brain Sciences, Magdeburg, Germany
- Department of Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany
- Max Planck Institute for Biological Cybernetics, Tübingen, Germany
- Department of Psychiatry and Psychotherapy, University Tübingen, Tübingen, Germany
| | - Maija Dambrova
- Laboratory of Pharmaceutical Pharmacology, Latvian Institute of Organic Synthesis, Riga, Latvia
- Faculty of Pharmacy, Riga Stradins University, Riga, Latvia
| | - Bianca Besteher
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Philosophenweg 3, 07743, Jena, Germany.
- Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits, Underlying Mental Health (C-I-R-C), Jena, Magdeburg, Halle, Germany.
- German Center for Mental Health (DZPG), Site Halle, Jena, Magdeburg, Germany.
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10
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Jin P, Cui F, Xu M, Ren Y, Zhang L. Altered brain function and structure pre- and post- COVID-19 infection: a longitudinal study. Neurol Sci 2024; 45:1-9. [PMID: 38049550 DOI: 10.1007/s10072-023-07236-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 11/28/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Evidence indicates that the SARS-CoV-2 virus can infect the brain, resulting in central nervous system symptoms. However, there is a lack of a longitudinal imaging study investigating the impact of Coronavirus disease 2019 (COVID-19) infection on brain function. Consequently, this study aimed to fill this knowledge gap using functional magnetic resonance imaging (fMRI). METHODS Twenty-one participants underwent two resting-state fMRI scans before and after infection. The amplitude of low-frequency fluctuations (ALFF) and regional homogeneity (ReHo) were assessed to identify the brain function changes. Additionally, voxel-based morphometry (VBM) was utilized to assess changes in brain structure. Subsequently, brain regions that showed significant differences were identified as regions of interest (ROI) in functional connectivity analysis (FC). RESULTS After infection, ALFF was increased in the bilateral paracentral lobe and postcentral gyrus while decreased in the bilateral precuneus. Moreover, ReHo was decreased in the cerebellar vermis, accompanied by a decrease in FC with the bilateral postcentral gyrus. Furthermore, gray matter volume (GMV) reduction was observed in the left thalamus. The results of the correlation analysis revealed a negative correlation between ALFF values in the bilateral precuneus and scores on the self-rating anxiety scale (SAS) in pre- and post-infection datasets. CONCLUSION Neuroimaging alterations may occur before the manifestation of clinical symptoms, indicating that the functioning of the motor and sensory systems, as well as their connection, might be affected following infection. This alteration can potentially increase the potential of maladaptive responses to environmental stimuli. Furthermore, patients may be susceptible to future emotional disorders.
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Affiliation(s)
- Ping Jin
- Department of Radiology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Stadium Road 453#, Xihu District, Hangzhou City, 310000, Zhejiang Province, China
| | - Feng Cui
- Department of Radiology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Stadium Road 453#, Xihu District, Hangzhou City, 310000, Zhejiang Province, China
| | - Min Xu
- Department of Radiology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Stadium Road 453#, Xihu District, Hangzhou City, 310000, Zhejiang Province, China
| | - Yue Ren
- Department of Radiology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Stadium Road 453#, Xihu District, Hangzhou City, 310000, Zhejiang Province, China
| | - Luping Zhang
- Department of Radiology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Stadium Road 453#, Xihu District, Hangzhou City, 310000, Zhejiang Province, China.
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11
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Yaman H, Yılmaz O, Hanoğlu L, Bayazıt Y. fNIRS-based evaluation of the impact of SARS-CoV-2 infection central auditory processing. Brain Behav 2023; 13:e3303. [PMID: 37908040 PMCID: PMC10726898 DOI: 10.1002/brb3.3303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/29/2023] [Accepted: 10/18/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVES Coronavirus disease-2019 due to SARS-CoV-2 infection has been associated with neurological and neuropsychiatric illnesses as well as auditory system problems. In this study, we aimed to evaluate the impact of SARS-CoV-2 infection on the central auditory system by assessing the hemodynamic activation changes using functional near-infrared spectroscopy (fNIRS). METHODS Three participants who had SARS-CoV-2 infection (study group) and four participants who had no SARS-CoV-2 infection (control group) were included in the study. During the auditory oddball task in which two different frequencies of tonal stimulation were presented at 80 dB HL, the participants were asked to pay attention to the rare tonal stimulation and mentally count these target stimuli throughout the task. During this task, oxygenated hemodynamic response functions were evaluated with fNIRS. RESULTS Significantly increased oxygenated hemodynamic responses were observed in both groups during the task (p < .05), which was significantly higher in the study group (p < .05). Significantly more HbO activation was observed in the vmPFC, superior temporal gyrus, and medial temporal gyrus in the study group compared to controls (p < .05). Significantly higher hemodynamic activation was observed in the right hemisphere in both groups, which was significantly higher in the study group (p < .05). CONCLUSION SARS-CoV-2 infections may impact on central auditory processing or auditory attention due to changes in oxyhemoglobin levels in the frontal and temporal brain regions. It seems that SARS-CoV-2 infection is associated with an additional load on neural activity, and difficulties in focusing in auditory attention, following speech and hearing in noise as well as increased effort to perceive auditory cues.
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Affiliation(s)
- Handan Yaman
- Department of AudiologyIstanbul Medipol University Mega HospitalIstanbulTurkiye
- Functional Imaging and Cognitive‐Affective Neuroscience Lab (fINCAN), Research Institute for Health Sciences and Technologies (SABITA)Istanbul Medipol UniversityIstanbulTurkiye
| | - Oğuz Yılmaz
- Department of AudiologyIstanbul Medipol University Mega HospitalIstanbulTurkiye
- Department of Audiology, Faculty of Health SciencesIstanbul Medipol UniversityIstanbulTurkiye
| | - Lütfü Hanoğlu
- Functional Imaging and Cognitive‐Affective Neuroscience Lab (fINCAN), Research Institute for Health Sciences and Technologies (SABITA)Istanbul Medipol UniversityIstanbulTurkiye
- Department of NeurologyIstanbul Medipol University, Medipol Mega HospitalIstanbulTurkiye
| | - Yıldırım Bayazıt
- Department of ENT, Gaziosmanpaşa HospitalIstanbul Yeni Yüzyıl UniversityIstanbulTurkiye
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12
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Du Y, Zhao W, Huang S, Huang C, Li C, Chen Y, Huang Y, Yang L, Li C, Zhang H, Guo H, Liu J. Gray Matter Thickness and Subcortical Nuclear Volume in Men After SARS-CoV-2 Omicron Infection. JAMA Netw Open 2023; 6:e2345626. [PMID: 38032639 PMCID: PMC10690469 DOI: 10.1001/jamanetworkopen.2023.45626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Importance The clinical manifestations and effects on the brain of the SARS-CoV-2 Omicron variant in the acute postinfection phase remain unclear. Objective To investigate the pathophysiological mechanisms underlying clinical symptoms and changes to gray matter and subcortical nuclei among male patients after Omicron infection and to provide an imaging basis for early detection and intervention. Design, Setting, and Participants In this cohort study, a total of 207 men underwent health screening magnetic resonance imaging scans between August 28 and September 18, 2022; among them, 98 provided complete imaging and neuropsychiatric data. Sixty-one participants with Omicron infection were reevaluated after infection (January 6 to 14, 2023). Neuropsychiatric data, clinical symptoms, and magnetic resonance imaging data were collected in the acute post-Omicron period, and their clinical symptoms were followed up after 3 months. Gray matter indexes and subcortical nuclear volumes were analyzed. Associations between changes in gray matter and neuropsychiatric data were evaluated with correlation analyses. Exposures Gray matter thickness and subcortical nuclear volume change data were compared before and after Omicron infection. Main Outcomes and Measures The gray matter indexes and subcutaneous nuclear volume were generated from the 3-dimensional magnetization-prepared rapid acquisition gradient echo and were calculated with imaging software. Results Ninety-eight men underwent complete baseline data collection; of these, 61 (mean [SD] age, 43.1 [9.9] years) voluntarily enrolled in post-Omicron follow-up and 17 (mean [SD] age, 43.5 [10.0] years) voluntarily enrolled in 3-month follow-up. Compared with pre-Omicron measures, Beck Anxiety Inventory scores were significantly increased (median, 4.50 [IQR, 1.00-7.00] to 4.00 [IQR, 2.00-9.75]; P = .006) and depressive distress scores were significantly decreased (median, 18.00 [IQR, 16.00-20.22] to 16.00 [IQR, 15.00-19.00]; P = .003) at the acute post-Omicron follow-up. Fever, headache, fatigue, myalgia, cough, and dyspnea were the main symptoms during the post-Omicron follow-up; among the participants in the 3-month follow-up, fever (11 [64.7%] vs 2 [11.8%]; P = .01), myalgia (10 [58.8%] vs 3 (17.6%]; P = .04), and cough (12 [70.6%] vs 4 [23.5%]; P = .02) were significantly improved. The gray matter thickness in the left precuneus (mean [SD], 2.7 [0.3] to 2.6 [0.2] mm; P < .001) and right lateral occipital region (mean [SD], 2.8 [0.2] to 2.7 [0.2] and 2.5 [0.2] to 2.5 [0.2] mm; P < .001 for both) and the ratio of the right hippocampus volume to the total intracranial volume (mean [SD]. 0.003 [0.0003] to 0.003 [0.0002]; P = .04) were significantly reduced in the post-Omicron follow-up. The febrile group had reduced sulcus depth of the right inferior parietal region compared with the nonfebrile group (mean [SD], 3.9 [2.3] to 4.8 [1.1]; P = .048. In the post-Omicron period, the thickness of the left precuneus was negatively correlated with the Beck Anxiety Inventory scores (r = -0.39; P = .002; false discovery rate P = .02), and the ratio of the right hippocampus to the total intracranial volume was positively correlated with the Word Fluency Test scores (r = 0.34; P = .007). Conclusions and Relevance In this cohort study of male patients infected with the Omicron variant, the duration of symptoms in multiple systems after infection was short. Changes in gray matter thickness and subcortical nuclear volume injury were observed in the post-Omicron period. These findings provide new insights into the emotional and cognitive mechanisms of an Omicron infection, demonstrate its association with alterations to the nervous system, and verify an imaging basis for early detection and intervention of neurological sequelae.
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Affiliation(s)
- Yanyao Du
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Wei Zhao
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, China
- Clinical Research Center for Medical Imaging in Hunan Province, Changsha, China
- Department of Radiology Quality Control Center, Hunan Province, Changsha, China
| | - Sihong Huang
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Chuxin Huang
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Chang Li
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Yanjing Chen
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Yijie Huang
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Longtao Yang
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Cong Li
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Huiting Zhang
- MR Scientific Marketing, Siemens Healthineers Ltd, Wuhan, China
| | - Hu Guo
- MR Application, Siemens Healthineers Ltd, Changsha, China
| | - Jun Liu
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, China
- Clinical Research Center for Medical Imaging in Hunan Province, Changsha, China
- Department of Radiology Quality Control Center, Hunan Province, Changsha, China
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13
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Loftis JM, Firsick E, Shirley K, Adkins JL, Le-Cook A, Sano E, Hudson R, Moorman J. Inflammatory and mental health sequelae of COVID-19. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2023; 15:100186. [PMID: 37223650 PMCID: PMC10191701 DOI: 10.1016/j.cpnec.2023.100186] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 05/25/2023] Open
Abstract
The COVID-19 pandemic has caused significant negative consequences to mental health. Increased inflammatory factors and neuropsychiatric symptoms, such as cognitive impairment ("brain fog"), depression, and anxiety are associated with long COVID [post-acute sequelae of SARS-CoV-2 infection (PASC), termed neuro-PASC]. The present study sought to examine the role of inflammatory factors as predictors of neuropsychiatric symptom severity in the context of COVID-19. Adults (n = 52) who tested negative or positive for COVID-19 were asked to complete self-report questionnaires and to provide blood samples for multiplex immunoassays. Participants who tested negative for COVID-19 were assessed at baseline and at a follow-up study visit (∼4 weeks later). Individuals without COVID-19 reported significantly lower PHQ-4 scores at the follow-up visit, as compared to baseline (p = 0.03; 95% CI-1.67 to -0.084). Individuals who tested positive for COVID-19 and experienced neuro-PASC had PHQ-4 scores in the moderate range. The majority of people with neuro-PASC reported experiencing brain fog (70% vs. 30%). Those with more severe COVID-19 had significantly higher PHQ-4 scores, as compared to those with mild disease (p = 0.008; 95% CI 1.32 to 7.97). Changes in neuropsychiatric symptom severity were accompanied by alterations in immune factors, particularly monokine induced by gamma interferon (IFN-γ) (MIG, a. k.a. CXCL9). These findings add to the growing evidence supporting the usefulness of circulating MIG levels as a biomarker reflecting IFN-γ production, which is important because individuals with neuro-PASC have elevated IFN-γ responses to internal SARS-CoV-2 proteins.
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Affiliation(s)
- Jennifer M. Loftis
- Research & Development Service, VA Portland Health Care System, 3710 SW US Veterans Hospital Road, Portland, OR, USA
- Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
- Clinical Psychology PhD Program, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
- Department of Behavioral Neuroscience, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | - Evan Firsick
- Research & Development Service, VA Portland Health Care System, 3710 SW US Veterans Hospital Road, Portland, OR, USA
| | - Kate Shirley
- Research & Development Service, VA Portland Health Care System, 3710 SW US Veterans Hospital Road, Portland, OR, USA
- Department of Psychiatry, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
- Clinical Psychology PhD Program, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, USA
| | - James L. Adkins
- Research Service, Department of Veterans Affairs, James H. Quillen Veterans Affairs Medical Center, Johnson City, TN, USA
- Center of Excellence in Inflammation, Infectious Diseases and Immunity, East Tennessee State University, 1276 Gilbreath Drive, Box 70300, Johnson City, TN, USA
| | - Anh Le-Cook
- Research & Development Service, VA Portland Health Care System, 3710 SW US Veterans Hospital Road, Portland, OR, USA
| | - Emily Sano
- Research & Development Service, VA Portland Health Care System, 3710 SW US Veterans Hospital Road, Portland, OR, USA
| | - Rebekah Hudson
- Research & Development Service, VA Portland Health Care System, 3710 SW US Veterans Hospital Road, Portland, OR, USA
| | - Jonathan Moorman
- Research Service, Department of Veterans Affairs, James H. Quillen Veterans Affairs Medical Center, Johnson City, TN, USA
- Center of Excellence in Inflammation, Infectious Diseases and Immunity, East Tennessee State University, 1276 Gilbreath Drive, Box 70300, Johnson City, TN, USA
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14
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Invernizzi A, Renzetti S, van Thriel C, Rechtman E, Patrono A, Ambrosi C, Mascaro L, Cagna G, Gasparotti R, Reichenberg A, Tang CY, Lucchini RG, Wright RO, Placidi D, Horton MK. Covid-19 related cognitive, structural and functional brain changes among Italian adolescents and young adults: a multimodal longitudinal case-control study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.07.19.23292909. [PMID: 37503251 PMCID: PMC10371098 DOI: 10.1101/2023.07.19.23292909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Coronavirus disease 2019 (COVID-19) has been associated with brain functional, structural, and cognitive changes that persist months after infection. Most studies of the neurologic outcomes related to COVID-19 focus on severe infection and aging populations. Here, we investigated the neural activities underlying COVID-19 related outcomes in a case-control study of mildly infected youth enrolled in a longitudinal study in Lombardy, Italy, a global hotspot of COVID-19. All participants (13 cases, 27 controls, mean age 24 years) completed resting state functional (fMRI), structural MRI, cognitive assessments (CANTAB spatial working memory) at baseline (pre-COVID) and follow-up (post-COVID). Using graph theory eigenvector centrality (EC) and data-driven statistical methods, we examined differences in ECdelta (i.e., the difference in EC values pre- and post-COVID-19) and volumetricdelta (i.e., the difference in cortical volume of cortical and subcortical areas pre- and post-COVID) between COVID-19 cases and controls. We found that ECdeltasignificantly between COVID-19 and healthy participants in five brain regions; right intracalcarine cortex, right lingual gyrus, left hippocampus, left amygdala, left frontal orbital cortex. The left hippocampus showed a significant decrease in volumetricdelta between groups (p=0.041). The reduced ECdelta in the right amygdala associated with COVID-19 status mediated the association between COVID-19 and disrupted spatial working memory. Our results show persistent structural, functional and cognitive brain changes in key brain areas associated with olfaction and cognition. These results may guide treatment efforts to assess the longevity, reversibility and impact of the observed brain and cognitive changes following COVID-19.
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Affiliation(s)
- Azzurra Invernizzi
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stefano Renzetti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Christoph van Thriel
- Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Elza Rechtman
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alessandra Patrono
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Claudia Ambrosi
- Department of Neuroscience, Neuroradiology Unit, ASST Cremona
| | | | - Giuseppa Cagna
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Roberto Gasparotti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Abraham Reichenberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Cheuk Y Tang
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Roberto G Lucchini
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Department of Environmental Health Sciences, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, United States
| | - Robert O Wright
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Donatella Placidi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Megan K Horton
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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15
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Nouraeinejad A. The functional and structural changes in the hippocampus of COVID-19 patients. Acta Neurol Belg 2023:10.1007/s13760-023-02291-1. [PMID: 37226033 DOI: 10.1007/s13760-023-02291-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/15/2023] [Indexed: 05/26/2023]
Abstract
Since the hippocampus is predominantly susceptible to injuries caused by COVID-19, there are increasing data indicating the likelihood of post-infection memory loss and quickening neurodegenerative disorders, such as Alzheimer's disease. This is due to the fact that the hippocampus has imperative functions in spatial and episodic memory as well as learning. COVID-19 activates microglia in the hippocampus and induces a CNS cytokine storm, leading to loss of hippocampal neurogenesis. The functional and structural changes in the hippocampus of COVID-19 patients can explain neuronal degeneration and reduced neurogenesis in the human hippocampus. This will open a window to explain memory and cognitive dysfunctions in "long COVID" through the resultant loss of hippocampal neurogenesis.
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Affiliation(s)
- Ali Nouraeinejad
- Faculty of Brain Sciences, Institute of Ophthalmology, University College London (UCL), London, UK.
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16
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Wan X, Wang W, Wu X, Tan Q, Su X, Zhang S, Yang X, Li S, Shao H, Yue Q, Gong Q. Progressive structural damage in sleep-related hypermotor epilepsy. J Neurosci Res 2023. [PMID: 37183389 DOI: 10.1002/jnr.25203] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 03/19/2023] [Accepted: 04/21/2023] [Indexed: 05/16/2023]
Abstract
This study aimed to explore the alterations in gray matter volume (GMV) based on high-resolution structural data and the temporal precedence of structural alterations in patients with sleep-related hypermotor epilepsy (SHE). After preprocessing of T1 structural images, the voxel-based morphometry and source-based morphometry (SBM) methods were applied in 60 SHE patients and 56 healthy controls to analyze the gray matter volumetric alterations. Furthermore, a causal network of structural covariance (CaSCN) was constructed using Granger causality analysis based on structural data of illness duration ordering to assess the causal impact of structural changes in abnormal gray matter regions. The GMVs of SHE patients were widely reduced, mainly in the bilateral cerebellums, fusiform gyri, the right angular gyrus, the right postcentral gyrus, and the left parahippocampal gyrus. In addition to those regions, the results of the SBM analysis also found decreased GMV in the bilateral frontal lobes, precuneus, and supramarginal gyri. The analysis of CaSCN showed that along with disease progression, the cerebellum was the prominent node that tended to affect other brain regions in SHE patients, while the frontal lobe was the transition node and the supramarginal gyrus was the prominent node that may be easily affected by other brain regions. Our study found widely affected regions of decreased GMVs in SHE patients; these regions underlie the morphological basis of epileptic networks, and there is a temporal precedence relationship between them.
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Affiliation(s)
- Xinyue Wan
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Weina Wang
- Department of Radiology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xintong Wu
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, China
| | - Qiaoyue Tan
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
| | - Xiaorui Su
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
| | - Simin Zhang
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
| | - Xibiao Yang
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Shuang Li
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
| | - Hanbing Shao
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
| | - Qiang Yue
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Qiyong Gong
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
- Functional and Molecular Imaging Key Laboratory of Sichuan Province, Chengdu, China
- Department of Radiology, West China Xiamen Hospital of Sichuan University, Xiamen, China
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17
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Bendella Z, Widmann CN, Layer JP, Layer YL, Haase R, Sauer M, Bieler L, Lehnen NC, Paech D, Heneka MT, Radbruch A, Schmeel FC. Brain Volume Changes after COVID-19 Compared to Healthy Controls by Artificial Intelligence-Based MRI Volumetry. Diagnostics (Basel) 2023; 13:diagnostics13101716. [PMID: 37238200 DOI: 10.3390/diagnostics13101716] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/05/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Cohort studies that quantify volumetric brain data among individuals with different levels of COVID-19 severity are presently limited. It is still uncertain whether there exists a potential correlation between disease severity and the effects of COVID-19 on brain integrity. Our objective was to assess the potential impact of COVID-19 on measured brain volume in patients with asymptomatic/mild and severe disease after recovery from infection, compared with healthy controls, using artificial intelligence (AI)-based MRI volumetry. A total of 155 participants were prospectively enrolled in this IRB-approved analysis of three cohorts with a mild course of COVID-19 (n = 51, MILD), a severe hospitalised course (n = 48, SEV), and healthy controls (n = 56, CTL) all undergoing a standardised MRI protocol of the brain. Automated AI-based determination of various brain volumes in mL and calculation of normalised percentiles of brain volume was performed with mdbrain software, using a 3D T1-weighted magnetisation-prepared rapid gradient echo (MPRAGE) sequence. The automatically measured brain volumes and percentiles were analysed for differences between groups. The estimated influence of COVID-19 and demographic/clinical variables on brain volume was determined using multivariate analysis. There were statistically significant differences in measured brain volumes and percentiles of various brain regions among groups, even after the exclusion of patients undergoing intensive care, with significant volume reductions in COVID-19 patients, which increased with disease severity (SEV > MILD > CTL) and mainly affected the supratentorial grey matter, frontal and parietal lobes, and right thalamus. Severe COVID-19 infection, in addition to established demographic parameters such as age and sex, was a significant predictor of brain volume loss upon multivariate analysis. In conclusion, neocortical brain degeneration was detected in patients who had recovered from SARS-CoV-2 infection compared to healthy controls, worsening with greater initial COVID-19 severity and mainly affecting the fronto-parietal brain and right thalamus, regardless of ICU treatment. This suggests a direct link between COVID-19 infection and subsequent brain atrophy, which may have major implications for clinical management and future cognitive rehabilitation strategies.
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Affiliation(s)
- Zeynep Bendella
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Catherine Nichols Widmann
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
| | - Julian Philipp Layer
- Department of Radiation Oncology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany
- Institute of Experimental Oncology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany
| | - Yonah Lucas Layer
- Department of Radiation Oncology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany
| | - Robert Haase
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
| | - Malte Sauer
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Luzie Bieler
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany
| | - Nils Christian Lehnen
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
| | - Daniel Paech
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
| | - Michael T Heneka
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-Belval, 4367 Luxembourg, Luxembourg
| | - Alexander Radbruch
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
| | - Frederic Carsten Schmeel
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
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18
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Ferrucci R, Cuffaro L, Capozza A, Rosci C, Maiorana N, Groppo E, Reitano MR, Poletti B, Ticozzi N, Tagliabue L, Silani V, Priori A. Brain positron emission tomography (PET) and cognitive abnormalities one year after COVID-19. J Neurol 2023; 270:1823-1834. [PMID: 36692636 PMCID: PMC9873215 DOI: 10.1007/s00415-022-11543-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 01/25/2023]
Abstract
Emerging evidence indicates that the etiologic agent responsible for coronavirus disease 2019 (COVID-19), can cause neurological complications. COVID-19 may induce cognitive impairment through multiple mechanisms. The aim of the present study was to describe the possible neuropsychological and metabolic neuroimaging consequences of COVID-19 12 months after patients' hospital discharge. We retrospectively recruited 7 patients (age [mean ± SD] = 56 years ± 12.39, 4 men) who had been hospitalized for COVID-19 with persistent neuropsychological deficits 12 months after hospital discharge. All patients underwent cognitive assessment and brain (18F-FDG) PET/CT, and one also underwent 18F-amyloid PET/CT. Of the seven patients studied, four had normal glucose metabolism in the brain. Three patients showed various brain hypometabolism patterns: (1) unilateral left temporal mesial area hypometabolism; (2) pontine involvement; and (3) bilateral prefrontal area abnormalities with asymmetric parietal impairment. The patient who showed the most widespread glucose hypometabolism in the brain underwent an 18F-amyloid PET/CT to assess the presence of Aβ plaques. This examination showed significant Aβ deposition in the superior and middle frontal cortex, and in the posterior cingulate cortex extending mildly in the rostral and caudal anterior cingulate areas. Although some other reports have already suggested that brain hypometabolism may be associated with cognitive impairment at shorter intervals from SarsCov-2 infection, our study is the first to assess cognitive functions, brain metabolic activity and in a patient also amyloid PET one year after COVID-19, demonstrating that cerebral effects of COVID-19 can largely outlast the acute phase of the disease and even be followed by amyloid deposition.
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Affiliation(s)
- Roberta Ferrucci
- Department of Health Science, Aldo Ravelli Research Center, University of Milan, Milan, Italy
- Neurology Unit, ASST-Santi Paolo e Carlo Hospital, Milan, Italy
| | - Luca Cuffaro
- Neurology Unit, ASST-Santi Paolo e Carlo Hospital, Milan, Italy
| | - Antonella Capozza
- Nuclear Medicine Unit, ASST-Santi Paolo e Carlo Hospital, Milan, Italy
| | - Chiara Rosci
- Neurology Unit, ASST-Santi Paolo e Carlo Hospital, Milan, Italy
| | - Natale Maiorana
- Department of Health Science, Aldo Ravelli Research Center, University of Milan, Milan, Italy
| | | | | | - Barbara Poletti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Auxologico Institute, Milan, Italy
| | - Nicola Ticozzi
- Department of Neurology and Laboratory of Neuroscience, IRCCS Auxologico Institute, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Luca Tagliabue
- Nuclear Medicine Unit, ASST-Santi Paolo e Carlo Hospital, Milan, Italy
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, IRCCS Auxologico Institute, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Alberto Priori
- Department of Health Science, Aldo Ravelli Research Center, University of Milan, Milan, Italy.
- Neurology Unit, ASST-Santi Paolo e Carlo Hospital, Milan, Italy.
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19
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Furlanis G, Busan P, Formaggio E, Menichelli A, Lunardelli A, Ajcevic M, Pesavento V, Manganotti P. Stuttering-Like Dysfluencies as a Consequence of Long COVID-19. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:415-430. [PMID: 36749838 DOI: 10.1044/2022_jslhr-22-00381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
PURPOSE We present two patients who developed neurogenic stuttering after long COVID-19 related to SARS-CoV-2 infection. METHODS AND RESULTS Both patients experienced both physical (e.g., fatigue) and cognitive difficulties, which led to impaired function of attention, lexical retrieval, and memory consolidation. Both patients had new-onset stuttering-like speech dysfluencies: Blocks and repetitions were especially evident at the initial part of words and sentences, sometimes accompanied by effortful and associated movements (e.g., facial grimaces and oro-facial movements). Neuropsychological evaluations confirmed the presence of difficulties in cognitive tasks, while neurophysiological evaluations (i.e., electroencephalography) suggested the presence of "slowed" patterns of brain activity. Neurogenic stuttering and cognitive difficulties were evident for 4-5 months after negativization of SARS-CoV-2 nasopharyngeal swab, with gradual improvement and near-to-complete recovery. CONCLUSIONS It is now evident that SARS-CoV-2 infection may significantly involve the central nervous system, also resulting in severe and long-term consequences, even if the precise mechanisms are still unknown. In the present report, long COVID-19 resulted in neurogenic stuttering, as the likely consequence of a "slowed" metabolism of (pre)frontal and sensorimotor brain regions (as suggested by the present and previous clinical evidence). As a consequence, the pathophysiological mechanisms related to the appearance of neurogenic stuttering have been hypothesized, which help to better understand the broader and possible neurological consequences of COVID-19.
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Affiliation(s)
- Giovanni Furlanis
- Clinical Unit of Neurology, University Hospital and Health Services of Trieste, ASUGI, Italy
- Department of Medicine, Surgical and Health Sciences, University of Trieste, Italy
| | | | - Emanuela Formaggio
- Department of Neuroscience, Section of Rehabilitation, University of Padua, Italy
| | - Alina Menichelli
- Neuropsychological Service, Clinical Unit of Rehabilitation, University Hospital and Health Services of Trieste, ASUGI, Italy
| | - Alberta Lunardelli
- Neuropsychological Service, Clinical Unit of Rehabilitation, University Hospital and Health Services of Trieste, ASUGI, Italy
| | - Milos Ajcevic
- Department of Engineering and Architecture, University of Trieste, Italy
| | - Valentina Pesavento
- Neuropsychological Service, Clinical Unit of Rehabilitation, University Hospital and Health Services of Trieste, ASUGI, Italy
| | - Paolo Manganotti
- Clinical Unit of Neurology, University Hospital and Health Services of Trieste, ASUGI, Italy
- Department of Medicine, Surgical and Health Sciences, University of Trieste, Italy
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20
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Saleh MA, Hirasawa M, Sun M, Gülave B, Elassaiss-Schaap J, de Lange EC. The PBPK LeiCNS-PK3.0 framework predicts Nirmatrelvir (but not Remdesivir or Molnupiravir) to achieve effective concentrations against SARS-CoV-2 in human brain cells. Eur J Pharm Sci 2023; 181:106345. [PMID: 36462547 PMCID: PMC9710098 DOI: 10.1016/j.ejps.2022.106345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/17/2022] [Accepted: 11/29/2022] [Indexed: 12/02/2022]
Abstract
SARS-CoV-2 was shown to infect and persist in the human brain cells for up to 230 days, highlighting the need to treat the brain viral load. The CNS disposition of the antiCOVID-19 drugs: Remdesivir, Molnupiravir, and Nirmatrelvir, remains, however, unexplored. Here, we assessed the human brain pharmacokinetic profile (PK) against the EC90 values of the antiCOVID-19 drugs to predict drugs with favorable brain PK against the delta and the omicron variants. We also evaluated the intracellular PK of GS443902 and EIDD2061, the active metabolites of Remdesivir and Molnupiravir, respectively. Towards this, we applied LeiCNS-PK3.0, the physiologically based pharmacokinetic framework with demonstrated adequate predictions of human CNS PK. Under the recommended dosing regimens, the predicted brain extracellular fluid PK of only Nirmatrelvir was above the variants' EC90. The intracellular levels of GS443902 and EIDD2061 were below the intracellular EC90. Summarizing, our model recommends Nirmatrelvir as the promising candidate for (pre)clinical studies investigating the CNS efficacy of antiCOVID-19 drugs.
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Affiliation(s)
- Mohammed A.A. Saleh
- Division of Systems Pharmacology and Pharmacy, Leiden Academic Center for Drug Research, Leiden University, Leiden, The Netherlands
| | - Makoto Hirasawa
- Division of Systems Pharmacology and Pharmacy, Leiden Academic Center for Drug Research, Leiden University, Leiden, The Netherlands
| | - Ming Sun
- Division of Systems Pharmacology and Pharmacy, Leiden Academic Center for Drug Research, Leiden University, Leiden, The Netherlands
| | - Berfin Gülave
- Division of Systems Pharmacology and Pharmacy, Leiden Academic Center for Drug Research, Leiden University, Leiden, The Netherlands
| | | | - Elizabeth C.M. de Lange
- Division of Systems Pharmacology and Pharmacy, Leiden Academic Center for Drug Research, Leiden University, Leiden, The Netherlands,Corresponding author
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21
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Hafiz R, Gandhi TK, Mishra S, Prasad A, Mahajan V, Natelson BH, Di X, Biswal BB. Assessing functional connectivity differences and work-related fatigue in surviving COVID-negative patients. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2022.02.01.478677. [PMID: 35132408 PMCID: PMC8820653 DOI: 10.1101/2022.02.01.478677] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The Coronavirus Disease 2019 (COVID-19) has affected all aspects of life around the world. Neuroimaging evidence suggests the novel coronavirus can attack the central nervous system (CNS), causing cerebro-vascular abnormalities in the brain. This can lead to focal changes in cerebral blood flow and metabolic oxygen consumption rate in the brain. However, the extent and spatial locations of brain alterations in COVID-19 survivors are largely unknown. In this study, we have assessed brain functional connectivity (FC) using resting-state functional MRI (RS-fMRI) in 38 (25 males) COVID patients two weeks after hospital discharge, when PCR negative and 31 (24 males) healthy subjects. FC was estimated using independent component analysis (ICA) and dual regression. When compared to the healthy group, the COVID group demonstrated significantly enhanced FC in the basal ganglia and precuneus networks (family wise error (fwe) corrected, pfwe < 0.05), while, on the other hand, reduced FC in the language network (pfwe < 0.05). The COVID group also experienced higher fatigue levels during work, compared to the healthy group (p < 0.001). Moreover, within the precuneus network, we noticed a significant negative correlation between FC and fatigue scores across groups (Spearman's ρ = -0.47, p = 0.001, r2 = 0.22). Interestingly, this relationship was found to be significantly stronger among COVID survivors within the left parietal lobe, which is known to be structurally and functionally associated with fatigue in other neurological disorders.
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Affiliation(s)
- Rakibul Hafiz
- Department of Biomedical Engineering, New Jersey Institute of Technology (NJIT), 323 Dr Martin Luther King Jr Blvd, Newark, NJ 07102, USA
| | - Tapan Kumar Gandhi
- Department of Electrical Engineering, Indian Institute of Technology (IIT), Block II, IIT Delhi Main Rd, IIT Campus, Hauz Khas, New Delhi, Delhi 110016, India
| | - Sapna Mishra
- Department of Electrical Engineering, Indian Institute of Technology (IIT), Block II, IIT Delhi Main Rd, IIT Campus, Hauz Khas, New Delhi, Delhi 110016, India
| | - Alok Prasad
- Internal Medicine, Irene Hospital & Senior Consultant Medicine, Metro Heart and Super-specialty Hospital, New Delhi, India
| | - Vidur Mahajan
- Centre for Advanced Research in Imaging, Neuroscience & Genomics, Mahajan Imaging, New Delhi, India
| | - Benjamin H. Natelson
- Pain and Fatigue Study Center, Department of Neurology, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Xin Di
- Department of Biomedical Engineering, New Jersey Institute of Technology (NJIT), 323 Dr Martin Luther King Jr Blvd, Newark, NJ 07102, USA
| | - Bharat B. Biswal
- Department of Biomedical Engineering, New Jersey Institute of Technology (NJIT), 323 Dr Martin Luther King Jr Blvd, Newark, NJ 07102, USA
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22
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Rothstein TL. Cortical Grey matter volume depletion links to neurological sequelae in post COVID-19 "long haulers". BMC Neurol 2023; 23:22. [PMID: 36647063 PMCID: PMC9843113 DOI: 10.1186/s12883-023-03049-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 01/02/2023] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE COVID-19 (SARS-CoV-2) has been associated with neurological sequelae even in those patients with mild respiratory symptoms. Patients experiencing cognitive symptoms such as "brain fog" and other neurologic sequelae for 8 or more weeks define "long haulers". There is limited information regarding damage to grey matter (GM) structures occurring in COVID-19 "long haulers". Advanced imaging techniques can quantify brain volume depletions related to COVID-19 infection which is important as conventional Brain MRI often fails to identify disease correlates. 3-dimensional voxel-based morphometry (3D VBM) analyzes, segments and quantifies key brain volumes allowing comparisons between COVID-19 "long haulers" and normative data drawn from healthy controls, with values based on percentages of intracranial volume. METHODS This is a retrospective single center study which analyzed 24 consecutive COVID-19 infected patients with long term neurologic symptoms. Each patient underwent Brain MRI with 3D VBM at median time of 85 days following laboratory confirmation. All patients had relatively mild respiratory symptoms not requiring oxygen supplementation, hospitalization, or assisted ventilation. 3D VBM was obtained for whole brain and forebrain parenchyma, cortical grey matter (CGM), hippocampus, and thalamus. RESULTS The results demonstrate a statistically significant depletion of CGM volume in 24 COVID-19 infected patients. Reduced CGM volume likely influences their long term neurological sequelae and may impair post COVID-19 patient's quality of life and productivity. CONCLUSION This study contributes to understanding effects of COVID-19 infection on patient's neurocognitive and neurological function, with potential for producing serious long term personal and economic consequences, and ongoing challenges to public health systems.
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Affiliation(s)
- Ted L. Rothstein
- grid.253615.60000 0004 1936 9510Department of Neurology, George Washington University, Washington, DC USA
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23
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Araújo ST, Araújo CT, Silva E Castro R, de Oliveira Brügger LM, Souza E Silva NG, de Miranda DM, Simões E Silva AC. Imaging Markers of Neurologic Damage in COVID-19: A Systematic Review. Curr Med Chem 2023; 30:1086-1106. [PMID: 35786328 DOI: 10.2174/0929867329666220701124945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/12/2022] [Accepted: 04/21/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection commonly leads to neurologic manifestations. In the present review, we aimed to investigate potential neuroimaging markers of early diagnosis and prognosis of neurologic manifestations in COVID-19. METHODS Our study was registered in the Prospective Register of Systematic Reviews (PROSPERO) under the protocol CDR42021265443. Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we selected 51 studies for whole-manuscript analysis. RESULTS Magnetic resonance imaging (MRI) was the most common imaging method. The pattern, sites of lesion, signs, and symptoms of neurologic injury varied. Such manifestations possibly resulted from a direct viral infection or, most likely, from indirect mechanisms including coagulation disturbances, hypoxemia, and immunological responses. CONCLUSION The heterogeneity of the studies precludes any generalization of the findings. Brain MRI is the most informative imaging exam. Population studies, including the entire spectrum of COVID-19 are missing. There is still a need for future population studies evaluating neurologic manifestations of all COVID-19 severities acutely and chronically.
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Affiliation(s)
- Sara Tavares Araújo
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Clara Tavares Araújo
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Rafael Silva E Castro
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Lara Machado de Oliveira Brügger
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | | | - Debora Marques de Miranda
- Laboratory of Translational Medicine, Faculty of Medicine, UFMG, Belo Horizonte, MG, Brazil.,Department of Pediatrics, Faculty of Medicine, UFMG, Belo Horizonte, MG, Brazil
| | - Ana Cristina Simões E Silva
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.,Department of Pediatrics, Faculty of Medicine, UFMG, Belo Horizonte, MG, Brazil
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24
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Du Y, Zhao W, Huang S, Huang Y, Chen Y, Zhang H, Guo H, Liu J. Two-year follow-up of brain structural changes in patients who recovered from COVID-19: A prospective study. Psychiatry Res 2023; 319:114969. [PMID: 36462292 PMCID: PMC9684092 DOI: 10.1016/j.psychres.2022.114969] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/08/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022]
Abstract
The long-term effects of COVID-19 on brain structure remain unclear. A prospective study was conducted to explore the changes in brain structure in COVID-19 survivors at one and two years after discharge (COVID-19one, COVID-19two). The difference in gray matter volume (GMV) was analyzed using the voxel-based morphometry method, and correlation analyses were conducted. The dynamic changes in clinical sequelae varied. The GMVs in the cerebellum and vermis were reduced in COVID-19one and COVID-19two, positively correlated with lymphocyte count, and negatively correlated with neutrophil count, neutrophil/lymphocyte ratio (COVID-19one), and systemic immune-inflammation index (COVID-19two). The decreased GMVs in the left middle frontal gyrus, inferior frontal gyrus of the operculum, right middle temporal gyrus, and inferior temporal gyrus returned to normal in COVID-19two. The decreased GMV in the left frontal lobe was negatively correlated with the Athens Insomnia Scale (AIS). The GMV in the left temporal lobe was aggravated in COVID-19two and positively correlated with C-reactive protein. In conclusion, GMV recovery coexisted with injury, which was associated with AIS and inflammatory factors. This may shed some light on the dynamic changes in brain structure and the possible predictors that may be related to GMV changes in COVID-19two.
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Affiliation(s)
- Yanyao Du
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, Hunan Province 410011, China
| | - Wei Zhao
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, Hunan Province 410011, China; Clinical Research Center for Medical Imaging in Hunan Province, Changsha, Hunan 410011, China; Department of Radiology Quality Control Center, Changsha, Hunan Province 410011, China
| | - Sihong Huang
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, Hunan Province 410011, China
| | - Yijie Huang
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, Hunan Province 410011, China
| | - Yanjing Chen
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, Hunan Province 410011, China
| | - Huiting Zhang
- MR Scientific Marketing, Siemens Healthineers Ltd., Wuhan 430000, China
| | - Hu Guo
- MR Application, Siemens Healthineers Ltd., Changsha 410011, China
| | - Jun Liu
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, Hunan Province 410011, China; Clinical Research Center for Medical Imaging in Hunan Province, Changsha, Hunan 410011, China; Department of Radiology Quality Control Center, Changsha, Hunan Province 410011, China.
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25
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Dubey S, Das S, Ghosh R, Dubey MJ, Chakraborty AP, Roy D, Das G, Dutta A, Santra A, Sengupta S, Benito-León J. The Effects of SARS-CoV-2 Infection on the Cognitive Functioning of Patients with Pre-Existing Dementia. J Alzheimers Dis Rep 2023; 7:119-128. [PMID: 36891252 PMCID: PMC9986710 DOI: 10.3233/adr-220090] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 01/03/2023] [Indexed: 02/05/2023] Open
Abstract
Background Cognitive postscripts of COVID-19, codenamed as 'cognitive COVID' or 'brain fog,' characterized by multidomain cognitive impairments, are now being reckoned as the most devastating sequelae of COVID-19. However, the impact on the already demented brain has not been studied. Objective We aimed to assess the cognitive functioning and neuroimaging following SARS-CoV-2 infection in patients with pre-existing dementia. Methods Fourteen COVID-19 survivors with pre-existing dementia (four with Alzheimer's disease, five with vascular dementia, three with Parkinson's disease dementia, and two with the behavioral variant of frontotemporal dementia) were recruited. All these patients had detailed cognitive and neuroimaging evaluations within three months before suffering from COVID-19 and one year later. Results Of the 14 patients, ten required hospitalization. All developed or increased white matter hyperintensities that mimicked multiple sclerosis and small vessel disease. There was a significant increase in fatigue (p = 0.001) and depression (p = 0.016) scores following COVID-19. The mean Frontal Assessment Battery (p < 0.001) and Addenbrooke's Cognitive Examination (p = 0.001) scores also significantly worsened. Conclusion The rapid progression of dementia, the addition of further impairments/deterioration of cognitive abilities, and the increase or new appearance of white matter lesion burden suggest that previously compromised brains have little defense to withstand a new insult (i.e., 'second hit' like infection/dysregulated immune response, and inflammation). 'Brain fog' is an ambiguous terminology without specific attribution to the spectrum of post-COVID-19 cognitive sequelae. We propose a new codename, i.e. 'FADE-IN MEMORY' (i.e., Fatigue, decreased Fluency, Attention deficit, Depression, Executive dysfunction, slowed INformation processing speed, and subcortical MEMORY impairment).
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Affiliation(s)
- Souvik Dubey
- Department of Neuromedicine, Bangur Institute of Neurosciences (BIN), Kolkata, West Bengal, India
| | - Shambaditya Das
- Department of Neuromedicine, Bangur Institute of Neurosciences (BIN), Kolkata, West Bengal, India
| | - Ritwik Ghosh
- Department of General Medicine, Burdwan Medical College, and Hospital, Burdwan, West Bengal, India
| | - Mahua Jana Dubey
- Department of Psychiatry, Berhampur Mental Hospital, Berhampur, West Bengal, India
| | - Arka Prava Chakraborty
- Department of Neuromedicine, Bangur Institute of Neurosciences (BIN), Kolkata, West Bengal, India
| | - Dipayan Roy
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), Patna, Bihar, India.,Indian Institute of Technology (IIT), Madras, Tamil Nadu, India.,School of Sciences, Indira Gandhi National Open University, New Delhi, India
| | - Gautam Das
- Department of Neuromedicine, Bangur Institute of Neurosciences (BIN), Kolkata, West Bengal, India
| | - Ajitava Dutta
- Department of Neuromedicine, Bangur Institute of Neurosciences (BIN), Kolkata, West Bengal, India
| | - Arindam Santra
- Department of Neuromedicine, Bangur Institute of Neurosciences (BIN), Kolkata, West Bengal, India
| | - Samya Sengupta
- Department of General Medicine, Apollo Gleneagles Hospital, Kolkata, West Bengal, India
| | - Julián Benito-León
- Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain.,Centro de Investigación Biomódica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Department of Medicine, Complutense University, Madrid, Spain
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26
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Besteher B, Machnik M, Troll M, Toepffer A, Zerekidze A, Rocktäschel T, Heller C, Kikinis Z, Brodoehl S, Finke K, Reuken PA, Opel N, Stallmach A, Gaser C, Walter M. Larger gray matter volumes in neuropsychiatric long-COVID syndrome. Psychiatry Res 2022; 317:114836. [PMID: 36087363 PMCID: PMC9444315 DOI: 10.1016/j.psychres.2022.114836] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/02/2022] [Accepted: 09/04/2022] [Indexed: 01/04/2023]
Abstract
Neuropsychiatric symptoms are the most common sequelae of long-COVID. As accumulating evidence suggests an impact of survived SARS-CoV-2-infection on brain physiology, it is necessary to further investigate brain structural changes in relation to course and neuropsychiatric symptom burden in long-COVID. To this end, the present study investigated 3T-MRI scans from long-COVID patients suffering from neuropsychiatric symptoms (n = 30), and healthy controls (n = 20). Whole-brain comparison of gray matter volume (GMV) was conducted by voxel-based morphometry. To determine whether changes in GMV are predicted by neuropsychiatric symptom burden and/or initial severity of symptoms of COVID-19 and time since onset of COVID-19 stepwise linear regression analysis was performed. Significantly enlarged GMV in long-COVID patients was present in several clusters (spanning fronto-temporal areas, insula, hippocampus, amygdala, basal ganglia, and thalamus in both hemispheres) when compared to controls. Time since onset of COVID-19 was a significant regressor in four of these clusters with an inverse relationship. No associations with clinical symptom burden were found. GMV alterations in limbic and secondary olfactory areas are present in long-COVID patients and might be dynamic over time. Larger samples and longitudinal data in long-COVID patients are required to further clarify the mediating mechanisms between COVID-19, GMV and neuropsychiatric symptoms.
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Affiliation(s)
- Bianca Besteher
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, Jena 07743, Germany.
| | - Marlene Machnik
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, Jena 07743, Germany
| | - Marie Troll
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, Jena 07743, Germany
| | - Antonia Toepffer
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, Jena 07743, Germany
| | - Ani Zerekidze
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, Jena 07743, Germany
| | - Tonia Rocktäschel
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, Jena 07743, Germany
| | - Carina Heller
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, Jena 07743, Germany,Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, USA,Department of Clinical Psychology, Friedrich-Schiller-University Jena, Germany
| | - Zora Kikinis
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | | | - Kathrin Finke
- Department of Neurology, Jena University Hospital, Germany
| | - Philipp A. Reuken
- Department of Internal Medicine IV, Gastroenterology, Hepatology and Infectious Diseases, Jena University Hospital, Germany
| | - Nils Opel
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, Jena 07743, Germany
| | - Andreas Stallmach
- Department of Internal Medicine IV, Gastroenterology, Hepatology and Infectious Diseases, Jena University Hospital, Germany
| | - Christian Gaser
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, Jena 07743, Germany,Department of Neurology, Jena University Hospital, Germany
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Philosophenweg 3, Jena 07743, Germany
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27
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Carbone F, Zamarian L, Rass V, Bair S, Ritter M, Beer R, Mahlknecht P, Heim B, Limmert V, Peball M, Ellmerer P, Schiefecker AJ, Kofler M, Lindner A, Pfausler B, Putnina L, Kindl P, Löffler-Ragg J, Kiechl S, Seppi K, Djamshidian A, Helbok R. Cognitive dysfunction 1 year after COVID-19: evidence from eye tracking. Ann Clin Transl Neurol 2022; 9:1826-1831. [PMID: 36264758 DOI: 10.1002/acn3.51675] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/04/2022] [Accepted: 09/16/2022] [Indexed: 11/06/2022] Open
Abstract
Increasing evidence suggests persistent cognitive dysfunction after COVID-19. In this cross-sectional study, frontal lobe function was assessed 12 months after the acute phase of the disease, using tailored eye tracking assessments. Individuals who recovered from COVID-19 made significantly more errors in all eye tracking tasks compared to age/sex-matched healthy controls. Furthermore, patients who were treated as inpatients performed worse compared to outpatients and controls. Our results show impaired inhibitory cortical control in individuals who recovered from COVID-19. The association between disease severity and its sequelae may contribute to a better understanding of post-COVID-19 cognitive function.
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Affiliation(s)
- Federico Carbone
- Department of Neurology, Medical University of Innsbruck, 6020, Innsbruck, Austria
| | - Laura Zamarian
- Department of Neurology, Medical University of Innsbruck, 6020, Innsbruck, Austria
| | - Verena Rass
- Department of Neurology, Medical University of Innsbruck, 6020, Innsbruck, Austria
| | - Stefanie Bair
- Department of Neurology, Medical University of Innsbruck, 6020, Innsbruck, Austria
| | - Marcel Ritter
- Interactive Graphics and Simulation Group, University of Innsbruck, 6020, Innsbruck, Austria
| | - Ronny Beer
- Department of Neurology, Medical University of Innsbruck, 6020, Innsbruck, Austria
| | - Philipp Mahlknecht
- Department of Neurology, Medical University of Innsbruck, 6020, Innsbruck, Austria
| | - Beatrice Heim
- Department of Neurology, Medical University of Innsbruck, 6020, Innsbruck, Austria
| | - Victoria Limmert
- Department of Neurology, Medical University of Innsbruck, 6020, Innsbruck, Austria
| | - Marina Peball
- Department of Neurology, Medical University of Innsbruck, 6020, Innsbruck, Austria
| | - Philipp Ellmerer
- Department of Neurology, Medical University of Innsbruck, 6020, Innsbruck, Austria
| | | | - Mario Kofler
- Department of Neurology, Medical University of Innsbruck, 6020, Innsbruck, Austria
| | - Anna Lindner
- Department of Neurology, Medical University of Innsbruck, 6020, Innsbruck, Austria
| | - Bettina Pfausler
- Department of Neurology, Medical University of Innsbruck, 6020, Innsbruck, Austria
| | - Lauma Putnina
- Department of Neurology, Medical University of Innsbruck, 6020, Innsbruck, Austria
| | - Philipp Kindl
- Department of Neurology, Medical University of Innsbruck, 6020, Innsbruck, Austria
| | - Judith Löffler-Ragg
- Department of Internal Medicine II, Medical University of Innsbruck, 6020, Innsbruck, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, 6020, Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, 6020, Innsbruck, Austria
| | - Atbin Djamshidian
- Department of Neurology, Medical University of Innsbruck, 6020, Innsbruck, Austria
| | - Raimund Helbok
- Department of Neurology, Medical University of Innsbruck, 6020, Innsbruck, Austria
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28
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Sanabria-Diaz G, Etter MM, Melie-Garcia L, Lieb JM, Psychogios MN, Hutter G, Granziera C. Brain cortical alterations in COVID-19 patients with neurological symptoms. Front Neurosci 2022; 16:992165. [PMID: 36340780 PMCID: PMC9630324 DOI: 10.3389/fnins.2022.992165] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/28/2022] [Indexed: 07/29/2023] Open
Abstract
Background Growing evidence suggests that the central nervous system is affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), since infected patients suffer from acute and long-term neurological sequelae. Nevertheless, it is currently unknown whether the virus affects the brain cortex. The purpose of this study was to assess the cortical gray matter volume, the cortical thickness, and the cortical surface area in a group of SARS-CoV-2 infected patients with neurological symptoms compared to healthy control subjects. Additionally, we analyzed the cortical features and the association with inflammatory biomarkers in the cerebrospinal fluid (CSF) and plasma. Materials and methods Thirty-three patients were selected from a prospective cross-sectional study cohort during the ongoing pandemic (August 2020-April 2021) at the university hospitals of Basel and Zurich (Switzerland). The group included patients with different neurological symptom severity (Class I: nearly asymptomatic/mild symptoms, II: moderate symptoms, III: severe symptoms). Thirty-three healthy age and sex-matched subjects that underwent the same MRI protocol served as controls. For each anatomical T1w MPRAGE image, regional cortical gray matter volume, thickness, and surface area were computed with FreeSurfer. Using a linear regression model, cortical measures were compared between groups (patients vs. controls; Class I vs. II-III), with age, sex, MRI magnetic field strength, and total intracranial volume/mean thickness/total surface area as covariates. In a subgroup of patients, the association between cortical features and clinical parameters was assessed using partial correlation adjusting for the same covariates. P-values were corrected using a false discovery rate (FDR). Results Our findings revealed a lower cortical volume in COVID-19 patients' orbitofrontal, frontal, and cingulate regions than in controls (p < 0.05). Regional gray matter volume and thickness decreases were negatively associated with CSF total protein levels, the CSF/blood-albumin ratio, and CSF EN-RAGE levels. Conclusion Our data suggest that viral-triggered inflammation leads to neurotoxic damage in some cortical areas during the acute phase of a COVID-19 infection in patients with neurological symptoms.
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Affiliation(s)
- Gretel Sanabria-Diaz
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Manina Maja Etter
- Brain Tumor Immunotherapy Lab, Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
- Division of Neurosurgery, University Hospital Basel, Basel, Switzerland
| | - Lester Melie-Garcia
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Johanna M. Lieb
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Marios-Nikos Psychogios
- Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Gregor Hutter
- Brain Tumor Immunotherapy Lab, Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
- Division of Neurosurgery, University Hospital Basel, Basel, Switzerland
| | - Cristina Granziera
- Translational Imaging in Neurology (ThINK) Basel, Department of Biomedical Engineering, Faculty of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Basel, Switzerland
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29
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Catalogna M, Sasson E, Hadanny A, Parag Y, Zilberman-Itskovich S, Efrati S. Effects of hyperbaric oxygen therapy on functional and structural connectivity in post-COVID-19 condition patients: A randomized, sham-controlled trial. Neuroimage Clin 2022; 36:103218. [PMID: 36208548 PMCID: PMC9528018 DOI: 10.1016/j.nicl.2022.103218] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/29/2022] [Accepted: 10/01/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Post-COVID-19 condition refers to a range of persisting physical, neurocognitive, and neuropsychological symptoms after SARS-CoV-2 infection. Abnormalities in brain connectivity were found in recovered patients compared to non-infected controls. This study aims to evaluate the effect of hyperbaric oxygen therapy (HBOT) on brain connectivity in post-COVID-19 patients. METHODS In this randomized, sham-controlled, double-blind trial, 73 patients were randomized to receive 40 daily sessions of HBOT (n = 37) or sham treatment (n = 36). We examined pre- and post-treatment resting-state brain functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI) scans to evaluate functional and structural connectivity changes, which were correlated to cognitive and psychological distress measures. RESULTS The ROI-to-ROI analysis revealed decreased internetwork connectivity in the HBOT group which was negatively correlated to improvements in attention and executive function scores (p < 0.001). Significant group-by-time interactions were demonstrated in the right hippocampal resting state function connectivity (rsFC) in the medial prefrontal cortex (PFWE = 0.002). Seed-to-voxel analysis also revealed a negative correlation in the brief symptom inventory (BSI-18) score and in the rsFC between the amygdala seed, the angular gyrus, and the primary sensory motor area (PFWE = 0.012, 0.002). Positive correlations were found between the BSI-18 score and the left insular cortex seed and FPN (angular gyrus) (PFWE < 0.0001). Tractography based structural connectivity analysis showed a significant group-by-time interaction in the fractional anisotropy (FA) of left amygdala tracts (F = 7.81, P = 0.007). The efficacy measure had significant group-by-time interactions (F = 5.98, p = 0.017) in the amygdala circuit. CONCLUSIONS This study indicates that HBOT improves disruptions in white matter tracts and alters the functional connectivity organization of neural pathways attributed to cognitive and emotional recovery in post-COVID-19 patients. This study also highlights the potential of structural and functional connectivity analysis as a promising treatment response monitoring tool.
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Affiliation(s)
- Merav Catalogna
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Efrat Sasson
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Amir Hadanny
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel- Aviv University, Tel-Aviv, Israel
| | - Yoav Parag
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
| | - Shani Zilberman-Itskovich
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel- Aviv University, Tel-Aviv, Israel
| | - Shai Efrati
- Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel- Aviv University, Tel-Aviv, Israel; Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel.
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30
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Cattarinussi G, Miola A, Trevisan N, Valeggia S, Tramarin E, Mucignat C, Morra F, Minerva M, Librizzi G, Bordin A, Causin F, Ottaviano G, Antonini A, Sambataro F, Manara R. Altered brain regional homogeneity is associated with depressive symptoms in COVID-19. J Affect Disord 2022; 313:36-42. [PMID: 35764231 PMCID: PMC9233546 DOI: 10.1016/j.jad.2022.06.061] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/31/2022] [Accepted: 06/22/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND COVID-19 is an infectious disease that has spread worldwide in 2020, causing a severe pandemic. In addition to respiratory symptoms, neuropsychiatric manifestations are commonly observed, including chronic fatigue, depression, and anxiety. The neural correlates of neuropsychiatric symptoms in COVID-19 are still largely unknown. METHODS A total of 79 patients with COVID-19 (COV) and 17 healthy controls (HC) underwent 3 T functional magnetic resonance imaging at rest, as well as structural imaging. Regional homogeneity (ReHo) was calculated. We also measured depressive symptoms with the Patient Health Questionnaire (PHQ-9), anxiety using the General Anxiety Disorder 7-item scale, and fatigue with the Multidimension Fatigue Inventory. RESULTS In comparison with HC, COV showed significantly higher depressive scores. Moreover, COV presented reduced ReHo in the left angular gyrus, the right superior/middle temporal gyrus and the left inferior temporal gyrus, and higher ReHo in the right hippocampus. No differences in gray matter were detected in these areas. Furthermore, we observed a negative correlation between ReHo in the left angular gyrus and PHQ-9 scores and a trend toward a positive correlation between ReHo in the right hippocampus and PHQ-9 scores. LIMITATIONS Heterogeneity in the clinical presentation in COV, the different timing from the first positive molecular swab test to the MRI, and the cross-sectional design of the study limit the generalizability of our findings. CONCLUSIONS Our results suggest that COVID-19 infection may contribute to depressive symptoms via a modulation of local functional connectivity in cortico-limbic circuits.
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Affiliation(s)
- Giulia Cattarinussi
- Department of Neuroscience (DNS), University of Padova, Padua, Italy,Padua Neuroscience Center, University of Padova, Padua, Italy
| | - Alessandro Miola
- Department of Neuroscience (DNS), University of Padova, Padua, Italy,Padua Neuroscience Center, University of Padova, Padua, Italy
| | - Nicolò Trevisan
- Department of Neuroscience (DNS), University of Padova, Padua, Italy,Padua Neuroscience Center, University of Padova, Padua, Italy
| | - Silvia Valeggia
- Department of Medicine-DIMED, Radiology Institute, University of Padova, Azienda Ospedale-Università Padova, Padua, Italy
| | - Elena Tramarin
- Department of Medicine-DIMED, Radiology Institute, University of Padova, Azienda Ospedale-Università Padova, Padua, Italy
| | - Carla Mucignat
- Department of Molecular Medicine, University of Padova, Padua, Italy
| | - Francesco Morra
- Department of Medicine-DIMED, Radiology Institute, University of Padova, Azienda Ospedale-Università Padova, Padua, Italy
| | - Matteo Minerva
- Department of Medicine-DIMED, Radiology Institute, University of Padova, Azienda Ospedale-Università Padova, Padua, Italy
| | - Giovanni Librizzi
- Department of Medicine-DIMED, Radiology Institute, University of Padova, Azienda Ospedale-Università Padova, Padua, Italy
| | - Anna Bordin
- Department of Neurosciences, Otolaryngology Section University of Padova, Padua, Italy
| | - Francesco Causin
- Neuroradiology Unit, Neurosciences Department, University of Padova, Azienda Ospedale-Università Padova, Padua, Italy
| | - Giancarlo Ottaviano
- Department of Neurosciences, Otolaryngology Section University of Padova, Padua, Italy
| | - Angelo Antonini
- Padua Neuroscience Center, University of Padova, Padua, Italy,Parkinson and Movement Disorders Unit, Study Center for Neurodegeneration (CESNE), Department of Neurosciences, University of Padova, Padua, Italy
| | - Fabio Sambataro
- Department of Neuroscience (DNS), University of Padova, Padua, Italy; Padua Neuroscience Center, University of Padova, Padua, Italy.
| | - Renzo Manara
- Neuroradiology Unit, Neurosciences Department, University of Padova, Azienda Ospedale-Università Padova, Padua, Italy
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31
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Pelizzari L, Cazzoli M, Lipari S, Laganà MM, Cabinio M, Isernia S, Pirastru A, Clerici M, Baglio F. Mid-term MRI evaluation reveals microstructural white matter alterations in COVID-19 fully recovered subjects with anosmia presentation. Ther Adv Neurol Disord 2022; 15:17562864221111995. [PMID: 35899101 PMCID: PMC9310254 DOI: 10.1177/17562864221111995] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/18/2022] [Indexed: 12/11/2022] Open
Abstract
Background Little is still known about the mid/long-term effects of coronavirus disease 2019 (COVID-19) on the brain, especially in subjects who have never been hospitalized due to the infection. In this neuroimaging exploratory study, we analyzed the medium-term effect of COVID-19 on the brain of people who recovered from COVID-19, experienced anosmia during the acute phase of the disease, and have never been hospitalized due to SARS-Co-V-2 infection. Methods Forty-three individuals who had (COV+, n = 22) or had not (COV-, n = 21) been infected with SARS-Co-V-2 were included in the study; the two groups were age- and sex-matched and were investigated using 3T magnetic resonance imaging (MRI). Gray matter (GM) volume, white matter (WM) hyperintensity volume, WM microstrutural integrity (i.e. fractional anisotropy [FA], mean diffusivity [MD], axial diffusivity [AD], radial diffusivity [RD]) and cerebral blood flow (CBF) differences between the two groups were tested with either analysis of covariance or voxel-wise analyses. Results were family wise error (FWE) corrected. Results No significant differences between COV+ and COV- groups were observed in terms of GM volume, WM hyperintensity volume, and CBF. Conversely, local WM microstructural alterations were detected in COV+ when compared with COV- with tract-based spatial statistics. Specifically, COV+ showed lower FA (pFWE-peak = 0.035) and higher RD (pFWE-peak = 0.038) than COV- in several WM regions. Conclusion COVID-19 may produce mid/long-term microstructural effect on the brain, even in case of mild-to-moderate disease not requiring hospitalization. Further investigation and additional follow-ups are warranted to assess if the alterations reported in this study totally recover over time. As brain alterations could increase the risk of cognitive decline, greater knowledge of their trajectories is crucial to aid neurorehabilitation treatments.
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Affiliation(s)
| | - Marta Cazzoli
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | | | | | - Monia Cabinio
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Sara Isernia
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | | | - Mario Clerici
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Via Capecelatro 66, 20148, Milano, Italy
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Dehghani A, Zokaei E, Kahani SM, Alavinejad E, Dehghani M, Meftahi GH, Afarinesh MR. The potential impact of Covid-19 on CNS and psychiatric sequels. Asian J Psychiatr 2022; 72:103097. [PMID: 35405524 PMCID: PMC8982477 DOI: 10.1016/j.ajp.2022.103097] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/19/2022] [Accepted: 04/02/2022] [Indexed: 01/08/2023]
Abstract
Due to its high prevalence and fatality, the current Severe Acute Respiratory Syndrome-coronavirus-2 (SARS-CoV-2) virus, which first emerged in China in 2019, quickly spread around the world and immediately became a serious global health concern. Although respiratory issues were initially the most prominent symptom of coronavirus disease 2019 (COVID-19), it became obvious rapidly that COVID-19, like many other coronavirus family members, could affect the central nervous system (CNS). During the pandemic, CNS involvement expressed itself in a variety of forms, including insomnia, anosmia, headaches, encephalopathies, encephalitis, cerebrovascular accidents, cognitive and memory impairment, and increased psychiatric disorders. Almost everyone who has been infected has at least one of these neurological symptoms, demonstrating that the virus has a high ability to impact the CNS. As the coronavirus pandemic passes its second year, the manifestations it can cause in the long run, such as its psychological sequels, have not yet been thoroughly studied. Given the high importance of this issue in today's society and due to the lack of reliable knowledge about the COVID-19 landscape on psychiatric disorders, we intend to investigate coronavirus's possible effect on mental illnesses based on available literature. Because the majority of the psychological effects of the coronavirus can continue for a long period after the pandemic ends, our research can give insight into potential psychiatric sequels associated with COVID-19.
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Affiliation(s)
- Ali Dehghani
- Department of Medical Genetics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Elham Zokaei
- Department of Biology, Faculty of Science, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Seyyed Mohammad Kahani
- Department of Medical Genetics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Elaheh Alavinejad
- Department of Medical Genetics, Faculty of Medical Sciences, Tehran University of Medical Science, Tehran, Iran
| | - Mohammad Dehghani
- Department of Pathology and Stem Cell Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Mohammad Reza Afarinesh
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran.
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Hafiz R, Gandhi TK, Mishra S, Prasad A, Mahajan V, Di X, Natelson BH, Biswal BB. Higher limbic and basal ganglia volumes in surviving COVID-negative patients and the relations to fatigue. NEUROIMAGE. REPORTS 2022; 2:100095. [PMID: 35496469 PMCID: PMC9040524 DOI: 10.1016/j.ynirp.2022.100095] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 04/13/2022] [Accepted: 04/15/2022] [Indexed: 11/06/2022]
Abstract
Background Among systemic abnormalities caused by the novel coronavirus, little is known about the critical attack on the central nervous system (CNS). Few studies have shown cerebrovascular pathologies that indicate CNS involvement in acute patients. However, replication studies are necessary to verify if these effects persist in COVID-19 survivors more conclusively. Furthermore, recent studies indicate fatigue is highly prevalent among 'long-COVID' patients. How morphometry in each group relate to work-related fatigue need to be investigated. Method COVID survivors were MRI scanned two weeks after hospital discharge. We hypothesized, these survivors will demonstrate altered gray matter volume (GMV) and experience higher fatigue levels when compared to healthy controls, leading to stronger correlation of GMV with fatigue. Voxel-based morphometry was performed on T1-weighted MRI images between 46 survivors and 30 controls. Unpaired two-sample t-test and multiple linear regression were performed to observe group differences and correlation of fatigue with GMV. Results The COVID group experienced significantly higher fatigue levels and GMV of this group was significantly higher within the Limbic System and Basal Ganglia when compared to healthy controls. Moreover, while a significant positive correlation was observed across the whole group between GMV and self-reported fatigue, COVID subjects showed stronger effects within the Posterior Cingulate, Precuneus and Superior Parietal Lobule. Conclusion Brain regions with GMV alterations in our analysis align with both single case acute patient reports and current group level neuroimaging findings. We also newly report a stronger positive correlation of GMV with fatigue among COVID survivors within brain regions associated with fatigue, indicating a link between structural abnormality and brain function in this cohort.
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Affiliation(s)
- Rakibul Hafiz
- Department of Biomedical Engineering, New Jersey Institute of Technology (NJIT), 323 Dr Martin Luther King Jr Blvd, Newark, NJ, 07102, USA
| | - Tapan Kumar Gandhi
- Department of Electrical Engineering, Indian Institute of Technology (IIT), Block II, IIT Delhi Main Rd, IIT Campus, Hauz Khas, New Delhi, Delhi 110016, India
| | - Sapna Mishra
- Department of Electrical Engineering, Indian Institute of Technology (IIT), Block II, IIT Delhi Main Rd, IIT Campus, Hauz Khas, New Delhi, Delhi 110016, India
| | - Alok Prasad
- Internal Medicine, Irene Hospital & Senior Consultant Medicine, Metro Heart and Super-specialty Hospital, New Delhi, India
| | - Vidur Mahajan
- Centre for Advanced Research in Imaging, Neuroscience & Genomics, Mahajan Imaging, New Delhi, India
| | - Xin Di
- Department of Biomedical Engineering, New Jersey Institute of Technology (NJIT), 323 Dr Martin Luther King Jr Blvd, Newark, NJ, 07102, USA
| | - Benjamin H Natelson
- Pain & Fatigue Study Center, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, 5 East 98th Street, 7th Floor, New York, NY, 10029, USA
| | - Bharat B Biswal
- Department of Biomedical Engineering, New Jersey Institute of Technology (NJIT), 323 Dr Martin Luther King Jr Blvd, Newark, NJ, 07102, USA
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Structural covariance changes in major cortico-basal ganglia and thalamic networks in amyloid-positive patients with white matter hyperintensities. Neurobiol Aging 2022; 117:117-127. [DOI: 10.1016/j.neurobiolaging.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 05/19/2022] [Accepted: 05/23/2022] [Indexed: 11/23/2022]
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35
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Yu AT, Absar NM. Long-term Neuropsychiatric Complications and 18F-FDG-PET Hypometabolism in the Brain From Prolonged Infection of COVID-19. Alzheimer Dis Assoc Disord 2022; 36:173-175. [PMID: 34966022 PMCID: PMC9132237 DOI: 10.1097/wad.0000000000000485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 11/07/2021] [Indexed: 11/21/2022]
Abstract
It is becoming increasingly clear that the worldwide outbreak of severe acute respiratory syndrome coronavirus 2 will have long-term negative consequences. Some patients report functional complaints long after recovery from coronavirus disease-2019 (COVID-19), which include fatigue, breathlessness, heart palpitations, loss or alteration of taste and smell, and problems with attention, memory, and cognition. However, the long-term complications for those patients who had severe symptoms and prolonged hypoxia during their course of their hospital stay is still unknown. We report 2 patients with confirmed diagnoses of COVID-19 who experienced prolonged infection and developed rapid progressive dementia following COVID-19 pneumonia after a follow-up period of 5 to 10 months. As these cases may become more prevalent over time, we should learn to recognize the early signs of long-term COVID-19 complications in those who are especially vulnerable to neurocognitive decline.
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Affiliation(s)
| | - Nicole M. Absar
- Department of Psychiatry and Behavioral Health
- Stony Brook Center of Excellence for Alzheimer’s Disease, Stony Brook University, Stony Brook, NY
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36
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Hafiz R, Gandhi TK, Mishra S, Prasad A, Mahajan V, Di X, Natelson BH, Biswal BB. Higher Limbic and Basal Ganglia volumes in surviving COVID-negative patients and the relations to fatigue. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022. [PMID: 34845462 DOI: 10.1101/2022.11.08.22281807v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Among systemic abnormalities caused by the novel coronavirus, little is known about the critical attack on the central nervous system (CNS). Few studies have shown cerebrovascular pathologies that indicate CNS involvement in acute patients. However, replication studies are necessary to verify if these effects persist in COVID-19 survivors more conclusively. Furthermore, recent studies indicate fatigue is highly prevalent among 'long-COVID' patients. How morphometry in each group relate to work-related fatigue need to be investigated. METHOD COVID survivors were MRI scanned two weeks after hospital discharge. We hypothesized, these survivors will demonstrate altered gray matter volume (GMV) and experience higher fatigue levels when compared to healthy controls, leading to stronger correlation of GMV with fatigue. Voxel-based morphometry was performed on T1-weighted MRI images between 46 survivors and 30 controls. Unpaired two-sample t-test and multiple linear regression were performed to observe group differences and correlation of fatigue with GMV. RESULTS The COVID group experienced significantly higher fatigue levels and GMV of this group was significantly higher within the Limbic System and Basal Ganglia when compared to healthy controls. Moreover, while a significant positive correlation was observed across the whole group between GMV and self-reported fatigue, COVID subjects showed stronger effects within the Posterior Cingulate, Precuneus and Superior Parietal Lobule . CONCLUSION Brain regions with GMV alterations in our analysis align with both single case acute patient reports and current group level neuroimaging findings. We also newly report a stronger positive correlation of GMV with fatigue among COVID survivors within brain regions associated with fatigue, indicating a link between structural abnormality and brain function in this cohort.
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Affiliation(s)
- Rakibul Hafiz
- Department of Biomedical Engineering, New Jersey Institute of Technology (NJIT), 323 Dr Martin Luther King Jr Blvd, Newark, NJ 07102, USA
| | - Tapan Kumar Gandhi
- Department of Electrical Engineering, Indian Institute of Technology (IIT), Block II, IIT Delhi Main Rd, IIT Campus, Hauz Khas, New Delhi, Delhi 110016, India
| | - Sapna Mishra
- Department of Electrical Engineering, Indian Institute of Technology (IIT), Block II, IIT Delhi Main Rd, IIT Campus, Hauz Khas, New Delhi, Delhi 110016, India
| | - Alok Prasad
- Internal Medicine, Irene Hospital & Senior Consultant Medicine, Metro Heart and Super-specialty Hospital, New Delhi, India
| | - Vidur Mahajan
- Centre for Advanced Research in Imaging, Neuroscience & Genomics, Mahajan Imaging, New Delhi, India
| | - Xin Di
- Department of Biomedical Engineering, New Jersey Institute of Technology (NJIT), 323 Dr Martin Luther King Jr Blvd, Newark, NJ 07102, USA
| | - Benjamin H Natelson
- Director, Pain & Fatigue Study Center, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, 5 East 98th Street, 7th Floor, New York, NY 10029
| | - Bharat B Biswal
- Department of Biomedical Engineering, New Jersey Institute of Technology (NJIT), 323 Dr Martin Luther King Jr Blvd, Newark, NJ 07102, USA
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Decreased gray matter volume is associated with theory of mind deficit in adolescents with schizophrenia. Brain Imaging Behav 2022; 16:1441-1450. [PMID: 35060009 DOI: 10.1007/s11682-021-00591-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 11/02/2022]
Abstract
Schizophrenia patients often suffer from deficit in theory of mind (TOM). Prior neuroimaging studies revealed neuroimaging correlates of TOM deficit in adults with schizophrenia, neuroimaging correlates of TOM in adolescents is less well established. This study aimed to investigate gray matter volume (GMV) abnormalities and TOM deficits in schizophrenic adolescents, and examine the relationship between them. Twenty adolescent schizophrenic patients and 25 age, sex-matched healthy controls underwent T1-weighted magnetic resonance imaging (MRI) scans, and were examined for TOM based on the Reading the Mind in the Eyes test (RMET). Univariate voxel-based morphometry (VBM) and multivariate source-based morphometry (SBM) were employed to examine alterations of two GMV phenotypes in schizophrenic adolescents: voxel-wise GMV and covarying structural brain patterns (SBPs). Compared with controls, our results revealed a significant deficit in RMET performance of the patients, Voxel-wise VBM analysis revealed that patients exhibited decreased GMV in bilateral insula, orbitofrontal cortex, and right rolandic operculum, and GMV of these brain regions were positively correlated with RMET performance. Multivariate SBM analysis identified a significantly different between-group SBP comprising of bilateral insula and inferior frontal cortex, bilateral superior temporal cortex, and bilateral lateral parietal cortex and right rolandic operculum. The loading scores of this SBP was positively correlated with RMET performance. This study revealed impairment of TOM ability in schizophrenic adolescents and revealed an association between TOM deficit and decreased GMV in regions which are crucial for social cognition, thereby provided insight and possible target regions for understanding the neural pathology and normalizing TOM deficit in adolescent schizophrenia patients.
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Abstract
Several studies have recently been conducted showing persistent COVID-19 symptoms in patients recovering after the acute phase of the disease. Energy imbalance plays a leading role in the pathogenesis of post-COVID syndrome. The choice of a metabolic cytoprotection drug with anti-asthenic activity will be decisive for the further tactics of managing the patient not only in the hospital, but also during the entire further period of recovery after the infection.
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Hafiz R, Gandhi TK, Mishra S, Prasad A, Mahajan V, Di X, Natelson BH, Biswal BB. Higher Limbic and Basal Ganglia volumes in surviving COVID-negative patients and the relations to fatigue.. [PMID: 34845462 PMCID: PMC8629206 DOI: 10.1101/2021.11.23.21266761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background: Among systemic abnormalities caused by the novel coronavirus, little is known about the critical attack on the central nervous system (CNS). Few studies have shown cerebrovascular pathologies that indicate CNS involvement in acute patients. However, replication studies are necessary to verify if these effects persist in COVID-19 survivors more conclusively. Furthermore, recent studies indicate fatigue is highly prevalent among ‘long-COVID’ patients. How morphometry in each group relate to work-related fatigue need to be investigated. Method: COVID survivors were MRI scanned two weeks after hospital discharge. We hypothesized, these survivors will demonstrate altered gray matter volume (GMV) and experience higher fatigue levels when compared to healthy controls, leading to stronger correlation of GMV with fatigue. Voxel-based morphometry was performed on T1-weighted MRI images between 46 survivors and 30 controls. Unpaired two-sample t-test and multiple linear regression were performed to observe group differences and correlation of fatigue with GMV. Results: The COVID group experienced significantly higher fatigue levels and GMV of this group was significantly higher within the Limbic System and Basal Ganglia when compared to healthy controls. Moreover, while a significant positive correlation was observed across the whole group between GMV and self-reported fatigue, COVID subjects showed stronger effects within the Posterior Cingulate, Precuneus and Superior Parietal Lobule. Conclusion: Brain regions with GMV alterations in our analysis align with both single case acute patient reports and current group level neuroimaging findings. We also newly report a stronger positive correlation of GMV with fatigue among COVID survivors within brain regions associated with fatigue, indicating a link between structural abnormality and brain function in this cohort.
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40
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Widmann CN, Wieberneit M, Bieler L, Bernsen S, Gräfenkämper R, Brosseron F, Schmeel C, Tacik P, Skowasch D, Radbruch A, Heneka MT. Longitudinal Neurocognitive and Pulmonological Profile of Long COVID-19: Protocol for the COVIMMUNE-Clin Study. JMIR Res Protoc 2021; 10:e30259. [PMID: 34559059 PMCID: PMC8589042 DOI: 10.2196/30259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/12/2021] [Accepted: 09/08/2021] [Indexed: 01/10/2023] Open
Abstract
Background There is a dearth of information about “brain fog,” characterized by concentration, word-finding, or memory problems, which has been listed in the new World Health Organization provisional classification “U09.9 Post-COVID-19 Condition.” Moreover, the extent to which these symptoms may be associated with neurological, pulmonary, or psychiatric difficulties is unclear. Objective This ongoing cohort study aims to carefully assess neurocognitive function in the context of the neurological, psychiatric, and pulmonary sequelae of SARS-CoV-2 infection among patients with asymptomatic/mild and severe cases of COVID-19 after remission, including actively recruited healthy controls. Methods A total of 150 participants will be included in this pilot study. The cohort will comprise patients who tested positive for SARS-CoV-2 infection with either an asymptomatic course or a mild course defined as no symptoms except for olfactory and taste dysfunction (n=50), patients who tested positive for SARS-CoV-2 infection with a severe disease course (n=50), and a healthy control group (n=50) with similar age and sex distribution based on frequency matching. A comprehensive neuropsychological assessment will be performed comprising nuanced aspects of complex attention, including language, executive function, verbal and visual learning, and memory. Psychiatric, personality, social and lifestyle factors, sleep, and fatigue will be evaluated. Brain magnetic resonance imaging, neurological and physical assessment, and pulmonological and lung function examinations (including body plethysmography, diffusion capacity, clinical assessments, and questionnaires) will also be performed. Three visits are planned with comprehensive testing at the baseline and 12-month visits, along with brief neurological and neuropsychological examinations at the 6-month assessment. Blood-based biomarkers of neurodegeneration will be quantified at baseline and 12-month follow-up. Results At the time of submission, the study had begun recruitment through telephone and in-person screenings. The first patient was enrolled in the study at the beginning of April 2021. Interim data analysis of baseline information is expected to be complete by December 2021 and study completion is expected at the end of December 2022. Preliminary group comparisons indicate worse word list learning, short- and long-delayed verbal recall, and verbal recognition in both patient cohorts compared with those of the healthy control group, adjusted for age and sex. Initial volumetric comparisons show smaller grey matter, frontal, and temporal brain volumes in both patient groups compared with those of healthy controls. These results are quite robust but are neither final nor placed in the needed context intended at study completion. Conclusions To the best of our knowledge, this is the first study to include objective and comprehensive longitudinal analyses of neurocognitive sequelae of COVID-19 in an extreme group comparison stratified by disease severity with healthy controls actively recruited during the pandemic. Results from this study will contribute to the nascent literature on the prolonged effects of COVID-19 on neurocognitive performance via our coassessment of neuroradiological, neurological, pulmonary, psychiatric, and lifestyle factors. Trial Registration International Clinical Trials Registry Platform DRKS00023806; https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00023806 International Registered Report Identifier (IRRID) DERR1-10.2196/30259
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Affiliation(s)
- Catherine N Widmann
- Section Neuropsychology, Department of Neurodegenerative Diseases and Gerontopsychiatry, University of Bonn Medical Center, Bonn, Germany.,German Center for Neurodegenerative Diseases, Bonn, Germany
| | - Michelle Wieberneit
- Section Neuropsychology, Department of Neurodegenerative Diseases and Gerontopsychiatry, University of Bonn Medical Center, Bonn, Germany
| | - Luzie Bieler
- Section Neuropsychology, Department of Neurodegenerative Diseases and Gerontopsychiatry, University of Bonn Medical Center, Bonn, Germany
| | - Sarah Bernsen
- German Center for Neurodegenerative Diseases, Bonn, Germany.,Department of Neurodegenerative Diseases and Gerontopsychiatry, University of Bonn Medical Center, Bonn, Germany
| | - Robin Gräfenkämper
- Section Neuropsychology, Department of Neurodegenerative Diseases and Gerontopsychiatry, University of Bonn Medical Center, Bonn, Germany.,Department of Psychiatry, University of Bonn Medical Center, Bonn, Germany
| | | | - Carsten Schmeel
- Department of Neuroradiology, University of Bonn Medical Center, Bonn, Germany
| | - Pawel Tacik
- German Center for Neurodegenerative Diseases, Bonn, Germany.,Department of Neurodegenerative Diseases and Gerontopsychiatry, University of Bonn Medical Center, Bonn, Germany
| | - Dirk Skowasch
- Department of Cardiology, Pneumology and Angiology, Internal Medicine II, University of Bonn Medical Center, Bonn, Germany
| | - Alexander Radbruch
- Department of Neuroradiology, University of Bonn Medical Center, Bonn, Germany
| | - Michael T Heneka
- German Center for Neurodegenerative Diseases, Bonn, Germany.,Department of Neurodegenerative Diseases and Gerontopsychiatry, University of Bonn Medical Center, Bonn, Germany
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Viszlayová D, Sojka M, Dobrodenková S, Szabó S, Bilec O, Turzová M, Ďurina J, Baloghová B, Borbély Z, Kršák M. SARS-CoV-2 RNA in the Cerebrospinal Fluid of a Patient with Long COVID. Ther Adv Infect Dis 2021; 8:20499361211048572. [PMID: 34659752 PMCID: PMC8511908 DOI: 10.1177/20499361211048572] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/02/2021] [Indexed: 01/07/2023] Open
Abstract
Over 10% of COVID-19 convalescents report post-COVID-19 complications, namely, ‘long
COVID’ or ‘post-COVID syndrome,’ including a number of neuro-psychiatric symptoms. The
pathophysiology of COVID-19 in the central nervous system is poorly understood but may
represent post-COVID injury, ongoing sterile maladaptive inflammation, or SARS-CoV-2
persistence. We describe a long COVID patient with SARS-CoV-2 RNA in the cerebrospinal
fluid, which seems important, specifically due to recent reports of gray matter volume
loss in COVID-19 patients. Further studies of SARS-CoV2 RNA, markers of inflammation, and
neuronal damage in the CSF of patients with long COVID would be useful and should address
whether the CNS can serve as a reservoir of SARS-CoV-2, clarify the pathway by which
COVID-19 contributes to CNS dysfunction, and how best to therapeutically address it.
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Affiliation(s)
- Daša Viszlayová
- Department of Neurology, Faculty Hospital Nové Zámky, Nové Zámky, Slovakia
| | - Martin Sojka
- Regional Public Health Authority in Komárno, Komárno, Slovakia
| | | | - Szabolcs Szabó
- Department of Neurology, Faculty Hospital Nové Zámky, Nové Zámky, Slovakia
| | - Ondrej Bilec
- Department of Neurology, Faculty Hospital Nové Zámky, Nové Zámky, Slovakia
| | - Mária Turzová
- Department of Neurology, Faculty Hospital Nové Zámky, Nové Zámky, Slovakia
| | - Juraj Ďurina
- Department of Internal medicine, Faculty Hospital Nové Zámky, Nové Zámky, Slovakia
| | - Barbara Baloghová
- Department of Internal medicine, Faculty Hospital Nové Zámky, Nové Zámky, Slovakia
| | - Zoltán Borbély
- Department of Internal medicine, Faculty Hospital Nové Zámky, Nové Zámky, Slovakia
| | - Martin Kršák
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of Colorado, Anschutz Medical Campus, 12700 East 19th Avenue Box 168, Aurora, CO 80045, USA
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Najt P, Richards HL, Fortune DG. Brain imaging in patients with COVID-19: A systematic review. Brain Behav Immun Health 2021; 16:100290. [PMID: 34230916 PMCID: PMC8249107 DOI: 10.1016/j.bbih.2021.100290] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 06/26/2021] [Indexed: 02/02/2023] Open
Abstract
Background There is increasing evidence that SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) not only affects the respiratory tract but also influence the central nervous system (CNS), resulting in neurological symptoms such as loss of smell and taste. Growing literature indicates largely distributed brain alterations encompassing subcortical micro- and macro-bleeds, cerebral swelling and haemorrhage in gray and white matter tissue. A systematic review was performed to synthesise the potential evidence of the brain correlates of SARS-CoV-2. Methods A literature search was conducted using electronic databases for studies reporting neuroimaging abnormalities in SARS-CoV-2 infected individuals. Identified case series, cohort studies, and case control studies on SARS-CoV-2 effects on the brain were critically appraised for methodological quality. A narrative synthesis of the findings from the included studies is presented. Results Twenty-seven studies were included in the review, including 5 case series, 8 cohort studies and 14 case control studies. The findings revealed predominant involvement of the olfactory system with disruptions across four olfactory structures. Abnormalities also extended to the corpus callosum, cingulate cortex, and insula, jointly implicating the olfactory brain network. Conclusion Alterations in olfactory areas, along with neighbouring brain regions, including prefrontal and limbic regions were associated to contraction of SARS-CoV-2. Viral infection could either trigger systemic reactions, or use the olfactory's unique anatomical organisation as an environmental entry zone to directly impact on the CNS. A spectrum of brain changes particularly at advanced stage relates to SARS-CoV-2 Across severity phases SARS-CoV-2 affects olfactory structures Emerging abnormalities in COVID-19 is associated with the olfactory brain network
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Affiliation(s)
- Pablo Najt
- Department of Psychology, University of Limerick, Ireland
| | - Helen L Richards
- Department of Clinical Psychology, Mercy University Hospital, Cork, Ireland
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43
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Tu Y, Zhang Y, Li Y, Zhao Q, Bi Y, Lu X, Kong Y, Wang L, Lu Z, Hu L. Post-traumatic stress symptoms in COVID-19 survivors: a self-report and brain imaging follow-up study. Mol Psychiatry 2021; 26:7475-7480. [PMID: 34285348 PMCID: PMC8290134 DOI: 10.1038/s41380-021-01223-w] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/16/2021] [Accepted: 06/25/2021] [Indexed: 02/05/2023]
Abstract
Previous coronavirus pandemics were associated elevated post-traumatic stress symptoms (PTSS), but the self-report and neurological basis of PTSS in patients who survived coronavirus disease 2019 (COVID-19) are largely unknown. We conducted a two-session study to record PTSS in the COVID-19 survivors discharged from hospitals for a short (i.e., about 3 months, Session 1) to a medium period (i.e., about 6 months, Session 2), as well as brain imaging data in Session 2. The control groups were non-COVID-19 locals. Session 1 was completed for 126 COVID-19 survivors and 126 controls. Session 2 was completed for 47 COVID-19 survivors and 43 controls. The total score of post-traumatic stress disorder (PTSD) checklist for DSM-5 (PCL-5) score was significantly higher in COVID-19 survivors compared with controls in both sessions. The PCL-5 score in COVID-19 survivors was positively correlated with the duration after discharge (r = 0.27, p = 0.003 for Session 1), and increased by 20% from Session 1 to Session 2 for the survivors who participated both sessions. The increase was positively correlated with individual’s test-retest duration (r = 0.46, p = 0.03). Brain structural volume and functional activity in bilateral hippocampus and amygdala were significantly larger in COVID-19 survivors compared with controls. However, the volumes of the left hippocampus and amygdala were negatively correlated with the PCL-5 score for the COVID-19 survivors. Our study suggests that COVID-19 survivors might face possible PTSS deteriorations, and highlights the importance of monitoring mental wellness of COVID-19 survivors.
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Affiliation(s)
- Yiheng Tu
- grid.454868.30000 0004 1797 8574CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
- grid.410726.60000 0004 1797 8419Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yuqi Zhang
- grid.410726.60000 0004 1797 8419Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
- grid.454868.30000 0004 1797 8574CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, China
| | - Yu Li
- grid.414375.00000 0004 7588 8796Organ Transplantation Department, Third Affiliated Hospital of Second Military Medical University, Shanghai, China
| | - Qing Zhao
- grid.454868.30000 0004 1797 8574CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
- grid.410726.60000 0004 1797 8419Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yanzhi Bi
- grid.454868.30000 0004 1797 8574CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
- grid.410726.60000 0004 1797 8419Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xuejing Lu
- grid.454868.30000 0004 1797 8574CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
- grid.410726.60000 0004 1797 8419Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yazhuo Kong
- grid.410726.60000 0004 1797 8419Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
- grid.454868.30000 0004 1797 8574CAS Key Laboratory of Behavioral Science, Institute of Psychology, Beijing, China
| | - Li Wang
- grid.454868.30000 0004 1797 8574CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
- grid.410726.60000 0004 1797 8419Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Zhijie Lu
- grid.414375.00000 0004 7588 8796Department of Anesthesiology, Third Affiliated Hospital of Second Military Medical University, Shanghai, China
| | - Li Hu
- grid.454868.30000 0004 1797 8574CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
- grid.410726.60000 0004 1797 8419Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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