1
|
Grunden N, Calabria M, García-Sánchez C, Pons C, Arroyo JA, Gómez-Ansón B, Estévez-García MDC, Belvís R, Morollón N, Cordero-Carcedo M, Mur I, Pomar V, Domingo P. Evolving trends in neuropsychological profiles of post COVID-19 condition: A 1-year follow-up in individuals with cognitive complaints. PLoS One 2024; 19:e0302415. [PMID: 39116061 PMCID: PMC11309414 DOI: 10.1371/journal.pone.0302415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 04/02/2024] [Indexed: 08/10/2024] Open
Abstract
Cognitive difficulties are reported as lasting sequelae within post COVID-19 condition. However, the chronicity of these difficulties and related factors of fatigue, mood, and perceived health have yet to be fully determined. To address this, the current longitudinal study aimed to clarify the trends of cognitive test performance and cognitive domain impairment following COVID-19 onset, and whether hospitalization influences outcomes. 57 participants who reported subjective cognitive difficulties after confirmed COVID-19 infection were assessed at baseline (~6 months post COVID-19) and follow-up (~15 months later) visits. Assessments included measures across multiple cognitive domains and self-report questionnaires of fatigue, mood, and overall health. Analyses were conducted in three stages: at the test score level (raw and adjusted scores), at the cognitive domain level, and stratified by hospitalization status during infection. Results at the test-score level indicate that cognitive performance remains relatively stable across assessments at the group level, with no significant improvements in any adjusted test scores at follow-up. Cognitive domain analyses indicate significant reductions in attention and executive functioning impairment, while memory impairment is slower to resolve. On self-report measures, there was a significant improvement in overall health ratings at follow-up. Finally, those hospitalized during infection performed worse on timed cognitive measures across visits and accounted for a larger proportion of cases with short-term and working memory impairment at follow-up. Overall, our findings indicate that cognitive difficulties persist both at test score and cognitive domain levels in many cases of post COVID-19 condition, but evidence suggests some improvement in global measures of attention, executive functioning and overall self-rated health. Furthermore, an effect of hospitalization on cognitive symptoms post COVID-19 may be more discernible over time.
Collapse
Affiliation(s)
- Nicholas Grunden
- Department of Psychology, Concordia University, Montreal, Canada
| | - Marco Calabria
- Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Carmen García-Sánchez
- Neuropsychology Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Catalina Pons
- Facultat de Psicologia, Ciències de l’Educació i l’Esport, Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Juan Antonio Arroyo
- Internal Medicine Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Beatriz Gómez-Ansón
- Neurodiagnostic Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Roberto Belvís
- Neurology Department, Headache Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Noemí Morollón
- Neurology Department, Headache Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Mónica Cordero-Carcedo
- Neuropsychology Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Isabel Mur
- Infectious Disease Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Virginia Pomar
- Infectious Disease Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Pere Domingo
- Infectious Disease Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| |
Collapse
|
2
|
Thomas M, Hameed M, Hussein M, George S, Rajalekshmi MR, Akram J, Sharma R, Al Adab AHO, Ahmad M, Singh R, Raza T. A prospective cohort study on cognitive and psychological outcomes in COVID-19 ICU survivors at 3 months of follow up. Front Med (Lausanne) 2024; 11:1288761. [PMID: 39144668 PMCID: PMC11322111 DOI: 10.3389/fmed.2024.1288761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 07/08/2024] [Indexed: 08/16/2024] Open
Abstract
Objective The Outcomes - Short and Long term in ICU patient with COVID-19 "OUTSTRIP COVID-19" study was initiated to assess overall mortality, physical and psychiatric co-morbidities, reduction in lung function, and the ability to return to work post-ICU discharge with a follow-up period of 2 years in COVID-19 patients admitted to ICUs in Qatar. This paper focuses on the prevalence of cognitive impairment, depression, anxiety, and stress at baseline and 3 months after ICU discharge. Methods This prospective cohort study included 100 ICU survivors reviewed at baseline within 7 weeks of ICU discharge, with a 3-month follow-up. Demographics, clinical characteristics, and relevant medical history were collected at baseline. Cognitive outcomes were assessed using the Montreal Cognitive Assessment-Basic (MoCA-B) tool, while psychological outcomes were evaluated using the Depression Anxiety and Stress Scale-21 (DASS-21). Results At baseline, 72% of ICU survivors exhibited mild cognitive impairment, which significantly improved to 56% at 3 months. However, severe cognitive impairment persisted in 20% of survivors at 3 months.For psychological outcomes, the mean depression score remained below 9 (5.64 ± 6.90) at both time points, with no significant change. At baseline, 25% of survivors had clinical depression, which reduced to 16% at 3 months.The mean anxiety score at baseline (9.35 ± 8.50) significantly decreased to 6.51 ± 7.74 (p = 0.002) at 3 months. Anxiety was not reported by 48% of survivors at baseline and this increased to 66% at 3 months. Severe to extremely severe anxiety decreased from 19% to 12% during the same period.The mean stress score at baseline (8.34 ± 8.07) did not significantly change at 3 months. At baseline, 18% experienced stress, which decreased to 12% at 3 months, with 5.3% facing severe to extremely severe stress. Conclusion COVID-19 ICU survivors experience significant cognitive impairment, anxiety, and stress. While cognitive impairment and anxiety showed improvements at 3 months, depression and stress remained unchanged. These outcomes strongly emphasize the requirement for thorough post-ICU care and comprehensive mental health assistance for individuals recovering from COVID-19. Customized interventions and additional research endeavors are crucial to effectively manage the cognitive and psychological consequences faced by these patients. The exploration of telemonitoring and innovative approaches can offer avenues to enhance the overall quality of life for survivors. Further investigation should encompass extended timeframes to analyze prolonged effects and consider the broader socioeconomic impact.
Collapse
Affiliation(s)
- Merlin Thomas
- Pulmonary Division, Department of Chest, Hamad General Hospital, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medicine, Doha, Qatar
| | - Mansoor Hameed
- Pulmonary Division, Department of Chest, Hamad General Hospital, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medicine, Doha, Qatar
| | - Mousa Hussein
- Pulmonary Division, Department of Chest, Hamad General Hospital, Doha, Qatar
- Department of Clinical Medicine, Qatar University, Doha, Qatar
| | - Saibu George
- Department of Clinical Medicine, Weill Cornell Medicine, Doha, Qatar
- Department of Medical Intensive Care, Hamad General Hospital, Doha, Qatar
| | - M. R. Rajalekshmi
- Department of Medical Research Centre, Hamad Medical Corporation, Doha, Qatar
| | - Jaweria Akram
- Department of Medical Intensive Care, Hamad General Hospital, Doha, Qatar
| | - Rohit Sharma
- Department of Internal Medicine, Geisinger Health System, Danville, PA, United States
| | - Aisha Hussain O. Al Adab
- Pulmonary Division, Department of Chest, Hamad General Hospital, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medicine, Doha, Qatar
| | - Mushtaq Ahmad
- Pulmonary Division, Department of Chest, Hamad General Hospital, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medicine, Doha, Qatar
| | - Rajvir Singh
- Medical Research Centre, Hamad Medical Corporation, Doha, Qatar
| | - Tasleem Raza
- Pulmonary Division, Department of Chest, Hamad General Hospital, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medicine, Doha, Qatar
- Department of Medical Intensive Care, Hamad General Hospital, Doha, Qatar
| |
Collapse
|
3
|
Liu YH, Wu QX, Wang QH, Zhang QF, Tang Y, Liu D, Wang JJ, Liu XY, Wang LR, Li L, Xu C, Zhu J, Wang YJ. Tracking cognitive trajectories in older survivors of COVID-19 up to 2.5 years post-infection. NATURE AGING 2024:10.1038/s43587-024-00667-3. [PMID: 38987646 DOI: 10.1038/s43587-024-00667-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 06/12/2024] [Indexed: 07/12/2024]
Abstract
Emerging evidence suggests that neurological and other post-acute sequelae of COVID-19 can persist beyond or develop following SARS-CoV-2 infection. However, the long-term trajectories of cognitive change after a COVID-19 infection remain unclear. Here we investigated cognitive changes over a period of 2.5 years among 1,245 individuals aged 60 years or older who survived infection with the original SARS-CoV-2 strain in Wuhan, China, and 358 uninfected spouses. We show that the overall incidence of cognitive impairment among older COVID-19 survivors was 19.1% at 2.5 years after infection and hospitalization, evaluated using the Telephone Interview for Cognitive Status-40. Cognitive decline primarily manifested in individuals with severe COVID-19 during the initial year of infection, after which the rate of decline decelerated. Severe COVID-19, cognitive impairment at 6 months and hypertension were associated with long-term cognitive decline. These findings reveal the long-term cognitive trajectory of the disease and underscore the importance of post-infection cognitive care for COVID-19 survivors.
Collapse
Affiliation(s)
- Yu-Hui Liu
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China.
- Chongqing Key Laboratory of Ageing and Brain Diseases, Chongqing, China.
- State Key Laboratory of Trauma and Chemical Poisoning, Chongqing, China.
| | - Quan-Xin Wu
- Cadre Ward Two, General Hospital of Central Theater Command of PLA, Wuhan, China
| | - Qing-Hua Wang
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory of Ageing and Brain Diseases, Chongqing, China
| | - Qiao-Feng Zhang
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory of Ageing and Brain Diseases, Chongqing, China
| | - Yi Tang
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory of Ageing and Brain Diseases, Chongqing, China
| | - Di Liu
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory of Ageing and Brain Diseases, Chongqing, China
| | - Jing-Juan Wang
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory of Ageing and Brain Diseases, Chongqing, China
| | - Xiao-Yu Liu
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory of Ageing and Brain Diseases, Chongqing, China
| | - Ling-Ru Wang
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory of Ageing and Brain Diseases, Chongqing, China
| | - Li Li
- Department of Respiratory Medicine, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Cheng Xu
- Department of Oncology, General Hospital of Central Theater Command of PLA, Wuhan, China
| | - Jie Zhu
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China
- Chongqing Key Laboratory of Ageing and Brain Diseases, Chongqing, China
| | - Yan-Jiang Wang
- Department of Neurology and Center for Clinical Neuroscience, Daping Hospital, Third Military Medical University, Chongqing, China.
- Chongqing Key Laboratory of Ageing and Brain Diseases, Chongqing, China.
- State Key Laboratory of Trauma and Chemical Poisoning, Chongqing, China.
| |
Collapse
|
4
|
Takahashi Y, Yatomi T, Yamaguchi N, Yoshimura K, Hori S, Uchida H. Comparable Psychotropic Prescription Rates After Hospital Discharge Between Patients with COVID-19 and Those With Non-COVID-19-Related Respiratory Infection. PHARMACOPSYCHIATRY 2024; 57:186-190. [PMID: 38531375 DOI: 10.1055/a-2286-1427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
INTRODUCTION Whether psychiatric symptoms after recovery from coronavirus disease 2019 (COVID-19) are specific to this illness remains unclear. METHODS In this retrospective study, the Diagnosis Procedure Combination data and outpatient clinic data were used for patients who received inpatient treatment in Saiseikai-affiliated hospitals for COVID-19 or other respiratory tract infections (non-COVID) from 2020 to 2022. The primary outcome was new prescriptions of psychotropic drugs after discharge (i. e., prescriptions of psychotropics to patients who had not received them before or during their hospitalization). Values of interest were compared between groups using the chi-square test or Fisher's exact test. A COX proportional-hazards model was used to examine factors associated with psychotropic prescriptions after discharge in age- and sex-matched COVID-19 and non-COVID patients. RESULTS Of 31,993 chart records, 19,613 were excluded due to a positive history with psychiatric disorders (n=2,445), prescriptions of psychotropics (n=744), and no follow-ups (n=16,424). Thus, 3,648 COVID-19 and 8,732 non-COVID patients were included (mean [range] duration of follow-up, days: 146.9 [1-727] and 239.2 [1-729], respectively). Two hundred and four (5.6%) of the 3,648 patients with COVID-19 received psychotropic prescriptions after discharge. No statistically significant differences were observed in the prescription rates of any psychotropic category between the COVID-19 and non-COVID groups. An increase in severity during hospitalization was significantly associated with more frequent psychotropic prescriptions (hazard ratio 1.83, p<0.001). DISCUSSION The development of psychiatric symptoms should be closely observed, especially in patients who experienced increased severity during hospitalization, regardless of whether they suffered from COVID-19.
Collapse
Affiliation(s)
- Yuna Takahashi
- Division of Drug Informatics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Taisuke Yatomi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Naohito Yamaguchi
- Saiseikai Research Institute of Health Care and Welfare, Tokyo, Japan
| | - Kimio Yoshimura
- Department of Health Policy and Management, Keio University School of Medicine, Tokyo, Japan
| | - Satoko Hori
- Division of Drug Informatics, Keio University Faculty of Pharmacy, Tokyo, Japan
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
5
|
Leone MA, Helbok R, Bianchi E, Yasuda CL, Konti M, Ramankulov D, Lolich M, Lovrencic-Huzjan A, Kovács T, Armon C, Cotelli MS, Cavallieri F, Grosu O, Kiteva-Trenchevska G, Rodriguez-Leyva I, Boldingh M, Brola W, Maia LF, de Seabra MML, Davidescu EI, Popescu BO, Kopishinskaia S, Bassetti CLA, Moro E. Outcome predictors of post-COVID conditions in the European Academy of Neurology COVID-19 registry. J Neurol 2024; 271:3153-3168. [PMID: 38436682 DOI: 10.1007/s00415-024-12212-8] [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: 11/20/2023] [Revised: 01/18/2024] [Accepted: 01/20/2024] [Indexed: 03/05/2024]
Abstract
Several neurological manifestations are part of the post-COVID condition. We aimed to: (1) evaluate the 6-month outcome in the cohort of patients with neurological manifestations during the COVID-19 acute phase and surviving the infection, and find outcome predictors; (2) define the prevalence and type of neurological symptoms persistent at six months after the infection. Data source was an international registry of patients with COVID-19 infection and neurological symptoms, signs or diagnoses established by the European Academy of Neurology. Functional status at six-month follow-up was measured with the modified Rankin scale (mRS), and defined as: "stable/improved" if the mRS at six months was equal as or lower than the baseline score; "worse" if it was higher than the baseline score. By October 30, 2022, 1,003 lab-confirmed COVID-19 patients were followed up for a median of 6.5 months. Compared to their pre-morbid status, 522 patients (52%) were stable/improved, whereas 465 (46%) were worse (functional status missing for 16). Age, hospitalization, several pre-COVID-19 comorbidities, and COVID-19 general complications were predictors of a worse status. Amongst neurological manifestations, stroke carried the highest risk for worse outcome (OR 5.96), followed by hyperactive delirium (2.8), and peripheral neuropathies (2.37). On the other hand, hyposmia/hypogeusia (0.38), headache (0.40), myalgia (0.45), and COVID-19 vaccination (0.52) were predictors of a favourable prognosis. Persisting neurological symptoms or signs were reported by 316/1003 patients (31.5%), the commonest being fatigue (n = 133), and impaired memory or concentration (n = 103). Our study identified significant long-term prognostic predictors in patients with COVID-19 and neurological manifestations.
Collapse
Affiliation(s)
- Maurizio Angelo Leone
- Department of Neurosciences, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
| | - Raimund Helbok
- Department of Neurology, Neurocritical Care Unit, Vienna, Austria.
| | - Elisa Bianchi
- Department of Neurosciences, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - Maria Konti
- European Academy of Neurology, Vienna, Austria
| | | | | | | | - Tibor Kovács
- Department of Neurology, Semmelweis University Budapest, Budapest, Hungary
| | - Carmel Armon
- Tel Aviv University School of Medicine and Shamir (Assaf Harofeh), Medical Center, Tel Aviv, Israel
| | | | - Francesco Cavallieri
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS Di Reggio Emilia, Reggio Emilia, Italy
| | - Oxana Grosu
- Diomid Gherman Institute of Neurology and Neurosurgery, Chișinău, Moldova
| | - Gordana Kiteva-Trenchevska
- Medical Faculty, University Clinic for Neurology, University "Ss. Cyril and Methodius", Skopje, North Macedonia
| | - Ildefonso Rodriguez-Leyva
- Medicine Faculty, Head Neurology Program, Hospital Central "Dr. Ignacio Moronnes Prieto", Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
| | - Marion Boldingh
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Waldemar Brola
- Department of Neurology, Specialist Hospital Konskie, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Luís F Maia
- Department of Neurology, Centro Hospitalar Universitário Do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
- Institute for Research & Innovation in Health (i3S), Porto, Portugal
| | - Mafalda Maria Laracho de Seabra
- Neurology Department, Hospital de São João, Porto, Portugal
- Neurology and Neurosurgery Unit of Clinical Neurosciences and Mental Health Department, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Eugenia Irene Davidescu
- Neurology Department, Colentina Clinical Hospital, Bucharest, Romania
- Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Bogdan Ovidiu Popescu
- Neurology Department, Colentina Clinical Hospital, Bucharest, Romania
- Department of Clinical Neurosciences, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | | | | | - Elena Moro
- Division of Neurology, Centre Hospitalier Universitaire of Grenoble, Grenoble Alpes University, Grenoble Institute of Neuroscience, Grenoble, France
| |
Collapse
|
6
|
Frontera JA, Betensky RA, Pirofski LA, Wisniewski T, Yoon H, Ortigoza MB. Trajectories of Inflammatory Markers and Post-COVID-19 Cognitive Symptoms: A Secondary Analysis of the CONTAIN COVID-19 Randomized Trial. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200227. [PMID: 38626359 PMCID: PMC11087048 DOI: 10.1212/nxi.0000000000200227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/24/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND AND OBJECTIVES Chronic systemic inflammation has been hypothesized to be a mechanistic factor leading to post-acute cognitive dysfunction after COVID-19. However, little data exist evaluating longitudinal inflammatory markers. METHODS We conducted a secondary analysis of data collected from the CONTAIN randomized trial of convalescent plasma in patients hospitalized for COVID-19, including patients who completed an 18-month assessment of cognitive symptoms and PROMIS Global Health questionnaires. Patients with pre-COVID-19 dementia/cognitive abnormalities were excluded. Trajectories of serum cytokine panels, D-dimer, fibrinogen, C-reactive peptide (CRP), ferritin, lactate dehydrogenase (LDH), and absolute neutrophil counts (ANCs) were evaluated over 18 months using repeated measures and Friedman nonparametric tests. The relationships between the area under the curve (AUC) for each inflammatory marker and 18-month cognitive and global health outcomes were assessed. RESULTS A total of 279 patients (N = 140 received plasma, N = 139 received placebo) were included. At 18 months, 76/279 (27%) reported cognitive abnormalities and 78/279 (28%) reported fair or poor overall health. PROMIS Global Mental and Physical Health T-scores were 0.5 standard deviations below normal in 24% and 51% of patients, respectively. Inflammatory marker levels declined significantly from hospitalization to 18 months for all markers (IL-2, IL-2R, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12, IL-13, INFγ, TNFα, D-dimer, fibrinogen, ferritin, LDH, CRP, neutrophils; all p < 0.05), with the exception of IL-1β, which remained stable over time. There were no significant associations between the AUC for any inflammatory marker and 18-month cognitive symptoms, any neurologic symptom, or PROMIS Global Physical or Mental health T-scores. Receipt of convalescent plasma was not associated with any outcome measure. DISCUSSION At 18 months posthospitalization for COVID-19, cognitive abnormalities were reported in 27% of patients, and below average PROMIS Global Mental and Physical Health scores occurred in 24% and 51%, respectively. However, there were no associations with measured inflammatory markers, which decreased over time.
Collapse
Affiliation(s)
- Jennifer A Frontera
- From the Department of Neurology (J.A.F., T.W.), New York University Grossman School of Medicine; Department of Biostatistics (R.A.B.), NYU; Division of Infectious Disease (L.P.), Department of Medicine, Montefiore Medical Center; Department of Microbiology and Immunology; Division of Infectious Disease (H.Y.), Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx; and Division of Infectious Disease (M.B.O.), Department of Medicine, NYU Grossman School of Medicine, New York
| | - Rebecca A Betensky
- From the Department of Neurology (J.A.F., T.W.), New York University Grossman School of Medicine; Department of Biostatistics (R.A.B.), NYU; Division of Infectious Disease (L.P.), Department of Medicine, Montefiore Medical Center; Department of Microbiology and Immunology; Division of Infectious Disease (H.Y.), Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx; and Division of Infectious Disease (M.B.O.), Department of Medicine, NYU Grossman School of Medicine, New York
| | - Liise-Anne Pirofski
- From the Department of Neurology (J.A.F., T.W.), New York University Grossman School of Medicine; Department of Biostatistics (R.A.B.), NYU; Division of Infectious Disease (L.P.), Department of Medicine, Montefiore Medical Center; Department of Microbiology and Immunology; Division of Infectious Disease (H.Y.), Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx; and Division of Infectious Disease (M.B.O.), Department of Medicine, NYU Grossman School of Medicine, New York
| | - Thomas Wisniewski
- From the Department of Neurology (J.A.F., T.W.), New York University Grossman School of Medicine; Department of Biostatistics (R.A.B.), NYU; Division of Infectious Disease (L.P.), Department of Medicine, Montefiore Medical Center; Department of Microbiology and Immunology; Division of Infectious Disease (H.Y.), Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx; and Division of Infectious Disease (M.B.O.), Department of Medicine, NYU Grossman School of Medicine, New York
| | - Hyunah Yoon
- From the Department of Neurology (J.A.F., T.W.), New York University Grossman School of Medicine; Department of Biostatistics (R.A.B.), NYU; Division of Infectious Disease (L.P.), Department of Medicine, Montefiore Medical Center; Department of Microbiology and Immunology; Division of Infectious Disease (H.Y.), Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx; and Division of Infectious Disease (M.B.O.), Department of Medicine, NYU Grossman School of Medicine, New York
| | - Mila B Ortigoza
- From the Department of Neurology (J.A.F., T.W.), New York University Grossman School of Medicine; Department of Biostatistics (R.A.B.), NYU; Division of Infectious Disease (L.P.), Department of Medicine, Montefiore Medical Center; Department of Microbiology and Immunology; Division of Infectious Disease (H.Y.), Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx; and Division of Infectious Disease (M.B.O.), Department of Medicine, NYU Grossman School of Medicine, New York
| |
Collapse
|
7
|
Klinkhammer S, Duits AA, Horn J, Slooter AJC, Verwijk E, Van Santen S, Visser-Meily JMA, Van Heugten C. Prevalence and trajectories of neuropsychological post-COVID-19 symptoms in initially hospitalized patients. J Rehabil Med 2024; 56:jrm25315. [PMID: 38470168 PMCID: PMC10949081 DOI: 10.2340/jrm.v56.25315] [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: 11/07/2023] [Accepted: 01/30/2024] [Indexed: 03/13/2024] Open
Abstract
OBJECTIVE To investigate the prevalence and trajectories of post-COVID-19 neuropsychological symptoms. DESIGN Prospective longitudinal multicentre cohort study. SUBJECTS A total of 205 patients initially hospitalized with SARS-CoV-2 (COVID-19). METHODS Validated questionnaires were administered at 9 months (T1) and 15 months (T2) post-hospital discharge to assess fatigue, cognitive complaints, insomnia, anxiety, depression, and post-traumatic stress symptoms. RESULTS Analyses included 184 out of 205 patients. Approximately 50% experienced high cognitive complaints at T1 and T2, while severe fatigue affected 52.5% at T1 and 55.6% at T2. Clinically relevant insomnia scores were observed in 25% of patients at both time-points. Clinically relevant anxiety scores were present in 18.3% at T1 and 16.7% at T2, depression in 15.0% at T1 and 18.9% at T2, and PTSD in 12.4% at T1 and 11.8% at T2. Most symptoms remained stable, with 59.2% of patients experiencing at least 1 persistent symptom. In addition, 31.5% of patients developed delayed-onset symptoms. CONCLUSION Post-COVID-19 cognitive complaints and fatigue are highly prevalent and often persist. A subgroup develops delayed symptoms. Emotional distress is limited. Screening can help identify most patients experiencing long-term problems. Future research should determine risk factors for persistent and delayed onset symptoms.
Collapse
Affiliation(s)
- Simona Klinkhammer
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands; Limburg Brain Injury Center, Maastricht University, Maastricht, the Netherlands
| | - Annelien A Duits
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands; Department of Medical Psychology, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Janneke Horn
- Department of Intensive Care, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Arjen J C Slooter
- UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Department of Neurology, UZ Brussel and Vrije Universiteit Brussel, Brussels Health Campus, Jette, Belgium
| | - Esmée Verwijk
- Amsterdam Neuroscience, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Medical Psychology, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Psychology, Brain and Cognition, University of Amsterdam, Amsterdam, the Netherlands
| | - Susanne Van Santen
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Johanna M A Visser-Meily
- Department of Rehabilitation, Physical Therapy Science & Sports, University Medical Center Utrecht, Utrecht, the Netherlands; Center of Excellence for Rehabilitation Medicine and De Hoogstraat Rehabilitation, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Caroline Van Heugten
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands; Limburg Brain Injury Center, Maastricht University, Maastricht, the Netherlands; Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.
| |
Collapse
|
8
|
Fisicaro F, Lanza G, Concerto C, Rodolico A, Di Napoli M, Mansueto G, Cortese K, Mogavero MP, Ferri R, Bella R, Pennisi M. COVID-19 and Mental Health: A "Pandemic Within a Pandemic". ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1458:1-18. [PMID: 39102186 DOI: 10.1007/978-3-031-61943-4_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
The COVID-19 pandemic has brought significant changes in daily life for humanity and has had a profound impact on mental health. As widely acknowledged, the pandemic has led to notable increases in rates of anxiety, depression, distress, and other mental health-related issues, affecting both infected patients and non-infected individuals. COVID-19 patients and survivors face heightened risks for various neurological and psychiatric disorders and complications. Vulnerable populations, including those with pre-existing mental health conditions and individuals living in poverty or frailty, may encounter additional challenges. Tragically, suicide rates have also risen, particularly among young people, due to factors such as unemployment, financial crises, domestic violence, substance abuse, and social isolation. Efforts are underway to address these mental health issues, with healthcare professionals urged to regularly screen both COVID-19 and post-COVID-19 patients and survivors for psychological distress, ensuring rapid and appropriate interventions. Ongoing periodic follow-up and multidimensional, interdisciplinary approaches are essential for individuals experiencing long-term psychiatric sequelae. Preventive strategies must be developed to mitigate mental health problems during both the acute and recovery phases of COVID-19 infection. Vaccination efforts continue to prioritize vulnerable populations, including those with mental health conditions, to prevent future complications. Given the profound implications of mental health problems, including shorter life expectancy, diminished quality of life, heightened distress among caregivers, and substantial economic burden, it is imperative that political and health authorities prioritize the mental well-being of all individuals affected by COVID-19, including infected individuals, non-infected individuals, survivors, and caregivers.
Collapse
Affiliation(s)
- Francesco Fisicaro
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via Santa Sofia 97, 95123, Catania, Italy
| | - Giuseppe Lanza
- Department of Surgery and Medical-Surgery Specialties, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy.
- Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS, Via Conte Ruggero 78, 94018, Troina, Italy.
| | - Carmen Concerto
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Via Santa Sofia 89, 95123, Catania, Italy
| | - Alessandro Rodolico
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Via Santa Sofia 89, 95123, Catania, Italy
| | - Mario Di Napoli
- Neurological Service, SS Annunziata Hospital, Viale Mazzini 100, 67039, Sulmona, L'Aquila, Italy
| | - Gelsomina Mansueto
- Department of Advanced Medical and Surgical Sciences (DAMSS), University of Campania "Luigi Vanvitelli", Piazza L. Miraglia 2, 80138, Naples, Italy
- Clinical Department of Laboratory Services and Public Health-Legal Medicine Unit, University of Campania "Luigi Vanvitelli", Via Luciano Armanni 5, 80138, Naples, Italy
| | - Klizia Cortese
- Department of Educational Sciences, University of Catania, Via Teatro Greco 84, 95124, Catania, Italy
| | - Maria P Mogavero
- Sleep Disorders Center, Division of Neuroscience, San Raffaele Scientific Institute, Via Stamira d'Ancona 20, 20127, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Raffaele Ferri
- Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS, Via Conte Ruggero 78, 94018, Troina, Italy
| | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Via Santa Sofia 87, 95123, Catania, Italy
| | - Manuela Pennisi
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via Santa Sofia 97, 95123, Catania, Italy
| |
Collapse
|
9
|
Cipolli GC, Alonso V, Yasuda CL, Assumpção DD, Cachioni M, Melo RCD, Hinsliff-Smith K, Yassuda MS. Cognitive impairment in post-acute COVID-19 syndrome: a scoping review. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:1053-1069. [PMID: 38157873 PMCID: PMC10756850 DOI: 10.1055/s-0043-1777115] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 09/22/2023] [Indexed: 01/03/2024]
Abstract
Emerging studies indicate the persistence of symptoms beyond the acute phase of COVID-19. Cognitive impairment has been observed in certain individuals for months following infection. Currently, there is limited knowledge about the specific cognitive domains that undergo alterations during the post-acute COVID-19 syndrome and the potential impact of disease severity on cognition. The aim of this review is to examine studies that have reported cognitive impairment in post-acute COVID-19, categorizing them into subacute and chronic phases. The methodology proposed by JBI was followed in this study. The included studies were published between December 2019 and December 2022. The search was conducted in PubMed, PubMed PMC, BVS - BIREME, Embase, SCOPUS, Cochrane, Web of Science, Proquest, PsycInfo, and EBSCOHost. Data extraction included specific details about the population, concepts, context, and key findings or recommendations relevant to the review objectives. A total of 7,540 records were identified and examined, and 47 articles were included. The cognitive domains most frequently reported as altered 4 to 12 weeks after acute COVID-19 were language, episodic memory, and executive function, and after 12 weeks, the domains most affected were attention, episodic memory, and executive function. The results of this scoping review highlight that adults with post-acute COVID-19 syndrome may have impairment in specific cognitive domains.
Collapse
Affiliation(s)
- Gabriela Cabett Cipolli
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Programa de Pós-graduação em Gerontologia, Campinas SP, Brazil.
| | - Vanessa Alonso
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Programa de Pós-graduação em Gerontologia, Campinas SP, Brazil.
| | - Clarissa Lin Yasuda
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Neurologia, Campinas SP, Brazil.
| | - Daniela de Assumpção
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Programa de Pós-graduação em Gerontologia, Campinas SP, Brazil.
| | - Meire Cachioni
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Programa de Pós-graduação em Gerontologia, Campinas SP, Brazil.
- Universidade de São Paulo, Escola de Artes, Ciências e Humanidades, Programa de Pós-graduação em Gerontologia, São Paulo SP, Brazil.
| | - Ruth Caldeira de Melo
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Programa de Pós-graduação em Gerontologia, Campinas SP, Brazil.
- Universidade de São Paulo, Escola de Artes, Ciências e Humanidades, Programa de Pós-graduação em Gerontologia, São Paulo SP, Brazil.
| | - Kathryn Hinsliff-Smith
- De Montfort University, Faculty of Health and Life Sciences, Leicester School of Nursing & Midwifery, United Kingdom.
| | - Mônica Sanches Yassuda
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Programa de Pós-graduação em Gerontologia, Campinas SP, Brazil.
- Universidade de São Paulo, Escola de Artes, Ciências e Humanidades, Programa de Pós-graduação em Gerontologia, São Paulo SP, Brazil.
| |
Collapse
|
10
|
Frontera JA, Guekht A, Allegri RF, Ashraf M, Baykan B, Crivelli L, Easton A, Garcia-Azorin D, Helbok R, Joshi J, Koehn J, Koralnik I, Netravathi M, Michael B, Nilo A, Özge A, Padda K, Pellitteri G, Prasad K, Romozzi M, Saylor D, Seed A, Thakur K, Uluduz D, Vogrig A, Welte TM, Westenberg E, Zhuravlev D, Zinchuk M, Winkler AS. Evaluation and treatment approaches for neurological post-acute sequelae of COVID-19: A consensus statement and scoping review from the global COVID-19 neuro research coalition. J Neurol Sci 2023; 454:120827. [PMID: 37856998 DOI: 10.1016/j.jns.2023.120827] [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: 06/20/2023] [Revised: 09/14/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023]
Abstract
Post-acute neurological sequelae of COVID-19 affect millions of people worldwide, yet little data is available to guide treatment strategies for the most common symptoms. We conducted a scoping review of PubMed/Medline from 1/1/2020-4/1/2023 to identify studies addressing diagnosis and treatment of the most common post-acute neurological sequelae of COVID-19 including: cognitive impairment, sleep disorders, headache, dizziness/lightheadedness, fatigue, weakness, numbness/pain, anxiety, depression and post-traumatic stress disorder. Utilizing the available literature and international disease-specific society guidelines, we constructed symptom-based differential diagnoses, evaluation and management paradigms. This pragmatic, evidence-based consensus document may serve as a guide for a holistic approach to post-COVID neurological care and will complement future clinical trials by outlining best practices in the evaluation and treatment of post-acute neurological signs/symptoms.
Collapse
Affiliation(s)
- Jennifer A Frontera
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA.
| | - Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia; Pirogov Russian National Research Medical University, Moscow, Russia
| | | | - Mariam Ashraf
- Department of Anesthesiology, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, NY, USA
| | - Betül Baykan
- Department of Neurology, Istanbul University, Istanbul Faculty of Medicine, and EMAR Medical Center, Istanbul, Turkey
| | - Lucía Crivelli
- Department of Cognitive Neurology, Fleni, Buenos Aires, Argentina
| | - Ava Easton
- The Encephalitis Society, Malton, UK; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - David Garcia-Azorin
- Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Raimund Helbok
- Department of Neurology, Neuro-Intensive Care Unit, Medical University of Innsbruck, Innsbruck, Austria; Department of Neurology, Johannes Kepler University, Linz, Austria
| | - Jatin Joshi
- Department of Anesthesiology, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, NY, USA
| | - Julia Koehn
- Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Igor Koralnik
- Departmentof Neurology, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - M Netravathi
- Department of Neurology, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - Benedict Michael
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK; National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool, UK; The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Annacarmen Nilo
- Clinical Neurology, Santa Maria della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Aynur Özge
- Department of Neurology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Karanbir Padda
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Gaia Pellitteri
- Clinical Neurology, Santa Maria della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Kameshwar Prasad
- Chief Executive Office, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Marina Romozzi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Dipartimento Universitario Di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Deanna Saylor
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Adam Seed
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Kiran Thakur
- Department of Neurology, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | - Derya Uluduz
- Department of Neurology, Istanbul University, Istanbul Faculty of Medicine, and EMAR Medical Center, Istanbul, Turkey
| | - Alberto Vogrig
- Clinical Neurology, Santa Maria della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy; Department of Medicine, University of Udine Medical School, Udine, Italy
| | - Tamara M Welte
- Department of Neurology, Universitätsklinikum Erlangen, Erlangen, Germany; Department of Neurology, Center for Global Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Erica Westenberg
- Department of Neurology, Center for Global Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Dmitry Zhuravlev
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - Mikhail Zinchuk
- Moscow Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - Andrea S Winkler
- Department of Neurology, Center for Global Health, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway; Blavatnik Institute of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
11
|
Dehkharghani S, Vogel A, Jandhyala N, Chung C, Shu L, Frontera J, Yaghi S. Continued Infarction Growth and Penumbral Consumption After Reperfusion in Vaccine-Naive Patients With COVID-19: A Case-Control Study. AJR Am J Roentgenol 2023; 221:517-525. [PMID: 37195793 DOI: 10.2214/ajr.23.29296] [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] [Indexed: 05/18/2023]
Abstract
BACKGROUND. Neurologic sequelae of SARS-CoV-2 include potentially malignant cerebrovascular events arising from complex hemodynamic, hematologic, and inflammatory processes occurring in concert. OBJECTIVE. This study concerns the hypothesis that despite angiographic reperfusion COVID-19 promotes continued consumption of at-risk tissue volumes after acute ischemic stroke (AIS), yielding critical insights into prognostication and monitoring paradigms in vaccine-naive patients experiencing AIS. METHODS. This retrospective study compared 100 consecutive COVID-19 patients with AIS presenting between March 2020 and April 2021 with a contemporaneous cohort of 282 AIS patients without COVID-19. Reperfusion classes were dichotomized into positive (extended thrombolysis in cerebral ischemia [eTICI] score = 2c-3) and negative (eTICI score < 2c) groups. All patients underwent endovascular therapy after initial CT perfusion imaging (CTP) to document infarction core and total hypoperfusion volumes. RESULTS. Ten COVID-positive (mean age ± SD, 67 ± 12 years; seven men, three women) and 144 COVID-negative patients (mean age, 71 ± 16 years; 76 men, 68 women) undergoing endovascular reperfusion, with antecedent CTP and follow-up imaging, comprised the final dataset. Initial infarction core and total hypoperfusion volumes (mean ± SD) were 1.5 ± 18 mL and 85 ± 100 mL in COVID-negative patients and 30.5 ± 34 mL and 117 ± 80.5 mL in COVID-positive patients, respectively. Final infarction volumes were significantly larger in patients with COVID-19, with median volumes of 77.8 mL versus 18.2 mL among control patients (p = .01), as were normalized measures of infarction growth relative to baseline infarction volume (p = .05). In adjusted logistic parametric regression models, COVID positivity emerged as a significant predictor for continued infarct growth (OR, 5.10 [95% CI, 1.00-25.95]; p = .05). CONCLUSION. These findings support the potentially aggressive clinical course of cerebrovascular events in patients with COVID-19, suggesting greater infarction growth and ongoing consumption of at-risk tissues, even after angiographic reperfusion. CLINICAL IMPACT. SARS-CoV-2 infection may promote continued infarction progression despite angiographic reperfusion in vaccine-naive patients with large-vessel occlusion AIS. The findings carry potential implications for prognostication, treatment selection, and surveillance for infarction growth among revascularized patients in future waves of infection by novel viral strains.
Collapse
Affiliation(s)
- Seena Dehkharghani
- Department of Radiology, New York University Langone Medical Center, Center for Biomedical Imaging, 660 1st Ave, 2nd Fl, New York, NY 10016
- Department of Neurology, New York University Langone Health, New York, NY
| | - Andre Vogel
- Department of Radiology, New York University Grossman School of Medicine, New York, NY
| | - Nora Jandhyala
- Department of Radiology, New York University Grossman School of Medicine, New York, NY
| | - Charlotte Chung
- Department of Radiology, New York University Langone Medical Center, Center for Biomedical Imaging, 660 1st Ave, 2nd Fl, New York, NY 10016
| | - Liqi Shu
- Department of Neurology, Brown University, Providence, RI
| | - Jennifer Frontera
- Department of Neurology, New York University Langone Health, New York, NY
| | - Shadi Yaghi
- Department of Neurology, Brown University, Providence, RI
| |
Collapse
|
12
|
Gonçalves NG, Aliberti MJR, Bertola L, Avelino-Silva T, Dias MB, Apolinario D, Busatto G, Forlenza O, Nitrini R, Brucki SMD, Brunoni AR, Vidal KSM, Jacob-Filho W, Suemoto CK. Dissipating the fog: Cognitive trajectories and risk factors 1 year after COVID-19 hospitalization. Alzheimers Dement 2023; 19:3771-3782. [PMID: 36861807 DOI: 10.1002/alz.12993] [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: 11/07/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 03/03/2023]
Abstract
INTRODUCTION Cognitive impairment is common after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, associations between post-hospital discharge risk factors and cognitive trajectories have not been explored. METHODS A total of 1105 adults (mean age ± SD 64.9 ± 9.9 years, 44% women, 63% White) with severe coronavirus disease 2019 (COVID-19) were evaluated for cognitive function 1 year after hospital discharge. Scores from cognitive tests were harmonized, and clusters of cognitive impairment were defined using sequential analysis. RESULTS Three groups of cognitive trajectories were observed during the follow-up: no cognitive impairment, initial short-term cognitive impairment, and long-term cognitive impairment. Predictors of cognitive decline after COVID-19 were older age (β = -0.013, 95% CI = -0.023;-0.003), female sex (β = -0.230, 95% CI = -0.413;-0.047), previous dementia diagnosis or substantial memory complaints (β = -0.606, 95% CI = -0.877;-0.335), frailty before hospitalization (β = -0.191, 95% CI = -0.264;-0.119), higher platelet count (β = -0.101, 95% CI = -0.185;-0.018), and delirium (β = -0.483, 95% CI = -0.724;-0.244). Post-discharge predictors included hospital readmissions and frailty. DISCUSSION Cognitive impairment was common and the patterns of cognitive trajectories depended on sociodemographic, in-hospital, and post-hospitalization predictors. HIGHLIGHTS Cognitive impairment after coronavirus disease 2019 (COVID-19) hospital discharge was associated with higher age, less education, delirium during hospitalization, a higher number of hospitalizations post discharge, and frailty before and after hospitalization. Frequent cognitive evaluations for 12-month post-COVID-19 hospitalization showed three possible cognitive trajectories: no cognitive impairment, initial short-term impairment, and long-term impairment. This study highlights the importance of frequent cognitive testing to determine patterns of COVID-19 cognitive impairment, given the high frequency of incident cognitive impairment 1 year after hospitalization.
Collapse
Affiliation(s)
- Natalia Gomes Gonçalves
- Department of Pathology, Faculdade de Medicina da Universidade de São Paulo FMUSP, São Paulo, Brazil
| | | | - Laiss Bertola
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Thiago Avelino-Silva
- Division of Geriatrics, LIM-66, Faculdade de Medicina da Universidade de São Paulo FMUSP, São Paulo, Brazil
| | - Murilo Bacchini Dias
- Division of Geriatrics, LIM-66, Faculdade de Medicina da Universidade de São Paulo FMUSP, São Paulo, Brazil
| | | | - Geraldo Busatto
- Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Orestes Forlenza
- Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ricardo Nitrini
- Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Andre Russowsky Brunoni
- Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Wilson Jacob-Filho
- Division of Geriatrics, LIM-66, Faculdade de Medicina da Universidade de São Paulo FMUSP, São Paulo, Brazil
| | - Claudia Kimie Suemoto
- Division of Geriatrics, LIM-66, Faculdade de Medicina da Universidade de São Paulo FMUSP, São Paulo, Brazil
| |
Collapse
|
13
|
Cysique LA, Jakabek D, Bracken SG, Allen‐Davidian Y, Heng B, Chow S, Dehhaghi M, Staats Pires A, Darley DR, Byrne A, Phetsouphanh C, Kelleher A, Dore GJ, Matthews GV, Guillemin GJ, Brew BJ. The kynurenine pathway relates to post-acute COVID-19 objective cognitive impairment and PASC. Ann Clin Transl Neurol 2023; 10:1338-1352. [PMID: 37318955 PMCID: PMC10424655 DOI: 10.1002/acn3.51825] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVE To determine the prevalence and natural history of post-acute COVID-19 objective cognitive impairment and function, and their relationship to demographic, clinical factors, post-acute sequelae of COVID-19 (PASC), and biomarkers. METHODS A total of 128 post-acute COVID-19 patients (age = 46 ± 15; 42% women, acute disease severity: not hospitalized: 38.6% mild: 0-1 symptoms, 52% 2+ symptoms; 9.4% hospitalized) completed standard cognition, olfaction, and mental health examinations 2-, 4-, and 12-month post diagnosis. Over the same time frame, WHO-defined PASC was determined. Blood cytokines, peripheral neurobiomarkers, and kynurenine pathway (KP) metabolites were measured. Objective cognitive function was demographically/practice corrected, and impairment prevalence was determined using the evidence-based Global Deficit Score method to detect at least mild cognitive impairment (GDS > 0.5). Linear mixed effect regression models with time effect (month post diagnosis) evaluated the relationships to cognition. RESULTS Across the 12-month study period, mild to moderate cognitive impairment ranged from 16% to 26%, and 46.5% were impaired at least once. Impairment associated with poorer work capacity (p < 0.05), and 2-month objectively tested anosmia (p < 0.05). PASC with (p = 0.01) and without disability (p < 0.03) associated with acute COVID-19 severity. KP measures showed prolonged activation (2 to 8 months) (p < 0.0001) linked to IFN-beta in those with PASC. Of the blood analytes, only the KP metabolites (elevated quinolinic acid, 3-hydroxyanthranilic acid, kynurenine, the kynurenine/tryptophan ratio) associated (p < 0.001) with poorer cognitive performance and greater likelihood of impairment. PASC, independent of disability associated with abnormal kynurenine/tryptophan (p < 0.03). INTERPRETATION The kynurenine pathway relates to post-acute COVID-19 objective cognitive impairment and PASC, thereby enabling biomarker and therapeutic possibilities.
Collapse
Affiliation(s)
- Lucette A. Cysique
- Peter Duncan Neuroscience Research UnitSt. Vincent's Centre for Applied Medical ResearchDarlinghurstNew South WalesAustralia
- School of PsychologyUNSWSydneyNew South WalesAustralia
| | - David Jakabek
- Neurology DepartmentSt. Vincent's HospitalDarlinghurstNew South WalesAustralia
| | | | - Yasmin Allen‐Davidian
- Peter Duncan Neuroscience Research UnitSt. Vincent's Centre for Applied Medical ResearchDarlinghurstNew South WalesAustralia
- School of PsychologyMacquarie UniversitySydneyNew South WalesAustralia
| | - Benjamin Heng
- Macquarie Medical SchoolMacquarie UniversitySydneyNew South WalesAustralia
- PANDIS.orgSydneyNew South WalesAustralia
| | - Sharron Chow
- Macquarie Medical SchoolMacquarie UniversitySydneyNew South WalesAustralia
| | - Mona Dehhaghi
- Macquarie Medical SchoolMacquarie UniversitySydneyNew South WalesAustralia
- PANDIS.orgSydneyNew South WalesAustralia
| | | | - David R. Darley
- Faculty of MedicineUNSWSydneyNew South WalesAustralia
- Respiratory Medicine DepartmentSt. Vincent's HospitalDarlinghurstNew South WalesAustralia
| | - Anthony Byrne
- Faculty of MedicineUNSWSydneyNew South WalesAustralia
- Respiratory Medicine DepartmentSt. Vincent's HospitalDarlinghurstNew South WalesAustralia
| | | | - Anthony Kelleher
- Kirby InstituteUNSWSydneyNew South WalesAustralia
- Infectious Disease and Immunology DepartmentSt. Vincent's HospitalDarlinghurstNew South WalesAustralia
| | - Gregory J. Dore
- Kirby InstituteUNSWSydneyNew South WalesAustralia
- Infectious Disease and Immunology DepartmentSt. Vincent's HospitalDarlinghurstNew South WalesAustralia
| | - Gail V. Matthews
- Kirby InstituteUNSWSydneyNew South WalesAustralia
- Infectious Disease and Immunology DepartmentSt. Vincent's HospitalDarlinghurstNew South WalesAustralia
| | - Gilles J. Guillemin
- Macquarie Medical SchoolMacquarie UniversitySydneyNew South WalesAustralia
- PANDIS.orgSydneyNew South WalesAustralia
| | - Bruce J. Brew
- Peter Duncan Neuroscience Research UnitSt. Vincent's Centre for Applied Medical ResearchDarlinghurstNew South WalesAustralia
- Neurology DepartmentSt. Vincent's HospitalDarlinghurstNew South WalesAustralia
- Faculty of MedicineUNSWSydneyNew South WalesAustralia
| |
Collapse
|
14
|
Jackson C, Stewart ID, Plekhanova T, Cunningham PS, Hazel AL, Al-Sheklly B, Aul R, Bolton CE, Chalder T, Chalmers JD, Chaudhuri N, Docherty AB, Donaldson G, Edwardson CL, Elneima O, Greening NJ, Hanley NA, Harris VC, Harrison EM, Ho LP, Houchen-Wolloff L, Howard LS, Jolley CJ, Jones MG, Leavy OC, Lewis KE, Lone NI, Marks M, McAuley HJC, McNarry MA, Patel BV, Piper-Hanley K, Poinasamy K, Raman B, Richardson M, Rivera-Ortega P, Rowland-Jones SL, Rowlands AV, Saunders RM, Scott JT, Sereno M, Shah AM, Shikotra A, Singapuri A, Stanel SC, Thorpe M, Wootton DG, Yates T, Gisli Jenkins R, Singh SJ, Man WDC, Brightling CE, Wain LV, Porter JC, Thompson AAR, Horsley A, Molyneaux PL, Evans RA, Jones SE, Rutter MK, Blaikley JF. Effects of sleep disturbance on dyspnoea and impaired lung function following hospital admission due to COVID-19 in the UK: a prospective multicentre cohort study. THE LANCET. RESPIRATORY MEDICINE 2023; 11:673-684. [PMID: 37072018 PMCID: PMC10156429 DOI: 10.1016/s2213-2600(23)00124-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND Sleep disturbance is common following hospital admission both for COVID-19 and other causes. The clinical associations of this for recovery after hospital admission are poorly understood despite sleep disturbance contributing to morbidity in other scenarios. We aimed to investigate the prevalence and nature of sleep disturbance after discharge following hospital admission for COVID-19 and to assess whether this was associated with dyspnoea. METHODS CircCOVID was a prospective multicentre cohort substudy designed to investigate the effects of circadian disruption and sleep disturbance on recovery after COVID-19 in a cohort of participants aged 18 years or older, admitted to hospital for COVID-19 in the UK, and discharged between March, 2020, and October, 2021. Participants were recruited from the Post-hospitalisation COVID-19 study (PHOSP-COVID). Follow-up data were collected at two timepoints: an early time point 2-7 months after hospital discharge and a later time point 10-14 months after hospital discharge. Sleep quality was assessed subjectively using the Pittsburgh Sleep Quality Index questionnaire and a numerical rating scale. Sleep quality was also assessed with an accelerometer worn on the wrist (actigraphy) for 14 days. Participants were also clinically phenotyped, including assessment of symptoms (ie, anxiety [Generalised Anxiety Disorder 7-item scale questionnaire], muscle function [SARC-F questionnaire], dyspnoea [Dyspnoea-12 questionnaire] and measurement of lung function), at the early timepoint after discharge. Actigraphy results were also compared to a matched UK Biobank cohort (non-hospitalised individuals and recently hospitalised individuals). Multivariable linear regression was used to define associations of sleep disturbance with the primary outcome of breathlessness and the other clinical symptoms. PHOSP-COVID is registered on the ISRCTN Registry (ISRCTN10980107). FINDINGS 2320 of 2468 participants in the PHOSP-COVID study attended an early timepoint research visit a median of 5 months (IQR 4-6) following discharge from 83 hospitals in the UK. Data for sleep quality were assessed by subjective measures (the Pittsburgh Sleep Quality Index questionnaire and the numerical rating scale) for 638 participants at the early time point. Sleep quality was also assessed using device-based measures (actigraphy) a median of 7 months (IQR 5-8 months) after discharge from hospital for 729 participants. After discharge from hospital, the majority (396 [62%] of 638) of participants who had been admitted to hospital for COVID-19 reported poor sleep quality in response to the Pittsburgh Sleep Quality Index questionnaire. A comparable proportion (338 [53%] of 638) of participants felt their sleep quality had deteriorated following discharge after COVID-19 admission, as assessed by the numerical rating scale. Device-based measurements were compared to an age-matched, sex-matched, BMI-matched, and time from discharge-matched UK Biobank cohort who had recently been admitted to hospital. Compared to the recently hospitalised matched UK Biobank cohort, participants in our study slept on average 65 min (95% CI 59 to 71) longer, had a lower sleep regularity index (-19%; 95% CI -20 to -16), and a lower sleep efficiency (3·83 percentage points; 95% CI 3·40 to 4·26). Similar results were obtained when comparisons were made with the non-hospitalised UK Biobank cohort. Overall sleep quality (unadjusted effect estimate 3·94; 95% CI 2·78 to 5·10), deterioration in sleep quality following hospital admission (3·00; 1·82 to 4·28), and sleep regularity (4·38; 2·10 to 6·65) were associated with higher dyspnoea scores. Poor sleep quality, deterioration in sleep quality, and sleep regularity were also associated with impaired lung function, as assessed by forced vital capacity. Depending on the sleep metric, anxiety mediated 18-39% of the effect of sleep disturbance on dyspnoea, while muscle weakness mediated 27-41% of this effect. INTERPRETATION Sleep disturbance following hospital admission for COVID-19 is associated with dyspnoea, anxiety, and muscle weakness. Due to the association with multiple symptoms, targeting sleep disturbance might be beneficial in treating the post-COVID-19 condition. FUNDING UK Research and Innovation, National Institute for Health Research, and Engineering and Physical Sciences Research Council.
Collapse
Affiliation(s)
- Callum Jackson
- Department of Mathematics, University of Manchester, Manchester, UK
| | - Iain D Stewart
- Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart & Lung Institute, Imperial College London, London, UK
| | - Tatiana Plekhanova
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK; NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Peter S Cunningham
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Andrew L Hazel
- Department of Mathematics, University of Manchester, Manchester, UK
| | - Bashar Al-Sheklly
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Oxford Road, Manchester, UK
| | - Raminder Aul
- St Georges University Hospitals NHS Foundation Trust, London, UK
| | - Charlotte E Bolton
- Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK; NIHR Nottingham BRC respiratory theme, Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK; Persistent Physical Symptoms Research and Treatment Unit, South London and Maudsley NHS Trust, London, UK
| | - James D Chalmers
- University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | | | - Annemarie B Docherty
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Gavin Donaldson
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Charlotte L Edwardson
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK; NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Omer Elneima
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Neil J Greening
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Neil A Hanley
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Oxford Road, Manchester, UK
| | - Victoria C Harris
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK; University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Ewen M Harrison
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Ling-Pei Ho
- MRC Human Immunology Unit, University of Oxford, Oxford, UK; Oxford NIHR Biomedical Research Centre, Oxford, UK
| | - Linzy Houchen-Wolloff
- Centre for Exercise and Rehabilitation Science, NIHR Leicester Biomedical Research Centre-Respiratory, University of Leicester, Leicester, UK; Department of Respiratory Sciences, University of Leicester, Leicester, UK; Therapy Department, University Hospitals of Leicester, NHS Trust, Leicester, UK
| | - Luke S Howard
- Imperial College Healthcare NHS Trust, London, UK; Imperial College London, London, UK
| | - Caroline J Jolley
- Faculty of Life Sciences & Medicine, King's College Hospital NHS Foundation Trust, London, UK; Kings College London, London, UK
| | - Mark G Jones
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; NIHR Southampton Biomedical Research Centre, University Hospitals Southampton, Southampton, UK
| | - Olivia C Leavy
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Keir E Lewis
- Hywel Dda University Health Board, Wales, UK; University of Swansea, Wales, UK; Respiratory Innovation Wales, Wales, UK
| | - Nazir I Lone
- The Usher Institute, University of Edinburgh, Edinburgh, UK; Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Michael Marks
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK; Hospital for Tropical Diseases, University College London Hospital, London, UK; Division of Infection and Immunity, University College London, London, UK
| | - Hamish J C McAuley
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Melitta A McNarry
- Department of Sport and Exercise Sciences, Swansea University, Swansea, UK
| | - Brijesh V Patel
- Anaesthetics, Pain Medicine, and Intensive Care, Imperial College London, London, UK; Royal Brompton and Harefield Clinical Group, Guy's andSt Thomas' NHS Foundation Trust, London, UK
| | - Karen Piper-Hanley
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | | | - Betty Raman
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Matthew Richardson
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Pilar Rivera-Ortega
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Oxford Road, Manchester, UK
| | - Sarah L Rowland-Jones
- Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Alex V Rowlands
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK; NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Ruth M Saunders
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Janet T Scott
- MRC-University of Glasgow Centre for Virus Research, Glasgow, UK
| | - Marco Sereno
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Ajay M Shah
- Faculty of Life Sciences & Medicine, King's College Hospital NHS Foundation Trust, London, UK; Kings College London, London, UK
| | - Aarti Shikotra
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Amisha Singapuri
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Stefan C Stanel
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Oxford Road, Manchester, UK
| | - Mathew Thorpe
- Centre for Medical Informatics, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Daniel G Wootton
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK; University Hospitals of Leicester NHS Trust, Leicester, UK
| | - R Gisli Jenkins
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Sally J Singh
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - William D-C Man
- National Heart & Lung Institute, Imperial College London, London, UK; Kings College London, London, UK; Royal Brompton and Harefield Clinical Group, Guy's andSt Thomas' NHS Foundation Trust, London, UK
| | - Christopher E Brightling
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Louise V Wain
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK; Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Joanna C Porter
- UCL Respiratory, Department of Medicine, University College London, Rayne Institute, London, UK; ILD Service, University College London Hospital, London, UK
| | - A A Roger Thompson
- Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Alex Horsley
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Oxford Road, Manchester, UK
| | | | - Rachael A Evans
- The Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK; University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Samuel E Jones
- Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Helsinki, Finland
| | - Martin K Rutter
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Oxford Road, Manchester, UK
| | - John F Blaikley
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Oxford Road, Manchester, UK.
| |
Collapse
|
15
|
Ganesh A, Rosentreter RE, Chen Y, Mehta R, McLeod GA, Wan MW, Krett JD, Mahjoub Y, Lee AS, Schwartz IS, Richer LP, Metz LM, Smith EE, Hill MD. Patient-reported outcomes of neurologic and neuropsychiatric symptoms in mild COVID-19: a prospective cohort study. CMAJ Open 2023; 11:E696-E705. [PMID: 37553227 PMCID: PMC10414975 DOI: 10.9778/cmajo.20220248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Various neurologic manifestations have been reported in patients with COVID-19, mostly in retrospective studies of patients admitted to hospital, but there are few data on patients with mild COVID-19. We examined the frequency and persistence of neurologic/neuropsychiatric symptoms in patients with mild COVID-19 in a 1-year prospective cohort study, as well as assessment of use of health care services and patient-reported outcomes. METHODS Participants in the Alberta HOPE COVID-19 trial (hydroxychloroquine v. placebo for 5 d), managed as outpatients, were prospectively assessed 3 months and 1 year after their positive test result. They completed detailed neurologic/neuropsychiatric symptom questionnaires, the telephone version of the Montreal Cognitive Assessment (T-MoCA), the Kessler Psychological Distress Scale (K10) and the EuroQol EQ-5D-3L (measure of quality of life). Close informants completed the Mild Behavioural Impairment Checklist (MBI-C) and the Informant Questionnaire on Cognitive Decline in the Elderly. We also tracked use of health care services and neurologic investigations. RESULTS The cohort consisted of 198 participants (87 female [43.9%] median age 45 yr, interquartile range 37-54 yr). Of the 179 participants with symptom assessments, 139 (77.6%) reported at least 1 neurologic symptom, the most common being anosmia/dysgeusia (99 [55.3%]), myalgia (76 [42.5%]) and headache (75 [41.9%]). Forty patients (22.3%) reported persistent symptoms at 1 year, including confusion (20 [50.0%]), headache (21 [52.5%]), insomnia (16 [40.0%]) and depression (14 [35.0%]); 27/179 (15.1%) reported no improvement. Body mass index (BMI), a history of asthma and lack of full-time employment were associated with the presence and persistence of neurologic/neuropsychiatric symptoms; female sex was independently associated with both (presence: odds ratio [OR] adjusted for age, race, BMI, history of asthma and neuropsychiatric history 5.04, 95% confidence interval [CI] 1.58 to 16.10). Compared to participants without persistent symptoms, those with persistent symptoms had more hospital admissions and family physician visits, and worse MBI-C scores and less frequent independence for instrumental activities at 1 year (83.8% v. 97.8%, p = 0.005). Patients with any or persistent neurologic symptoms had worse psychologic distress (K10 score ≥ 20: adjusted OR 12.1, 95% CI 1.4 to 97.2) and quality of life (median EQ-5D-3L visual analogue scale rating 75 v. 90, p < 0.001); 42/84 (50.0%) had a T-MoCA score less than 18 at 3 months, as did 36 (42.9%) at 1 year. Participants who reported memory loss were more likely than those who did not report such symptoms to have informant-reported cognitive-behavioural decline (1-yr MBI-C score ≥ 6.5: adjusted OR 15.0, 95% CI 2.42 to 92.60). INTERPRETATION Neurologic/neuropsychiatric symptoms were commonly reported in survivors of mild COVID-19, and they persisted in 1 in 5 patients 1 year later. Symptoms were associated with worse participant- and informant-reported outcomes. Trial registration: ClinicalTrials.gov, no. NCT04329611.
Collapse
Affiliation(s)
- Aravind Ganesh
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta.
| | - Ryan E Rosentreter
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta
| | - Yushi Chen
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta
| | - Rahul Mehta
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta
| | - Graham A McLeod
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta
| | - Miranda W Wan
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta
| | - Jonathan D Krett
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta
| | - Yasamin Mahjoub
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta
| | - Angela S Lee
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta
| | - Ilan S Schwartz
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta
| | - Lawrence P Richer
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta
| | - Luanne M Metz
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta
| | - Eric E Smith
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta
| | - Michael D Hill
- Departments of Clinical Neurosciences (Ganesh, McLeod, Wan, Krett, Mahjoub, Lee, Metz, Smith, Hill), Community Health Sciences (Ganesh, Smith, Hill), Medicine (Rosentreter, Hill) and Radiology (Hill), University of Calgary Cumming School of Medicine; The Hotchkiss Brain Institute (Ganesh, Metz, Smith, Hill) and The Mathison Centre for Mental Health Research & Education (Ganesh), University of Calgary, Calgary, Alta.; Departments of Dentistry (Chen) and Medicine (Mehta, Schwartz), Faculty of Medicine and Dentistry, University of Alberta; Department of Pediatrics (Richer), Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta; and Women and Children's Health Research Institute (Richer), University of Alberta, Edmonton, Alta
| |
Collapse
|
16
|
Gottlieb M, Spatz ES, Yu H, Wisk LE, Elmore JG, Gentile NL, Hill M, Huebinger RM, Idris AH, Kean ER, Koo K, Li SX, McDonald S, Montoy JCC, Nichol G, O’Laughlin KN, Plumb ID, Rising KL, Santangelo M, Saydah S, Wang RC, Venkatesh A, Stephens KA, Weinstein RA. Long COVID Clinical Phenotypes up to 6 Months After Infection Identified by Latent Class Analysis of Self-Reported Symptoms. Open Forum Infect Dis 2023; 10:ofad277. [PMID: 37426952 PMCID: PMC10327879 DOI: 10.1093/ofid/ofad277] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/15/2023] [Indexed: 07/11/2023] Open
Abstract
Background The prevalence, incidence, and interrelationships of persistent symptoms after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection vary. There are limited data on specific phenotypes of persistent symptoms. Using latent class analysis (LCA) modeling, we sought to identify whether specific phenotypes of COVID-19 were present 3 months and 6 months post-infection. Methods This was a multicenter study of symptomatic adults tested for SARS-CoV-2 with prospectively collected data on general symptoms and fatigue-related symptoms up to 6 months postdiagnosis. Using LCA, we identified symptomatically homogenous groups among COVID-positive and COVID-negative participants at each time period for both general and fatigue-related symptoms. Results Among 5963 baseline participants (4504 COVID-positive and 1459 COVID-negative), 4056 had 3-month and 2856 had 6-month data at the time of analysis. We identified 4 distinct phenotypes of post-COVID conditions (PCCs) at 3 and 6 months for both general and fatigue-related symptoms; minimal-symptom groups represented 70% of participants at 3 and 6 months. When compared with the COVID-negative cohort, COVID-positive participants had higher occurrence of loss of taste/smell and cognition problems. There was substantial class-switching over time; those in 1 symptom class at 3 months were equally likely to remain or enter a new phenotype at 6 months. Conclusions We identified distinct classes of PCC phenotypes for general and fatigue-related symptoms. Most participants had minimal or no symptoms at 3 and 6 months of follow-up. Significant proportions of participants changed symptom groups over time, suggesting that symptoms present during the acute illness may differ from prolonged symptoms and that PCCs may have a more dynamic nature than previously recognized. Clinical Trials Registration. NCT04610515.
Collapse
Affiliation(s)
- Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Erica S Spatz
- Section of Cardiovascular Medicine, Yale School of Medicine,New Haven, Connecticut, USA
- Department of Epidemiology, Yale School of Public Health,New Haven, Connecticut, USA
- Yale Center for Outcomes Research and Evaluation, Yale School of Medicine,New Haven, Connecticut, USA
| | - Huihui Yu
- Section of Cardiovascular Medicine, Yale School of Medicine,New Haven, Connecticut, USA
- Yale Center for Outcomes Research and Evaluation, Yale School of Medicine,New Haven, Connecticut, USA
| | - Lauren E Wisk
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Joann G Elmore
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Nicole L Gentile
- Post-COVID Rehabilitation and Recovery Clinic, Department of Family Medicine, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Mandy Hill
- Department of Emergency Medicine, UTHealth, Houston, Texas, USA
| | | | - Ahamed H Idris
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Efrat R Kean
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Katherine Koo
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Shu-Xia Li
- Yale Center for Outcomes Research and Evaluation, Yale School of Medicine,New Haven, Connecticut, USA
| | - Samuel McDonald
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Juan Carlos C Montoy
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Graham Nichol
- Departments of Medicine and Emergency Medicine, University of Washington, Seattle, Washington, USA
| | - Kelli N O’Laughlin
- Departments of Emergency Medicine and Global Health, University of Washington, Seattle, Washington, USA
| | - Ian D Plumb
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kristin L Rising
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Center for Connected Care, Sidney Kimmel Medical School, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michelle Santangelo
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Sharon Saydah
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ralph C Wang
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Arjun Venkatesh
- Yale Center for Outcomes Research and Evaluation, Yale School of Medicine,New Haven, Connecticut, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kari A Stephens
- Departments of Family Medicine, Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Robert A Weinstein
- Division of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
- Department of Internal Medicine, Cook County Hospital, Chicago, Illinois, USA
- The CORE Center, Chicago, Illinois, USA
| |
Collapse
|
17
|
Giraldo GSP, Ali ST, Kang AK, Patel TR, Budhiraja S, Gaelen JI, Lank GK, Clark JR, Mukherjee S, Singer T, Venkatesh A, Orban ZS, Lim PH, Jimenez M, Miller J, Taylor C, Szymanski AL, Scarpelli J, Graham EL, Balabanov RD, Barcelo BE, Cahan JG, Ruckman K, Shepard AG, Slutzky MW, LaFaver K, Kumthekar PU, Shetty NK, Carroll KS, Ho SU, Lukas RV, Batra A, Liotta EM, Koralnik IJ. Neurologic Manifestations of Long COVID Differ Based on Acute COVID-19 Severity. Ann Neurol 2023; 94:146-159. [PMID: 36966460 PMCID: PMC10724021 DOI: 10.1002/ana.26649] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/15/2023] [Accepted: 03/13/2023] [Indexed: 03/27/2023]
Abstract
OBJECTIVE To characterize neurologic manifestations in post-hospitalization Neuro-PASC (PNP) and non-hospitalized Neuro-PASC (NNP) patients. METHODS Prospective study of the first 100 consecutive PNP and 500 NNP patients evaluated at a Neuro-COVID-19 clinic between 5/2020 and 8/2021. RESULTS PNP were older than NNP patients (mean 53.9 vs 44.9 y; p < 0.0001) with a higher prevalence of pre-existing comorbidities. An average 6.8 months from onset, the main neurologic symptoms were "brain fog" (81.2%), headache (70.3%), and dizziness (49.5%) with only anosmia, dysgeusia and myalgias being more frequent in the NNP compared to the PNP group (59 vs 39%, 57.6 vs 39% and 50.4 vs 33%, all p < 0.003). Moreover, 85.8% of patients experienced fatigue. PNP more frequently had an abnormal neurologic exam than NNP patients (62.2 vs 37%, p < 0.0001). Both groups had impaired quality of life in cognitive, fatigue, sleep, anxiety, and depression domains. PNP patients performed worse on processing speed, attention, and working memory tasks than NNP patients (T-score 41.5 vs 55, 42.5 vs 47 and 45.5 vs 49, all p < 0.001) and a US normative population. NNP patients had lower results in attention task only. Subjective impression of cognitive ability correlated with cognitive test results in NNP but not in PNP patients. INTERPRETATION PNP and NNP patients both experience persistent neurologic symptoms affecting their quality of life. However, they harbor significant differences in demographics, comorbidities, neurologic symptoms and findings, as well as pattern of cognitive dysfunction. Such differences suggest distinct etiologies of Neuro-PASC in these populations warranting targeted interventions. ANN NEUROL 2023;94:146-159.
Collapse
Affiliation(s)
- Gina S. Perez Giraldo
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sareen T. Ali
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Anthony K. Kang
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Tulsi R. Patel
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Shreya Budhiraja
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jordan I. Gaelen
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Grace K. Lank
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jeffrey R. Clark
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Shreya Mukherjee
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Tracey Singer
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Aditi Venkatesh
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Zachary S. Orban
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Patrick H. Lim
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Millenia Jimenez
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Janet Miller
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Carolyn Taylor
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - April L Szymanski
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jessica Scarpelli
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Edith L. Graham
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Roumen D. Balabanov
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Bianca E. Barcelo
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Joshua G. Cahan
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kaitlyn Ruckman
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alan G. Shepard
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Marc W. Slutzky
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kathrin LaFaver
- Saratoga Hospital Medical Group, Neurology, Saratoga Springs, NY
| | - Priya U. Kumthekar
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Neil K. Shetty
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Katherine S. Carroll
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sam U. Ho
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Rimas V. Lukas
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ayush Batra
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Eric M. Liotta
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Igor J. Koralnik
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| |
Collapse
|
18
|
Role of the MicroRNAs in the Pathogenic Mechanism of Painful Symptoms in Long COVID: Systematic Review. Int J Mol Sci 2023; 24:ijms24043574. [PMID: 36834984 PMCID: PMC9963913 DOI: 10.3390/ijms24043574] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023] Open
Abstract
The ongoing pandemic of COVID-19 has caused more than 6.7 million tragic deaths, plus, a large percentage of people who survived it present a myriad of chronic symptoms that last for at least 6 months; this has been named as long COVID. Some of the most prevalent are painful symptoms like headache, joint pain, migraine, neuropathic-like pain, fatigue and myalgia. MicroRNAs are small non-coding RNAs that regulate genes, and their involvement in several pathologies has been extensively shown. A deregulation of miRNAs has been observed in patients with COVID-19. The objective of the present systematic review was to show the prevalence of chronic pain-like symptoms of patients with long COVID and based on the expression of miRNAs in patients with COVID-19, and to present a proposal on how they may be involved in the pathogenic mechanisms of chronic pain-like symptoms. A systematic review was carried out in online databases for original articles published between March 2020 to April 2022; the systematic review followed the PRISMA guidelines, and it was registered in PROSPERO with registration number CRD42022318992. A total of 22 articles were included for the evaluation of miRNAs and 20 regarding long COVID; the overall prevalence of pain-like symptoms was around 10 to 87%, plus, the miRNAs that were commonly up and downregulated were miR-21-5p, miR-29a,b,c-3p miR-92a,b-3p, miR-92b-5p, miR-126-3p, miR-150-5p, miR-155-5p, miR-200a, c-3p, miR-320a,b,c,d,e-3p, and miR-451a. The molecular pathways that we hypothesized to be modulated by these miRNAs are the IL-6/STAT3 proinflammatory axis and the compromise of the blood-nerve barrier; these two mechanisms could be associated with the prevalence of fatigue and chronic pain in the long COVID population, plus they could be novel pharmacological targets in order to reduce and prevent these symptoms.
Collapse
|
19
|
Kubota T, Kuroda N, Sone D. Neuropsychiatric aspects of long COVID: A comprehensive review. Psychiatry Clin Neurosci 2023; 77:84-93. [PMID: 36385449 PMCID: PMC10108156 DOI: 10.1111/pcn.13508] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/21/2022] [Accepted: 11/07/2022] [Indexed: 11/18/2022]
Abstract
Although some patients have persistent symptoms or develop new symptoms following coronavirus disease 2019 (COVID-19) infection, neuropsychiatric aspects of long COVID are not well known. This review summarizes and provides an update on the neuropsychiatric dimensions of long COVID. Its neuropsychiatric manifestations commonly include fatigue, cognitive impairment, sleep disorders, depression, anxiety, and post-traumatic stress disorder. There are no specific tests for long COVID, but some characteristic findings such as hypometabolism on positron emission tomography have been reported. The possible mechanisms of long COVID include inflammation, ischemic effects, direct viral invasion, and social and environmental changes. Some patient characteristics and the severity and complications of acute COVID-19 infection may be associated with an increased risk of neuropsychiatric symptoms. Long COVID may resolve spontaneously or persist, depending on the type of neuropsychiatric symptoms. Although established treatments are lacking, various psychological and pharmacological treatments have been attempted. Vaccination against COVID-19 infection plays a key role in the prevention of long coronavirus disease. With differences among the SARS-CoV-2 variants, including the omicron variant, the aspects of long COVID are likely to change in the future. Further studies clarifying the aspects of long COVID to develop effective treatments are warranted.
Collapse
Affiliation(s)
- Takafumi Kubota
- Department of Neurology, National Hospital Organization Sendai Medical Center, Sendai, Japan.,Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Naoto Kuroda
- Department of Epileptology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Pediatrics, Wayne State University, Detroit, Michigan, USA
| | - Daichi Sone
- Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
20
|
Mazurkiewicz I, Chatys-Bogacka Z, Slowik J, Klich-Raczka A, Fedyk-Lukasik M, Slowik A, Wnuk M, Drabik L. Fatigue after COVID-19 in non-hospitalized patients according to sex. Brain Behav 2023; 13:e2849. [PMID: 36620918 PMCID: PMC9927850 DOI: 10.1002/brb3.2849] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/19/2022] [Accepted: 11/30/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Limited evidence exists on sex differences in post-COVID fatigue among non-hospitalized patients. Therefore, aim of the study was to evaluate the course of chronic fatigue symptoms in non-hospitalized subjects with the SARS-CoV-2 infection, according to sex. METHODS Patients and staff from the University Hospital in Krakow anonymously and retrospectively completed neuropsychological questionnaire that included eight symptoms of chronic fatigue syndrome. The presence of these symptoms was assessed before COVID-19 and 0-4, 4-12, and >12 weeks postinfection. The inclusion criteria were as follows: age 18 or more years, >12 weeks since the onset of the SARS-CoV-2 infection, and diagnosis confirmed by the RT-PCR from anasopharyngeal swab. RESULTS We included 303 patients (79.53% women, 47.52% medical personnel) assessed retrospectively after a median of 30 (interquartile range: 23-35) weeks since the onset of symptoms. A higher prevalence of at least one chronic fatigue symptom was found in females in all time intervals after the onset of COVID-19 compared to males (p < .036). Women, compared to men, more often experienced persistent fatigue, not caused by effort and persisting after rest (for <4 weeks, odds ratio [OR] = 2.31, 95% confidence interval [CI]: 1.13-4.73; for 4-12 weeks, OR = 1.95, 95% CI: 1.06-3.61), non-restorative sleep (for <4 weeks, OR = 2.17, 95% CI: 1.23-3.81; for >12 weeks, OR = 1.95, 95% CI: 1.03-3.71), and sore throat (for <4 weeks, OR = 1.97, 95% CI: 1.03-3.78; for 4-12 weeks, OR = 2.76, 95% CI: 1.05-7.27). Sex differences in headache, arthralgia, and prolonged postexercise fatigue were observed only during the first 4 weeks (OR = 2.59, 95% CI: 1.45-4.60, OR = 2.97, 95% CI: 1.02-8.64, and OR = 1.87, 95% CI: 1.01-3.51, respectively). There were no differences between women and men in myalgia and self-reported lymph node enlargement. CONCLUSIONS The course of post-COVID fatigue differs significantly between sexes in non-hospitalized individuals with COVID-19, with women more often suffering from persistent fatigue, not caused by effort and persisting after rest, non-restorative sleep, and sore throat.
Collapse
Affiliation(s)
| | - Zaneta Chatys-Bogacka
- Department of Neurology, University Hospital in Krakow, Krakow, Poland.,Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Joanna Slowik
- Department of Periodontology, Preventive Dentistry and Oral Medicine, Institute of Dentistry, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Alicja Klich-Raczka
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland.,Department of Internal Medicine and Geriatrics, University Hospital in Krakow, Krakow, Poland
| | - Malgorzata Fedyk-Lukasik
- Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
| | - Agnieszka Slowik
- Department of Neurology, University Hospital in Krakow, Krakow, Poland.,Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Marcin Wnuk
- Department of Neurology, University Hospital in Krakow, Krakow, Poland.,Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Leszek Drabik
- Department of Pharmacology, Jagiellonian University Medical College, Krakow, Poland.,Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland
| |
Collapse
|
21
|
Ho FF, Xu S, Kwong TMH, Li ASC, Ha EH, Hua H, Liong C, Leung KC, Leung TH, Lin Z, Wong SYS, Pan F, Chung VCH. Prevalence, Patterns, and Clinical Severity of Long COVID among Chinese Medicine Telemedicine Service Users: Preliminary Results from a Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1827. [PMID: 36767195 PMCID: PMC9914360 DOI: 10.3390/ijerph20031827] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/11/2023] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION The emergence and persistence of symptoms after acute COVID-19 is expected to become a major burden on healthcare systems. We assessed the features of the post-COVID-19 Syndrome (Long COVID) burden in a cohort of COVID-19 patients during the fifth major wave in Hong Kong. METHODS A cross-sectional study of 135 patients with confirmed COVID-19 from Feb to Apr 2022 who utilized traditional Chinese medicine telemedicine services was conducted. The COVID-19 Yorkshire Rehabilitation Scale was administered using an online survey 12 weeks after the COVID-19 infection. Prevalence of symptom severity and functional impairments were assessed to identify burdens and patterns. The correlation between symptom severity, functional impairments, patient characteristics, and overall health was evaluated. RESULTS The mean age was 46.8 years, with 46 (34.1%) males. Symptoms, functional impairments, and overall health worsened significantly when compared to the status prior to the infection. More than 50% reported the following sequelae 12 weeks after the acute infection: breathlessness, laryngeal or airway complications, fatigue, weakness, sleep, cognition, and anxiety. The presence of a single symptom or functional impairment significantly correlated with at least seven other problems positively, except for pain. Severity tended to be higher among vulnerable groups, including those who were chronic disease patients, older, less well educated, female, or had incomplete COVID-19 vaccinations. CONCLUSIONS Long COVID is a significant healthcare burden among telemedicine users in Hong Kong, with complex needs for symptom and functional impairment management. Designing relevant health and rehabilitation services tailored to the needs of these patients is warranted.
Collapse
Affiliation(s)
- Fai Fai Ho
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin 999077, Hong Kong
| | - Shanshan Xu
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin 999077, Hong Kong
- Department of Epidemiology & Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, China
| | - Talos Ming Hong Kwong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin 999077, Hong Kong
| | - Angus Siu-cheong Li
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin 999077, Hong Kong
| | - Eun Hae Ha
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin 999077, Hong Kong
- The Chinese University of Hong Kong Chinese Medicine Specialty Clinic cum Clinical Teaching and Research Centre, School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin 999077, Hong Kong
| | - Heyu Hua
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin 999077, Hong Kong
- The Chinese University of Hong Kong Chinese Medicine Specialty Clinic cum Clinical Teaching and Research Centre, School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin 999077, Hong Kong
| | - Ching Liong
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin 999077, Hong Kong
- The Chinese University of Hong Kong Chinese Medicine Specialty Clinic cum Clinical Teaching and Research Centre, School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin 999077, Hong Kong
| | - Kwan Chi Leung
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin 999077, Hong Kong
- The Chinese University of Hong Kong Chinese Medicine Specialty Clinic cum Clinical Teaching and Research Centre, School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin 999077, Hong Kong
| | - Ting Hung Leung
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin 999077, Hong Kong
- The Chinese University of Hong Kong Chinese Medicine Specialty Clinic cum Clinical Teaching and Research Centre, School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin 999077, Hong Kong
| | - Zhixiu Lin
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin 999077, Hong Kong
- The Chinese University of Hong Kong Chinese Medicine Specialty Clinic cum Clinical Teaching and Research Centre, School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin 999077, Hong Kong
| | - Samuel Yeung-Shan Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin 999077, Hong Kong
| | - Faming Pan
- Department of Epidemiology & Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, China
| | - Vincent Chi Ho Chung
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin 999077, Hong Kong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin 999077, Hong Kong
| |
Collapse
|
22
|
Relationship between Reaction Times and Post-COVID-19 Symptoms Assessed by a Web-Based Visual Detection Task. Healthcare (Basel) 2023; 11:healthcare11030284. [PMID: 36766859 PMCID: PMC9914750 DOI: 10.3390/healthcare11030284] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/19/2023] Open
Abstract
Long-COVID is a clinical condition in which patients affected by SARS-CoV-2 usually report a wide range of physical and cognitive symptoms from 3 to 6 months after the infection recovery. The aim of the current study was to assess the link between self-reported long-COVID symptoms and reaction times (RTs) in a self-administered Visual Detection Task (VDT) in order to identify the predictor symptoms of the slowing in reaction times to determine attention impairment. In total, 362 participants (age (mean ± S.D.: 38.56 ± 13.14); sex (female-male: 73.76-26.24%)) responded to a web-based self-report questionnaire consisting of four sections: demographics, disease-related characteristics, and medical history questions. The final section consisted of a 23 item 5-point Likert-scale questionnaire related to long-term COVID-19 symptoms. After completing the questionnaire, subjects performed a VDT on a tablet screen to assess reaction times (RTs). An exploratory factorial analysis (EFA) was performed on the 23 long-COVID symptom questions, identifying 4 factors (cognition, behavior, physical condition, presence of anosmia and/or ageusia). The most important predictors of RTs were cognition and physical factors. By dissecting the cognitive and physical factors, learning, visual impairment, and headache were the top predictors of subjects' performance in the VDT. Long-COVID subjects showed higher RTs in the VDT after a considerable time post-disease, suggesting the presence of an attention deficit disorder. Attention impairment due to COVID-19 can be due to the presence of headaches, visual impairments, and the presence of cognitive problems related to the difficulty in learning new activities. The link between the slowing of reaction times and physical and cognitive symptoms post-COVID-19 suggests that attention deficit disorder is caused by a complex interaction between physical and cognitive symptoms. In addition, the study provides evidence that RTs in a VDT represent a reliable measure to detect the presence of long-COVID neurological sequelae.
Collapse
|
23
|
Saucier J, Jose C, Beroual Z, Al-Qadi M, Chartrand S, Libert E, Losier MC, Cooling K, Girouard G, Jbilou J, Chamard-Witkowski L. Cognitive inhibition deficit in long COVID-19: An exploratory study. Front Neurol 2023; 14:1125574. [PMID: 37122293 PMCID: PMC10140516 DOI: 10.3389/fneur.2023.1125574] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/13/2023] [Indexed: 05/02/2023] Open
Abstract
Background and objectives An increasing number of research studies point toward the importance and prevalence of long-term neurocognitive symptoms following infection with COVID-19. Our objectives were to capture the prevalence of cognitive impairments from 1 to 16 months post-COVID-19 infection, assess the changes in neuropsychological functions over time, and identify factors that can predict long-term deficits in cognition. Methodology A cross-sectional research design was adopted to compare four sub-samples recruited over a 16-month timeframe (1-4, 5-8, 9-12, and 13-16 months). Phone interviews were conducted at least 6 weeks after being infected by COVID-19. Sociodemographic and clinical questionnaires were administered followed by standardized neurocognitive and psychological tests and health questionnaires screening cognitive symptoms, anxiety, depression, fatigue, and autonomy. Results Regarding general health questionnaires, 55.2% of the 134 participants had symptoms of psychiatric illness, while 21.6% of patients had moderate-to-severe anxiety or depression. Cognitive efficiency was diminished in 19.4% of our population. Executive dysfunction was screened in 56% of patients, and an impairment of cognitive flexibility and inhibition was revealed in 38.8%. Depression, hospital or intensive care unit (ICU) admission, and the duration of hospital or ICU stay were associated with an inhibition deficit. The duration elapsed from the initial infection, and the neurocognitive assessment was not associated with a decrease in inhibition deficit. The prevalence of cognitive impairments, other than inhibition deficit, tended to decrease during the study period. Discussion This study supports the extensive literature on the cognitive and neuropsychiatric sequelae of COVID-19 and highlights long-lasting inhibition deficits, while other cognitive functions seemed to improve over time. The severity of infection could interact as a catalyst in the complex interplay between depression and executive functions. The absence of a relation between inhibition deficits and sociodemographic or medical factors reinforces the need for cognitive screening in all COVID-19 patients. Future research should focus on inhibition deficits longitudinally to assess the progression of this impairment.
Collapse
Affiliation(s)
- Jacob Saucier
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Center de Formation Médicale du Nouveau-Brunswick, Moncton, NB, Canada
| | - Caroline Jose
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Vitality Health Network, Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB, Canada
| | - Zaynab Beroual
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Center de Formation Médicale du Nouveau-Brunswick, Moncton, NB, Canada
| | - Mohammad Al-Qadi
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Center de Formation Médicale du Nouveau-Brunswick, Moncton, NB, Canada
| | - Simon Chartrand
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Center de Formation Médicale du Nouveau-Brunswick, Moncton, NB, Canada
| | - Eméraldine Libert
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Center de Formation Médicale du Nouveau-Brunswick, Moncton, NB, Canada
| | - Marie-Claire Losier
- Vitality Health Network, Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB, Canada
| | - Kendra Cooling
- Vitality Health Network, Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB, Canada
| | - Gabriel Girouard
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Center de Formation Médicale du Nouveau-Brunswick, Moncton, NB, Canada
- Vitality Health Network, Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB, Canada
| | - Jalila Jbilou
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Center de Formation Médicale du Nouveau-Brunswick, Moncton, NB, Canada
- School of Psychology, Université de Moncton, Moncton, NB, Canada
| | - Ludivine Chamard-Witkowski
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Center de Formation Médicale du Nouveau-Brunswick, Moncton, NB, Canada
- Vitality Health Network, Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB, Canada
- *Correspondence: Ludivine Chamard-Witkowski,
| |
Collapse
|
24
|
Wisniewski T, Masurkar AV. Gait dysfunction in Alzheimer disease. HANDBOOK OF CLINICAL NEUROLOGY 2023; 196:267-274. [PMID: 37620073 DOI: 10.1016/b978-0-323-98817-9.00013-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Alzheimer's disease (AD) is the most common cause of age-associated dementia and will exponentially rise in prevalence in the coming decades, supporting the parallel development of the early stage detection and disease-modifying strategies. While primarily considered as a cognitive disorder, AD also features motor symptoms, primarily gait dysfunction. Such gait abnormalities can be phenotyped across classic clinical syndromes as well as by quantitative kinematic assessments to address subtle dysfunction at preclinical and prodromal stages. As such, certain measures of gait can predict the future cognitive and functional decline. Moreover, cross-sectional and longitudinal studies have associated gait abnormalities with imaging, biofluid, and genetic markers of AD across all stages. This suggests that gait assessment is an important tool in the clinical assessment of patients across the AD spectrum, especially to help identify at-risk individuals.
Collapse
Affiliation(s)
- Thomas Wisniewski
- Department of Neurology, NYU School of Medicine, New York, NY, United States; Department of Pathology, NYU School of Medicine, New York, NY, United States; Department of Psychiatry, NYU School of Medicine, New York, NY, United States; Division of Cognitive Neurology, Center for Cognitive Neurology, NYU School of Medicine, New York, NY, United States.
| | - Arjun V Masurkar
- Department of Neurology, NYU School of Medicine, New York, NY, United States; Division of Cognitive Neurology, Center for Cognitive Neurology, NYU School of Medicine, New York, NY, United States
| |
Collapse
|
25
|
Chen S, Cardinal RN, Auckland K, Gräf S, O'Brien JT, Underwood BR. Risk Factors for Longer-Term Mortality in Discharged Patients with Dementia and SARS-CoV-2 Infection: A Matched Case-Control Study. J Alzheimers Dis 2023; 92:295-309. [PMID: 36744344 DOI: 10.3233/jad-221093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Persisting symptoms and increased mortality after SARS-CoV-2 infection has been described in COVID-19 survivors. OBJECTIVE We examined longer-term mortality in patients with dementia and SARS-CoV-2 infection. METHODS A retrospective matched case-control study of 165 patients with dementia who survived an acute hospital admission with COVID-19 infection, and 1325 patients with dementia who survived a hospital admission but without SARS-CoV-2 infection. Potential risk factors investigated included socio-demographic factors, clinical features, and results of investigations. Data were fitted using a Cox proportional hazard model. RESULTS Compared to patients with dementia but without SARS-CoV-2 infection, people with dementia and SARS-CoV-2 infection had a 4.4-fold risk of death (adjusted hazard ratio [aHR] = 4.44, 95% confidence interval [CI] 3.13-6.30) even beyond the acute phase of infection. This excess mortality could be seen up to 125 days after initial recovery but was not elevated beyond this time. Risk factors for COVID-19-associated mortality included prescription of antipsychotics (aHR = 3.06, 95% CI 1.40-6.69) and benzodiazepines (aHR = 3.00, 95% CI 1.28-7.03). Abnormalities on investigation associated with increased mortality included high white cell count (aHR = 1.21, 95% CI 1.04-1.39), higher absolute neutrophil count (aHR = 1.28, 95% CI 1.12-1.46), higher C-reactive protein (aHR = 1.01, 95% CI 1.00-1.02), higher serum sodium (aHR = 1.09, 95% CI 1.01-1.19), and higher ionized calcium (aHR = 1.03, 95% CI 1.00-1.06). The post-acute COVID mortality could be modeled for the first 120 days after recovery with a balanced accuracy of 87.2%. CONCLUSION We found an increased mortality in patients with dementia beyond the acute phase of illness. We identified several investigation results associated with increased mortality, and increased mortality in patients prescribed antipsychotics or benzodiazepines.
Collapse
Affiliation(s)
- Shanquan Chen
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Rudolf N Cardinal
- Department of Psychiatry, University of Cambridge, Cambridge, UK.,Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | | | | | - Stefan Gräf
- Department of Medicine, University of Cambridge, Cambridge, UK.,Departmentof Haematology, University of Cambridge, Cambridge, UK.,NIHR BioResource for Translational Research, Cambridge, UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Benjamin R Underwood
- Department of Psychiatry, University of Cambridge, Cambridge, UK.,Cambridgeshire and Peterborough NHS Foundation Trust, UK
| |
Collapse
|
26
|
Frontera JA, Sabadia S, Yang D, de Havenon A, Yaghi S, Lewis A, Lord AS, Melmed K, Thawani S, Balcer LJ, Wisniewski T, Galetta SL. Life stressors significantly impact long-term outcomes and post-acute symptoms 12-months after COVID-19 hospitalization. J Neurol Sci 2022; 443:120487. [PMID: 36379135 PMCID: PMC9637014 DOI: 10.1016/j.jns.2022.120487] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/12/2022] [Accepted: 11/01/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Limited data exists evaluating predictors of long-term outcomes after hospitalization for COVID-19. METHODS We conducted a prospective, longitudinal cohort study of patients hospitalized for COVID-19. The following outcomes were collected at 6 and 12-months post-diagnosis: disability using the modified Rankin Scale (mRS), activities of daily living assessed with the Barthel Index, cognition assessed with the telephone Montreal Cognitive Assessment (t-MoCA), Neuro-QoL batteries for anxiety, depression, fatigue and sleep, and post-acute symptoms of COVID-19. Predictors of these outcomes, including demographics, pre-COVID-19 comorbidities, index COVID-19 hospitalization metrics, and life stressors, were evaluated using multivariable logistic regression. RESULTS Of 790 COVID-19 patients who survived hospitalization, 451(57%) completed 6-month (N = 383) and/or 12-month (N = 242) follow-up, and 77/451 (17%) died between discharge and 12-month follow-up. Significant life stressors were reported in 121/239 (51%) at 12-months. In multivariable analyses, life stressors including financial insecurity, food insecurity, death of a close contact and new disability were the strongest independent predictors of worse mRS, Barthel Index, depression, fatigue, and sleep scores, and prolonged symptoms, with adjusted odds ratios ranging from 2.5 to 20.8. Other predictors of poor outcome included older age (associated with worse mRS, Barthel, t-MoCA, depression scores), baseline disability (associated with worse mRS, fatigue, Barthel scores), female sex (associated with worse Barthel, anxiety scores) and index COVID-19 severity (associated with worse Barthel index, prolonged symptoms). CONCLUSIONS Life stressors contribute substantially to worse functional, cognitive and neuropsychiatric outcomes 12-months after COVID-19 hospitalization. Other predictors of poor outcome include older age, female sex, baseline disability and severity of index COVID-19.
Collapse
Affiliation(s)
- Jennifer A Frontera
- Departments of Neurology, New York University Grossman School of Medicine, New York, NY, USA.
| | - Sakinah Sabadia
- Departments of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Dixon Yang
- Department of Neurology, New York Presbyterian, Columbia Medical Center, New York, NY, USA
| | - Adam de Havenon
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Shadi Yaghi
- Department of Neurology, Brown University School of Medicine, Providence, RI, USA
| | - Ariane Lewis
- Departments of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Aaron S Lord
- Departments of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Kara Melmed
- Departments of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Sujata Thawani
- Departments of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Laura J Balcer
- Departments of Neurology, New York University Grossman School of Medicine, New York, NY, USA; Population Health, New York University Grossman School of Medicine, New York, NY, USA; Ophthalmology, New York University Grossman School of Medicine, New York, NY, USA
| | - Thomas Wisniewski
- Departments of Neurology, New York University Grossman School of Medicine, New York, NY, USA; Pathology, New York University Grossman School of Medicine, New York, NY, USA; Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Steven L Galetta
- Departments of Neurology, New York University Grossman School of Medicine, New York, NY, USA; Ophthalmology, New York University Grossman School of Medicine, New York, NY, USA
| |
Collapse
|
27
|
Hartung TJ, Neumann C, Bahmer T, Chaplinskaya-Sobol I, Endres M, Geritz J, Haeusler KG, Heuschmann PU, Hildesheim H, Hinz A, Hopff S, Horn A, Krawczak M, Krist L, Kudelka J, Lieb W, Maetzler C, Mehnert-Theuerkauf A, Montellano FA, Morbach C, Schmidt S, Schreiber S, Steigerwald F, Störk S, Maetzler W, Finke C. Fatigue and cognitive impairment after COVID-19: A prospective multicentre study. EClinicalMedicine 2022; 53:101651. [PMID: 36133318 PMCID: PMC9482331 DOI: 10.1016/j.eclinm.2022.101651] [Citation(s) in RCA: 69] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/16/2022] [Accepted: 08/30/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Reliable estimates of frequency, severity and associated factors of both fatigue and cognitive impairment after COVID-19 are needed. Also, it is not clear whether the two are distinct sequelae of COVID-19 or part of the same syndrome." METHODS In this prospective multicentre study, frequency of post-COVID fatigue and cognitive impairment were assessed in n = 969 patients (535 [55%] female) ≥6 months after SARS-CoV-2 infection with the FACIT-Fatigue scale (cut-off ≤30) and Montreal Cognitive Assessment (≤25 mild, ≤17 moderate impairment) between November 15, 2020 and September 29, 2021 at University Medical Center Schleswig-Holstein, Campus Kiel and University Hospital Würzburg in Germany. 969 matched non-COVID controls were drawn from a pre-pandemic, randomised, Germany-wide population survey which also included the FACIT-Fatigue scale. Associated sociodemographic, comorbid, clinical, psychosocial factors and laboratory markers were identified with univariate and multivariable linear regression models. FINDINGS On average 9 months after infection, 19% of patients had clinically relevant fatigue, compared to 8% of matched non-COVID controls (p < 0.001). Factors associated with fatigue were female gender, younger age, history of depression and the number of acute COVID symptoms. Among acute COVID symptoms, altered consciousness, dizziness and myalgia were most strongly associated with long-term fatigue. Moreover, 26% of patients had mild and 1% had moderate cognitive impairment. Factors associated with cognitive impairment were older age, male gender, shorter education and a history of neuropsychiatric disease. There was no significant correlation between fatigue and cognitive impairment and only 5% of patients suffered from both conditions. INTERPRETATION Fatigue and cognitive impairment are two common, but distinct sequelae of COVID-19 with potentially separate pathophysiological pathways. FUNDING German Federal Ministry of Education and Research (BMBF).
Collapse
Key Words
- CI, confidence interval
- COVID-19
- COVID-19, Coronavirus Disease 2019
- CRP, C-reactive protein
- CSF, cerebrospinal fluid
- Cognitive dysfunction
- Fatigue
- GAD-7, 7-item anxiety screening questionnaire
- MoCA, Montreal Cognitive Assessment
- NAPKON, National Pandemic Cohort Network
- PCR, polymerase chain reaction
- PHQ-8, 8-item depression module of the Patient Health Questionnaire
- PSQI, Pittsburgh Sleep Quality Index
- Post-acute COVID-19 syndrome
- SARS-CoV-2
- SARS-CoV-2, Severe Acute Respiratory Distress Syndrome caused by Corona Virus 2
- VIF, variance inflation factor
Collapse
Affiliation(s)
- Tim J. Hartung
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Christian Neumann
- Neurology Department, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Thomas Bahmer
- Internal Medicine Department I, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany
- Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany
| | | | - Matthias Endres
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Berlin, Germany
- Excellence Cluster NeuroCure, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Germany
| | - Johanna Geritz
- Neurology Department, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | | | - Peter U. Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Clinical Trial Center, University Hospital Würzburg, Würzburg, Germany
| | - Hanna Hildesheim
- Neurology Department, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Andreas Hinz
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Sina Hopff
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne, Duesseldorf, Germany
| | - Anna Horn
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Michael Krawczak
- Institute of Medical Informatics and Statistics, Kiel University, University Medical Center Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Lilian Krist
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jennifer Kudelka
- Neurology Department, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology, Kiel University, Kiel, Germany
| | - Corina Maetzler
- Neurology Department, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Felipe A. Montellano
- Department of Neurology, Universitätsklinikum Würzburg, Würzburg, Germany
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- Comprehensive Heart Failure Center, University and University Hospital Würzburg, Würzburg, Germany
| | - Caroline Morbach
- University Hospital Würzburg, Department for Medicine I and Comprehensive Heart Failure Center, Würzburg, Germany
| | - Sein Schmidt
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Clinical Study Center, Berlin, Germany
| | - Stefan Schreiber
- Universitätsklinikum Schleswig-Holstein, Christian-Albrechts-Universität zu Kiel, Klinik für Innere Medizin I, Kiel, Germany
| | - Flo Steigerwald
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan Störk
- Department of Clinical Research & Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Würzburg, Germany
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Walter Maetzler
- Neurology Department, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Carsten Finke
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Corresponding author at: Department of Neurology, Charité – Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany.
| |
Collapse
|
28
|
Graham EL, Koralnik IJ, Liotta EM. Therapeutic Approaches to the Neurologic Manifestations of COVID-19. Neurotherapeutics 2022; 19:1435-1466. [PMID: 35861926 PMCID: PMC9302225 DOI: 10.1007/s13311-022-01267-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 02/07/2023] Open
Abstract
As of May 2022, there have been more than 527 million infections with severe acute respiratory disease coronavirus type 2 (SARS-CoV-2) and over 6.2 million deaths from Coronavirus Disease 2019 (COVID-19) worldwide. COVID-19 is a multisystem illness with important neurologic consequences that impact long-term morbidity and mortality. In the acutely ill, the neurologic manifestations of COVID-19 can include distressing but relatively benign symptoms such as headache, myalgias, and anosmia; however, entities such as encephalopathy, stroke, seizures, encephalitis, and Guillain-Barre Syndrome can cause neurologic injury and resulting disability that persists long after the acute pulmonary illness. Furthermore, as many as one-third of patients may experience persistent neurologic symptoms as part of a Post-Acute Sequelae of SARS-CoV-2 infection (Neuro-PASC) syndrome. This Neuro-PASC syndrome can affect patients who required hospitalization for COVID-19 or patients who did not require hospitalization and who may have had minor or no pulmonary symptoms. Given the large number of individuals affected and the ability of neurologic complications to impair quality of life and productivity, the neurologic manifestations of COVID-19 are likely to have major and long-lasting personal, public health, and economic consequences. While knowledge of disease mechanisms and therapies acquired prior to the pandemic can inform us on how to manage patients with the neurologic manifestations of COVID-19, there is a critical need for improved understanding of specific COVID-19 disease mechanisms and development of therapies that target the neurologic morbidities of COVID-19. This current perspective reviews evidence for proposed disease mechanisms as they inform the neurologic management of COVID-19 in adult patients while also identifying areas in need of further research.
Collapse
Affiliation(s)
- Edith L Graham
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave Suite 1150, Chicago, IL, 60611, USA
| | - Igor J Koralnik
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave Suite 1150, Chicago, IL, 60611, USA
| | - Eric M Liotta
- The Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave Suite 1150, Chicago, IL, 60611, USA.
| |
Collapse
|
29
|
Quality of Life and Mental Health Status in Recovered COVID-19 Subjects at Two Years after Infection in Taizhou, China: A Longitudinal Cohort Study. Brain Sci 2022; 12:brainsci12070939. [PMID: 35884745 PMCID: PMC9316455 DOI: 10.3390/brainsci12070939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 11/17/2022] Open
Abstract
According to previous studies, mental status in 1-year COVID-19 survivors might range from 6–43%. Longer-term psychological consequences in recovered COVID-19 subjects are unknown, so we analyzed longer-term quality of life and mental status in recovered COVID-19 subjects at 2 years after infection. Among 144 recovered COVID-19 subjects in the Taizhou region, 73 and 45 completed face-to-face follow-ups at the first year and second year after infection, respectively, with a 61.7% follow-up rate. The questionnaire, which was administered at both follow-ups, included questions about quality of life, psychological health, and post-traumatic stress disorder (PTSD). The Mann-Whitney U test was used to the differences of each scale between the first and second year. Among the 45 people who completed both follow-up visits, the incidence of psychological problems was 4.4% (2/45) in the first year, and no new psychological abnormalities were observed in the second year. Quality of life improved, while the General Health Questionnaire (GHQ-12) and Impact of Event Scale-Revised (IES-R) scores did not improve over time. The incidence of mental disorders was lower than those in previous studies. Multidisciplinary management for COVID-19 in this study hospital may have reduced the frequency to a certain extent. However, among those with mental health problems, such problems may exist for a long time, and long-term attention should be given to the psychological status of recovered COVID-19 subjects.
Collapse
|
30
|
Rothstein A, Favilla C, Sloane K, Witsch J. Perspective: COVID-19 and Its Neurologic Sequelae. TRANSLATIONAL PERIOPERATIVE AND PAIN MEDICINE 2022; 9:478-481. [PMID: 36381996 PMCID: PMC9645563 DOI: 10.31480/2330-4871/162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
COVID-19 led to a catastrophic, international, public health crisis after its first detection in 2019 [1]. Though it is primarily a respiratory virus, it impacts the central and peripheral nervous systems leading to further COVID-19-associated disability [2]. This Perspective reviews our current understanding of the neurological sequelae of COVID-19 and the gaps in our understanding of their treatment and epidemiology.
Collapse
Affiliation(s)
- Aaron Rothstein
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christopher Favilla
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kelly Sloane
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jens Witsch
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|