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Wang Z, Wang S, Li H, Wang M, Zhang X, Xu J, Xu Q, Wang J. Causal effect of COVID-19 on longitudinal volumetric changes in subcortical structures: A mendelian randomization study. Heliyon 2024; 10:e37193. [PMID: 39296245 PMCID: PMC11408012 DOI: 10.1016/j.heliyon.2024.e37193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 08/06/2024] [Accepted: 08/28/2024] [Indexed: 09/21/2024] Open
Abstract
A few observational neuroimaging investigations have reported subcortical structural changes in the individuals who recovered from the coronavirus disease-2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but the causal relationships between COVID-19 and longitudinal changes of subcortical structures remain unclear. We performed two-sample Mendelian randomization (MR) analyses to estimate putative causal relationships between three COVID-19 phenotypes (susceptibility, hospitalization, and severity) and longitudinal volumetric changes of seven subcortical structures derived from MRI. Our findings demonstrated that genetic liability to SARS-CoV-2 infection had a great long-term impact on the volumetric reduction of subcortical structures, especially caudate. Our investigation may contribute in part to the understanding of the neural mechanisms underlying COVID-19-related neurological and neuropsychiatric sequelae.
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Affiliation(s)
- Zirui Wang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Siqi Wang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Haonan Li
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Mengdong Wang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Xingyu Zhang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Jiayuan Xu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Qiang Xu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Junping Wang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
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2
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Rudroff T. Frontal-striatal glucose metabolism and fatigue in patients with multiple sclerosis, long COVID, and COVID-19 recovered controls. Exp Brain Res 2024; 242:2125-2136. [PMID: 38970653 DOI: 10.1007/s00221-024-06882-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 06/20/2024] [Indexed: 07/08/2024]
Abstract
This study compared brain glucose metabolism using FDG-PET in the caudate nucleus, putamen, globus pallidus, thalamus, and dorsolateral prefrontal cortex (DLPFC) among patients with Long COVID, patients with fatigue, people with multiple sclerosis (PwMS) patients with fatigue, and COVID recovered controls. PwMS exhibited greater hypometabolism compared to long COVID patients with fatigue and the COVID recovered control group in all studied brain areas except the globus pallidus (effect size range 0.7-1.5). The results showed no significant differences in glucose metabolism between patients with Long COVID and the COVID recovered control group in these regions. These findings suggest that long COVID fatigue may involve non-CNS systems, neurotransmitter imbalances, or psychological factors not captured by FDG-PET, while MS-related fatigue is associated with more severe frontal-striatal circuit dysfunction due to demyelination and neurodegeneration. Symmetrical standardized uptake values (SUVs) between hemispheres in all groups imply that fatigue in these conditions may be related to global or network-level alterations rather than hemisphere-specific changes. Future studies should employ fine-grained analysis methods, explore other brain regions, and control for confounding factors to better understand the pathophysiology of fatigue in MS and long COVID. Longitudinal studies tracking brain glucose metabolism in patients with Long COVID could provide insights into the evolution of metabolic patterns as the condition progresses.
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Affiliation(s)
- Thorsten Rudroff
- Department of Health and Human Physiology, University of Iowa, E432 Field House, Iowa City, IA, 52242, USA.
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
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3
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Nagy B, Protzner AB, Czigler B, Gaál ZA. Resting-state neural dynamics changes in older adults with post-COVID syndrome and the modulatory effect of cognitive training and sex. GeroScience 2024:10.1007/s11357-024-01324-8. [PMID: 39210163 DOI: 10.1007/s11357-024-01324-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024] Open
Abstract
Post-COVID syndrome manifests with numerous neurological and cognitive symptoms, the precise origins of which are still not fully understood. As females and older adults are more susceptible to developing this condition, our study aimed to investigate how post-COVID syndrome alters intrinsic brain dynamics in older adults and whether biological sex and cognitive training might modulate these effects, with a specific focus on older females. The participants, aged between 60 and 75 years, were divided into three experimental groups: healthy old female, post-COVID old female and post-COVID old male. They underwent an adaptive task-switching training protocol. We analysed multiscale entropy and spectral power density of resting-state EEG data collected before and after the training to assess neural signal complexity and oscillatory power, respectively. We found no difference between post-COVID females and males before training, indicating that post-COVID similarly affected both sexes. However, cognitive training was effective only in post-COVID females and not in males, by modulating local neural processing capacity. This improvement was further evidenced by comparing healthy and post-COVID females, wherein the latter group showed increased finer timescale entropy (1-30 ms) and higher frequency band power (11-40 Hz) before training, but these differences disappeared following cognitive training. Our results suggest that in older adults with post-COVID syndrome, there is a pronounced shift from more global to local neural processing, potentially contributing to accelerated neural aging in this condition. However, cognitive training seems to offer a promising intervention method for modulating these changes in brain dynamics, especially among females.
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Affiliation(s)
- Boglárka Nagy
- Institute of Cognitive Neuroscience and Psychology, HUN-REN Research Centre for Natural Sciences, Budapest, Hungary.
| | - Andrea B Protzner
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Mathison Centre for Mental Health Research and Education, University of Calgary, Calgary, Alberta, Canada
| | | | - Zsófia Anna Gaál
- Institute of Cognitive Neuroscience and Psychology, HUN-REN Research Centre for Natural Sciences, Budapest, Hungary
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4
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Jáuregui-Renaud K, Cooper-Bribiesca D, Miguel-Puga JA, Alcantara-Calderón Y, Roaro-Figueroa MF, Herrera-Ocampo M, Guzmán-Chacón MJ. Quality of Sleep and Mental Symptoms Contribute to Health-Related Quality of Life after COVID-19 Pneumonia, a Follow-Up Study of More than 2 Years. Biomedicines 2024; 12:1574. [PMID: 39062147 PMCID: PMC11275141 DOI: 10.3390/biomedicines12071574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/11/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
A follow-up study was designed to assess correlations among physical signs, quality of sleep, common mental symptoms, and health-related quality of life after moderate to severe COVID-19 pneumonia. Daily changes in dyspnoea and pulse oximetry were recorded (200 days), and four evaluations (in >2 years) were performed on quality of sleep, mental symptoms, cognitive performance, and health-related quality of life. In a single center, 72 adults participated in the study (52.5 ± 13.7 years old), with no psychiatry/neurology/chronic lung/infectious diseases, chronic use of corticosteroids/immunosuppressive therapy, or pregnancy. Daily agendas showed delayed decreases in dyspnoea scores compared to pulse oximetry and heart rate recordings; however, changes in pulse oximetry were minimal. Slight changes in cognitive performance were related to the general characteristics of the participants (obesity and tobacco use) and with the severity of acute disease (MANCOVA, p < 0.001). Health-related quality of life gradually improved (MANCOVA, p < 0.004). During recovery, bad quality of sleep and mental symptoms (mainly attention/concentration) contributed to the subscores on health perception and vitality in the health-related quality of life assessment. Early mental support services including sleep hygiene could be beneficial during rehabilitation after acute COVID-19.
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Affiliation(s)
- Kathrine Jáuregui-Renaud
- Unidad de Investigación Médica en Otoneurología, Instituto Mexicano del Seguro Social, Ciudad de México 06720, Mexico; (D.C.-B.); (J.A.M.-P.)
| | - Davis Cooper-Bribiesca
- Unidad de Investigación Médica en Otoneurología, Instituto Mexicano del Seguro Social, Ciudad de México 06720, Mexico; (D.C.-B.); (J.A.M.-P.)
- Departamento de Psiquiatría, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México 06720, Mexico; (Y.A.-C.); (M.J.G.-C.)
| | - José Adán Miguel-Puga
- Unidad de Investigación Médica en Otoneurología, Instituto Mexicano del Seguro Social, Ciudad de México 06720, Mexico; (D.C.-B.); (J.A.M.-P.)
| | - Yadira Alcantara-Calderón
- Departamento de Psiquiatría, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México 06720, Mexico; (Y.A.-C.); (M.J.G.-C.)
| | - María Fernanda Roaro-Figueroa
- Programa de Apoyo y Fomento a la Investigación Estudiantil, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico; (M.F.R.-F.); (M.H.-O.)
| | - Mariana Herrera-Ocampo
- Programa de Apoyo y Fomento a la Investigación Estudiantil, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico; (M.F.R.-F.); (M.H.-O.)
| | - Melodie Jedid Guzmán-Chacón
- Departamento de Psiquiatría, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México 06720, Mexico; (Y.A.-C.); (M.J.G.-C.)
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5
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Churchill NW, Roudaia E, Chen JJ, Sekuler A, Gao F, Masellis M, Lam B, Cheng I, Heyn C, Black SE, MacIntosh BJ, Graham SJ, Schweizer TA. Persistent fatigue in post-acute COVID syndrome is associated with altered T1 MRI texture in subcortical structures: a preliminary investigation. Behav Brain Res 2024; 469:115045. [PMID: 38734034 DOI: 10.1016/j.bbr.2024.115045] [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: 02/20/2024] [Revised: 05/03/2024] [Accepted: 05/06/2024] [Indexed: 05/13/2024]
Abstract
Post-acute COVID syndrome (PACS) is a global health concern and is often associated with debilitating symptoms. Post-COVID fatigue is a particularly frequent and troubling issue, and its underlying mechanisms remain incompletely understood. One potential contributor is micropathological injury of subcortical and brainstem structures, as has been identified in other patient populations. Texture-based analysis (TA) may be used to measure such changes in anatomical MRI data. The present study develops a methodology of voxel-wise TA mapping in subcortical and brainstem regions, which is then applied to T1-weighted MRI data from a cohort of 48 individuals who had PACS (32 with and 16 without ongoing fatigue symptoms) and 15 controls who had cold and flu-like symptoms but tested negative for COVID-19. Both groups were assessed an average of 4-5 months post-infection. There were no significant differences between PACS and control groups, but significant differences were observed within the PACS groups, between those with and without fatigue symptoms. This included reduced texture energy and increased entropy, along with reduced texture correlation, cluster shade and profile in the putamen, pallidum, thalamus and brainstem. These findings provide new insights into the neurophysiological mechanisms that underlie PACS, with altered tissue texture as a potential biomarker of this debilitating condition.
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Affiliation(s)
- Nathan W Churchill
- Brain Health and Wellness Research Program, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Unity Health Toronto, Canada; Physics Department, Toronto Metropolitan University, Canada.
| | - Eugenie Roudaia
- Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, Ontario, Canada
| | - J Jean Chen
- Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, Ontario, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Allison Sekuler
- Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, Ontario, Canada; Department of Psychology, University of Toronto, Toronto, Ontario, Canada; Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Fuqiang Gao
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Mario Masellis
- Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, Ontario, Canada; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin Lam
- Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, Ontario, Canada; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ivy Cheng
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada; Integrated Community Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Chris Heyn
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Sandra E Black
- Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, Ontario, Canada; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Bradley J MacIntosh
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada; Computational Radiology & Artificial Intelligence Unit, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Simon J Graham
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada; Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada; Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Tom A Schweizer
- Brain Health and Wellness Research Program, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Unity Health Toronto, Canada; Faculty of Medicine (Neurosurgery), University of Toronto, Canada
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6
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Gao Y, Lin K, Wang B, Ji W, Liu J, Du M, Wang W, Li Y, Du X, Wang Y, Jiang T. Decision-making ability limitations and brain neural activity changes in healthcare workers after mild COVID-19. Neurosci Res 2024; 204:14-21. [PMID: 38355017 DOI: 10.1016/j.neures.2024.02.001] [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: 08/16/2023] [Revised: 01/25/2024] [Accepted: 02/04/2024] [Indexed: 02/16/2024]
Abstract
Studies have demonstrated that the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) extensively affects brain function. Although cognitive dysfunction is considered a common manifestation in COVID-19 patients during the recovery period, the potential changes in decision-making ability, are not yet clear. Decision-making functions are essential to the work of healthcare workers. However, there is a lack of a multidimensional assessment of its functioning in COVID-19 cases. Here, we used tests combined with the resting-state functional magnetic resonance imaging (rs-fMRI) stabilization feature amplitude of low-frequency fluctuations (ALFF) to explore decision-making behavior and brain neural activity changes in healthcare workers after mild COVID-19. Participants were divided into the SARS-CoV-2 infected group (SI, n = 41) and healthy controls (HC, n = 42). All participants underwent a series of neuropsychological tests. They performed the Iowa Gambling Task (IGT) and the Game of Dice Task (GDT), followed by fMRI (n = 20) to assess their decision-making ability under ambiguous and risky conditions and changes in brain neural activity. The SI group performed worse in verbal memory than the HC group. Furthermore, the SI group performed worse in the IGT, whereas no significant difference was observed in the GDT. In addition, rs-fMRI showed enhanced spontaneous neural activity in the postcentral gyrus and inferior parietal lobe in the SI group compared to the HC group.
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Affiliation(s)
- Yaotian Gao
- Department of Neurosurgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China; Anhui Public Health Clinical Center, Hefei, China
| | - Keyi Lin
- Department of Neurosurgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China; Anhui Public Health Clinical Center, Hefei, China
| | - Bangyue Wang
- Department of Neurosurgery, the Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wei Ji
- Department of Neurosurgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China; Anhui Public Health Clinical Center, Hefei, China; Department of Neurosurgery, Huaan Brain Hospital, Hefei, China
| | - Jia Liu
- Anhui Public Health Clinical Center, Hefei, China; Department of Radiology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Mengcheng Du
- Department of Neurosurgery, the Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wei Wang
- Department of Neurosurgery, the Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yan Li
- Anhui Public Health Clinical Center, Hefei, China; Department of Radiology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiaowen Du
- Anhui Public Health Clinical Center, Hefei, China; Department of Radiology, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yuyang Wang
- Department of Neurosurgery, the Second Affiliated Hospital of Anhui Medical University, Hefei, China.
| | - Tao Jiang
- Department of Neurosurgery, the First Affiliated Hospital of Anhui Medical University, Hefei, China; Anhui Public Health Clinical Center, Hefei, China; Anhui Provincial Institute of Translational Medicine, Hefei, China.
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7
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Rudroff T. Long COVID in Brain Health Research: A Call to Action. Brain Sci 2024; 14:587. [PMID: 38928587 PMCID: PMC11201626 DOI: 10.3390/brainsci14060587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/03/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
The COVID-19 pandemic has brought attention to the long-term consequences of the virus, particularly the persistent symptoms that characterize long COVID. This syndrome, which can last for months after the initial infection, includes a range of neurological and neuropsychiatric manifestations that have significant implications for brain health and dementia research. This review explores the current understanding of long COVID's cognitive, neurological, and psychiatric symptoms and their potential impact on brain stimulation and neuroimaging studies. It argues that researchers must adapt their study designs and screening processes to account for the confounding effects of long COVID and ensure the accuracy and reliability of their findings. To advance the understanding of this condition and its long-term effects on brain health, the review proposes a series of strategies, including the development of standardized screening tools, the investigation of underlying mechanisms, and the identification of risk factors and protective factors. It also emphasizes the importance of collaborative research efforts and international data sharing platforms in accelerating the pace of discovery and developing targeted interventions for individuals with long COVID. As the prevalence of this condition continues to grow, it is imperative that the neuroscience community comes together to address this challenge and support those affected by long COVID.
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Affiliation(s)
- Thorsten Rudroff
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA 52242, USA;
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
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8
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Molina-Gil MJ, Guerra-Martín MD, Diego-Cordero RD. Primary Health Care Case-Management Nurses during the COVID-19 Pandemic: A Qualitative Study. NURSING REPORTS 2024; 14:1119-1128. [PMID: 38804417 PMCID: PMC11130922 DOI: 10.3390/nursrep14020084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/24/2024] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
The COVID-19 has caused high morbidity and mortality in vulnerable people, such as those affected by chronic diseases, and case-management nurses (CMNs) are reference professionals for their health care and management. The objective of this study is to better understand the discourse, experiences, and feelings about the professional performance of CMNs during the pandemic. A qualitative study was conducted by conducting semi-structured interviews with CMNs (n = 31) from the province of Seville (Spain) and performing a narrative discourse analysis. The Atlas Ti 6.2 software program was used. Two categories were defined: 1. CMNs' competencies (76 verbatim testimonies); and 2. Consequences of the COVID-19 pandemic (61 verbatim testimonies). This study was granted due permission by the Research Ethics Committee belonging to the University of Seville, under protocol code: 1139-N-22. The pandemic caused an increase in CMNs' workload, and they had to assume their usual care tasks for vulnerable populations in addition to simultaneously prioritizing assistance in nursing homes. We can highlight CMNs' adaptation to the pandemic situation and to these new requirements in the context of their significant social commitment to the advanced practice of the profession, a commitment that is closely related to leadership. We should also indicate that interpersonal relationships were improved, and that there was technological progress. Some CMNs mentioned an increase in their workload and reported experiencing burnout syndrome. We conclude that CMNs' management of health care during the pandemic has been extraordinary, especially in regard to the most vulnerable populations of patients, including individuals with chronic diseases and institutionalized older adults, a fact that has been valued by the institutions and by society in general.
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Affiliation(s)
- María José Molina-Gil
- Southern Seville Health Management Area, Andalusian Health Service, 41071 Sevilla, Spain;
- Francisco Maldonado of Osuna University Center, 41640 Osuna, Seville, Spain
| | - María Dolores Guerra-Martín
- Department of Nursing, Faculty of Nursing, Physiotherapy, and Podiatry, University of Seville, 41009 Seville, Spain;
- Institute of Biomedicine of Seville (IBiS), 41013 Seville, Spain
| | - Rocío De Diego-Cordero
- Department of Nursing, Faculty of Nursing, Physiotherapy, and Podiatry, University of Seville, 41009 Seville, Spain;
- Institute of Biomedicine of Seville (IBiS), 41013 Seville, Spain
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9
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Duindam HB, Mengel D, Kox M, Göpfert JC, Kessels RPC, Synofzik M, Pickkers P, Abdo WF. Systemic inflammation relates to neuroaxonal damage associated with long-term cognitive dysfunction in COVID-19 patients. Brain Behav Immun 2024; 117:510-520. [PMID: 38336025 DOI: 10.1016/j.bbi.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/23/2023] [Accepted: 02/02/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Cognitive deficits are increasingly recognized as a long-term sequela of severe COVID-19. The underlying processes and molecular signatures associated with these long-term neurological sequalae of COVID-19 remain largely unclear, but may be related to systemic inflammation-induced effects on the brain. We studied the systemic inflammation-brain interplay and its relation to development of long-term cognitive impairment in patients who survived severe COVID-19. Trajectories of systemic inflammation and neuroaxonal damage blood biomarkers during ICU admission were analyzed and related to long-term cognitive outcomes. METHODS Prospective longitudinal cohort study of patients with severe COVID-19 surviving ICU admission. During admission, blood was sampled consecutively to assess levels of inflammatory cytokines and neurofilament light chain (NfL) using an ultrasensitive multiplex Luminex assay and single molecule array technique (Simoa). Cognitive functioning was evaluated using a comprehensive neuropsychological assessment six months after ICU-discharge. RESULTS Ninety-six patients (median [IQR] age 61 [55-69] years) were enrolled from March 2020 to June 2021 and divided into two cohorts: those who received no COVID-19-related immunotherapy (n = 28) and those treated with either dexamethasone or dexamethasone and tocilizumab (n = 68). Plasma NfL concentrations increased in 95 % of patients during their ICU stay, from median [IQR] 23 [18-38] pg/mL at admission to 250 [160-271] pg/mL after 28 days, p < 0.001. Besides age, glomerular filtration rate, immunomodulatory treatment, and C-reactive protein, more specific markers of systemic inflammation at day 14 (i.e., interleukin (IL)-8, tumour necrosis factor, and IL-1 receptor antagonist) were significant predictors of blood NfL levels at day 14 of ICU admission (R2 = 44 %, p < 0.001), illustrating the association between sustained systemic inflammation and neuroaxonal damage. Twenty-six patients (27 %) exhibited cognitive impairment six months after discharge from the ICU. NfL concentrations showed a more pronounced increase in patients that developed cognitive impairment (p = 0.03). Higher NfL predicted poorer outcome in information processing speed (Trail Making Test A, r = -0.26, p = 0.01; Letter Digit Substitution Test, r = -0.24, p = 0.02). DISCUSSION Prolonged systemic inflammation in critically ill COVID-19 patients is related to neuroaxonal damage and subsequent long-term cognitive impairment. Moreover, our findings suggest that plasma NfL concentrations during ICU stay may possess prognostic value in predicting future long-term cognitive impairment in patients that survived severe COVID-19.
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Affiliation(s)
- H B Duindam
- Radboud University Medical Center, Department of Intensive Care Medicine, Nijmegen, the Netherlands
| | - D Mengel
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany; German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - M Kox
- Radboud University Medical Center, Department of Intensive Care Medicine, Nijmegen, the Netherlands
| | - J C Göpfert
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Reutlingen, Germany
| | - R P C Kessels
- Radboud University, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, the Netherlands; Radboud University Medical Center, Department of Medical Psychology and Radboudumc Alzheimer Center, Nijmegen, the Netherlands; Vincent van Gogh Institute for Psychiatry, Venray, the Netherlands
| | - M Synofzik
- Center for Neurology and Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany; German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - P Pickkers
- Radboud University Medical Center, Department of Intensive Care Medicine, Nijmegen, the Netherlands
| | - W F Abdo
- Radboud University Medical Center, Department of Intensive Care Medicine, Nijmegen, the Netherlands.
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10
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Romero-Molina AO, Ramirez-Garcia G, Chirino-Perez A, Fuentes-Zavaleta DA, Hernandez-Castillo CR, Marrufo-Melendez O, Lopez-Gonzalez D, Rodriguez-Rodriguez M, Castorena-Maldonado A, Rodriguez-Agudelo Y, Paz-Rodriguez F, Chavez-Oliveros M, Lozano-Tovar S, Gutierrez-Romero A, Arauz-Gongora A, Garcia-Santos RA, Fernandez-Ruiz J. SARS-CoV-2's brain impact: revealing cortical and cerebellar differences via cluster analysis in COVID-19 recovered patients. Neurol Sci 2024; 45:837-848. [PMID: 38172414 DOI: 10.1007/s10072-023-07266-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/12/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND COVID-19 is a disease known for its neurological involvement. SARS-CoV-2 infection triggers neuroinflammation, which could significantly contribute to the development of long-term neurological symptoms and structural alterations in the gray matter. However, the existence of a consistent pattern of cerebral atrophy remains uncertain. OBJECTIVE Our study aimed to identify patterns of brain involvement in recovered COVID-19 patients and explore potential relationships with clinical variables during hospitalization. METHODOLOGY In this study, we included 39 recovered patients and 39 controls from a pre-pandemic database to ensure their non-exposure to the virus. We obtained clinical data of the patients during hospitalization, and 3 months later; in addition we obtained T1-weighted magnetic resonance images and performed standard screening cognitive tests. RESULTS We identified two groups of recovered patients based on a cluster analysis of the significant cortical thickness differences between patients and controls. Group 1 displayed significant cortical thickness differences in specific cerebral regions, while Group 2 exhibited significant differences in the cerebellum, though neither group showed cognitive deterioration at the group level. Notably, Group 1 showed a tendency of higher D-dimer values during hospitalization compared to Group 2, prior to p-value correction. CONCLUSION This data-driven division into two groups based on the brain structural differences, and the possible link to D-dimer values may provide insights into the underlying mechanisms of SARS-COV-2 neurological disruption and its impact on the brain during and after recovery from the disease.
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Affiliation(s)
- Angel Omar Romero-Molina
- Instituto de Neuroetologia, Universidad Veracruzana, Xalapa, Veracruz, Mexico
- Laboratorio de Neuropsicologia, Facultad de Medicina, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | - Gabriel Ramirez-Garcia
- Laboratorio de Neuropsicologia, Facultad de Medicina, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | - Amanda Chirino-Perez
- Laboratorio de Neuropsicologia, Facultad de Medicina, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Juan Fernandez-Ruiz
- Instituto de Neuroetologia, Universidad Veracruzana, Xalapa, Veracruz, Mexico.
- Laboratorio de Neuropsicologia, Facultad de Medicina, Universidad Nacional Autonoma de Mexico, Mexico City, Mexico.
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11
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Maliha ST, Fatemi R, Araf Y. COVID-19 and the brain: understanding the pathogenesis and consequences of neurological damage. Mol Biol Rep 2024; 51:318. [PMID: 38386201 DOI: 10.1007/s11033-024-09279-x] [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: 09/08/2023] [Accepted: 01/22/2024] [Indexed: 02/23/2024]
Abstract
SARS-CoV-2 has been known remarkably since December 2019 as a strain of pathogenic coronavirus. Starting from the earlier stages of the COVID-19 pandemic until now, we have witnessed many cases of neurological damage caused by SARS-CoV-2. There are many studies and research conducted on COVID-19-positive-patients that have found brain-related abnormalities with clear neurological symptoms, ranging from simple headaches to life-threatening strokes. For treating neurological damage, knowing the actual pathway or mechanism of causing brain damage via SARS-CoV-2 is very important. For this reason, we have tried to explain the possible pathways of brain damage due to SARS-CoV-2 with mechanisms and illustrations. The SARS-CoV-2 virus enters the human body by binding to specific ACE2 receptors in the targeted cells, which are present in the glial cells and CNS neurons of the human brain. It is found that direct and indirect infections with SARS-CoV-2 in the brain result in endothelial cell death, which alters the BBB tight junctions. These probable alterations can be the reason for the excessive transmission and pathogenicity of SARS-CoV-2 in the human brain. In this precise review, we have tried to demonstrate the neurological symptoms in the case of COVID-19-positive-patients and the possible mechanisms of neurological damage, along with the treatment options for brain-related abnormalities. Knowing the transmission mechanism of SARS-CoV-2 in the human brain can assist us in generating novel treatments associated with neuroinflammation in other brain diseases.
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Affiliation(s)
- Sumaiya Tasnim Maliha
- Biotechnology Program, Department of Mathematics and Natural Sciences, School of Data and Sciences, BRAC University, Dhaka, Bangladesh
| | - Rabeya Fatemi
- Department of Genetic Engineering and Biotechnology, East West University, Dhaka, 1212, Bangladesh
| | - Yusha Araf
- Department of Biotechnology, Bangladesh Agricultural University, Mymensingh, Bangladesh.
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12
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Ladds E, Darbyshire JL, Bakerly ND, Falope Z, Tucker-Bell I. Cognitive dysfunction after covid-19. BMJ 2024; 384:e075387. [PMID: 38302141 DOI: 10.1136/bmj-2023-075387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Affiliation(s)
- Emma Ladds
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Julie L Darbyshire
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Nawar Diar Bakerly
- The Northern Care Alliance, Manchester Metropolitan University, University of Manchester
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13
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Liu X, Chiu SH, Tan CYR, Chua AJK. Long-term recovery from COVID-19 olfactory and gustatory dysfunction: a longitudinal study. Singapore Med J 2024:00077293-990000000-00071. [PMID: 38189414 DOI: 10.4103/singaporemedj.smj-2022-174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 05/30/2023] [Indexed: 01/09/2024]
Affiliation(s)
| | | | | | - Andy Jian Kai Chua
- Department of Otolaryngology - Head and Neck Surgery, Sengkang General Hospital, Singapore
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14
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Pileggi CA, Parmar G, Elkhatib H, Stewart CM, Alecu I, Côté M, Bennett SA, Sandhu JK, Cuperlovic-Culf M, Harper ME. The SARS-CoV-2 spike glycoprotein interacts with MAO-B and impairs mitochondrial energetics. CURRENT RESEARCH IN NEUROBIOLOGY 2023; 5:100112. [PMID: 38020812 PMCID: PMC10663135 DOI: 10.1016/j.crneur.2023.100112] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/21/2023] [Accepted: 09/25/2023] [Indexed: 12/01/2023] Open
Abstract
SARS-CoV-2 infection is associated with both acute and post-acute neurological symptoms. Emerging evidence suggests that SARS-CoV-2 can alter mitochondrial metabolism, suggesting that changes in brain metabolism may contribute to the development of acute and post-acute neurological complications. Monoamine oxidase B (MAO-B) is a flavoenzyme located on the outer mitochondrial membrane that catalyzes the oxidative deamination of monoamine neurotransmitters. Computational analyses have revealed high similarity between the SARS-CoV-2 spike glycoprotein receptor binding domain on the ACE2 receptor and MAO-B, leading to the hypothesis that SARS-CoV-2 spike glycoprotein may alter neurotransmitter metabolism by interacting with MAO-B. Our results empirically establish that the SARS-CoV-2 spike glycoprotein interacts with MAO-B, leading to increased MAO-B activity in SH-SY5Y neuron-like cells. Common to neurodegenerative disease pathophysiological mechanisms, we also demonstrate that the spike glycoprotein impairs mitochondrial bioenergetics, induces oxidative stress, and perturbs the degradation of depolarized aberrant mitochondria through mitophagy. Our findings also demonstrate that SH-SY5Y neuron-like cells expressing the SARS-CoV-2 spike protein were more susceptible to MPTP-induced necrosis, likely necroptosis. Together, these results reveal novel mechanisms that may contribute to SARS-CoV-2-induced neurodegeneration.
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Affiliation(s)
- Chantal A. Pileggi
- Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
- Ottawa Institute of Systems Biology, University of Ottawa, ON, K1H 8M5, Canada
- National Research Council of Canada, Digital Technologies Research Centre, 1200 Montreal Road, Ottawa, ON, K1A 0R6, Canada
| | - Gaganvir Parmar
- Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
- Ottawa Institute of Systems Biology, University of Ottawa, ON, K1H 8M5, Canada
| | - Hussein Elkhatib
- Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
- Ottawa Institute of Systems Biology, University of Ottawa, ON, K1H 8M5, Canada
| | - Corina M. Stewart
- Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
- Ottawa Institute of Systems Biology, University of Ottawa, ON, K1H 8M5, Canada
- Current Address: Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Irina Alecu
- Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
- Ottawa Institute of Systems Biology, University of Ottawa, ON, K1H 8M5, Canada
- Neural Regeneration Laboratory, Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Marceline Côté
- Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
- Ottawa Institute of Systems Biology, University of Ottawa, ON, K1H 8M5, Canada
- Centre for Infection, Immunity and Inflammation, University of Ottawa, ON, K1H 8M5, Canada
| | - Steffany A.L. Bennett
- Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
- Ottawa Institute of Systems Biology, University of Ottawa, ON, K1H 8M5, Canada
- Neural Regeneration Laboratory, Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Jagdeep K. Sandhu
- Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
- Ottawa Institute of Systems Biology, University of Ottawa, ON, K1H 8M5, Canada
- Centre for Infection, Immunity and Inflammation, University of Ottawa, ON, K1H 8M5, Canada
- Human Health Therapeutics Research Centre, National Research Council Canada, 1200 Montreal Road, Ottawa, ON, K1A 0R6, Canada
| | - Miroslava Cuperlovic-Culf
- Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
- Ottawa Institute of Systems Biology, University of Ottawa, ON, K1H 8M5, Canada
- National Research Council of Canada, Digital Technologies Research Centre, 1200 Montreal Road, Ottawa, ON, K1A 0R6, Canada
| | - Mary-Ellen Harper
- Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
- Ottawa Institute of Systems Biology, University of Ottawa, ON, K1H 8M5, Canada
- Centre for Infection, Immunity and Inflammation, University of Ottawa, ON, K1H 8M5, Canada
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15
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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.
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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
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16
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Yulug B, Ayyıldız B, Ayyıldız S, Sayman D, Salar AB, Cankaya S, Ozdemir Oktem E, Ozsimsek A, Kurt CC, Lakadamyalı H, Akturk A, Altay Ö, Hanoglu L, Velioglu HA, Mardinoglu A. Infection with COVID-19 is no longer a public emergency: But what about degenerative dementia? J Med Virol 2023; 95:e29072. [PMID: 37724347 DOI: 10.1002/jmv.29072] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/16/2023] [Accepted: 08/23/2023] [Indexed: 09/20/2023]
Abstract
Although no longer considered a public health threat, post-COVID cognitive syndrome continues to impact on a considerable proportion of individuals who were infected with COVID-19. Recent studies have also suggested that COVID may be represent a critical risk factor for the development of Alzheimer's disease (AD). We compared 17 COVID patients with 20 controls and evaluated the effects of COVID-19 on general cognitive performance, hippocampal volume, and connections using structural and seed-based connectivity analysis. We showed that COVID patients exhibited considerably worse cognitive functioning and increased hippocampal connectivity supported by the strong correlation between hippocampal connectivity and cognitive scores. Our findings of higher hippocampal connectivity with no observable hippocampal morphological changes even in mild COVID cases may be represent evidence of a prestructural compensatory mechanism for stimulating additional neuronal resources to combat cognitive dysfunction as recently shown for the prodromal stages of degenerative cognitive disorders. Our findings may be also important in light of recent data showing that other viral infections as well as COVID may constitute a critical risk factor for the development of AD. To our knowledge, this is the first study that investigated network differences in COVID patients, with a particular focus on compensatory hippocampal connectivity.
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Affiliation(s)
- Burak Yulug
- Department of Neurology and Neuroscience, Alanya Alaaddin Keykubat University, Antalya, Turkey
| | - Behçet Ayyıldız
- Anatomy PhD Program, Graduate School of Health Sciences, Kocaeli University, Istanbul, Turkey
| | - Sevilay Ayyıldız
- Anatomy PhD Program, Graduate School of Health Sciences, Kocaeli University, Istanbul, Turkey
- Department of Neuroradiology, School of Medicine, Technical University of Munich, Munich, Germany
- TUM-NIC Neuroimaging Center, School of Medicine, Technical University of Munich, Munich, Germany
| | - Dila Sayman
- Department of Neurology and Neuroscience, Alanya Alaaddin Keykubat University, Antalya, Turkey
| | - Ali Behram Salar
- Department of Neuroscience, Faculty of Medicine, Istanbul Medipol University, Istanbul, Türkiye
| | - Seyda Cankaya
- Department of Neurology and Neuroscience, Alanya Alaaddin Keykubat University, Antalya, Turkey
| | - Ece Ozdemir Oktem
- Department of Neurology and Neuroscience, Alanya Alaaddin Keykubat University, Antalya, Turkey
| | - Ahmet Ozsimsek
- Department of Neurology and Neuroscience, Alanya Alaaddin Keykubat University, Antalya, Turkey
| | - Cagla Ceren Kurt
- Department of Physiotherapy, Alanya Alaaddin Keykubat University, Antalya, Turkey
| | - Hatice Lakadamyalı
- Department of Radiology, Alanya Alaaddin Keykubat University, Antalya, Turkey
| | - Aynur Akturk
- Department of Neurology and Neuroscience, Alanya Alaaddin Keykubat University, Antalya, Turkey
| | - Özlem Altay
- KTH-Royal Institute of Technology, Stockholm, Sweden
| | - Lutfu Hanoglu
- Department of Neurology, Istanbul Medipol University, Istanbul, Turkey
| | - Halil Aziz Velioglu
- Department of Neuroscience, Faculty of Medicine, Istanbul Medipol University, Istanbul, Türkiye
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Adil Mardinoglu
- KTH-Royal Institute of Technology, Stockholm, Sweden
- King's College London, Faculty of Dentistry, London, UK
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17
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Aderinto N, Olatunji D, Abdulbasit M, Edun M. The essential role of neuroimaging in diagnosing and managing cerebrovascular disease in Africa: a review. Ann Med 2023; 55:2251490. [PMID: 37643607 PMCID: PMC10496522 DOI: 10.1080/07853890.2023.2251490] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/11/2023] [Accepted: 08/20/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Cerebrovascular disease is a significant cause of morbidity and mortality in Africa, and using neuroimaging techniques has improved the diagnosis and management of this disease. However, there is a lack of comprehensive reviews of the role and effectiveness of neuroimaging techniques in the African context. METHODS We reviewed the literature to evaluate the role of neuroimaging in diagnosing and managing cerebrovascular disease in Africa. Our search included electronic databases such as PubMed, Scopus, and Google Scholar from 2000 to April 2023. We included peer-reviewed studies written in English that reported on the use of neuroimaging in diagnosing and managing cerebrovascular disease in African populations. We excluded non-peer-reviewed articles, letters, editorials, and studies unrelated to cerebrovascular disease, neuroimaging, or Africa. A total of 102 potential articles were identified; after applying our exclusion criteria and removing duplicated articles, 51 articles were reviewed. RESULTS Our findings suggest that neuroimaging techniques such as CT, MRI, and Skull x-ray play a crucial role in diagnosing and managing cerebrovascular disease in Africa. CT and MRI were the most commonly used techniques, with CT being more widely available and less expensive than MRI. However, challenges to using neuroimaging in Africa include the high cost of equipment and maintenance, lack of trained personnel, and inadequate infrastructure. These challenges limit the widespread use of neuroimaging in diagnosing and managing cerebrovascular disease in Africa. CONCLUSION Neuroimaging techniques are essential for diagnosing and managing cerebrovascular disease in Africa, but challenges to their use must be addressed to improve healthcare outcomes. Our policy recommendations can help improve the availability and accessibility of neuroimaging services in Africa.
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Affiliation(s)
- Nicholas Aderinto
- Department of Medicine and Surgery, Ladoke Akintola University of Technology, Nigeria
| | - Deji Olatunji
- Department of Medicine and Surgery, University of Ilorin, Nigeria
| | - Muili Abdulbasit
- Department of Medicine and Surgery, Ladoke Akintola University of Technology, Nigeria
| | - Mariam Edun
- Department of Medicine and Surgery, University of Ilorin, Nigeria
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18
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Petersen M, Nägele FL, Mayer C, Schell M, Petersen E, Kühn S, Gallinat J, Fiehler J, Pasternak O, Matschke J, Glatzel M, Twerenbold R, Gerloff C, Thomalla G, Cheng B. Brain imaging and neuropsychological assessment of individuals recovered from a mild to moderate SARS-CoV-2 infection. Proc Natl Acad Sci U S A 2023; 120:e2217232120. [PMID: 37220275 PMCID: PMC10235949 DOI: 10.1073/pnas.2217232120] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 03/23/2023] [Indexed: 05/25/2023] Open
Abstract
As severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infections have been shown to affect the central nervous system, the investigation of associated alterations of brain structure and neuropsychological sequelae is crucial to help address future health care needs. Therefore, we performed a comprehensive neuroimaging and neuropsychological assessment of 223 nonvaccinated individuals recovered from a mild to moderate SARS-CoV-2 infection (100 female/123 male, age [years], mean ± SD, 55.54 ± 7.07; median 9.7 mo after infection) in comparison with 223 matched controls (93 female/130 male, 55.74 ± 6.60) within the framework of the Hamburg City Health Study. Primary study outcomes were advanced diffusion MRI measures of white matter microstructure, cortical thickness, white matter hyperintensity load, and neuropsychological test scores. Among all 11 MRI markers tested, significant differences were found in global measures of mean diffusivity (MD) and extracellular free water which were elevated in the white matter of post-SARS-CoV-2 individuals compared to matched controls (free water: 0.148 ± 0.018 vs. 0.142 ± 0.017, P < 0.001; MD [10-3 mm2/s]: 0.747 ± 0.021 vs. 0.740 ± 0.020, P < 0.001). Group classification accuracy based on diffusion imaging markers was up to 80%. Neuropsychological test scores did not significantly differ between groups. Collectively, our findings suggest that subtle changes in white matter extracellular water content last beyond the acute infection with SARS-CoV-2. However, in our sample, a mild to moderate SARS-CoV-2 infection was not associated with neuropsychological deficits, significant changes in cortical structure, or vascular lesions several months after recovery. External validation of our findings and longitudinal follow-up investigations are needed.
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Affiliation(s)
- Marvin Petersen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20251Hamburg, Germany
| | - Felix Leonard Nägele
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20251Hamburg, Germany
| | - Carola Mayer
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20251Hamburg, Germany
| | - Maximilian Schell
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20251Hamburg, Germany
| | - Elina Petersen
- Department of Cardiology, University Heart and Vascular Center, 20251Hamburg, Germany
- Population Health Research Department, University Heart and Vascular Center, 20251Hamburg, Germany
| | - Simone Kühn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20251Hamburg, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20251Hamburg, Germany
| | - Jens Fiehler
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, 20251Hamburg, Germany
| | - Ofer Pasternak
- Department of Psychiatry, Brigham and Women’s Hospital, Harvard Medical School, 202115Boston, MA
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 202Boston, MA
| | - Jakob Matschke
- Institute of Neuropathology, University Center Hamburg-Eppendorf, Hamburg, 20251Gemany
| | - Markus Glatzel
- Institute of Neuropathology, University Center Hamburg-Eppendorf, Hamburg, 20251Gemany
| | - Raphael Twerenbold
- Department of Cardiology, University Heart and Vascular Center, 20251Hamburg, Germany
- Population Health Research Department, University Heart and Vascular Center, 20251Hamburg, Germany
- German Center for Cardiovascular Research, Partner site Hamburg/Kiel/Luebeck, 20251Hamburg, Germany
- University Center of Cardiovascular Science, University Heart and Vascular Center, 202115Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20251Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20251Hamburg, Germany
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20251Hamburg, Germany
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19
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Salvato G, Inglese E, Fazia T, Crottini F, Crotti D, Valentini F, Palmas G, Bollani A, Basilico S, Gandola M, Gelosa G, Gentilini D, Bernardinelli L, Stracciari A, Scaglione F, Agostoni EC, Bottini G. The Association between Dysnatraemia during Hospitalisation and Post-COVID-19 Mental Fatigue. J Clin Med 2023; 12:jcm12113702. [PMID: 37297898 DOI: 10.3390/jcm12113702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/19/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
COVID-19 may induce short- and long-term cognitive failures after recovery, but the underlying risk factors are still controversial. Here, we investigated whether (i) the odds of experiencing persistent cognitive failures differ based on the patients' disease course severity and sex at birth; and (ii) the patients' electrolytic profile in the acute stage represents a risk factor for persistent cognitive failures. We analysed data from 204 patients suffering from COVID-19 and hospitalised during the first pandemic wave. According to the 7-point WHO-OS scale, their disease course was classified as severe or mild. We investigated the presence of persistent cognitive failures collected after hospital discharge, while electrolyte profiles were collected during hospitalisation. The results showed that females who suffered from a mild course compared to a severe course of COVID-19 had a higher risk of presenting with persistent mental fatigue after recovery. Furthermore, in females who suffered from a mild course of COVID-19, persistent mental fatigue was related to electrolyte imbalance, in terms of both hypo- and hypernatremia, during hospitalisation in the acute phase. These findings have important implications for the clinical management of hospitalised COVID-19 patients. Attention should be paid to potential electrolyte imbalances, mainly in females suffering from mild COVID-19.
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Affiliation(s)
- Gerardo Salvato
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Cognitive Neuropsychology Centre, ASST "Grande Ospedale Metropolitano" Niguarda, 20162 Milan, Italy
- NeuroMI, Milan Centre for Neuroscience, 20126 Milan, Italy
| | - Elvira Inglese
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Department of Laboratory Medicine, ASST "Grande Ospedale Metropolitano" Niguarda, 20162 Milan, Italy
| | - Teresa Fazia
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Francesco Crottini
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Daniele Crotti
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Federica Valentini
- Cognitive Neuropsychology Centre, ASST "Grande Ospedale Metropolitano" Niguarda, 20162 Milan, Italy
| | - Giulio Palmas
- Cognitive Neuropsychology Centre, ASST "Grande Ospedale Metropolitano" Niguarda, 20162 Milan, Italy
| | - Alessandra Bollani
- Cognitive Neuropsychology Centre, ASST "Grande Ospedale Metropolitano" Niguarda, 20162 Milan, Italy
| | - Stefania Basilico
- Cognitive Neuropsychology Centre, ASST "Grande Ospedale Metropolitano" Niguarda, 20162 Milan, Italy
- NeuroMI, Milan Centre for Neuroscience, 20126 Milan, Italy
| | - Martina Gandola
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Cognitive Neuropsychology Centre, ASST "Grande Ospedale Metropolitano" Niguarda, 20162 Milan, Italy
- NeuroMI, Milan Centre for Neuroscience, 20126 Milan, Italy
| | - Giorgio Gelosa
- NeuroMI, Milan Centre for Neuroscience, 20126 Milan, Italy
- Neurology Department, ASST "Grande Ospedale Metropolitano" Niguarda, 20162 Milan, Italy
| | - Davide Gentilini
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Bioinformatics and Statistical Genomic Unit, Istituto Auxologico Italiano IRCCS, 20095 Milan, Italy
| | - Luisa Bernardinelli
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Andrea Stracciari
- Department of Psychology, University of Bologna, 40126 Bologna, Italy
| | - Francesco Scaglione
- Department of Laboratory Medicine, ASST "Grande Ospedale Metropolitano" Niguarda, 20162 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Elio Clemente Agostoni
- NeuroMI, Milan Centre for Neuroscience, 20126 Milan, Italy
- Neurology Department, ASST "Grande Ospedale Metropolitano" Niguarda, 20162 Milan, Italy
| | - Gabriella Bottini
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Cognitive Neuropsychology Centre, ASST "Grande Ospedale Metropolitano" Niguarda, 20162 Milan, Italy
- NeuroMI, Milan Centre for Neuroscience, 20126 Milan, Italy
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Bendella Z, Widmann CN, Layer JP, Layer YL, Haase R, Sauer M, Bieler L, Lehnen NC, Paech D, Heneka MT, Radbruch A, Schmeel FC. Brain Volume Changes after COVID-19 Compared to Healthy Controls by Artificial Intelligence-Based MRI Volumetry. Diagnostics (Basel) 2023; 13:diagnostics13101716. [PMID: 37238200 DOI: 10.3390/diagnostics13101716] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/05/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Cohort studies that quantify volumetric brain data among individuals with different levels of COVID-19 severity are presently limited. It is still uncertain whether there exists a potential correlation between disease severity and the effects of COVID-19 on brain integrity. Our objective was to assess the potential impact of COVID-19 on measured brain volume in patients with asymptomatic/mild and severe disease after recovery from infection, compared with healthy controls, using artificial intelligence (AI)-based MRI volumetry. A total of 155 participants were prospectively enrolled in this IRB-approved analysis of three cohorts with a mild course of COVID-19 (n = 51, MILD), a severe hospitalised course (n = 48, SEV), and healthy controls (n = 56, CTL) all undergoing a standardised MRI protocol of the brain. Automated AI-based determination of various brain volumes in mL and calculation of normalised percentiles of brain volume was performed with mdbrain software, using a 3D T1-weighted magnetisation-prepared rapid gradient echo (MPRAGE) sequence. The automatically measured brain volumes and percentiles were analysed for differences between groups. The estimated influence of COVID-19 and demographic/clinical variables on brain volume was determined using multivariate analysis. There were statistically significant differences in measured brain volumes and percentiles of various brain regions among groups, even after the exclusion of patients undergoing intensive care, with significant volume reductions in COVID-19 patients, which increased with disease severity (SEV > MILD > CTL) and mainly affected the supratentorial grey matter, frontal and parietal lobes, and right thalamus. Severe COVID-19 infection, in addition to established demographic parameters such as age and sex, was a significant predictor of brain volume loss upon multivariate analysis. In conclusion, neocortical brain degeneration was detected in patients who had recovered from SARS-CoV-2 infection compared to healthy controls, worsening with greater initial COVID-19 severity and mainly affecting the fronto-parietal brain and right thalamus, regardless of ICU treatment. This suggests a direct link between COVID-19 infection and subsequent brain atrophy, which may have major implications for clinical management and future cognitive rehabilitation strategies.
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Affiliation(s)
- Zeynep Bendella
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Catherine Nichols Widmann
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
| | - Julian Philipp Layer
- Department of Radiation Oncology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany
- Institute of Experimental Oncology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany
| | - Yonah Lucas Layer
- Department of Radiation Oncology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany
| | - Robert Haase
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
| | - Malte Sauer
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
| | - Luzie Bieler
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany
| | - Nils Christian Lehnen
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
| | - Daniel Paech
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
| | - Michael T Heneka
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, 53127 Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
- Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-Belval, 4367 Luxembourg, Luxembourg
| | - Alexander Radbruch
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
| | - Frederic Carsten Schmeel
- Department of Neuroradiology, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universität Bonn, Venusberg-Campus 1, 53127 Bonn, Germany
- German Center for Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany
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21
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Liu TC, Yoo SM, Sim MS, Motwani Y, Viswanathan N, Wenger NS. Perceived Cognitive Deficits in Patients With Symptomatic SARS-CoV-2 and Their Association With Post-COVID-19 Condition. JAMA Netw Open 2023; 6:e2311974. [PMID: 37145596 DOI: 10.1001/jamanetworkopen.2023.11974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
Importance Neuropsychiatric symptoms are common in acute SARS-CoV-2 infection and in post-COVID-19 condition (PCC; colloquially known as long COVID), but the association between early presenting neuropsychiatric symptoms and PCC is unknown. Objective To describe the characteristics of patients with perceived cognitive deficits within the first 4 weeks of SARS-CoV-2 infection and the association of those deficits with PCC symptoms. Design, Setting, and Participants This prospective cohort study was conducted from April 2020 to February 2021, with follow-up of 60 to 90 days. The cohort consisted of adults enrolled in the University of California, Los Angeles, SARS-CoV-2 Ambulatory Program who had a laboratory-confirmed symptomatic SARS-CoV-2 infection and were either hospitalized in a University of California, Los Angeles, hospital or one of 20 local health care facilities, or were outpatients referred by a primary care clinician. Data analysis was performed from March 2022 to February 2023. Exposure Laboratory-confirmed SARS-CoV-2 infection. Main Outcomes and Measures Patients responded to surveys that included questions about perceived cognitive deficits modified from the Perceived Deficits Questionnaire, Fifth Edition, (ie, trouble being organized, trouble concentrating, and forgetfulness) and symptoms of PCC at 30, 60, and 90 days after hospital discharge or initial laboratory-confirmed infection of SARS-CoV-2. Perceived cognitive deficits were scored on a scale from 0 to 4. Development of PCC was determined by patient self-report of persistent symptoms 60 or 90 days after initial SARS-CoV-2 infection or hospital discharge. Results Of 1296 patients enrolled in the program, 766 (59.1%) (mean [SD] age, 60.0 [16.7] years; 399 men [52.1%]; 317 Hispanic/Latinx patients [41.4%]) completed the perceived cognitive deficit items at 30 days after hospital discharge or outpatient diagnosis. Of the 766 patients, 276 (36.1%) perceived a cognitive deficit, with 164 (21.4%) having a mean score of greater than 0 to 1.5 and 112 patients (14.6 %) having a mean score greater than 1.5. Prior cognitive difficulties (odds ratio [OR], 1.46; 95% CI, 1.16-1.83) and diagnosis of depressive disorder (OR, 1.51; 95% CI, 1.23-1.86) were associated with report of a perceived cognitive deficit. Patients reporting perceived cognitive deficits in the first 4 weeks of SARS-CoV-2 infection were more likely to report symptoms of PCC than those without perceived cognitive deficits (118 of 276 patients [42.8%] vs 105 of 490 patients [21.4%]; χ21, 38.9; P < .001). Adjusting for demographic and clinical factors, perceived cognitive deficits in the first 4 weeks of SARS-CoV-2 were associated with PCC symptoms (patients with a cognitive deficit score of >0 to 1.5: OR, 2.42; 95% CI, 1.62-3.60; patients with cognitive deficit score >1.5: OR, 2.97; 95% CI, 1.86-4.75) compared to patients who reported no perceived cognitive deficits. Conclusions and Relevance These findings suggest that patient-reported perceived cognitive deficits in the first 4 weeks of SARS-CoV-2 infection are associated with PCC symptoms and that there may be an affective component to PCC in some patients. The underlying reasons for PCC merit additional exploration.
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Affiliation(s)
- Teresa C Liu
- Division of General Internal Medicine & Health Services Research, Department of Medicine, University of California, Los Angeles
| | - Sun M Yoo
- Division of General Internal Medicine & Health Services Research, Department of Medicine, University of California, Los Angeles
| | - Myung S Sim
- Department of Medicine Statistics Core, University of California, Los Angeles
| | - Yash Motwani
- Department of Medicine Statistics Core, University of California, Los Angeles
| | - Nisha Viswanathan
- Division of General Internal Medicine & Health Services Research, Department of Medicine, University of California, Los Angeles
| | - Neil S Wenger
- Division of General Internal Medicine & Health Services Research, Department of Medicine, University of California, Los Angeles
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22
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Gelpi E, Klotz S, Beyerle M, Wischnewski S, Harter V, Kirschner H, Stolz K, Reisinger C, Lindeck-Pozza E, Zoufaly A, Leoni M, Gorkiewicz G, Zacharias M, Haberler C, Hainfellner J, Woehrer A, Hametner S, Roetzer T, Voigtländer T, Ricken G, Endmayr V, Haider C, Ludwig J, Polt A, Wilk G, Schmid S, Erben I, Nguyen A, Lang S, Simonitsch-Klupp I, Kornauth C, Nackenhorst M, Kläger J, Kain R, Chott A, Wasicky R, Krause R, Weiss G, Löffler-Rag J, Berger T, Moser P, Soleiman A, Asslaber M, Sedivy R, Klupp N, Klimpfinger M, Risser D, Budka H, Schirmer L, Pröbstel AK, Höftberger R. Multifactorial White Matter Damage in the Acute Phase and Pre-Existing Conditions May Drive Cognitive Dysfunction after SARS-CoV-2 Infection: Neuropathology-Based Evidence. Viruses 2023; 15:908. [PMID: 37112888 PMCID: PMC10144140 DOI: 10.3390/v15040908] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/24/2023] [Accepted: 03/27/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND There is an urgent need to better understand the mechanisms underlying acute and long-term neurological symptoms after COVID-19. Neuropathological studies can contribute to a better understanding of some of these mechanisms. METHODS We conducted a detailed postmortem neuropathological analysis of 32 patients who died due to COVID-19 during 2020 and 2021 in Austria. RESULTS All cases showed diffuse white matter damage with a diffuse microglial activation of a variable severity, including one case of hemorrhagic leukoencephalopathy. Some cases revealed mild inflammatory changes, including olfactory neuritis (25%), nodular brainstem encephalitis (31%), and cranial nerve neuritis (6%), which were similar to those observed in non-COVID-19 severely ill patients. One previously immunosuppressed patient developed acute herpes simplex encephalitis. Acute vascular pathologies (acute infarcts 22%, vascular thrombosis 12%, diffuse hypoxic-ischemic brain damage 40%) and pre-existing small vessel diseases (34%) were frequent findings. Moreover, silent neurodegenerative pathologies in elderly persons were common (AD neuropathologic changes 32%, age-related neuronal and glial tau pathologies 22%, Lewy bodies 9%, argyrophilic grain disease 12.5%, TDP43 pathology 6%). CONCLUSIONS Our results support some previous neuropathological findings of apparently multifactorial and most likely indirect brain damage in the context of SARS-CoV-2 infection rather than virus-specific damage, and they are in line with the recent experimental data on SARS-CoV-2-related diffuse white matter damage, microglial activation, and cytokine release.
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Affiliation(s)
- Ellen Gelpi
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Sigrid Klotz
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Miriam Beyerle
- Departments of Neurology, Biomedicine and Clinical Research, University Hospital and University of Basel, 4031 Basel, Switzerland; (M.B.); (A.-K.P.)
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Department of Clinical Research, University Hospital and University of Basel, 4031 Basel, Switzerland;
| | - Sven Wischnewski
- Department of Neurology, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany;
- Mannheim Center for Translational Neuroscience and Institute for Innate Immunoscience, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Verena Harter
- Department of Pathology, Klinik Favoriten, 1100 Vienna, Austria (H.K.); (R.S.); (M.K.)
| | - Harald Kirschner
- Department of Pathology, Klinik Favoriten, 1100 Vienna, Austria (H.K.); (R.S.); (M.K.)
| | - Katharina Stolz
- Department of Forensic Medicine, Medical University of Vienna, 1090 Vienna, Austria; (K.S.); (C.R.); (N.K.); (D.R.)
| | - Christoph Reisinger
- Department of Forensic Medicine, Medical University of Vienna, 1090 Vienna, Austria; (K.S.); (C.R.); (N.K.); (D.R.)
| | | | - Alexander Zoufaly
- Intensive Care Unit, Klinik Favoriten, 1100 Vienna, Austria;
- Faculty of Medicine, Sigmund Freud University, 1020 Vienna, Austria
| | - Marlene Leoni
- D&F Institute of Pathology, Neuropathology, Medical University Graz, 8036 Graz, Austria; (M.L.); (G.G.); (M.Z.); (M.A.)
| | - Gregor Gorkiewicz
- D&F Institute of Pathology, Neuropathology, Medical University Graz, 8036 Graz, Austria; (M.L.); (G.G.); (M.Z.); (M.A.)
| | - Martin Zacharias
- D&F Institute of Pathology, Neuropathology, Medical University Graz, 8036 Graz, Austria; (M.L.); (G.G.); (M.Z.); (M.A.)
| | - Christine Haberler
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Johannes Hainfellner
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Adelheid Woehrer
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Simon Hametner
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Thomas Roetzer
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Till Voigtländer
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Gerda Ricken
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Verena Endmayr
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Carmen Haider
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Judith Ludwig
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Andrea Polt
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Gloria Wilk
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Susanne Schmid
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Irene Erben
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Anita Nguyen
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Susanna Lang
- Department of Pathology, Medical University of Vienna, 1090 Vienna, Austria; (S.L.); (I.S.-K.); (C.K.); (M.N.); (R.K.)
| | - Ingrid Simonitsch-Klupp
- Department of Pathology, Medical University of Vienna, 1090 Vienna, Austria; (S.L.); (I.S.-K.); (C.K.); (M.N.); (R.K.)
| | - Christoph Kornauth
- Department of Pathology, Medical University of Vienna, 1090 Vienna, Austria; (S.L.); (I.S.-K.); (C.K.); (M.N.); (R.K.)
- Münchner Leukämielabor, 81377 Munich, Germany
| | - Maja Nackenhorst
- Department of Pathology, Medical University of Vienna, 1090 Vienna, Austria; (S.L.); (I.S.-K.); (C.K.); (M.N.); (R.K.)
| | - Johannes Kläger
- Department of Pathology, Medical University of Vienna, 1090 Vienna, Austria; (S.L.); (I.S.-K.); (C.K.); (M.N.); (R.K.)
| | - Renate Kain
- Department of Pathology, Medical University of Vienna, 1090 Vienna, Austria; (S.L.); (I.S.-K.); (C.K.); (M.N.); (R.K.)
| | - Andreas Chott
- Institute of Pathology, Klinik Ottakring, 1160 Vienna, Austria; (A.C.); (R.W.)
| | - Richard Wasicky
- Institute of Pathology, Klinik Ottakring, 1160 Vienna, Austria; (A.C.); (R.W.)
| | - Robert Krause
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria;
| | - Günter Weiss
- Department of Internal Medicine and Pulmonology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (G.W.); (J.L.-R.)
| | - Judith Löffler-Rag
- Department of Internal Medicine and Pulmonology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (G.W.); (J.L.-R.)
| | - Thomas Berger
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
- Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria
| | - Patrizia Moser
- Department of Neuropathology, Tirol Kliniken GmbH, 6020 Innsbruck, Austria; (P.M.); (A.S.)
| | - Afshin Soleiman
- Department of Neuropathology, Tirol Kliniken GmbH, 6020 Innsbruck, Austria; (P.M.); (A.S.)
| | - Martin Asslaber
- D&F Institute of Pathology, Neuropathology, Medical University Graz, 8036 Graz, Austria; (M.L.); (G.G.); (M.Z.); (M.A.)
| | - Roland Sedivy
- Department of Pathology, Klinik Favoriten, 1100 Vienna, Austria (H.K.); (R.S.); (M.K.)
| | - Nikolaus Klupp
- Department of Forensic Medicine, Medical University of Vienna, 1090 Vienna, Austria; (K.S.); (C.R.); (N.K.); (D.R.)
| | - Martin Klimpfinger
- Department of Pathology, Klinik Favoriten, 1100 Vienna, Austria (H.K.); (R.S.); (M.K.)
- Department of Pathology, Medical University of Vienna, 1090 Vienna, Austria; (S.L.); (I.S.-K.); (C.K.); (M.N.); (R.K.)
| | - Daniele Risser
- Department of Forensic Medicine, Medical University of Vienna, 1090 Vienna, Austria; (K.S.); (C.R.); (N.K.); (D.R.)
| | - Herbert Budka
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Lucas Schirmer
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Department of Clinical Research, University Hospital and University of Basel, 4031 Basel, Switzerland;
- Department of Neurology, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany;
- Interdisciplinary Center for Neurosciences, Heidelberg University, 69120 Heidelberg, Germany
| | - Anne-Katrin Pröbstel
- Departments of Neurology, Biomedicine and Clinical Research, University Hospital and University of Basel, 4031 Basel, Switzerland; (M.B.); (A.-K.P.)
- Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), Department of Clinical Research, University Hospital and University of Basel, 4031 Basel, Switzerland;
| | - Romana Höftberger
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria; (S.K.); (C.H.); (J.H.); (A.W.); (S.H.); (T.R.); (T.V.); (V.E.); (C.H.); (J.L.); (A.P.); (G.W.); (S.S.); (I.E.); (A.N.); (T.B.); (H.B.)
- Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, 1090 Vienna, Austria
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23
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Churchill NW, Roudaia E, Chen JJ, Gilboa A, Sekuler A, Ji X, Gao F, Lin Z, Jegatheesan A, Masellis M, Goubran M, Rabin JS, Lam B, Cheng I, Fowler R, Heyn C, Black SE, MacIntosh BJ, Graham SJ, Schweizer TA. Effects of post-acute COVID-19 syndrome on the functional brain networks of non-hospitalized individuals. Front Neurol 2023; 14:1136408. [PMID: 37051059 PMCID: PMC10083436 DOI: 10.3389/fneur.2023.1136408] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/07/2023] [Indexed: 03/29/2023] Open
Abstract
IntroductionThe long-term impact of COVID-19 on brain function remains poorly understood, despite growing concern surrounding post-acute COVID-19 syndrome (PACS). The goal of this cross-sectional, observational study was to determine whether there are significant alterations in resting brain function among non-hospitalized individuals with PACS, compared to symptomatic individuals with non-COVID infection.MethodsData were collected for 51 individuals who tested positive for COVID-19 (mean age 41±12 yrs., 34 female) and 15 controls who had cold and flu-like symptoms but tested negative for COVID-19 (mean age 41±14 yrs., 9 female), with both groups assessed an average of 4-5 months after COVID testing. None of the participants had prior neurologic, psychiatric, or cardiovascular illness. Resting brain function was assessed via functional magnetic resonance imaging (fMRI), and self-reported symptoms were recorded.ResultsIndividuals with COVID-19 had lower temporal and subcortical functional connectivity relative to controls. A greater number of ongoing post-COVID symptoms was also associated with altered functional connectivity between temporal, parietal, occipital and subcortical regions.DiscussionThese results provide preliminary evidence that patterns of functional connectivity distinguish PACS from non-COVID infection and correlate with the severity of clinical outcome, providing novel insights into this highly prevalent disorder.
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Affiliation(s)
- Nathan W. Churchill
- Neuroscience Research Program, St. Michael’s Hospital, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science of St. Michael’s Hospital, Toronto, ON, Canada
- Physics Department, Toronto Metropolitan University, Toronto, ON, Canada
- *Correspondence: Nathan W. Churchill,
| | - Eugenie Roudaia
- Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, ON, Canada
| | - J. Jean Chen
- Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Asaf Gilboa
- Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, ON, Canada
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Allison Sekuler
- Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, ON, Canada
- Department of Psychology, University of Toronto, Toronto, ON, Canada
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - Xiang Ji
- LC Campbell Cognitive Neurology Research Group, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Fuqiang Gao
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Zhongmin Lin
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Aravinthan Jegatheesan
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Mario Masellis
- Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, ON, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Maged Goubran
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Jennifer S. Rabin
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Benjamin Lam
- Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, ON, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Ivy Cheng
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
- Integrated Community Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Robert Fowler
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Emergency and Critical Care Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Chris Heyn
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Sandra E. Black
- Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, ON, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Bradley J. MacIntosh
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada
- Computational Radiology and Artificial Intelligence Unit, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Simon J. Graham
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Tom A. Schweizer
- Neuroscience Research Program, St. Michael’s Hospital, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science of St. Michael’s Hospital, Toronto, ON, Canada
- Faculty of Medicine (Neurosurgery), University of Toronto, Toronto, ON, Canada
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24
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Okrzeja J, Garkowski A, Kubas B, Moniuszko-Malinowska A. Imaging and neuropathological findings in patients with Post COVID-19 Neurological Syndrome-A review. Front Neurol 2023; 14:1136348. [PMID: 36846139 PMCID: PMC9947471 DOI: 10.3389/fneur.2023.1136348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/25/2023] [Indexed: 02/11/2023] Open
Abstract
Post COVID-19 syndrome is determined as signs and symptoms that appear during or after an infection consistent with SARS-CoV-2 disease, persist for more than 12 weeks and are not explained by an alternative diagnosis. This review presents the neuropathological findings and imaging findings in Post COVID-19 Neurological Syndrome: the focal point is on the manifestations of involvement evident on brain and spine imaging.
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Affiliation(s)
- Jakub Okrzeja
- Medical University of Białystok, Białystok, Poland,*Correspondence: Jakub Okrzeja ✉
| | - Adam Garkowski
- Department of Radiology, Medical University of Białystok, Białystok, Poland
| | - Bożena Kubas
- Department of Radiology, Medical University of Białystok, Białystok, Poland
| | - Anna Moniuszko-Malinowska
- Department of Infectious Diseases and Neuroinfections, Medical University of Białystok, Białystok, Poland
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25
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Rothstein TL. Cortical Grey matter volume depletion links to neurological sequelae in post COVID-19 "long haulers". BMC Neurol 2023; 23:22. [PMID: 36647063 PMCID: PMC9843113 DOI: 10.1186/s12883-023-03049-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 01/02/2023] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE COVID-19 (SARS-CoV-2) has been associated with neurological sequelae even in those patients with mild respiratory symptoms. Patients experiencing cognitive symptoms such as "brain fog" and other neurologic sequelae for 8 or more weeks define "long haulers". There is limited information regarding damage to grey matter (GM) structures occurring in COVID-19 "long haulers". Advanced imaging techniques can quantify brain volume depletions related to COVID-19 infection which is important as conventional Brain MRI often fails to identify disease correlates. 3-dimensional voxel-based morphometry (3D VBM) analyzes, segments and quantifies key brain volumes allowing comparisons between COVID-19 "long haulers" and normative data drawn from healthy controls, with values based on percentages of intracranial volume. METHODS This is a retrospective single center study which analyzed 24 consecutive COVID-19 infected patients with long term neurologic symptoms. Each patient underwent Brain MRI with 3D VBM at median time of 85 days following laboratory confirmation. All patients had relatively mild respiratory symptoms not requiring oxygen supplementation, hospitalization, or assisted ventilation. 3D VBM was obtained for whole brain and forebrain parenchyma, cortical grey matter (CGM), hippocampus, and thalamus. RESULTS The results demonstrate a statistically significant depletion of CGM volume in 24 COVID-19 infected patients. Reduced CGM volume likely influences their long term neurological sequelae and may impair post COVID-19 patient's quality of life and productivity. CONCLUSION This study contributes to understanding effects of COVID-19 infection on patient's neurocognitive and neurological function, with potential for producing serious long term personal and economic consequences, and ongoing challenges to public health systems.
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Affiliation(s)
- Ted L. Rothstein
- grid.253615.60000 0004 1936 9510Department of Neurology, George Washington University, Washington, DC USA
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26
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Golzari-Sorkheh M, Weaver DF, Reed MA. COVID-19 as a Risk Factor for Alzheimer's Disease. J Alzheimers Dis 2023; 91:1-23. [PMID: 36314211 DOI: 10.3233/jad-220800] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Severe acute respiratory disease coronavirus 2 (SARS-CoV-2) is responsible for the coronavirus disease 2019 (COVID-19) pandemic. Although a primarily respiratory disease, recent reports indicate that it also affects the central nervous system (CNS). Over 25% of COVID-19 patients report neurological symptoms such as memory loss, anosmia, hyposmia, confusion, and headaches. The neurological outcomes may be a result of viral entry into the CNS and/or resulting neuroinflammation, both of which underlie an elevated risk for Alzheimer's disease (AD). Herein, we ask: Is COVID-19 a risk factor for AD? To answer, we identify the literature and review mechanisms by which COVID-19-mediated neuroinflammation can contribute to the development of AD, evaluate the effects of acute versus chronic phases of infection, and lastly, discuss potential therapeutics to address the rising rates of COVID-19 neurological sequelae.
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Affiliation(s)
| | - Donald F Weaver
- Krembil Research Institute, University Health Network, Toronto, ON, Canada.,Department of Chemistry, University of Toronto, Toronto, ON, Canada.,Department of Pharmaceutical Chemistry, University of Toronto, Toronto, ON, Canada
| | - Mark A Reed
- Krembil Research Institute, University Health Network, Toronto, ON, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
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27
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Park J, Hung L, Randhawa P, Surage J, Sullivan M, Levine H, Ortega M. 'Now I can bend and meet people virtually in my home': The experience of a remotely supervised online chair yoga intervention and visual socialisation among older adults with dementia. Int J Older People Nurs 2023; 18:e12513. [PMID: 36373431 DOI: 10.1111/opn.12513] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 10/08/2022] [Accepted: 10/17/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Little research has been conducted on telehealth-based interventions in older adults. There has been no study of the use of telehealth-based online chair yoga (CY) to improve physical activity and manage dementia symptoms and socialisation for older adults with dementia who are socially isolated. OBJECTIVES The study identified benefits, challenges and facilitators in participating in remotely supervised online CY from the perspective of older adults with dementia and their caregivers, including what would help them to participate in online interventions. METHODS In a qualitative descriptive design, four online focus groups (two pre-intervention and two post-intervention) conducted via videoconference explored the benefits, challenges and facilitators in participating in a remotely supervised twice-weekly, 8-week online CY intervention. A total of 17 participants (eight people with dementia and nine family caregivers) attended the focus groups. The data were subjected to thematic analysis. RESULTS Thematic analysis of data identified three themes from the perspectives of older adults with dementia and their caregivers: (a) benefits (e.g. sleep and relaxation, emotional regulation, flexibility, muscle strength, convenience, caregiver-participant connection), (b) challenges (e.g. technological setup) and (c) lessons learned (e.g. inclusion of caregiver, yoga instructor, visual cues, socialisation, safety). The online intervention was beneficial to participants, who reported that they wanted to continue home-based online CY practice. CONCLUSION Convenience was the major advantage for the participant to continue to practice online CY. The online intervention offered virtual socialisation, which could be significant for motivating older adults to continue the CY program. IMPLICATIONS FOR PRACTICE Gerontological nurses could add CY as a nonpharmacological component of a treatment plan and monitor older adults' progress during the online intervention. The home-based online CY intervention should be prioritised to promote health and wellness in socially isolated older adults with dementia.
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Affiliation(s)
- Juyoung Park
- Florida Atlantic University, Phyllis and Harvey Sandler School of Social Work, Florida, USA
| | - Lillian Hung
- The University of British Columbia, School of Nursing, Vancouver, Canada
| | | | - Jayshree Surage
- Integrative Health Sciences, Maryland University of Integrative Health, Laurel, Maryland, USA
| | - Marlysa Sullivan
- Integrative Health Sciences, Maryland University of Integrative Health, Laurel, Maryland, USA
| | - Hannah Levine
- Charles E. Schmidt College of Medicine, Marcus Institute of Integrative Health at FAU Medicine, Florida Atlantic University, Florida, USA
| | - María Ortega
- Louis and Anne Green Memory and Wellness Center of the Christine E. Lynn College of Nursing, Florida Atlantic University, Florida, USA
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28
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Respiratory psychophysiology and COVID-19: A research agenda. Biol Psychol 2023; 176:108473. [PMID: 36535514 PMCID: PMC9756651 DOI: 10.1016/j.biopsycho.2022.108473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 12/03/2022] [Accepted: 12/04/2022] [Indexed: 12/23/2022]
Abstract
After multiple waves of the COVID-19 pandemic, it has become clear that the impact of SARS-CoV-2 will carry on for years to come. Acutely infected patients show a broad range of disease severity, depending on virus variant, vaccination status, age and the presence of underlying medical and physical conditions, including obesity. Additionally, a large number of patients who have been infected with the virus present with post-COVID syndrome. In September 2020, the International Society for the Advancement of Respiratory Psychophysiology organized a virtual interest meeting on 'Respiratory research in the age of COVID-19', which aimed to discuss how research in respiratory psychophysiology could contribute to a better understanding of psychophysiological interactions in COVID-19. In the resulting current paper, we propose an interdisciplinary research agenda discussing selected research questions on acute and long-term neurobiological, physiological and psychological outcomes and mechanisms related to respiration and the airways in COVID-19, as well as research questions on comorbidity and potential treatment options, such as physical rehabilitation.
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29
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Kim WSH, Ji X, Roudaia E, Chen JJ, Gilboa A, Sekuler A, Gao F, Lin Z, Jegatheesan A, Masellis M, Goubran M, Rabin JS, Lam B, Cheng I, Fowler R, Heyn C, Black SE, Graham SJ, MacIntosh BJ. MRI Assessment of Cerebral Blood Flow in Nonhospitalized Adults Who Self-Isolated Due to COVID-19. J Magn Reson Imaging 2022. [PMID: 36472248 PMCID: PMC9877942 DOI: 10.1002/jmri.28555] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Neurological symptoms associated with coronavirus disease 2019 (COVID-19), such as fatigue and smell/taste changes, persist beyond infection. However, little is known of brain physiology in the post-COVID-19 timeframe. PURPOSE To determine whether adults who experienced flu-like symptoms due to COVID-19 would exhibit cerebral blood flow (CBF) alterations in the weeks/months beyond infection, relative to controls who experienced flu-like symptoms but tested negative for COVID-19. STUDY TYPE Prospective observational. POPULATION A total of 39 adults who previously self-isolated at home due to COVID-19 (41.9 ± 12.6 years of age, 59% female, 116.5 ± 62.2 days since positive diagnosis) and 11 controls who experienced flu-like symptoms but had a negative COVID-19 diagnosis (41.5 ± 13.4 years of age, 55% female, 112.1 ± 59.5 since negative diagnosis). FIELD STRENGTH AND SEQUENCES A 3.0 T; T1-weighted magnetization-prepared rapid gradient and echo-planar turbo gradient-spin echo arterial spin labeling sequences. ASSESSMENT Arterial spin labeling was used to estimate CBF. A self-reported questionnaire assessed symptoms, including ongoing fatigue. CBF was compared between COVID-19 and control groups and between those with (n = 11) and without self-reported ongoing fatigue (n = 28) within the COVID-19 group. STATISTICAL TESTS Between-group and within-group comparisons of CBF were performed in a voxel-wise manner, controlling for age and sex, at a family-wise error rate of 0.05. RESULTS Relative to controls, the COVID-19 group exhibited significantly decreased CBF in subcortical regions including the thalamus, orbitofrontal cortex, and basal ganglia (maximum cluster size = 6012 voxels and maximum t-statistic = 5.21). Within the COVID-19 group, significant CBF differences in occipital and parietal regions were observed between those with and without self-reported on-going fatigue. DATA CONCLUSION These cross-sectional data revealed regional CBF decreases in the COVID-19 group, suggesting the relevance of brain physiology in the post-COVID-19 timeframe. This research may help elucidate the heterogeneous symptoms of the post-COVID-19 condition. EVIDENCE LEVEL 2. TECHNICAL EFFICACY Stage 3.
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Affiliation(s)
- William S H Kim
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Xiang Ji
- LC Campbell Cognitive Neurology Research Group, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Eugenie Roudaia
- Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, Ontario, Canada
| | - J Jean Chen
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, Ontario, Canada.,Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Asaf Gilboa
- Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Allison Sekuler
- Rotman Research Institute, Baycrest Academy for Research and Education, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto, Toronto, Ontario, Canada.,Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Fuqiang Gao
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,LC Campbell Cognitive Neurology Research Group, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Zhongmin Lin
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Aravinthan Jegatheesan
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Mario Masellis
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,LC Campbell Cognitive Neurology Research Group, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Maged Goubran
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Jennifer S Rabin
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin Lam
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,LC Campbell Cognitive Neurology Research Group, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ivy Cheng
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Integrated Community Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Robert Fowler
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Emergency & Critical Care Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Chris Heyn
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Sandra E Black
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,LC Campbell Cognitive Neurology Research Group, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Simon J Graham
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Bradley J MacIntosh
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Computational Radiology & Artificial Intelligence Unit, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
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30
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Petr J, Keil VC. Editorial for "MRI Assessment of Cerebral Blood Flow in Non-Hospitalized Adults Who Self-Isolated Due to COVID-19". J Magn Reson Imaging 2022:10.1002/jmri.28556. [PMID: 36458970 PMCID: PMC9878232 DOI: 10.1002/jmri.28556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 12/05/2022] Open
Affiliation(s)
- Jan Petr
- Helmholtz‐Zentrum Dresden‐Rossendorf, Institute of Radiopharmaceutical Cancer ResearchDresdenGermany,Department of Radiology and Nuclear MedicineAmsterdam University Medical CenterAmsterdamThe Netherlands
| | - Vera C. Keil
- Department of Radiology and Nuclear MedicineAmsterdam University Medical CenterAmsterdamThe Netherlands,Amsterdam NeuroscienceAmsterdam University Medical CenterAmsterdamThe Netherlands
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31
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Pavel B, Moroti R, Spataru A, Popescu MR, Panaitescu AM, Zagrean AM. Neurological Manifestations of SARS-CoV2 Infection: A Narrative Review. Brain Sci 2022; 12:1531. [PMID: 36421855 PMCID: PMC9688734 DOI: 10.3390/brainsci12111531] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 08/30/2023] Open
Abstract
The COVID-19 virus frequently causes neurological complications. These have been described in various forms in adults and children. Headache, seizures, coma, and encephalitis are some of the manifestations of SARS-CoV-2-induced neurological impairment. Recent publications have revealed important aspects of viral pathophysiology and its involvement in nervous-system impairment in humans. We evaluated the latest literature describing the relationship between COVID-19 infection and the central nervous system. We searched three databases for observational and interventional studies in adults published between December 2019 and September 2022. We discussed in narrative form the neurological impairment associated with COVID-19, including clinical signs and symptoms, imaging abnormalities, and the pathophysiology of SARS-CoV2-induced neurological damage.
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Affiliation(s)
- Bogdan Pavel
- Department of Functional Sciences, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Clinical Emergency Hospital of Plastic, Reconstructive Surgery and Burns, 010713 Bucharest, Romania
| | - Ruxandra Moroti
- Clinical Department 2, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Matei Bals National Institute of Infectious Diseases, 021105 Bucharest, Romania
| | - Ana Spataru
- Department of Critical Care, King’s College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Mihaela Roxana Popescu
- Cardiothoracic Medicine Department, University of Medicine and Pharmacy Carol Davila, 020021 Bucharest, Romania
- Department of Cardiology, Elias Emergency University Hospital, 011461 Bucharest, Romania
| | - Anca Maria Panaitescu
- Department of Obstetrics and Gynecology Filantropia Clinical Hospital Bucharest, 011171 Bucharest, Romania
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Ana-Maria Zagrean
- Department of Functional Sciences, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
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32
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Desai DD, Yu SE, Salvatore B, Goldberg Z, Bowers EMR, Moore JA, Phan B, Lee SE. Olfactory and neurological outcomes of SARS-CoV-2 from acute infection to recovery. FRONTIERS IN ALLERGY 2022; 3:1019274. [DOI: 10.3389/falgy.2022.1019274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/07/2022] [Indexed: 11/07/2022] Open
Abstract
Educational objectiveTo investigate the impact of SARS-CoV-2 on sinonasal quality of life, olfaction, and cognition at different stages of viral infection and evaluate the association between olfaction and cognition in this population cohort.ObjectivesWhile olfactory dysfunction (OD) is a frequently reported symptom of COVID-19 (98% prevalence), neurocognitive symptoms are becoming more apparent as patients recover from infection. This study aims to address how different stages of infection [active infection (positive PCR test, symptomatic) vs. recovered (7 days post-symptoms)] compared to healthy control patients influence sinonasal quality of life, olfactory function, and cognition.Study designProspective, longitudinal, case-control.MethodsParticipants completed the SNOT-22, University of Pennsylvania Smell Identification Test (UPSIT) and validated cognitive examinations to assess degree of smell loss and neurocognitive function at baseline and at 1 and 3 months for the active group and 3 months for the recovered group. Self-reported olfactory function and overall health metrics were also collected.ResultsThe recovered group had the lowest average UPSIT score of 27.6 compared to 32.7 (active) and 32.6 (healthy control). 80% (n = 24) of the recovered patients and 56.3% (n = 9) of the active patients suffered from smell loss. In follow-up, the active group showed improvement in UPSIT scores while the recovered group scores worsened. In terms of neurocognitive performance, recovered patients had lower processing speed despite an improving UPSIT score.ConclusionSARS-CoV-2 infection was found to impact olfactory function in a delayed fashion with significant impact despite recovery from active infection. Although olfactory function improved, decrements in cognitive processing speed were detected in our cohort.
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The impact of social isolation due to the COVID-19 pandemic on patients with dementia and caregivers. Acta Neuropsychiatr 2022; 34:276-281. [PMID: 35369891 DOI: 10.1017/neu.2022.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Social distancing to limit COVID-19 transmission has led to extensive lifestyle changes, including for people with dementia (PWD). The aim of this study, therefore, was to assess the impact of lockdown on the mental health of PWD and their carers. METHODS Forty-five carers of PWD completed a telephone interview during the baseline assessment of the SOLITUDE study to gather information on life conditions and changes in symptoms of PWD during lockdown. Associations between changes in symptoms of PWD and carers' concerns and mental health were investigated. RESULTS About 44% of carers experienced anxiety and irritability and reported changes in behavioural and cognitive symptoms in PWD. These changes were associated with worse carers' mental health and concerns about faster disease progression (χ2 = 13.542, p < 0.001). CONCLUSION COVID-19-related social isolation has had a negative impact on patients' and carers' mental health. Potential long-term neurocognitive consequences require further investigation.
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Busatto GF, de Araujo AL, Castaldelli-Maia JM, Damiano RF, Imamura M, Guedes BF, de Rezende Pinna F, Sawamura MVY, Mancini MC, da Silva KR, Garcia ML, Sumita N, Brunoni AR, da Silva Duarte AJ, Burdmann EA, Kallas EG, Cerri GG, Nitrini R, Bento RF, Rocha VG, de Souza HP, Miguel EC, de Carvalho CRR, Forlenza OV, Batistella LR. Post-acute sequelae of SARS-CoV-2 infection: relationship of central nervous system manifestations with physical disability and systemic inflammation. Psychol Med 2022; 52:2387-2398. [PMID: 35521752 PMCID: PMC9151630 DOI: 10.1017/s0033291722001374] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Despite the multitude of clinical manifestations of post-acute sequelae of SARS-CoV-2 infection (PASC), studies applying statistical methods to directly investigate patterns of symptom co-occurrence and their biological correlates are scarce. METHODS We assessed 30 symptoms pertaining to different organ systems in 749 adults (age = 55 ± 14 years; 47% female) during in-person visits conducted at 6-11 months after hospitalization due to coronavirus disease 2019 (COVID-19), including six psychiatric and cognitive manifestations. Symptom co-occurrence was initially investigated using exploratory factor analysis (EFA), and latent variable modeling was then conducted using Item Response Theory (IRT). We investigated associations of latent variable severity with objective indices of persistent physical disability, pulmonary and kidney dysfunction, and C-reactive protein and D-dimer blood levels, measured at the same follow-up assessment. RESULTS The EFA extracted one factor, explaining 64.8% of variance; loadings were positive for all symptoms, and above 0.35 for 16 of them. The latent trait generated using IRT placed fatigue, psychiatric, and cognitive manifestations as the most discriminative symptoms (coefficients > 1.5, p < 0.001). Latent trait severity was associated with decreased body weight and poorer physical performance (coefficients > 0.240; p ⩽ 0.003), and elevated blood levels of C-reactive protein (coefficient = 0.378; 95% CI 0.215-0.541; p < 0.001) and D-dimer (coefficient = 0.412; 95% CI 0.123-0.702; p = 0.005). Results were similar after excluding subjects with pro-inflammatory comorbidities. CONCLUSIONS Different symptoms that persist for several months after moderate or severe COVID-19 may unite within one latent trait of PASC. This trait is dominated by fatigue and psychiatric symptoms, and is associated with objective signs of physical disability and persistent systemic inflammation.
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Affiliation(s)
- Geraldo F. Busatto
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
- Diretoria Executiva dos LIMs, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Adriana Ladeira de Araujo
- Diretoria Executiva dos LIMs, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - João Mauricio Castaldelli-Maia
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
- Departamento de Neurociências, Centro Universitário da Faculdade de Medicina do ABC, São Paulo, SP, Brasil
| | - Rodolfo Furlan Damiano
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Marta Imamura
- Departamento de Medicina Legal, Etica Medica e Medicina Social e do Trabalho, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Bruno F. Guedes
- Departamento de Neurologia, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Fabio de Rezende Pinna
- Departamento de Oftalmologia e Otorrinolaringologia, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Marcio Valente Yamada Sawamura
- Departamento de Radiologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Márcio C. Mancini
- Unidade de Obesidade e Síndrome Metabólica, Disciplina de Endocrinologia e Metabologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Katia R. da Silva
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Michelle L. Garcia
- Divisão de Pneumologia, Instituto do Coração, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Nairo Sumita
- Departamento de Patologia Clínica, LIM/03 – Laboratório de Medicina Laboratorial, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Andre Russowsky Brunoni
- Departamento de Clínica Médica, LIM/27 – Laboratório de Neurociências, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Alberto J. da Silva Duarte
- Departamento de Dermatologia, Laboratório de Dermatologia e Imunodeficiências, LIM-56, Faculdade de Medicina e Instituto de Medicina Tropical de São Paulo, São Paulo, SP, Brasil
| | - Emmanuel A. Burdmann
- Departamento de Clínica Médica, LIM/12 – Laboratório de Pesquisa Básica em Doenças Renais, Disciplina de Nefrologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Esper G. Kallas
- Departamento de Moléstias Infecciosas e Parasitárias, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Giovanni G. Cerri
- Departamento de Radiologia, Faculdade de Medicina, LIM/44, Laboratório de Ressonância Magnética em Neurorradiologia Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brasil
| | - Ricardo Nitrini
- Departamento de Neurologia, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Ricardo F. Bento
- Departamento de Oftalmologia e Otorrinolaringologia, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
- Divisão de Otorrinolaringologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Vanderson Geraldo Rocha
- Serviço de Hematologia, Hemoterapia e Terapia Celular, Divisão de Clínica Médica I do ICHC, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Heraldo Possolo de Souza
- Departamento de Clínica Médica, Disciplina de Emergências Clínicas, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Euripedes C. Miguel
- Departamento e Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Carlos R. R. de Carvalho
- Divisão de Pneumologia, Instituto do Coração, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Orestes V. Forlenza
- Departamento e Instituto de Psiquiatria, Laboratório de Neurociências – LIM-27, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
| | - Linamara Rizzo Batistella
- Departamento de Medicina Legal, Etica Medica e Medicina Social e do Trabalho, Faculdade de Medicina da Universidade de São Paulo HCFMUSP, São Paulo, SP, Brasil
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2-[ 18F]-FDG PET for imaging brain involvement in patients with long COVID: perspective of the EANM Neuroimaging Committee. Eur J Nucl Med Mol Imaging 2022; 49:3599-3606. [PMID: 35840817 PMCID: PMC9286958 DOI: 10.1007/s00259-022-05913-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Koc HC, Xiao J, Liu W, Li Y, Chen G. Long COVID and its Management. Int J Biol Sci 2022; 18:4768-4780. [PMID: 35874958 PMCID: PMC9305273 DOI: 10.7150/ijbs.75056] [Citation(s) in RCA: 79] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/22/2022] [Indexed: 12/12/2022] Open
Abstract
The pandemic of COVID-19 is the biggest public health crisis in 21st Century. Besides the acute symptoms after infection, patients and society are also being challenged by the long-term health complications associated with COVID-19, commonly known as long COVID. While health professionals work hard to find proper treatments, large amount of knowledge has been accumulated in recent years. In order to deal with long COVID efficiently, it is important for people to keep up with current progresses and take proactive actions on long COVID. For this purpose, this review will first introduce the general background of long COVID, and then discuss its risk factors, diagnostic indicators and management strategies. This review will serve as a useful resource for people to understand and prepare for long COVID that will be with us in the foreseeable future.
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Affiliation(s)
- Ho Cheng Koc
- Centre of Reproduction, Development & Aging, Faculty of Health Sciences, University of Macau, Taipa, Macau, China
- Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Taipa, Macau, China
| | - Jing Xiao
- Centre of Reproduction, Development & Aging, Faculty of Health Sciences, University of Macau, Taipa, Macau, China
- Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Taipa, Macau, China
- Interventional Medical Centre, Zhuhai People's Hospital, Zhuhai Hospital Affiliated with Jinan University, Zhuhai 519000, China
| | - Weiwei Liu
- Centre of Reproduction, Development & Aging, Faculty of Health Sciences, University of Macau, Taipa, Macau, China
- Bioimaging and Stem Cell Core Facility, Faculty of Health Sciences, University of Macau, Taipa, Macau, China
| | - Yong Li
- Interventional Medical Centre, Zhuhai People's Hospital, Zhuhai Hospital Affiliated with Jinan University, Zhuhai 519000, China
| | - Guokai Chen
- Centre of Reproduction, Development & Aging, Faculty of Health Sciences, University of Macau, Taipa, Macau, China
- Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Taipa, Macau, China
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Liu X, Yan W, Lu T, Han Y, Lu L. Longitudinal Abnormalities in Brain Structure in COVID-19 Patients. Neurosci Bull 2022; 38:1608-1612. [PMID: 35794292 PMCID: PMC9261203 DOI: 10.1007/s12264-022-00913-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/05/2022] [Indexed: 02/07/2023] Open
Affiliation(s)
- Xiaoxing Liu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191 China
| | - Wei Yan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191 China
| | - Tangsheng Lu
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, 100191 China
| | - Ying Han
- National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, 100191 China
| | - Lin Lu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191 China ,Peking-Tsinghua Center for Life Sciences and PKU-IDG/McGovern Institute for Brain Research, Peking University, Beijing, 100871 China
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Douaud G, Lee S, Alfaro-Almagro F, Arthofer C, Wang C, McCarthy P, Lange F, Andersson JLR, Griffanti L, Duff E, Jbabdi S, Taschler B, Keating P, Winkler AM, Collins R, Matthews PM, Allen N, Miller KL, Nichols TE, Smith SM. SARS-CoV-2 is associated with changes in brain structure in UK Biobank. Nature 2022. [DOI: 10.1038/s41586-022-04569-5 3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AbstractThere is strong evidence of brain-related abnormalities in COVID-191–13. However, it remains unknown whether the impact of SARS-CoV-2 infection can be detected in milder cases, and whether this can reveal possible mechanisms contributing to brain pathology. Here we investigated brain changes in 785 participants of UK Biobank (aged 51–81 years) who were imaged twice using magnetic resonance imaging, including 401 cases who tested positive for infection with SARS-CoV-2 between their two scans—with 141 days on average separating their diagnosis and the second scan—as well as 384 controls. The availability of pre-infection imaging data reduces the likelihood of pre-existing risk factors being misinterpreted as disease effects. We identified significant longitudinal effects when comparing the two groups, including (1) a greater reduction in grey matter thickness and tissue contrast in the orbitofrontal cortex and parahippocampal gyrus; (2) greater changes in markers of tissue damage in regions that are functionally connected to the primary olfactory cortex; and (3) a greater reduction in global brain size in the SARS-CoV-2 cases. The participants who were infected with SARS-CoV-2 also showed on average a greater cognitive decline between the two time points. Importantly, these imaging and cognitive longitudinal effects were still observed after excluding the 15 patients who had been hospitalised. These mainly limbic brain imaging results may be the in vivo hallmarks of a degenerative spread of the disease through olfactory pathways, of neuroinflammatory events, or of the loss of sensory input due to anosmia. Whether this deleterious effect can be partially reversed, or whether these effects will persist in the long term, remains to be investigated with additional follow-up.
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Douaud G, Lee S, Alfaro-Almagro F, Arthofer C, Wang C, McCarthy P, Lange F, Andersson JLR, Griffanti L, Duff E, Jbabdi S, Taschler B, Keating P, Winkler AM, Collins R, Matthews PM, Allen N, Miller KL, Nichols TE, Smith SM. SARS-CoV-2 is associated with changes in brain structure in UK Biobank. Nature 2022; 604:697-707. [PMID: 35255491 PMCID: PMC9046077 DOI: 10.1038/s41586-022-04569-5] [Citation(s) in RCA: 782] [Impact Index Per Article: 391.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 02/21/2022] [Indexed: 01/01/2023]
Abstract
There is strong evidence of brain-related abnormalities in COVID-191-13. However, it remains unknown whether the impact of SARS-CoV-2 infection can be detected in milder cases, and whether this can reveal possible mechanisms contributing to brain pathology. Here we investigated brain changes in 785 participants of UK Biobank (aged 51-81 years) who were imaged twice using magnetic resonance imaging, including 401 cases who tested positive for infection with SARS-CoV-2 between their two scans-with 141 days on average separating their diagnosis and the second scan-as well as 384 controls. The availability of pre-infection imaging data reduces the likelihood of pre-existing risk factors being misinterpreted as disease effects. We identified significant longitudinal effects when comparing the two groups, including (1) a greater reduction in grey matter thickness and tissue contrast in the orbitofrontal cortex and parahippocampal gyrus; (2) greater changes in markers of tissue damage in regions that are functionally connected to the primary olfactory cortex; and (3) a greater reduction in global brain size in the SARS-CoV-2 cases. The participants who were infected with SARS-CoV-2 also showed on average a greater cognitive decline between the two time points. Importantly, these imaging and cognitive longitudinal effects were still observed after excluding the 15 patients who had been hospitalised. These mainly limbic brain imaging results may be the in vivo hallmarks of a degenerative spread of the disease through olfactory pathways, of neuroinflammatory events, or of the loss of sensory input due to anosmia. Whether this deleterious effect can be partially reversed, or whether these effects will persist in the long term, remains to be investigated with additional follow-up.
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Affiliation(s)
- Gwenaëlle Douaud
- FMRIB Centre, Wellcome Centre for Integrative Neuroimaging (WIN), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
| | - Soojin Lee
- FMRIB Centre, Wellcome Centre for Integrative Neuroimaging (WIN), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Fidel Alfaro-Almagro
- FMRIB Centre, Wellcome Centre for Integrative Neuroimaging (WIN), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Christoph Arthofer
- FMRIB Centre, Wellcome Centre for Integrative Neuroimaging (WIN), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Chaoyue Wang
- FMRIB Centre, Wellcome Centre for Integrative Neuroimaging (WIN), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Paul McCarthy
- FMRIB Centre, Wellcome Centre for Integrative Neuroimaging (WIN), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Frederik Lange
- FMRIB Centre, Wellcome Centre for Integrative Neuroimaging (WIN), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Jesper L R Andersson
- FMRIB Centre, Wellcome Centre for Integrative Neuroimaging (WIN), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Ludovica Griffanti
- FMRIB Centre, Wellcome Centre for Integrative Neuroimaging (WIN), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- OHBA, Wellcome Centre for Integrative Neuroimaging (WIN), Department of Psychiatry, University of Oxford, Oxford, UK
| | - Eugene Duff
- FMRIB Centre, Wellcome Centre for Integrative Neuroimaging (WIN), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Saad Jbabdi
- FMRIB Centre, Wellcome Centre for Integrative Neuroimaging (WIN), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Bernd Taschler
- FMRIB Centre, Wellcome Centre for Integrative Neuroimaging (WIN), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Peter Keating
- Ear Institute, University College London, London, UK
| | - Anderson M Winkler
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Rory Collins
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Paul M Matthews
- UK Dementia Research Institute and Department of Brain Sciences, Imperial College, London, UK
| | - Naomi Allen
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Karla L Miller
- FMRIB Centre, Wellcome Centre for Integrative Neuroimaging (WIN), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - Stephen M Smith
- FMRIB Centre, Wellcome Centre for Integrative Neuroimaging (WIN), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Hugon J, Queneau M, Sanchez Ortiz M, Msika EF, Farid K, Paquet C. Cognitive decline and brainstem hypometabolism in long COVID: A case series. Brain Behav 2022; 12:e2513. [PMID: 35290729 PMCID: PMC9014998 DOI: 10.1002/brb3.2513] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/11/2021] [Accepted: 01/11/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To assess FDG cerebral PET in patients suffering from cognitive impairment linked to Long COVID. The COVID pandemic has affected dozens of millions of people around the world and has resulted in the deaths of more than 3 million people. Following the acute forms, it has been reported sometimes long forms of COVID, with involvements of several organs including the brain. Neurological complications can include cognitive disturbances (brain fog) that are very common and can seriously disturb the life of patients. METHODS Fluorodeoxyglucose PETs were performed in 3 patients with cognitive decline following COVID infection. RESULTS We report here 3 cases of brain fog with major hypometabolic areas of the pons revealed by the cerebral FDG PET. CONCLUSION The dysfunction of the locus coeruleus in these patients could partly explain the cognitive disorders observed. Further studies involving larger cohorts of patients suffering from cognitive dysfunction will be needed to determine if the brainstem is frequently affected in these patients.
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Affiliation(s)
- Jacques Hugon
- Center of Cognitive Neurology, University of Paris, Lariboisière FW Hospital, APHP, Inserm 1184, Paris, France.,Memory Clinic, Paris, France
| | - Mathieu Queneau
- Department of Molecular Imaging, North Cardiologic Center, Saint Denis, France
| | - Marta Sanchez Ortiz
- Center of Cognitive Neurology, University of Paris, Lariboisière FW Hospital, APHP, Inserm 1184, Paris, France
| | | | - Karim Farid
- Department of Molecular Medicine, CHU Fort de France, Martinique, France
| | - Claire Paquet
- Center of Cognitive Neurology, University of Paris, Lariboisière FW Hospital, APHP, Inserm 1184, Paris, France
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Verger A, Kas A, Dudouet P, Goehringer F, Salmon-Ceron D, Guedj E. Visual interpretation of brain hypometabolism related to neurological long COVID: a French multicentric experience. Eur J Nucl Med Mol Imaging 2022; 49:3197-3202. [PMID: 35320385 PMCID: PMC8941296 DOI: 10.1007/s00259-022-05753-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/01/2022] [Indexed: 11/30/2022]
Abstract
Background This multicentre study aimed to provide a qualitative and consensual description of brain hypometabolism observed through the visual analysis of 18F-FDG PET images of patients with suspected neurological long COVID, regarding the previously reported long-COVID hypometabolic pattern involving hypometabolism in the olfactory bulbs and other limbic/paralimbic regions, as well as in the brainstem and cerebellum. Methods From the beginning of August 2021 to the end of October 2021, the brain 18F-FDG PET scans of patients referred for suspected neurological long COVID with positive reverse transcription polymerase chain reaction (RT-PCR) and/or serology tests for SARS-CoV-2 infection were retrospectively reviewed in three French nuclear medicine departments (143 patients; 47.4 years old ± 13.6; 98 women). Experienced nuclear physicians from each department classified brain 18F-FDG PET scans according to the same visual interpretation analysis as being normal, mildly to moderately (or incompletely) affected, or otherwise severely affected within the previously reported long-COVID hypometabolic pattern. Results On the 143 brain 18F-FDG PET scans performed during this 3-month period, 53% of the scans were visually interpreted as normal, 21% as mildly to moderately or incompletely affected, and 26% as severely affected according to the COVID hypometabolic pattern. On average, PET scans were performed at 10.9 months from symptom onset (± 4.8). Importantly, this specific hypometabolic pattern was similarly identified in the three nuclear medicine departments. Typical illustrative examples are provided to help nuclear physicians interpret long-COVID profiles. Conclusion The proposed PET metabolic pattern is easily identified upon visual interpretation in clinical routine for approximately one half of patients with suspected neurological long COVID, requiring special consideration for frontobasal paramedian regions, the brainstem and the cerebellum, and certainly further adapted follow-up and medical care, while the second half of patients have normal brain PET metabolism on average 10.9 months from symptom onset.
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Affiliation(s)
- Antoine Verger
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, Université de Lorraine, CHRU Nancy, 54000, Nancy, France
- Université de Lorraine, IADI, INSERM U1254, F-54000, Nancy, France
| | - Aurélie Kas
- Nuclear Medicine Department & Laboratoire d'Imagerie Biomédicale, Pitié-Salpêtrière Hospital, APHP Sorbonne Université, CNRS, INSERM, 75013, Paris, France
| | - Pierre Dudouet
- IRD, AP-HM, SSA, VITROME, Aix Marseille Univ, Marseille, France
- IHU-Méditerranée Infection, Marseille, France
| | - François Goehringer
- Department of Infectious Diseases, Université de Lorraine, CHRU Nancy, 54000, Nancy, France
| | - Dominique Salmon-Ceron
- Department of Immunology and Infectious Diseases, Cochin-Hôtel-Dieu Hospital, Assistance Publique -Hôpitaux de Paris (APHP), Hôpitaux Universitaires Paris Centre - Université de Paris, Paris, France
- University of Paris School of Medicine, Paris, France
| | - Eric Guedj
- Nuclear Medicine Department, APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, CERIMED, Aix Marseille Univ, Marseille, France.
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Douaud G, Lee S, Alfaro-Almagro F, Arthofer C, Wang C, McCarthy P, Lange F, Andersson JLR, Griffanti L, Duff E, Jbabdi S, Taschler B, Keating P, Winkler AM, Collins R, Matthews PM, Allen N, Miller KL, Nichols TE, Smith SM. SARS-CoV-2 is associated with changes in brain structure in UK Biobank. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022:2021.06.11.21258690. [PMID: 34189535 PMCID: PMC8240690 DOI: 10.1101/2021.06.11.21258690] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
There is strong evidence for brain-related abnormalities in COVID-19 1-13 . It remains unknown however whether the impact of SARS-CoV-2 infection can be detected in milder cases, and whether this can reveal possible mechanisms contributing to brain pathology. Here, we investigated brain changes in 785 UK Biobank participants (aged 51-81) imaged twice, including 401 cases who tested positive for infection with SARS-CoV-2 between their two scans, with 141 days on average separating their diagnosis and second scan, and 384 controls. The availability of pre-infection imaging data reduces the likelihood of pre-existing risk factors being misinterpreted as disease effects. We identified significant longitudinal effects when comparing the two groups, including: (i) greater reduction in grey matter thickness and tissue-contrast in the orbitofrontal cortex and parahippocampal gyrus, (ii) greater changes in markers of tissue damage in regions functionally-connected to the primary olfactory cortex, and (iii) greater reduction in global brain size. The infected participants also showed on average larger cognitive decline between the two timepoints. Importantly, these imaging and cognitive longitudinal effects were still seen after excluding the 15 cases who had been hospitalised. These mainly limbic brain imaging results may be the in vivo hallmarks of a degenerative spread of the disease via olfactory pathways, of neuroinflammatory events, or of the loss of sensory input due to anosmia. Whether this deleterious impact can be partially reversed, or whether these effects will persist in the long term, remains to be investigated with additional follow up.
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43
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Voruz P, Cionca A, Jacot de Alcântara I, Nuber-Champier A, Allali G, Benzakour L, Thomasson M, Lalive PH, Lövblad KO, Braillard O, Nehme M, Coen M, Serratrice J, Pugin J, Guessous I, Landis BN, Adler D, Griffa A, Van De Ville D, Assal F, Péron JA. OUP accepted manuscript. Brain Commun 2022; 4:fcac057. [PMID: 35350554 PMCID: PMC8956133 DOI: 10.1093/braincomms/fcac057] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/17/2022] [Accepted: 03/06/2022] [Indexed: 11/13/2022] Open
Abstract
Lack of awareness of cognitive impairment (i.e. anosognosia) could be a key
factor for distinguishing between neuropsychological post-COVID-19 condition
phenotypes. In this context, the 2-fold aim of the present study was to (i)
establish the prevalence of anosognosia for memory impairment, according to the
severity of the infection in the acute phase and (ii) determine whether
anosognosic patients with post-COVID syndrome have a different cognitive and
psychiatric profile from nosognosic patients, with associated differences in
brain functional connectivity. A battery of neuropsychological, psychiatric,
olfactory, dyspnoea, fatigue and quality-of-life tests was administered
227.07 ± 42.69 days post-SARS-CoV-2 infection to 102
patients (mean age: 56.35 years, 65 men, no history of neurological,
psychiatric, neuro-oncological or neurodevelopmental disorder prior to
infection) who had experienced either a mild (not hospitalized;
n = 45), moderate (conventional
hospitalization; n = 34) or severe
(hospitalization with intensive care unit stay and mechanical ventilation;
n = 23) presentation in the acute
phase. Patients were first divided into two groups according to the presence or
absence of anosognosia for memory deficits (26 anosognosic patients and 76
nosognosic patients). Of these, 49 patients underwent an MRI. Structural images
were visually analysed, and statistical intergroup analyses were then performed
on behavioural and functional connectivity measures. Only 15.6% of
patients who presented mild disease displayed anosognosia for memory
dysfunction, compared with 32.4% of patients with moderate presentation
and 34.8% of patients with severe disease. Compared with nosognosic
patients, those with anosognosia for memory dysfunction performed significantly
more poorly on objective cognitive and olfactory measures. By contrast, they
gave significantly more positive subjective assessments of their quality of
life, psychiatric status and fatigue. Interestingly, the proportion of patients
exhibiting a lack of consciousness of olfactory deficits was significantly
higher in the anosognosic group. Functional connectivity analyses revealed a
significant decrease in connectivity, in the anosognosic group as compared with
the nosognosic group, within and between the following networks: the left
default mode, the bilateral somatosensory motor, the right executive control,
the right salient ventral attention and the bilateral dorsal attention networks,
as well as the right Lobules IV and V of the cerebellum. Lack of awareness of
cognitive disorders and, to a broader extent, impairment of the self-monitoring
brain system, may be a key factor for distinguishing between the clinical
phenotypes of post-COVID syndrome with neuropsychological deficits.
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Affiliation(s)
- Philippe Voruz
- Clinical and Experimental Neuropsychology Laboratory, Faculty of Psychology, University of Geneva, Geneva, Switzerland
- Neurology Department, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Alexandre Cionca
- Clinical and Experimental Neuropsychology Laboratory, Faculty of Psychology, University of Geneva, Geneva, Switzerland
| | - Isabele Jacot de Alcântara
- Clinical and Experimental Neuropsychology Laboratory, Faculty of Psychology, University of Geneva, Geneva, Switzerland
- Neurology Department, Geneva University Hospitals, Geneva, Switzerland
| | - Anthony Nuber-Champier
- Clinical and Experimental Neuropsychology Laboratory, Faculty of Psychology, University of Geneva, Geneva, Switzerland
| | - Gilles Allali
- Neurology Department, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Leenaards Memory Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Lamyae Benzakour
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Psychiatry Department, Geneva University Hospitals, Geneva, Switzerland
| | - Marine Thomasson
- Clinical and Experimental Neuropsychology Laboratory, Faculty of Psychology, University of Geneva, Geneva, Switzerland
- Neurology Department, Geneva University Hospitals, Geneva, Switzerland
| | - Patrice H Lalive
- Neurology Department, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Karl-Olof Lövblad
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Diagnostic and Interventional Neuroradiology Department, Geneva University Hospitals, Geneva, Switzerland
| | - Olivia Braillard
- Division and Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Mayssam Nehme
- Division and Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Matteo Coen
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Internal Medicine Department, Geneva University Hospitals, Geneva, Switzerland
| | - Jacques Serratrice
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Internal Medicine Department, Geneva University Hospitals, Geneva, Switzerland
| | - Jérôme Pugin
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Intensive Care Department, Geneva University Hospitals, Geneva, Switzerland
| | - Idris Guessous
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division and Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Basile N Landis
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Rhinology-Olfactology Unit, Otorhinolaryngology Department, Geneva University Hospitals, Geneva, Switzerland
| | - Dan Adler
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Alessandra Griffa
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Institute of Bioengineering, Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Dimitri Van De Ville
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Institute of Bioengineering, Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Frédéric Assal
- Neurology Department, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Julie A Péron
- Clinical and Experimental Neuropsychology Laboratory, Faculty of Psychology, University of Geneva, Geneva, Switzerland
- Neurology Department, Geneva University Hospitals, Geneva, Switzerland
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44
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Manca R, De Marco M, Colston A, Raymont V, Amin J, Davies R, Kumar P, Russell G, Blackburn DJ, Venneri A. The Impact of Social Isolation Due to COVID-19 on Symptom Progression in People With Dementia: Findings of the SOLITUDE Study. Front Psychiatry 2022; 13:877595. [PMID: 35619615 PMCID: PMC9127264 DOI: 10.3389/fpsyt.2022.877595] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/11/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND People with dementia (PWD) are vulnerable to abrupt changes to daily routines. The lockdown enforced on the 23rd of March 2020 in the UK to contain the expansion of the COVID-19 pandemic limited opportunities for PWD to access healthcare services and socialise. The SOLITUDE study explored the potential long-term effects of lockdown on PWD's symptoms and carers' burden. METHODS Forty-five carers and 36 PWD completed a telephone-based assessment at recruitment (T0) and after 3 (T1) and 6 months (T2). PWD completed measures validated for telephonic evaluations of cognition and depression. Carers completed questionnaires on their burden and on PWD's health and answered a customised interview on symptom changes observed in the initial months of lockdown. Longitudinal changes were investigated for all outcome variables with repeated-measures models. Additional post hoc multiple regression analyses were carried out to investigate whether several objective factors (i.e., demographics and time under social restrictions) and carer-reported symptom changes observed following lockdown before T0 were associated with all outcomes at T0. RESULTS No significant changes were observed in any outcomes over the 6 months of observations. However, post hoc analyses showed that the length of social isolation before T0 was negatively correlated with episodic and semantic memory performance at T0. Carers reporting worsening of neuropsychiatric symptoms and faster disease progression in PWD also reported higher burden. Moreover, carer-reported worsening of cognitive symptoms was associated with poorer semantic memory at T0. CONCLUSION PWD's symptoms and carers' burden remained stable over 6 months of observation. However, the amount of time spent under social restrictions before T0 appears to have had a significant detrimental impact on cognitive performance of patients. In fact, carer-reported cognitive decline during social isolation was consistent with the finding of poorer semantic memory, a domain sensitive to progression in Alzheimer's disease. Therefore, the initial stricter period of social isolation had greater detrimental impact on patients and their carers, followed then by a plateau. Future interventions may be designed to maintain an optimal level of social and cognitive engagement for PWD in challenging times, to prevent abrupt worsening of symptoms and associated detrimental consequences on patients' carers.
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Affiliation(s)
- Riccardo Manca
- Department of Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Matteo De Marco
- Department of Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Amanda Colston
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - Vanessa Raymont
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom.,Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Jay Amin
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,Memory Assessment and Research Centre, Moorgreen Hospital, Southern Health NHS Foundation Trust, Southampton, United Kingdom
| | - Rhys Davies
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Pramod Kumar
- Berkshire Healthcare NHS Foundation Trust, Bracknell, United Kingdom
| | - Gregor Russell
- Bradford District Care NHS Foundation Trust, Bradford, United Kingdom
| | - Daniel J Blackburn
- Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Annalena Venneri
- Department of Life Sciences, Brunel University London, Uxbridge, United Kingdom.,Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom
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45
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Fond G, Masson M, Lançon C, Richieri R, Guedj E. The neuroinflammatory pathways of post-SARS-CoV-2 psychiatric disorders. Encephale 2021; 47:399-400. [PMID: 13597840 PMCID: PMC8403666 DOI: 10.1016/j.encep.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- G Fond
- EA 3279-EA 3279: CEReSS, Health Service Research and Quality of Life Center, Aix Marseille Université, 27, boulevard Jean Moulin, 13005 Marseille, France; Department of Medical Information and Public Health, AP-HM, Aix Marseille Université, 27, boulevard Jean Moulin, 13005 Marseille, France
| | - M Masson
- Nightingale Hospitals-Paris, Clinique du Château de Garches, 11, bis rue de la Porte Jaune, 92380 Garches, France; Service Hospitalo-Universitaire, CH de Sainte-Anne, 1, rue Cabanis, 75014 Paris, France
| | - C Lançon
- EA 3279-EA 3279: CEReSS, Health Service Research and Quality of Life Center, Aix Marseille Université, 27, boulevard Jean Moulin, 13005 Marseille, France; Department of Psychiatry, La Conception University Hospital, AP-HM, 147, boulevard Baille, 13005 Marseille, France
| | - R Richieri
- Service Hospitalo-Universitaire, CH de Sainte-Anne, 1, rue Cabanis, 75014 Paris, France; Department of Psychiatry, La Conception University Hospital, AP-HM, 147, boulevard Baille, 13005 Marseille, France; Aix Marseille Université, CNRS, École Centrale Marseille, UMR 7249, Institut Fresnel, CERIMED, 27, boulevard Jean Moulin, 13005 Marseille, France
| | - E Guedj
- Aix Marseille Université, CNRS, École Centrale Marseille, UMR 7249, Institut Fresnel, CERIMED, 27, boulevard Jean Moulin, 13005 Marseille, France; Nuclear Medicine Department, La Timone University Hospital, AP-HM, 264, rue Saint Pierre, 13005 Marseille, France.
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46
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Guedj E, Morbelli S, Kaphan E, Campion JY, Dudouet P, Ceccaldi M, Cammilleri S, Nobili F, Eldin C. From early limbic inflammation to long COVID sequelae. Brain 2021; 144:e65. [PMID: 34142116 DOI: 10.1093/brain/awab215] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 01/08/2023] Open
Affiliation(s)
- Eric Guedj
- Aix Marseille Univ, APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, CERIMED, Nuclear Medicine Department, Marseille, France
| | - Silvia Morbelli
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elsa Kaphan
- APHM, Service de Neurologie, Hôpital de la Timone, Marseille, France
| | - Jacques-Yves Campion
- Aix Marseille Univ, APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, CERIMED, Nuclear Medicine Department, Marseille, France
| | - Pierre Dudouet
- Aix Marseille Univ, IRD, AP-HM, MEPHI, Marseille, France
| | - Mathieu Ceccaldi
- Aix Marseille Univ, INSERM, Inst Neurosci Syst, & APHM, Service de Neurologie et de Neuropsychologie, CHU Timone, Marseille, France
| | - Serge Cammilleri
- Aix Marseille Univ, APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, CERIMED, Nuclear Medicine Department, Marseille, France
| | - Flavio Nobili
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy
| | - Carole Eldin
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
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47
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VEREECKEN P. [A case of functional disorientation limited to direction in space]. L'ENCEPHALE 1958; 47:399-419. [PMID: 13597840 PMCID: PMC8403666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
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