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Nasir SM, Yahya N, Manan HA. Functional brain alterations in COVID-19 patients using resting-state fMRI: a systematic review. Brain Imaging Behav 2024:10.1007/s11682-024-00935-1. [PMID: 39347937 DOI: 10.1007/s11682-024-00935-1] [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] [Accepted: 09/15/2024] [Indexed: 10/01/2024]
Abstract
This study systematically reviews the available evidence on resting-state functional magnetic resonance imaging (rs-fMRI) related to neurological symptoms and cognitive declines in COVID-19 patients. We followed PRISMA guidelines and looked up the PubMed, and Scopus databases for articles search on COVID-19 patients with neurological impairments, and functional connectivity alteration using rs-fMRI technique. Articles published between January 1, 2020, and May 31, 2024, are included in this study. The Quality Assessment Tool for Observational Prospective and Cross-Sectional Studies from the National Heart, Lung, and Blood Institute (NHLBI) was used to assess the quality of papers. A total of 15 articles met the inclusion criteria. The result reveals that the most prevalent neurological impairment associated with COVID-19 was cognitive decline, encompassing issues in attention, memory, processing speed, executive functions, language, and visuospatial ability. The brain connectivity results reveal that two brain areas were functionally altered; the prefrontal cortex and parahippocampus. The functional connectivity mainly increased in the frontal, temporal, and anterior piriform cortex, and reduced in the cerebellum, superior orbitofrontal cortex, and middle temporal gyrus, which also correlated with cognitive decline. The findings of neurological symptoms indicate one study reported a Disorder of Consciousness (DoC), and four studies reported COVID-19 patients with olfactory dysfunction. The present study concludes that COVID-19 can alter brain functional connectivity and offers significant insight into how COVID-19 affects the neuronal foundation of cognitive decline and other neurological impairments.
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Affiliation(s)
- Siti Maisarah Nasir
- Makmal Pemprosesan Imej Kefungsian (Functional Image Processing Laboratory), Department of Radiology, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56 000, Cheras, Kuala Lumpur, Malaysia
| | - Noorazrul Yahya
- Diagnostic Imaging & Radiotherapy Program, School of Diagnostic & Applied Health Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Hanani Abdul Manan
- Makmal Pemprosesan Imej Kefungsian (Functional Image Processing Laboratory), Department of Radiology, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56 000, Cheras, Kuala Lumpur, Malaysia.
- Department of Radiology and Intervency, Hospital Pakar Kanak-Kanak (Children Specialist Hospital), Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, 56000, Bandar Tun Razak, Kuala Lumpur, Malaysia.
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Kesler SR, Franco-Rocha OY, De La Torre Schutz A, Lewis KA, Aziz RM, Henneghan AM, Melamed E, Brode WM. Altered functional brain connectivity, efficiency, and information flow associated with brain fog after mild to moderate COVID-19 infection. Sci Rep 2024; 14:22094. [PMID: 39333726 PMCID: PMC11437042 DOI: 10.1038/s41598-024-73311-0] [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: 10/11/2023] [Accepted: 09/16/2024] [Indexed: 09/29/2024] Open
Abstract
COVID-19 is associated with increased risk for cognitive decline but very little is known regarding the neural mechanisms of this risk. We enrolled 49 adults (55% female, mean age = 30.7 ± 8.7), 25 with and 24 without a history of COVID-19 infection. We administered standardized tests of cognitive function and acquired brain connectivity data using MRI. The COVID-19 group demonstrated significantly lower cognitive function (W = 475, p < 0.001, effect size r = 0.58) and lower functional connectivity in multiple brain regions (mean t = 3.47 ±0.36, p = 0.03, corrected, effect size d = 0.92 to 1.5). Hypo-connectivity of these regions was inversely correlated with subjective cognitive function and directly correlated with fatigue (p < 0.05, corrected). These regions demonstrated significantly reduced local efficiency (p < 0.026, corrected) and altered effective connectivity (p < 0.001, corrected). COVID-19 may have a widespread effect on the functional connectome characterized by lower functional connectivity and altered patterns of information processing efficiency and effective information flow. This may serve as an adaptation to the pathology of SARS-CoV-2 wherein the brain can continue functioning at near expected objective levels, but patients experience lowered efficiency as brain fog.
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Affiliation(s)
- Shelli R Kesler
- Department of Adult Health, School of Nursing, The University of Texas at Austin, Austin, TX, USA.
- Department of Diagnostic Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX, USA.
| | - Oscar Y Franco-Rocha
- Department of Adult Health, School of Nursing, The University of Texas at Austin, Austin, TX, USA
| | - Alexa De La Torre Schutz
- Department of Adult Health, School of Nursing, The University of Texas at Austin, Austin, TX, USA
| | - Kimberly A Lewis
- Department of Adult Health, School of Nursing, The University of Texas at Austin, Austin, TX, USA
| | - Rija M Aziz
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
- Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - Ashley M Henneghan
- Department of Adult Health, School of Nursing, The University of Texas at Austin, Austin, TX, USA
| | - Esther Melamed
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - W Michael Brode
- Department of Internal Medicine, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
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Dacosta-Aguayo R, Torán-Monserrat P, Carmona-Cervelló M, León-Gómez BB, Mataró M, Puig J, Monté-Rubio G, López-Lifante VM, Maria Manresa-Domínguez J, Zamora-Putin V, Montero-Alia P, Chacón C, Bielsa-Pascual J, Moreno-Gabriel E, García-Sierra R, Rodríguez-Pérez MC, Costa-Garrido A, Prado JG, Martínez-Cáceres E, Mateu L, Massanella M, Violán C, Lamonja-Vicente N. Multimodal neuroimaging in Long-COVID and its correlates with cognition 1.8 years after SARS-CoV-2 infection: a cross-sectional study of the Aliança ProHEpiC-19 Cognitiu. Front Neurol 2024; 15:1426881. [PMID: 39346769 PMCID: PMC11428557 DOI: 10.3389/fneur.2024.1426881] [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: 05/02/2024] [Accepted: 08/13/2024] [Indexed: 10/01/2024] Open
Abstract
Introduction There is a growing interest in the effect of Long-COVID (LC) on cognition, and neuroimaging allows us to gain insight into the structural and functional changes underlying cognitive impairment in LC. We used multimodal neuroimaging data in combination with neuropsychological evaluations to study cognitive complaints in a cohort of LC patients with mild to moderate severity symptoms. Methods We conducted a 3T brain magnetic resonance imaging (MRI) study with diffusion tensor imaging (DTI) and functional MRI (fMRI) sequences on 53 LC patients 1.8 years after acute COVID-19 onset. We administered neuropsychological tests to evaluate cognitive domains and examined correlations with Tract-Based Spatial Statistics (TBSS) and resting state. Results We included 53 participants with LC (mean age, 48.23 years; 88.7% females). According to the Frascati criteria, more than half of the participants had deficits in the executive (59%) and attentional (55%) domains, while 40% had impairments in the memory domain. Only one participant (1.89%) showed problems in the visuospatial and visuoconstructive domain. We observed that increased radial diffusivity in different white matter tracts was negatively correlated with the memory domain. Our results showed that higher resting state activity in the fronto-parietal network was associated with lower memory performance. Moreover, we detected increased functional connectivity among the bilateral hippocampus, the right hippocampus and the left amygdala, and the right hippocampus and the left middle temporal gyrus. These connectivity patterns were inversely related to memory and did not survive false discovery rate (FDR) correction. Discussion People with LC exhibit cognitive impairments linked to long-lasting changes in brain structure and function, which justify the cognitive alterations detected.
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Affiliation(s)
- Rosalia Dacosta-Aguayo
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
- Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
| | - Pere Torán-Monserrat
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
- Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
- Department of Medicine, Faculty of Medicine, Universitat de Girona, Girona, Spain
- Multidisciplinary Research Group in Health and Society (GREMSAS) (2021-SGR-0148), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
| | - Meritxell Carmona-Cervelló
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
| | - Brenda Biaani León-Gómez
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
| | - Maria Mataró
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain
- Institut de Neurociències, University of Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Josep Puig
- Radiology Department CDI, Hospital Clinic of Barcelona, Barcelona, Spain
- IDIBAPS (Instituto de Investigaciones Biomédicas August Pi i Sunyer), Barcelona, Spain
- Comparative Medicine and Bioimaging Center (CMCiB), Germans Trias i Pujol Research Institute, Badalona, Spain
| | - Gemma Monté-Rubio
- Comparative Medicine and Bioimaging Center (CMCiB), Germans Trias i Pujol Research Institute, Badalona, Spain
| | - Victor M López-Lifante
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
- Multidisciplinary Research Group in Health and Society (GREMSAS) (2021-SGR-0148), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
- Palau-Solità Healthcare Centre, Palau-Solità Plegamans Institut Català de la Salut, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Josep Maria Manresa-Domínguez
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
| | - Valeria Zamora-Putin
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
- Palau-Solità Healthcare Centre, Palau-Solità Plegamans Institut Català de la Salut, Barcelona, Spain
| | - Pilar Montero-Alia
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
- Multidisciplinary Research Group in Health and Society (GREMSAS) (2021-SGR-0148), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
| | - Carla Chacón
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
- Grup de REcerca en Impacte de les Malalties Cròniques i les seves Trajectòries (GRIMTra), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
| | - Jofre Bielsa-Pascual
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
| | - Eduard Moreno-Gabriel
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
- Multidisciplinary Research Group in Health and Society (GREMSAS) (2021-SGR-0148), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
- Department of Social Psychology, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Rosa García-Sierra
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
- Multidisciplinary Research Group in Health and Society (GREMSAS) (2021-SGR-0148), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
- Nursing Department, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Carmen Rodríguez-Pérez
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
| | - Anna Costa-Garrido
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
| | - Julia G Prado
- Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
- IrsiCaixa-AIDS Research, Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Eva Martínez-Cáceres
- Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
- Immunology Department, FOCIS Center of Excellence-Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Immunology Division, Laboratori Clinic Metropolitana Nord (LCMN), Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Lourdes Mateu
- Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
- IrsiCaixa-AIDS Research, Badalona, Spain
- Infectious Diseases Department, Fundació Lluita contra les Infeccions (FLI), Germans Trias i Pujol Hospital, Badalona, Spain
- Red Española de investigación en Covid Persistente, Madrid, Spain
| | - Marta Massanella
- Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
- IrsiCaixa-AIDS Research, Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Red Española de investigación en Covid Persistente, Madrid, Spain
| | - Concepción Violán
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
- Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
- Department of Medicine, Faculty of Medicine, Universitat de Girona, Girona, Spain
- Grup de REcerca en Impacte de les Malalties Cròniques i les seves Trajectòries (GRIMTra), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
- Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud (RICAPPS), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Noemí Lamonja-Vicente
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain
- Grup de REcerca en Impacte de les Malalties Cròniques i les seves Trajectòries (GRIMTra), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
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Fineschi S, Fahlström M, Fällmar D, Haller S, Wikström J. Comprehensive MRI assessment reveals subtle brain findings in non-hospitalized post-COVID patients with cognitive impairment. Front Neurosci 2024; 18:1435218. [PMID: 39319311 PMCID: PMC11420131 DOI: 10.3389/fnins.2024.1435218] [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: 05/19/2024] [Accepted: 08/07/2024] [Indexed: 09/26/2024] Open
Abstract
Background Impaired cognitive ability is one of the most frequently reported neuropsychiatric symptoms in the post-COVID phase among patients. It is unclear whether this condition is related to structural or functional brain changes. Purpose In this study, we present a multimodal magnetic resonance imaging study of 36 post-COVID patients and 36 individually matched controls who had a mild form of severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) infection from March 2020 to February 2022. This study aimed to investigate structural and functional brain alterations and their correlation with post-COVID symptoms and neurocognitive functions. Materials and methods The study protocol comprised an assessment of physical fatigue [Fatigue Severity Scale (FSS)], mental fatigue (Mental Fatigue Scale (MFS)], depression [Montgomery Asberg Depression Rating Scale (MADRS)], anxiety [Hospital Anxiety and Depression Scale (HAD)], post-COVID Symptoms Severity Score, and neurocognitive status [Repeatable Battery for the Assessment of Neuropsychological Status Update (RBANS)]. The magnetic resonance imaging protocol included morphological sequences, arterial spin labeling (ASL) and dynamic susceptibility contrast-enhanced (DSC) perfusion, diffusion tensor imaging (DTI), and resting-state functional magnetic resonance imaging (fMRI) sequences. Using these protocols, the assessments of macrostructural abnormalities, perfusion, gray matter density, white matter integrity, and brain connectivity were performed. Results Post-COVID patients had higher levels of physical fatigue, mental fatigue, depression, and anxiety than controls and showed cognitive impairment in all the RBANS domains except in Visuospatial/Construction. The subjective mental fatigue correlated with objective impaired cognitive ability in the RBANS test, particularly in the Attention domain. There were no differences between patients and controls regarding macrostructural abnormalities, regional volumes, regional perfusion metrics, gray matter density, or DTI parameters. We observed a significant positive correlation between RBANS Total Scale Index score and gray matter volume in the right superior/middle-temporal gyrus (p < 0.05) and a significant negative correlation between the white matter integrity and post-COVID symptoms (p < 0.05) in the same area. The connectivity differences were observed between patients and controls in a few regions, including the right middle frontal gyrus, an important area of convergence of the dorsal and ventral attention networks. We also noted a positive correlation between post-COVID symptoms and increased connectivity in the right temporoparietal junction, which is part of the ventral attention system. Conclusion In non-hospitalized subjects with post-COVID, we did not find any structural brain changes or changes in perfusion, compared to controls. However, we noted differences in connectivity within an important area for attention processes, which may be associated with post-COVID brain fog.
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Affiliation(s)
- Serena Fineschi
- Department of Public Health and Caring Sciences, Faculty of Medicine, Uppsala University, Uppsala, Sweden
- Östhammar Health Care Centre, Östhammar, Sweden
| | - Markus Fahlström
- Department of Surgical Sciences, Faculty of Medicine, Uppsala University, Uppsala, Sweden
| | - David Fällmar
- Department of Surgical Sciences, Faculty of Medicine, Uppsala University, Uppsala, Sweden
- Department of Radiology, Uppsala University Hospital, Uppsala, Sweden
| | - Sven Haller
- Department of Surgical Sciences, Faculty of Medicine, Uppsala University, Uppsala, Sweden
- Division of Radiodiagnostic and Interventional Radiology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Johan Wikström
- Department of Surgical Sciences, Faculty of Medicine, Uppsala University, Uppsala, Sweden
- Department of Radiology, Uppsala University Hospital, Uppsala, Sweden
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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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Goldenberg DL. How to understand the overlap of long COVID, chronic fatigue syndrome/myalgic encephalomyelitis, fibromyalgia and irritable bowel syndromes. Semin Arthritis Rheum 2024; 67:152455. [PMID: 38761526 DOI: 10.1016/j.semarthrit.2024.152455] [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: 02/19/2024] [Revised: 04/03/2024] [Accepted: 04/18/2024] [Indexed: 05/20/2024]
Abstract
Long COVID should be limited to patients with multiple, persistent symptoms not related to well-defined organ damage. Once redefined, a focused review of long COVID demonstrates striking similarity to chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), fibromyalgia (FM) and irritable bowel syndrome (IBS). Research in long COVID has revealed similar findings to those noted in CFS/ME and FM, characterized by central nervous system organ dysfunction. Long COVID, like CFS/ME, FM and IBS, is best understood as a bidirectional mind-body, neuroimmune illness.
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Affiliation(s)
- Don L Goldenberg
- Emeritus Professor of Medicine, Tufts University School of Medicine, United States; Adjunct Faculty, Departments of Medicine and Nursing, Oregon Health Sciences University, United States.
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7
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Park JM, Kim J, Kim YW, Kim DY, Yoon SY, Kim DH. Impact of COVID-19 on brain connectivity and rehabilitation outcome after stroke. Heliyon 2024; 10:e34941. [PMID: 39149072 PMCID: PMC11325376 DOI: 10.1016/j.heliyon.2024.e34941] [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: 03/07/2024] [Revised: 07/05/2024] [Accepted: 07/18/2024] [Indexed: 08/17/2024] Open
Abstract
Background Coronavirus disease (COVID-19) may induce neurological issues, impacting brain structure and stroke recovery. Limited studies have explored its effects on post-stroke rehabilitation. Our study compares brain structure and connectivity, assessing rehabilitation outcomes based on pre-stroke COVID-19 infection. Methods A retrospective analysis of 299 post-stroke rehabilitation cases from May 2021 to January 2023 included two groups: those diagnosed with COVID-19 at least two weeks before stroke onset (COVID group) and those without (control group). Criteria involved first unilateral supratentorial stroke, <3 months post-onset, initial MR imaging, and pre- and post-rehabilitation clinical assessments. Propensity score matching ensured age, sex, and initial clinical assessment similarities. Using lesion mapping, tract-based statistical analysis, and group-independent component analysis MRI scans were assessed for structural and functional differences. Results After propensity score matching, 12 patients were included in each group. Patient demographics showed no significant differences. Analyses of MR imaging revealed no significant differences between COVID and control groups. Post-rehabilitation clinical assessments improved notably in both groups, however the intergroup analysis showed no significant difference. Conclusions Previous COVID-19 infection did not affect brain structure or connectivity nor outcomes after rehabilitation.
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Affiliation(s)
- Jong Mi Park
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Jinna Kim
- Department of Radiology and Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Yong Wook Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Seo Yeon Yoon
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Dae Hyun Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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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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9
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Lin K, Gao Y, Ji W, Li Y, Wang W, Du M, Liu J, Hong Z, Jiang T, Wang Y. Attentional impairment and altered brain activity in healthcare workers after mild COVID-19. Brain Imaging Behav 2024; 18:566-575. [PMID: 38296922 PMCID: PMC11222278 DOI: 10.1007/s11682-024-00851-4] [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] [Accepted: 01/05/2024] [Indexed: 02/02/2024]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) is highly transmissible and pathogenic. Patients with mild cases account for the majority of those infected with coronavirus disease 2019 (COVID-19). Although there is evidence that many patients with COVID-19 have varying degrees of attentional impairment, little is known about how SARS-COV-2 affects attentional function. This study included a high-risk healthcare population divided into groups of healthcare workers (HCWs) with mild COVID-19 (patient group, n = 45) and matched healthy HCWs controls (HC group, n = 42), who completed general neuropsychological background tests and Attention Network Test (ANT), and underwent resting-state functional magnetic resonance imaging (rs-fMRI) using amplitude of low-frequency fluctuation (ALFF) to assess altered brain activity; Selective impairment occurred in orienting and executive control networks, but not in alert network, in the patient group, and widespread cognitive impairment encompassing general attention, memory, and executive dysfunction. Moreover, the patient group had significantly lower ALFF values in the left superior and left middle frontal gyri than the HC group. SARS-COV-2 infection may have led to reduced brain activity in the left superior and left middle frontal gyri, thus impairing attentional orienting and executive control networks, which may explain the development of attentional deficits after COVID-19.
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Affiliation(s)
- Keyi Lin
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Public Health Clinical Center, Hefei, China
| | - Yaotian Gao
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Public Health Clinical Center, 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, Hefei Huaan Brain Hospital, Hefei, China
| | - Yan Li
- Anhui Public Health Clinical Center, Hefei, China
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wei Wang
- Department of Neurosurgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Mengcheng Du
- Department of Neurosurgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jia Liu
- Anhui Public Health Clinical Center, Hefei, China
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhengyu Hong
- Anhui Public Health Clinical Center, Hefei, China
- Department of Radiology, The First 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.
| | - Yuyang Wang
- Department of Neurosurgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.
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10
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Gupta T, Kumar M, Kaur UJ, Rao A, Bharti R. Mapping ACE2 and TMPRSS2 co-expression in human brain tissue: implications for SARS-CoV-2 neurological manifestations. J Neurovirol 2024; 30:316-326. [PMID: 38600308 DOI: 10.1007/s13365-024-01206-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: 03/06/2024] [Revised: 03/31/2024] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
The Coronavirus Disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) primarily targets respiratory cells, but emerging evidence shows neurological involvement, with the virus directly affecting neurons and glia. SARS-CoV-2 entry into a target cell requires co-expression of ACE2 (Angiotensin-converting enzyme-2) and TMPRSS2 (Trans membrane serine protease-2). Relevant literature on human neurological tissue is sparse and mostly focused on the olfactory areas. This prompted our study to map brain-wide expression of these entry proteins and assess age-related changes. The normal brain tissue samples were collected from cerebral cortex, hippocampus, basal ganglia, thalamus, hypothalamus, brain stem and cerebellum; and were divided into two groups - up to 40 years (n = 10) and above 40 years (n = 10). ACE2 and TMPRSS2 gene expression analysis was done using qRT-PCR and protein co-expression was seen by immunofluorescence. The ACE2 and TMPRSS2 gene expression was observed to be highest in hypothalamus and thalamus regions, respectively. Immunoreactivity for both ACE-2 and TMPRSS2 was observed in all examined brain regions, confirming the presence of these viral entry receptors. Co-localisation was maximum in hypothalamus. Our study did not find any trend related to different age groups. The expression of both these viral entry receptors suggests that normal human brain is susceptibility to SARS-CoV-2, perhaps which could be related to the cognitive and neurological impairment that occur in patients.
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Affiliation(s)
- Tulika Gupta
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Munish Kumar
- Division of Neuro-anesthesia, Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ujjwal Jit Kaur
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Asha Rao
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ranjana Bharti
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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11
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Mohammadi S, Ghaderi S. Advanced magnetic resonance neuroimaging techniques: feasibility and applications in long or post-COVID-19 syndrome - a review. Ann Med Surg (Lond) 2024; 86:1584-1589. [PMID: 38463042 PMCID: PMC10923379 DOI: 10.1097/ms9.0000000000001808] [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: 11/16/2023] [Accepted: 01/29/2024] [Indexed: 03/12/2024] Open
Abstract
Long-term or post-COVID-19 syndrome (PCS) is a condition that affects people infected with SARS‑CoV‑2, the virus that causes COVID-19. PCS is characterized by a wide range of persistent or new symptoms that last months after the initial infection, such as fatigue, shortness of breath, cognitive dysfunction, and pain. Advanced magnetic resonance (MR) neuroimaging techniques can provide valuable information on the structural and functional changes in the brain associated with PCS as well as potential biomarkers for diagnosis and prognosis. In this review, we discuss the feasibility and applications of various advanced MR neuroimaging techniques in PCS, including perfusion-weighted imaging (PWI), diffusion-weighted imaging (DWI), susceptibility-weighted imaging (SWI), functional MR imaging (fMRI), diffusion tensor imaging (DTI), and tractography. We summarize the current evidence on neuroimaging findings in PCS, the challenges and limitations of these techniques, and the future directions for research and clinical practice. Although still uncertain, advanced MRI techniques show promise for gaining insight into the pathophysiology and guiding the management of COVID-19 syndrome, pending larger validation studies.
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Affiliation(s)
- Sana Mohammadi
- Department of Medical Sciences, School of Medicine, Iran University of Medical Sciences
| | - Sadegh Ghaderi
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
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12
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Hampshire A, Azor A, Atchison C, Trender W, Hellyer PJ, Giunchiglia V, Husain M, Cooke GS, Cooper E, Lound A, Donnelly CA, Chadeau-Hyam M, Ward H, Elliott P. Cognition and Memory after Covid-19 in a Large Community Sample. N Engl J Med 2024; 390:806-818. [PMID: 38416429 PMCID: PMC7615803 DOI: 10.1056/nejmoa2311330] [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: 02/29/2024]
Abstract
BACKGROUND Cognitive symptoms after coronavirus disease 2019 (Covid-19), the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), are well-recognized. Whether objectively measurable cognitive deficits exist and how long they persist are unclear. METHODS We invited 800,000 adults in a study in England to complete an online assessment of cognitive function. We estimated a global cognitive score across eight tasks. We hypothesized that participants with persistent symptoms (lasting ≥12 weeks) after infection onset would have objectively measurable global cognitive deficits and that impairments in executive functioning and memory would be observed in such participants, especially in those who reported recent poor memory or difficulty thinking or concentrating ("brain fog"). RESULTS Of the 141,583 participants who started the online cognitive assessment, 112,964 completed it. In a multiple regression analysis, participants who had recovered from Covid-19 in whom symptoms had resolved in less than 4 weeks or at least 12 weeks had similar small deficits in global cognition as compared with those in the no-Covid-19 group, who had not been infected with SARS-CoV-2 or had unconfirmed infection (-0.23 SD [95% confidence interval {CI}, -0.33 to -0.13] and -0.24 SD [95% CI, -0.36 to -0.12], respectively); larger deficits as compared with the no-Covid-19 group were seen in participants with unresolved persistent symptoms (-0.42 SD; 95% CI, -0.53 to -0.31). Larger deficits were seen in participants who had SARS-CoV-2 infection during periods in which the original virus or the B.1.1.7 variant was predominant than in those infected with later variants (e.g., -0.17 SD for the B.1.1.7 variant vs. the B.1.1.529 variant; 95% CI, -0.20 to -0.13) and in participants who had been hospitalized than in those who had not been hospitalized (e.g., intensive care unit admission, -0.35 SD; 95% CI, -0.49 to -0.20). Results of the analyses were similar to those of propensity-score-matching analyses. In a comparison of the group that had unresolved persistent symptoms with the no-Covid-19 group, memory, reasoning, and executive function tasks were associated with the largest deficits (-0.33 to -0.20 SD); these tasks correlated weakly with recent symptoms, including poor memory and brain fog. No adverse events were reported. CONCLUSIONS Participants with resolved persistent symptoms after Covid-19 had objectively measured cognitive function similar to that in participants with shorter-duration symptoms, although short-duration Covid-19 was still associated with small cognitive deficits after recovery. Longer-term persistence of cognitive deficits and any clinical implications remain uncertain. (Funded by the National Institute for Health and Care Research and others.).
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Affiliation(s)
- Adam Hampshire
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
| | - Adriana Azor
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
| | - Christina Atchison
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
| | - William Trender
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
| | - Peter J Hellyer
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
| | - Valentina Giunchiglia
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
| | - Masud Husain
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
| | - Graham S Cooke
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
| | - Emily Cooper
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
| | - Adam Lound
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
| | - Christl A Donnelly
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
| | - Marc Chadeau-Hyam
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
| | - Helen Ward
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
| | - Paul Elliott
- From the Department of Brain Sciences (A.H., A.A., W.T., V.G.), MRC Centre for Environment and Health (M.C.-H., P.E.), School of Public Health (C.A., E.C., A.L., C.A.D., M.C.-H., H.W., P.E.), and the Department of Infectious Disease (G.S.C.), Imperial College London, the National Institute for Health Research Imperial Biomedical Research Centre (C.A., G.S.C., E.C., A.L., H.W., P.E.), the Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London (P.J.H.), Imperial College Healthcare NHS Trust (G.S.C., H.W., P.E.), Health Data Research U.K. London at Imperial (P.E.), and U.K. Dementia Research Institute at Imperial (P.E.), London, and the Nuffield Department of Clinical Neurosciences (M.H.), the Departments of Experimental Psychology (M.H.) and Statistics (C.A.D.), and the Pandemic Sciences Institute (C.A.D.), University of Oxford, Oxford - all in the United Kingdom
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13
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Bungenberg J, Hohenfeld C, Costa AS, Heine J, Schwichtenberg K, Hartung T, Franke C, Binkofski F, Schulz JB, Finke C, Reetz K. Characteristic functional connectome related to Post-COVID-19 syndrome. Sci Rep 2024; 14:4997. [PMID: 38424415 PMCID: PMC10904373 DOI: 10.1038/s41598-024-54554-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 02/14/2024] [Indexed: 03/02/2024] Open
Abstract
Post-COVID-19 syndrome is a serious complication following SARS-CoV-2 infection, characterized primarily by fatigue and cognitive complaints. Although first metabolic and structural imaging alterations in Post-COVID-19 syndrome have been identified, their functional consequences remain unknown. Thus, we explored the impact of Post-COVID-19 syndrome on the functional connectome of the brain providing a deeper understanding of pathophysiological mechanisms. In a cross-sectional observational study, resting-state functional magnetic resonance imaging data of 66 patients with Post-COVID-19 syndrome after mild infection (mean age 42.3 years, 57 female) and 57 healthy controls (mean age 42.1 years, 38 female) with a mean time of seven months after acute COVID-19 were analysed using a graph theoretical approach. Network features were quantified using measures including mean distance, nodal degree, betweenness and Katz centrality, and compared between both groups. Graph measures were correlated with clinical measures quantifying fatigue, cognitive function, affective symptoms and sleep disturbances. Alterations were mainly found in the brainstem, olfactory cortex, cingulate cortex, thalamus and cerebellum on average seven months after SARS-CoV-2 infection. Additionally, strong correlations between fatigue severity, cognitive functioning and daytime sleepiness from clinical scales and graph measures were observed. Our study confirms functional relevance of brain imaging changes in Post-COVID-19 syndrome as mediating factors for persistent symptoms and improves our pathophysiological understanding.
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Affiliation(s)
- Julia Bungenberg
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
- JARA Brain Institute Molecular Neuroscience and Neuroimaging (INM-11), Research Centre Jülich and RWTH Aachen University, 52056, Aachen, Germany
| | - Christian Hohenfeld
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
- JARA Brain Institute Molecular Neuroscience and Neuroimaging (INM-11), Research Centre Jülich and RWTH Aachen University, 52056, Aachen, Germany
| | - Ana S Costa
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
- JARA Brain Institute Molecular Neuroscience and Neuroimaging (INM-11), Research Centre Jülich and RWTH Aachen University, 52056, Aachen, Germany
| | - Josephine Heine
- Department of Neurology, Charité-Universitätsmedizin Berlin, 10117, Berlin, Germany
- Faculty of Philosophy, Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, 10117, Berlin, Germany
| | - Katia Schwichtenberg
- Department of Neurology, Charité-Universitätsmedizin Berlin, 10117, Berlin, Germany
- Faculty of Philosophy, Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, 10117, Berlin, Germany
| | - Tim Hartung
- Department of Neurology, Charité-Universitätsmedizin Berlin, 10117, Berlin, Germany
- Faculty of Philosophy, Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, 10117, Berlin, Germany
| | - Christiana Franke
- Department of Neurology, Charité-Universitätsmedizin Berlin, 10117, Berlin, Germany
- Faculty of Philosophy, Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, 10117, Berlin, Germany
| | - Ferdinand Binkofski
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
- Division for Clinical Cognitive Sciences, Department of Neurology, RWTH Aachen University, 52074, Aachen, Germany
- Institute for Neuroscience and Medicine (INM-4), Research Center Jülich GmbH, 52425, Jülich, Germany
| | - Jörg B Schulz
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany
- JARA Brain Institute Molecular Neuroscience and Neuroimaging (INM-11), Research Centre Jülich and RWTH Aachen University, 52056, Aachen, Germany
| | - Carsten Finke
- Department of Neurology, Charité-Universitätsmedizin Berlin, 10117, Berlin, Germany
- Faculty of Philosophy, Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, 10117, Berlin, Germany
| | - Kathrin Reetz
- Department of Neurology, RWTH Aachen University, Pauwelsstraße 30, 52074, Aachen, Germany.
- JARA Brain Institute Molecular Neuroscience and Neuroimaging (INM-11), Research Centre Jülich and RWTH Aachen University, 52056, Aachen, Germany.
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14
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Zhang W, Gorelik AJ, Wang Q, Norton SA, Hershey T, Agrawal A, Bijsterbosch JD, Bogdan R. Associations between COVID-19 and putative markers of neuroinflammation: A diffusion basis spectrum imaging study. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.07.20.549891. [PMID: 37502886 PMCID: PMC10370178 DOI: 10.1101/2023.07.20.549891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
COVID-19 remains a significant international public health concern. Yet, the mechanisms through which symptomatology emerges remain poorly understood. While SARS-CoV-2 infection may induce prolonged inflammation within the central nervous system, the evidence primarily stems from limited small-scale case investigations. To address this gap, our study capitalized on longitudinal UK Biobank neuroimaging data acquired prior to and following COVID-19 testing (N=416 including n=224 COVID-19 cases; Mage=58.6). Putative neuroinflammation was assessed in gray matter structures and white matter tracts using non-invasive Diffusion Basis Spectrum Imaging (DBSI), which estimates inflammation-related cellularity (DBSI-restricted fraction; DBSI-RF) and vasogenic edema (DBSI-hindered fraction; DBSI-HF).We hypothesized that COVID-19 case status would be associated with increases in DBSI markers after accounting for potential confound (age, sex, race, body mass index, smoking frequency, and data acquisition interval) and multiple testing. COVID-19 case status was not significantly associated with DBSI-RF (|β|'s<0.28, pFDR >0.05), but with greater DBSI-HF in left pre- and post-central gyri and right middle frontal gyrus (β's>0.3, all pFDR=0.03). Intriguingly, the brain areas exhibiting increased putative vasogenic edema had previously been linked to COVID-19-related functional and structural alterations, whereas brain regions displaying subtle differences in cellularity between COVID-19 cases and controls included regions within or functionally connected to the olfactory network, which has been implicated in COVID-19 psychopathology. Nevertheless, our study might not have captured acute and transitory neuroinflammatory effects linked to SARS-CoV-2 infection, possibly due to symptom resolution before the imaging scan. Future research is warranted to explore the potential time- and symptom-dependent neuroinflammatory relationship with COVID-19.
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Affiliation(s)
- Wei Zhang
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Aaron J Gorelik
- Department of Psychological & Brain Sciences, Washington University, St. Louis, MO, United States
| | - Qing Wang
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Sara A Norton
- Department of Psychological & Brain Sciences, Washington University, St. Louis, MO, United States
| | - Tamara Hershey
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
- Department of Psychological & Brain Sciences, Washington University, St. Louis, MO, United States
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, United States
| | - Arpana Agrawal
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Janine D Bijsterbosch
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Ryan Bogdan
- Department of Psychological & Brain Sciences, Washington University, St. Louis, MO, United States
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15
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Fernández-de-las-Peñas C, Cancela-Cilleruelo I, Rodríguez-Jiménez J, Arias-Navalón JA, Martín-Guerrero JD, Pellicer-Valero OJ, Arendt-Nielsen L, Cigarán-Méndez M. Trajectory of post-COVID brain fog, memory loss, and concentration loss in previously hospitalized COVID-19 survivors: the LONG-COVID-EXP multicenter study. Front Hum Neurosci 2023; 17:1259660. [PMID: 38021227 PMCID: PMC10665893 DOI: 10.3389/fnhum.2023.1259660] [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: 07/16/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Objective This study aimed to apply Sankey plots and exponential bar plots for visualizing the trajectory of post-COVID brain fog, memory loss, and concentration loss in a cohort of previously hospitalized COVID-19 survivors. Methods A sample of 1,266 previously hospitalized patients due to COVID-19 during the first wave of the pandemic were assessed at 8.4 (T1), 13.2 (T2), and 18.3 (T3) months after hospital discharge. They were asked about the presence of the following self-reported cognitive symptoms: brain fog (defined as self-perception of sluggish or fuzzy thinking), memory loss (defined as self-perception of unusual forgetfulness), and concentration loss (defined as self-perception of not being able to maintain attention). We asked about symptoms that individuals had not experienced previously, and they attributed them to the acute infection. Clinical and hospitalization data were collected from hospital medical records. Results The Sankey plots revealed that the prevalence of post-COVID brain fog was 8.37% (n = 106) at T1, 4.7% (n = 60) at T2, and 5.1% (n = 65) at T3, whereas the prevalence of post-COVID memory loss was 14.9% (n = 189) at T1, 11.4% (n = 145) at T2, and 12.12% (n = 154) at T3. Finally, the prevalence of post-COVID concentration loss decreased from 6.86% (n = 87) at T1, to 4.78% (n = 60) at T2, and to 2.63% (n = 33) at T3. The recovery exponential curves show a decreasing trend, indicating that these post-COVID cognitive symptoms recovered in the following years after discharge. The regression models did not reveal any medical record data associated with post-COVID brain fog, memory loss, or concentration loss in the long term. Conclusion The use of Sankey plots shows a fluctuating evolution of post-COVID brain fog, memory loss, or concentration loss during the first years after the infection. In addition, exponential bar plots revealed a decrease in the prevalence of these symptoms during the first years after hospital discharge. No risk factors were identified in this cohort.
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Affiliation(s)
- César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid, Spain
- Center for Neuroplasticity and Pain, Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
| | - Ignacio Cancela-Cilleruelo
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid, Spain
| | - Jorge Rodríguez-Jiménez
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Madrid, Spain
| | | | - José D. Martín-Guerrero
- Intelligent Data Analysis Laboratory, Department of Electronic Engineering, ETSE (Engineering School), Universitat de València (UV), Valencia, Spain
- Valencian Graduate School and Research Network of Artificial Intelligence (ValgrAI), València, Spain
| | - Oscar J. Pellicer-Valero
- Image Processing Laboratory (IPL), Universitat de València, Parc Científic, Paterna, València, Spain
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain, Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
- Department of Gastroenterology & Hepatology, Mech-Sense, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
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16
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Churchill NW, Roudaia E, Jean Chen J, Gilboa A, Sekuler A, Ji X, Gao F, Lin Z, Masellis M, Goubran M, Rabin JS, Lam B, Cheng I, Fowler R, Heyn C, Black SE, MacIntosh BJ, Graham SJ, Schweizer TA. Persistent post-COVID headache is associated with suppression of scale-free functional brain dynamics in non-hospitalized individuals. Brain Behav 2023; 13:e3212. [PMID: 37872889 PMCID: PMC10636408 DOI: 10.1002/brb3.3212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 10/25/2023] Open
Abstract
INTRODUCTION Post-acute coronavirus disease 2019 (COVID-19) syndrome (PACS) is a growing concern, with headache being a particularly debilitating symptom with high prevalence. The long-term effects of COVID-19 and post-COVID headache on brain function remain poorly understood, particularly among non-hospitalized individuals. This study focused on the power-law scaling behavior of functional brain dynamics, indexed by the Hurst exponent (H). This measure is suppressed during physiological and psychological distress and was thus hypothesized to be reduced in individuals with post-COVID syndrome, with greatest reductions among those with persistent headache. METHODS Resting-state blood oxygenation level-dependent (BOLD) functional magnetic resonance imaging data were collected for 57 individuals who had COVID-19 (32 with no headache, 14 with ongoing headache, 11 recovered) and 17 controls who had cold and flu-like symptoms but tested negative for COVID-19. Individuals were assessed an average of 4-5 months after COVID testing, in a cross-sectional, observational study design. RESULTS No significant differences in H values were found between non-headache COVID-19 and control groups., while those with ongoing headache had significantly reduced H values, and those who had recovered from headache had elevated H values, relative to non-headache groups. Effects were greatest in temporal, sensorimotor, and insular brain regions. Reduced H in these regions was also associated with decreased BOLD activity and local functional connectivity. CONCLUSIONS These findings provide new insights into the neurophysiological mechanisms that underlie persistent post-COVID headache, with reduced BOLD scaling as a potential biomarker that is specific to this debilitating condition.
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Affiliation(s)
- Nathan W. Churchill
- Neuroscience Research Program, St. Michael's HospitalTorontoOntarioCanada
- Keenan Research Centre for Biomedical Science, St. Michael's HospitalTorontoOntarioCanada
- Physics DepartmentToronto Metropolitan UniversityTorontoOntarioCanada
| | - Eugenie Roudaia
- Rotman Research InstituteBaycrest Academy for Research and EducationTorontoOntarioCanada
| | - J. Jean Chen
- Rotman Research InstituteBaycrest Academy for Research and EducationTorontoOntarioCanada
- Department of Medical BiophysicsUniversity of TorontoTorontoOntarioCanada
- Institute of Biomedical EngineeringUniversity of TorontoTorontoOntarioCanada
| | - Asaf Gilboa
- Rotman Research InstituteBaycrest Academy for Research and EducationTorontoOntarioCanada
- Department of PsychologyUniversity of TorontoTorontoOntarioCanada
| | - Allison Sekuler
- Rotman Research InstituteBaycrest Academy for Research and EducationTorontoOntarioCanada
- Department of PsychologyUniversity of TorontoTorontoOntarioCanada
- Department of Psychology, Neuroscience & BehaviourMcMaster UniversityHamiltonOntarioCanada
| | - Xiang Ji
- LC Campbell Cognitive Neurology Research Group, Sunnybrook Health Sciences CentreTorontoOntarioCanada
| | - Fuqiang Gao
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
| | - Zhongmin Lin
- Department of Medical BiophysicsUniversity of TorontoTorontoOntarioCanada
- Physical Sciences PlatformSunnybrook Research InstituteTorontoOntarioCanada
| | - Mario Masellis
- Rotman Research InstituteBaycrest Academy for Research and EducationTorontoOntarioCanada
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoOntarioCanada
| | - Maged Goubran
- Department of Medical BiophysicsUniversity of TorontoTorontoOntarioCanada
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Physical Sciences PlatformSunnybrook Research InstituteTorontoOntarioCanada
- Harquail Centre for NeuromodulationSunnybrook Research InstituteTorontoOntarioCanada
| | - Jennifer S. Rabin
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoOntarioCanada
- Harquail Centre for NeuromodulationSunnybrook Research InstituteTorontoOntarioCanada
- Rehabilitation Sciences InstituteUniversity of TorontoTorontoOntarioCanada
| | - Benjamin Lam
- Rotman Research InstituteBaycrest Academy for Research and EducationTorontoOntarioCanada
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoOntarioCanada
| | - Ivy Cheng
- Evaluative Clinical SciencesSunnybrook Research InstituteTorontoOntarioCanada
- Integrated Community ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Department of MedicineUniversity of TorontoTorontoOntarioCanada
| | - Robert Fowler
- Department of MedicineUniversity of TorontoTorontoOntarioCanada
- Emergency & Critical Care Research ProgramSunnybrook Research InstituteTorontoOntarioCanada
| | - Chris Heyn
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Department of Medical ImagingUniversity of TorontoTorontoOntarioCanada
| | - Sandra E. Black
- Rotman Research InstituteBaycrest Academy for Research and EducationTorontoOntarioCanada
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoOntarioCanada
| | - Bradley J. MacIntosh
- Department of Medical BiophysicsUniversity of TorontoTorontoOntarioCanada
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Physical Sciences PlatformSunnybrook Research InstituteTorontoOntarioCanada
- Computational Radiology & Artificial Intelligence Unit, Division of Radiology and Nuclear MedicineOslo University HospitalOsloNorway
| | - Simon J. Graham
- Department of Medical BiophysicsUniversity of TorontoTorontoOntarioCanada
- Hurvitz Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
- Physical Sciences PlatformSunnybrook Research InstituteTorontoOntarioCanada
| | - Tom A. Schweizer
- Neuroscience Research Program, St. Michael's HospitalTorontoOntarioCanada
- Keenan Research Centre for Biomedical Science, St. Michael's HospitalTorontoOntarioCanada
- Faculty of Medicine (Neurosurgery)University of TorontoTorontoOntarioCanada
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