Late neurological consequences of SARS-CoV-2 infection: New challenges for the neurologist

Objective

In this study, a systematic review of the literature was performed to study the frequency of neurological symptoms and diseases in adult patients with COVID-19 that may be late consequences of SARS-CoV-2 infection.

Methods

Relevant studies were identified through electronic explorations of Scopus, PubMed, and Google Scholar. We followed PRISMA guidelines. Data were collected from studies where the diagnosis of COVID-19 was confirmed and its late neurological consequences occurred at least 4 weeks after initial SARS-CoV-2 infection. Review articles were excluded from the study. Neurological manifestations were stratified based on frequency (above 5, 10, and 20%), where the number of studies and sample size were significant.

Results

A total of 497 articles were identified for eligible content. This article provides relevant information from 45 studies involving 9,746 patients. Fatigue, cognitive problems, and smell and taste dysfunctions were the most frequently reported long-term neurological symptoms in patients with COVID-19. Other common neurological issues were paresthesia, headache, and dizziness.

Conclusion

On a global scale of patients affected with COVID-19, prolonged neurological problems have become increasingly recognized and concerning. Our review might be an additional source of knowledge about potential long-term neurological impacts.

Assistive Technology in Multiple Sclerosis Patients—Two Points of View

Objective: The goal of our study was determining the current needs and acceptance of patients with multiple sclerosis (MS) in the field of assistive technologies using materials from the “RAMCIP” project (Robotic Assistant for Mild Cognitive Impairment Patient at Home). Methods: There were two target groups: a population with MS, and medical personnel experienced in treating MS patients. This study was based on a two-step design method (workshops and surveys). Using the Likert scale, we identified the prioritization of users’ needs. Additionally, demographic and disease-specific data and their correlations with each other and with the level of priority of functionality were analyzed. Moreover, the acceptance aspect of the assistant robot and the respondents’ readiness to use it were determined. Results: We gathered 307 completed surveys (176 from MS patients, 131 from medical personnel). Functional capabilities from the safety category were a high priority in most cases. The medium priority functions concerned daily activities that required physical assistance and home management. The differences in prioritization between the two groups were also found. Variables such as age, level of disability, cognitive impairment, depression, and fatigue were associated with the priority level of the functionalities. Conclusion: In summary, our findings might contribute to a better adaptation of robotic assistants to the needs and expectations of the MS population.

Assessment of Perceived Attractiveness, Usability, and Societal Impact of a Multimodal Robotic Assistant for Aging Patients With Memory Impairments

The aim of the present study is to present the results of the assessment of clinical application of the robotic assistant for patients suffering from mild cognitive impairments (MCI) and Alzheimer Disease (AD). The human-robot interaction (HRI) evaluation approach taken within the study is a novelty in the field of social robotics. The proposed assessment of the robotic functionalities are based on end-user perception of attractiveness, usability and potential societal impact of the device. The methods of evaluation applied consist of User Experience Questionnaire (UEQ), AttrakDiff and the societal impact inventory tailored for the project purposes. The prototype version of the Robotic Assistant for MCI patients at Home (RAMCIP) was tested in a semi-controlled environment at the Department of Neurology (Lublin, Poland). Eighteen elderly participants, 10 healthy and 8 MCI, performed everyday tasks and functions facilitated by RAMCIP. The tasks consisted of semi-structuralized scenarios like: medication intake, hazardous events prevention, and social interaction. No differences between the groups of subjects were observed in terms of perceived attractiveness, usability nor-societal impact of the device. The robotic assistant societal impact and attractiveness were highly assessed. The usability of the device was reported as neutral due to the short time of interaction.

Outcome prediction in patients with acute repetitive seizures: Application of the Status Epilepticus Severity Score

Acute repetitive seizures (ARS) pose a risk of hospital admission with status epilepticus and a mortality threat, which underscores the need for the early prediction of a clinical course. Unfortunately, little attention has been given to ARS in this context, even though we possess the appropriate predictive tools for the stages of status epilepticus. Therefore, the main aim of this study was to assess the prognostic value of the Status Epilepticus Severity Score (STESS) in the population of patients with ARS. The study included a population of 200 patients. Almost half of the patients had achieved seizure cessations after diazepam administration, whereas 19.5% progressed to status epilepticus despite antiepileptic drug treatment. Mortality reached 10.5% of the total population. The receiver operating characteristic (ROC) curve for prediction of death by the STESS had an area under the curve (AUC) of 0.901, with an optimal cutoff point for discrimination ≥2 (sensitivity 0.95, specificity 0.71, and Youden index 0.66). Hosmer-Lemeshow indicated good calibration of the STESS (chi-square goodness-of-fit test = 3.24; P = .919). The study shows excellent effectiveness of the STESS in the prognosis of the clinical course in patients with ARS. STESS may be a valuable tool for the proper planning of diagnostic and therapeutic activities in this population.

Challenges for Service Robots-Requirements of Elderly Adults with Cognitive Impairments

OBJECTIVE

We focused on identifying the requirements and needs of people suffering from Alzheimer disease and early dementia stages with relation to robotic assistants.

METHODS

Based on focus groups performed in two centers (Poland and Spain), we created surveys for medical staff, patients, and caregivers, including: functional requirements; human-robot interaction, the design of the robotic assistant and user acceptance aspects. Using Likert scale and analysis made on the basis of the frequency of survey responses, we identified users' needs as high, medium, and low priority.

RESULTS

We gathered 264 completed surveys (100 from medical staff, 81 from caregivers, and 83 from potential users). Most of the respondents, almost at the same level in each of the three groups, accept robotic assistants and their support in everyday life. High level priority functional requirements were related to reacting in emergency situations (calling for help, detecting/removing obstacles) and to reminding about medication intake, about boiling water, turning off the gas and lights (almost 60% of answers). With reference to human-robot interaction, high priority was given to voice operated system and the capability of robotic assistants to reply to simple questions.

CONCLUSION

Our results help in achieving better understanding of the needs of patients with cognitive impairments during home tasks in everyday life. This way of conducting the research, with considerations for the interests of three stakeholder groups in two autonomic centers with proven experience regarding the needs of our patient groups, highlights the importance of obtained results.

Predictive model for patients with poor-grade subarachnoid haemorrhage in 30-day observation: a 9-year cohort study

OBJECTIVE

The purpose of this study was to identify prognostic factors and build the predictive model based on poor-grade subarachnoid haemorrhage (SAH) population received only supportive symptomatic treatment.

DESIGN

Prospective observational cohort study.

SETTING

Intensive care unit at the Clinical Department of Neurology.

PARTICIPANTS

A total of 101 patients with spontaneous SAH disqualified from neurosurgical operative treatment due to poor clinical condition. Data were collected over a 9-year period.

OUTCOME MEASURES

Unfavourable outcome was defined as a modified Rankin Score ≥ 5 at 30 days of observation.

RESULTS

Multivariable logistic regression analysis indicated the World Federation of Neurosurgical Societies Scale score, increasing age, Fisher grade and admission leucocytosis as independent predictive factors. The proposed scale subdivides the study population into four prognostic groups with significantly different outcomes: grade I: probability of favourable outcome 89.9%; grade II: 47.5%; grade III: 4.2%; grade IV: 0%. The receiver operating characteristic (ROC) curve for the prediction of outcome performed by the new scale had an area under the curve (AUC)=0.910 (excellent accuracy).

CONCLUSIONS

Unfavourable outcome in non-operated patients with poor-grade SAH is strongly predicted by traditional unmodifiable factors such as age, amount of bleeding in CT, level of consciousness as well as leucocytosis. A new predictive scale based on the above parameters seems to reliably predict the outcome and may contribute to more effective planning of therapeutic management in patients with poor-grade SAH.