Persistent neurologic symptoms and cognitive dysfunction in non‐hospitalized Covid‐19 “long haulers”

Abstract

Objective Most SARS‐CoV‐2‐infected individuals never require hospitalization. However, some develop prolonged symptoms. We sought to characterize the spectrum of neurologic manifestations in non‐hospitalized Covid‐19 “long haulers”. Methods This is a prospective study of the first 100 consecutive patients (50 SARS‐CoV‐2 laboratory‐positive (SARS‐CoV‐2+) and 50 laboratory‐negative (SARS‐CoV‐2‐) individuals) presenting to our Neuro‐Covid‐19 clinic between May and November 2020. Due to early pandemic testing limitations, patients were included if they met Infectious Diseases Society of America symptoms of Covid‐19, were never hospitalized for pneumonia or hypoxemia, and had neurologic symptoms lasting over 6 weeks. We recorded the frequency of neurologic symptoms and analyzed patient‐reported quality of life measures and standardized cognitive assessments. Results Mean age was 43.2 ± 11.3 years, 70% were female, and 48% were evaluated in televisits. The most frequent comorbidities were depression/anxiety (42%) and autoimmune disease (16%). The main neurologic manifestations were: “brain fog” (81%), headache (68%), numbness/tingling (60%), dysgeusia (59%), anosmia (55%), and myalgias (55%), with only anosmia being more frequent in SARS‐CoV‐2+ than SARS‐CoV‐2‐ patients (37/50 [74%] vs. 18/50 [36%]; p < 0.001). Moreover, 85% also experienced fatigue. There was no correlation between time from disease onset and subjective impression of recovery. Both groups exhibited impaired quality of life in cognitive and fatigue domains. SARS‐CoV‐2+ patients performed worse in attention and working memory cognitive tasks compared to a demographic‐matched US population (T‐score 41.5 [37, 48.25] and 43 [37.5, 48.75], respectively; both p < 0.01). Interpretation Non‐hospitalized Covid‐19 “long haulers” experience prominent and persistent “brain fog” and fatigue that affect their cognition and quality of life.

COVID-19 vaccination in patients with epilepsy: First experiences in a German tertiary epilepsy center

“…The Corona pandemic has led to dramatic changes in social and economic life worldwide. In addition to the high number of COVID-19-related dead, those who are seriously ill, and patients who are suffering from long/post COVID [1] , [2] , the general population is also affected by the way in which the dramatic pandemic measures have influenced psychosocial relations and daily living. All of these issues point toward the urgent need for vaccination.…”

A Comparison of the Clinical, Viral, Pathologic, and Immunologic Features of Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), and Coronavirus 2019 (COVID-19) Diseases

“…[113][114][115][116] Graham et al have reported on a group of 50 SARS-C0V-2 patients who were seen in the Neuro-COVID-19 Clinic at Northwestern University who were "long haulers." 117 The main neurologic symptoms were "brain fog," headache, numbness/tingling, dysgeusia, anosmia, myalgias, dizziness, pain, blurred vision, tinnitus, and dysgeusia in frequencies ranging from 81% for "brain fog" to 29% for tinnitus. Dys-or ageusia, which are specially common, appear to be attributable to the expression of ACE-2 receptors on Type II taste receptor cells in the fungiform papillae of the tongue.…”

High proportion of post-acute sequelae of SARS-CoV-2 infection in individuals 1-6 months after illness and association with disease severity in an outpatient telemedicine population

“…Subsequent evidence emerged that persistent symptoms are common for both hospitalized (3) and non-hospitalized (4) cohorts, and these patients have described challenges with stigma as well as difficulty accessing care for their symptoms (5). Later reports indicate disruption to usual activities and impaired quality of life may last months (6–8). Studies of survivors of severe acute respiratory syndrome (SARS) hospitalized from 2001-2003 showed persistent pulmonary dysfunction (9) as well as chronic fatigue and psychiatric illnesses (10) lasting years.…”

“…A meta-analysis of 47,910 patients found the most frequent symptoms include fatigue, headache, attention disorder, hair loss, and dyspnea (22) and noted a high degree of heterogeneity in published studies with a need for future studies to stratify results by patient baseline characteristics and disease severity. Individual cohort studies have reported a variety of specific risk factors for prolonged symptoms including female sex (23–25), higher body mass index (BMI) (23,24), middle age (26), older age (24,27), underlying autoimmunity (8), while one study found no significant predictors (28). Features of acute COVID-19 may predict PASC, with cohort studies finding increasing risk for: patients with more than 5 acute symptoms (24), presence of specific acute symptoms (chest pain, fatigue, fever, olfactory impairment, headaches, or diarrhea) (25), and hospitalization (26).…”