Brain Imaging Changes in Patients Recovered From COVID-19: A Narrative Review

Huang, Yan; Ling, Qiong; Manyande, Anne; Wu, Duozhi; Xiang, Boqi

doi:10.3389/fnins.2022.855868

Cited by 23 publications

(15 citation statements)

References 117 publications

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“…The pathophysiology of fatigue in PCS is still poorly understood. According to the first studies showing neuroimaging alterations in several brain regions [15][16][17][18], fatigue may involve a central mechanism. In this regard, impairment of GABAB-ergic neurotransmission has been detected using transcranial magnetic stimulation of the motor cortex [19,20], and another study found an association between APOE4 and post-COVID fatigue [21].…”

Section: Introductionmentioning

confidence: 99%

Neuropsychological Predictors of Fatigue in Post-COVID Syndrome

Matías‐Guiu

Delgado‐Alonso

Díez‐Cirarda

et al. 2022

JCM

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Fatigue is one of the most disabling symptoms in several neurological disorders and has an important cognitive component. However, the relationship between self-reported cognitive fatigue and objective cognitive assessment results remains elusive. Patients with post-COVID syndrome often report fatigue and cognitive issues several months after the acute infection. We aimed to develop predictive models of fatigue using neuropsychological assessments to evaluate the relationship between cognitive fatigue and objective neuropsychological assessment results. We conducted a cross-sectional study of 113 patients with post-COVID syndrome, assessing them with the Modified Fatigue Impact Scale (MFIS) and a comprehensive neuropsychological battery including standardized and computerized cognitive tests. Several machine learning algorithms were developed to predict MFIS scores (total score and cognitive fatigue score) based on neuropsychological test scores. MFIS showed moderate correlations only with the Stroop Color–Word Interference Test. Classification models obtained modest F1-scores for classification between fatigue and non-fatigued or between 3 or 4 degrees of fatigue severity. Regression models to estimate the MFIS score did not achieve adequate R2 metrics. Our study did not find reliable neuropsychological predictors of cognitive fatigue in the post-COVID syndrome. This has important implications for the interpretation of fatigue and cognitive assessment. Specifically, MFIS cognitive domain could not properly capture actual cognitive fatigue. In addition, our findings suggest different pathophysiological mechanisms of fatigue and cognitive dysfunction in post-COVID syndrome.

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Section: Introductionmentioning

confidence: 99%

Neuropsychological Predictors of Fatigue in Post-COVID Syndrome

Matías‐Guiu

Delgado‐Alonso

Díez‐Cirarda

et al. 2022

JCM

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“…Previous studies have assessed structural damage to the central nervous system (CNS) using advanced MRI techniques, such as diffusion tensor imaging (DTI) in PwMS and failed to find a significant association between perceived fatigability and structural alterations (Codella et al 2002a , 2002b ). Similarly, recent studies in people with post-COVID-19 symptoms found no significant differences in MRI findings between subjects with and without cognitive impairments and fatigue after acute infection (Hellgren et al 2021 ; Huang et al 2022 ). Moreover, despite several studies detecting changes in brain microstructure of people with post-COVID-19 with structural MRI (Colonna et al 2020 ; Freeman et al 2021 ; Hixon et al 2021 ; Nuzzo et al 2021 ; Cecchini et al 2022 ) and DTI (Liu et al 2019 ; Tian et al 2020 ; Qin et al 2021 ), no correlations with fatigue symptoms have been reported.…”

Section: Discussionmentioning

confidence: 85%

Fatigue and perceived fatigability, not objective fatigability, are prevalent in people with post-COVID-19

2022

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Persistent symptoms after acute COVID-19 infection, termed post-COVID-19 fatigue, occur in 44–70% of patients. Characterizing fatigue in this population is vital to determine the etiology of post-COVID-19 fatigue symptoms and to assess the effectiveness of potential interventions. The purpose of this study was to assess differences in perceived and objective fatigability between people with post-COVID-19 symptoms ( N = 29, 20 females) and people who had COVID-19 but are not experiencing persistent symptoms ( N = 20, 12 females). Perceived fatigability, fatigue, pain, and quality of life were assessed with the Fatigue Severity Scale (FSS), Fatigue Assessment Scale (FAS), Visual Analog Scale for Pain (VAS), and the EQ-5D-5L, respectively. Objective fatigability was evaluated with torque and work fatigue indices (FI-T and FI-W), calculated via an isokinetic fatigue task. The results revealed that, the subjects with post-COVID-19 symptoms had significantly higher FAS ( p < 0.01), FSS ( p < 0.01), VAS ( p < 0.01), and EQ-5D-5L VAS ( p < 0.01) scores compared to subjects without post-COVID-19 symptoms, indicating greater fatigue and perceived fatigability, increased pain, and worse quality of life. However, there were no differences between the two groups for the FI-Ts (all p ≥ 0.07) or FI-W (all p ≥ 0.08), indicating no differences in objective fatigability. This study found that people with post-COVID-19 symptoms have increased fatigue and perceived fatigability, but not objective fatigability, compared to subjects without post-COVID-19 symptoms.

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“…Our results support the proposed correlation between brain hypometabolism and lasting cognitive deficits in COVID-19 patients one year after the infection. We found a heterogeneous pattern of abnormalities variably affecting prefrontal, temporal-mesial, parietal and pontine areas, those more affected during SARS-CoV-2 [ 27 – 29 ] infection. However, in our sample not all patients who had cognitive deficits showed hypometabolism as measured by FDG-PET.…”

Section: Discussionmentioning

confidence: 94%

Brain positron emission tomography (PET) and cognitive abnormalities one year after COVID-19

Ferrucci

Cuffaro²,

Capozza

et al. 2023

J Neurol

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Emerging evidence indicates that the etiologic agent responsible for coronavirus disease 2019 (COVID-19), can cause neurological complications. COVID-19 may induce cognitive impairment through multiple mechanisms. The aim of the present study was to describe the possible neuropsychological and metabolic neuroimaging consequences of COVID-19 12 months after patients’ hospital discharge. We retrospectively recruited 7 patients (age [mean ± SD] = 56 years ± 12.39, 4 men) who had been hospitalized for COVID-19 with persistent neuropsychological deficits 12 months after hospital discharge. All patients underwent cognitive assessment and brain ( 18 F-FDG) PET/CT, and one also underwent 18 F-amyloid PET/CT. Of the seven patients studied, four had normal glucose metabolism in the brain. Three patients showed various brain hypometabolism patterns: (1) unilateral left temporal mesial area hypometabolism; (2) pontine involvement; and (3) bilateral prefrontal area abnormalities with asymmetric parietal impairment. The patient who showed the most widespread glucose hypometabolism in the brain underwent an 18 F-amyloid PET/CT to assess the presence of Aβ plaques. This examination showed significant Aβ deposition in the superior and middle frontal cortex, and in the posterior cingulate cortex extending mildly in the rostral and caudal anterior cingulate areas. Although some other reports have already suggested that brain hypometabolism may be associated with cognitive impairment at shorter intervals from SarsCov-2 infection, our study is the first to assess cognitive functions, brain metabolic activity and in a patient also amyloid PET one year after COVID-19, demonstrating that cerebral effects of COVID-19 can largely outlast the acute phase of the disease and even be followed by amyloid deposition.

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Brain Imaging Changes in Patients Recovered From COVID-19: A Narrative Review

Cited by 23 publications

References 117 publications

Neuropsychological Predictors of Fatigue in Post-COVID Syndrome

Neuropsychological Predictors of Fatigue in Post-COVID Syndrome

Fatigue and perceived fatigability, not objective fatigability, are prevalent in people with post-COVID-19

Brain positron emission tomography (PET) and cognitive abnormalities one year after COVID-19

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