Long-term neurological manifestations of COVID-19: prevalence and predictive factors

Abstract

BackgroundPreclinical and clinical investigations have argued for nervous system involvement in SARS-CoV-2 infection and for long term sequalae including neurological manifestationsMethodsa sample of 208 previously hospitalized COVID-19 patients, 165 patients were re-assessed at 6 months according to a structured standardized clinical protocol. Premorbid comorbidities and clinical status, severity of COVID-19 disease, complications during and after hospitalization were recorded.ResultsAt 6-month follow-up after hospitalisation due to COVID-19 disease, patients displayed a wide array of neurological symptoms, being fatigue (34%), memory/attention (31%), and sleep disorders (30%) the most frequent. Subjects reporting neurological symptoms were affected by more severe respiratory SARS-CoV-2 infection parameters during hospitalisation. At neurological examination, 37.4% of patients exhibited neurological abnormalities, being cognitive deficits (17.5%), hyposmia (15.7%) and postural tremor (13.8%) the most common. Patients with cognitive deficits at follow-up were comparable for age, sex and pre-admission comorbidities but experienced worse respiratory SARS-CoV-2 infection disease and longer hospitalisation.Conclusionslong term neurological manifestations after hospitalization due to COVID-19 infection affects one third of survivors. Multiple neurological abnormalities including mild cognitive impairment are associated with severity of respiratory SARS-CoV-2 infection.

Post-COVID-19 Syndrome: The Persistent Symptoms at the Post-viral Stage of the Disease. A Systematic Review of the Current Data

“…Finally, other studies evaluating heterogenous populations of mild-to-severe COVID-19 patients further confirmed persistent loss of smell up to 6 months after symptom onset (57,61,62,64,121,122). Moein et al in a prospective study on 82 mild-to-severe COVID-19 patients showed smell loss in ∼37% of patients at 2 months of follow-up (57).…”

“…At the same follow-up, a prospective study on 138 patients and a retrospective study on 90 mild-tosevere patients showed persistent hyposmia in 5-8% of patients (57,67). Lastly, Pilotto et al, by examining retrospectively 165 patients detected the presence of hyposmia in ∼15% of patients at up to 6 months of follow-up (61).…”

“…The most frequent neurological long-term symptoms in these patients were myalgia, arthralgia, sleeping troubles, and headache (46,50,61,116). Additionally, a general cognitive decay, i.e., deficit in attention and calculation, short-term memory, constructional apraxia, and written language, was also observed during up to 6 months of follow-up (61). At 2 months of follow-up 58.7% of 179 mild-tosevere COVID-19 patients presented a moderate neurocognitive decline while 39.1% of patients also showed psychiatric morbidity (56).…”

“…In this context, a recent editorial and a systematic review provided a detailed overview into the spectrum of mental disorders that can occur during the intermediate and long-term phases of COVID-19 in mild-to-critical patients (114,115). The most frequent neurological long-term symptoms in these patients were myalgia, arthralgia, sleeping troubles, and headache (46,50,61,116). Additionally, a general cognitive decay, i.e., deficit in attention and calculation, short-term memory, constructional apraxia, and written language, was also observed during up to 6 months of follow-up (61).…”

“…At 2 months of follow-up 58.7% of 179 mild-tosevere COVID-19 patients presented a moderate neurocognitive decline while 39.1% of patients also showed psychiatric morbidity (56). At a longer follow-up of 6 months, Pilotto et al, analyzing retrospectively 165 moderate-to-severe COVID-19 patients, showed that these long-term symptoms persisted in about 37% of patients (61). Also, symptoms consistent with orthostatic hypoperfusion syndrome and painful small fiber neuropathy were reported at short (3 weeks) and long (up to 3 months) follow-ups in two case-reports and in a small case-series (48,59,63).…”