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

Abstract

Background Clinical investigations have argued for long-term neurological manifestations in both hospitalised and non-hospitalised COVID-19 patients. It is unclear whether long-term neurological symptoms and features depend on COVID-19 severity. Methods From a sample of 208 consecutive non-neurological patients hospitalised for COVID-19 disease, 165 survivors were re-assessed at 6 months according to a structured standardised clinical protocol. Prevalence and predictors of long-term neurological manifestations were evaluated using multivariate logistic regression analyses. Results At 6-month follow-up after hospitalisation due to COVID-19 disease, patients displayed a wide array of symptoms; fatigue (34%), memory/attention (31%) and sleep disorders (30%) were the most frequent. At neurological examination, 40% of patients exhibited neurological abnormalities, such as hyposmia (18.0%), cognitive deficits (17.5%), postural tremor (13.8%) and subtle motor/sensory deficits (7.6%). Older age, premorbid comorbidities and severity of COVID-19 were independent predictors of neurological manifestations in logistic regression analyses. Conclusions Premorbid vulnerability and severity of SARS-CoV-2 infection impact on prevalence and severity of long-term neurological manifestations.

Neurological manifestations of long-COVID syndrome: a narrative review

“…A key finding of this study was that 40% of patients presented objectifiable abnormalities on neurological examination, with the most common being hyposmia (18%), cognitive deficits (18%), postural tremor (14%), and motor/sensory deficits (8%). 40 These results thus indicate that objectifiable correlates of CNS or PNS involvement are observed in more than one-third of ‘long-COVID’ patients.…”

“…First, neurological ‘long-COVID’ sequelae, with clinically objectifiable correlates of CNS or PNS involvement, seem to affect at least one-third of patients with antecedent SARS-CoV-2 infection. 27 , 40 Nonetheless, a threefold higher incidence is documented in observational studies including self-reported data from COVID-19 survivors. 32 , 34 – 38 , 150 Second, there is a substantial overlap between neurological and psychiatric ‘long-COVID’ symptoms.…”

“…In fact, a growing body of evidence indicates that long-lasting neurological deficits of ICU COVID-19 survivors display many similarities to postintensive care syndrome (PICS). 27 , 40 , 101 , 107 Thus, further research is required to identify potential overlaps and enable distinction between neurological manifestations of ‘long-COVID’ and PICS.…”

“… 106 , 109 Discordant findings are also found in the literature concerning the contribution of demographic factors to ‘long-COVID’. With respect to age, for example, although a number of studies support that increasing age confers an increased susceptibility to long-term sequelae, 5 , 40 , 109 other studies reported that younger patients may be at higher risk of ‘long-COVID’. 110 Moreover, a striking prevalence of ‘long-COVID’ symptoms of nearly 43% has been reported in children with antecedent SARS-CoV-2 infection, albeit these prevalence estimates remain debatable.…”

The Combined Use of Neuropsychiatric and Neuropsychological Assessment Tools to Make a Differential Dementia Diagnosis in the Presence of “Long-Haul” COVID-19

“…There is already preliminary evidence that COVID-19 can result in longer term cognitive difficulties (i.e., up to 6 months post-COVID-19) [ 11 ]. For example, even mild COVID-19 patients can demonstrate persistent deficits in memory and heightened psychiatric symptomatology up to 6 months posttreatment [ 12 , 13 ]. In addition, general cognitive decay (as measured by the Mini-Mental State Exam [MMSE]) was present in patients with severe COVID-19 who were entering the post-acute phase of illness (i.e., defined as clinical stability and complete weaning from sedative and antipsychotic medications) − on average 30 days post-COVID-19 diagnosis [ 14 ].…”