Neuropsychiatric manifestations of COVID-19 can be clustered in three distinct symptom categories

Abstract

Several studies have reported clinical manifestations of the new coronavirus disease. However, few studies have systematically evaluated the neuropsychiatric complications of COVID-19. We reviewed the medical records of 201 patients with confirmed COVID-19 (52 outpatients and 149 inpatients) that were treated in a large referral center in Tehran, Iran from March 2019 to May 2020. We used clustering approach to categorize clinical symptoms. One hundred and fifty-one patients showed at least one neuropsychiatric symptom. Limb force reductions, headache followed by anosmia, hypogeusia were among the most common neuropsychiatric symptoms in COVID-19 patients. Hierarchical clustering analysis showed that neuropsychiatric symptoms group together in three distinct groups: anosmia and hypogeusia; dizziness, headache, and limb force reduction; photophobia, mental state change, hallucination, vision and speech problem, seizure, stroke, and balance disturbance. Three non-neuropsychiatric cluster of symptoms included diarrhea and nausea; cough and dyspnea; and fever and weakness. Neuropsychiatric presentations are very prevalent and heterogeneous in patients with coronavirus 2 infection and these heterogeneous presentations may be originating from different underlying mechanisms. Anosmia and hypogeusia seem to be distinct from more general constitutional-like and more specific neuropsychiatric symptoms. Skeletal muscular manifestations might be a constitutional or a neuropsychiatric symptom.

Neurological manifestations in patients hospitalized with COVID‐19: A retrospective analysis from a large cohort in Northern Italy

“…These observations seem to confirm the model by Koralnik and Tyler (Koralnik & Tyler, 2020) who proposed that CNS invasion follows a different pathway of disease development compared to the classic respiratory illness. Mirfazeli et al performed a hierarchical clustering analysis of COVID-19-related different clinical manifestations and found that respiratory, neurologic and gastroenterological symptoms cluster largely unconnectedly (Mirfazeli et al, 2020). Anosmia and/or dysgeusia (recorded in 9.1% of individuals) and syncope (observed in 9.0%) were the most common neurologic manifestations.…”

Neuropsychiatric and Cognitive Sequelae of COVID-19

“…For a detailed discussion of these mechanisms, please see Wu et al (2020) . The neuronal pathway via the olfactory nerve and role of ACE2 has been observed to be the primary pathophysiological mechanisms contributing to neuropsychiatric and cognitive complications in COVID-19 ( Mirfazeli et al, 2020 ; Pantelis et al, 2020 ). This is mainly because coronaviruses affect the respiratory tract and can reach the ACE2-enzymes in the respiratory epithelial cells, and the olfactory nerve, providing a pathway for the coronavirus to enter the CNS.…”

“…In the short-term, 20–40% of COVID-19 cases may present with neuropsychiatric complications, such as cerebrovascular events, headache, dizziness, encephalopathies, anosmia, ageusia, and mood problems ( Bo et al, 2020 ; Crunfli et al, 2020 ; Lu et al, 2020 ; Mao et al, 2020 ; Mirfazeli et al, 2020 ; Troyer et al, 2020 ; Varatharaj et al, 2020 ; Wu et al, 2020 ; Zhang et al, 2020 ), see Table 1 . The acute effect of CoV infections on the CNS is manifested in viral encephalitis, infectious toxic encephalopathy, and acute cerebrovascular disease.…”

The role of gut-brain axis in SARA-CoV-2 neuroinvasion: Culprit or innocent bystander?

“…Some COVID-19 patients were clinically characterized by gastrointestinal symptoms as the first manifestation, and that the virus RNA has been isolated from the feces of confirmed patients. The cluster analysis results also showed that the clinical manifestations of the digestive system are pathologically close to those of the CNS ( Mirfazeli et al, 2020 ). We strongly agreed with the hypothesis that the SARS-CoV-2 is likely to affect the CNS through the intestine ( Esposito et al, 2020 ).…”