Selective visuoconstructional impairment following mild COVID-19 with inflammatory and neuroimaging correlation findings

Abstract

People recovered from COVID-19 may still present complications including respiratory and neurological sequelae. In other viral infections, cognitive impairment occurs due to brain damage or dysfunction caused by vascular lesions and inflammatory processes. Persistent cognitive impairment compromises daily activities and psychosocial adaptation. Some level of neurological and psychiatric consequences were expected and described in severe cases of COVID-19. However, it is debatable whether neuropsychiatric complications are related to COVID-19 or to unfoldings from a severe infection. Nevertheless, the majority of cases recorded worldwide were mild to moderate self-limited illness in non-hospitalized people. Thus, it is important to understand what are the implications of mild COVID-19, which is the largest and understudied pool of COVID-19 cases. We aimed to investigate adults at least four months after recovering from mild COVID-19, which were assessed by neuropsychological, ocular and neurological tests, immune markers assay, and by structural MRI and 18FDG-PET neuroimaging to shed light on putative brain changes and clinical correlations. In approximately one-quarter of mild-COVID-19 individuals, we detected a specific visuoconstructive deficit, which was associated with changes in molecular and structural brain imaging, and correlated with upregulation of peripheral immune markers. Our findings provide evidence of neuroinflammatory burden causing cognitive deficit, in an already large and growing fraction of the world population. While living with a multitude of mild COVID-19 cases, action is required for a more comprehensive assessment and follow-up of the cognitive impairment, allowing to better understand symptom persistence and the necessity of rehabilitation of the affected individuals.

Patients Recovering from COVID-19 who Presented Anosmia During their Acute Episode have Behavioral, Functional, and Structural Brain Alterations

“…Since the onset of the pandemic caused by the SARS-CoV-2 virus, evidence has accumulated that some recovered patients from the acute infection episode exhibit cognitive impairment and brain alterations. [1][2][3] Studies have found that even months after recovery from COVID-19 infection, some individuals continue to experience neurological, psychiatric, and cognitive effects. 4,5 Persistent cognitive symptoms have been linked to brain alterations, including cerebral hypoperfusion 6 and hypometabolism.…”

“…9 Moreover, even patients with mild COVID-19 also present subtle brain alterations. [1][2][3] It remains unknown which risk factors or clinical profiles distinguish mild COVID-19 patients who may present this alteration from those who do not.…”

“…This deficit was associated with molecular and structural brain imaging changes and correlated with the upregulation of peripheral immune markers. 3 Despite the increasing body of evidence, the specific clinical factors associated with brain alterations remain elusive, presenting challenges in identifying populations at risk of developing long-term brain and cognitive impairments following SARS-CoV-2 infection. The severity of acute infection is the most studied clinical factor that leads to brain and cognitive alteration.…”