Spectrum of neuropsychiatric manifestations in COVID-19

Nalleballe, Krishna; Onteddu, Sanjeeva; Sharma, Rohan; Dandu, Vasuki; Brown, Aliza; Jasti, Madhu; Yadala, Sisira; Veerapaneni, Karthika; Siddamreddy, Suman; Avula, Akshay; Kapoor, Nidhi; Kamran, Muhammad; Kovvuru, Sukanthi

doi:10.1016/j.bbi.2020.06.020

Cited by 221 publications

(229 citation statements)

References 29 publications

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“…There is growing literature showing that patients with COVID-19 may have neuropsychiatric manifestations. In a recent series, anxiety, mood disorders, emotional state symptoms, sleep disorders, and suicidal ideation have been reported in about 13% of COVID-19 patients [ 21 ]. In a nationwide, cross-specialty surveillance study of acute neurological and psychiatric complications of COVID-19, 25% were identified with altered mental status, reflecting both neurological and psychiatric diagnoses, such as encephalitis and psychosis [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Neurological manifestations of patients infected with the SARS-CoV-2: a systematic review of the literature

et al. 2020

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Objective To perform an updated review of the literature on the neurological manifestations of COVID-19-infected patients Methods A PRISMA-guideline-based systematic review was conducted on PubMed, EMBASE, and SCOPUS. Series reporting neurological manifestations of COVID-19 patients were studied. Results 39 studies and 68,361 laboratory-confirmed COVID-19 patients were included. Up to 21.3% of COVID-19 patients presented neurological symptoms. Headache (5.4%), skeletal muscle injury (5.1%), psychiatric disorders (4.6%), impaired consciousness (2.8%), gustatory/olfactory dysfunction (2.3%), acute cerebrovascular events (1.4%), and dizziness (1.3%), were the most frequently reported neurological manifestations. Ischemic stroke occurred among 1.3% of COVID-19 patients. Other less common neurological manifestations were cranial nerve impairment (0.6%), nerve root and plexus disorders (0.4%), epilepsy (0.7%), and hemorrhagic stroke (0.15%). Impaired consciousness and acute cerebrovascular events were reported in 14% and 4% of patients with a severe disease, respectively, and they were significantly higher compared to non-severe patients ( p < 0.05). Individual patient data from 129 COVID-19 patients with acute ischemic stroke (AIS) were extracted: mean age was 64.4 (SD ± 6.2), 78.5% had anterior circulation occlusions, the mean NIHSS was 15 (SD ± 7), and the intra-hospital mortality rate was 22.8%. Admission to the intensive care unit (ICU) was required among 63% of patients. Conclusion This updated review of literature, shows that headache, skeletal muscle injury, psychiatric disorders, impaired consciousness, and gustatory/olfactory dysfunction were the most common neurological symptoms of COVID-19 patients. Impaired consciousness and acute cerebrovascular events were significantly higher among patients with a severe infection. AIS patients required ICU admission in 63% of cases, while intra-hospital mortality rate was close to 23%. Electronic supplementary material The online version of this article (10.1007/s00415-020-10285-9) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Neurological manifestations of patients infected with the SARS-CoV-2: a systematic review of the literature

et al. 2020

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“…Manifestations such as insomnia, anxiety, post-traumatic stress symptoms (PTSD), psychosis and mood disorders have been described in several reports (see Table 1; Dinakaran et al, 2020;Liguori et al, 2020;Nalleballe et al, 2020;Rogers et al, 2020;Romero-Sanchez et al, 2020;Vindegaard and Benros, 2020). A study that retrieved data from a global health collaborative platform that included medical records of 40,469 COVID-19 positive cases, mostly from the United States (US) (76%), found that 22.5% had neurological and/or psychiatric manifestations, being anxiety and related disorders the most prevalent (4.6%) (Nalleballe et al, 2020).…”

Section: Neuropsychiatric Manifestations Of Covid-19mentioning

confidence: 99%

Cognitive and Neuropsychiatric Manifestations of COVID-19 and Effects on Elderly Individuals With Dementia

Alonso‐Lana

Marquié

Ruiz

et al. 2020

Front. Aging Neurosci.

147

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The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread worldwide and has had unprecedented effects in healthcare systems, economies and society. COVID-19 clinical presentation primarily affects the respiratory system causing bilateral pneumonia, but it is increasingly being recognized as a systemic disease, with neurologic manifestations reported in patients with mild symptoms but, most frequently, in those in a severe condition. Elderly individuals are at high risk of developing severe forms of COVID-19 due to factors associated with aging and a higher prevalence of medical comorbidities and, therefore, they are more vulnerable to possible lasting neuropsychiatric and cognitive impairments. Several reports have described insomnia, depressed mood, anxiety, post-traumatic stress disorder and cognitive impairment in a proportion of patients after discharge from the hospital. The potential mechanisms underlying these symptoms are not fully understood but are probably multifactorial, involving direct neurotrophic effect of SARS-CoV-2, consequences of long intensive care unit stays, the use of mechanical ventilation and sedative drugs, brain hypoxia, systemic inflammation, secondary effects of medications used to treat COVID-19 and dysfunction of peripheral organs. Chronic diseases such as dementia are a particular concern not only because they are associated with higher rates of hospitalization and mortality but also because COVID-19 further exacerbates the vulnerability of those with cognitive impairment. In patients with dementia, COVID-19 frequently has an atypical presentation with mental status changes complicating the early identification of cases. COVID-19 has had a dramatical impact in long-term care facilities, where rates of infection and mortality have been very high. Community measures implemented to slow the spread of the virus have forced to social distancing and cancelation of cognitive stimulation programs, which may have contributed to generate loneliness, behavioral symptoms and worsening of cognition in patients with dementia. COVID-19 has impacted the functioning of Memory Clinics, research programs and clinical trials in the Alzheimer's field, triggering the

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“…However, the TriNetX platform allows analysis in the form of queries. The TriNetX platform has previously been described in detail in several similar studies on COVID-19 that used this platform [3,8,9,10,11]. At University of Arkansas for Medical Sciences, the data from TriNetX is managed by the Arkansas Clinical Data Repository (AR-CDR) and maintained by the Department of Biomedical Informatics.…”

Section: Data Sourcementioning

confidence: 99%

Coronavirus Disease 2019 in Patients With Prior Ischemic Stroke

Nalleballe¹,

Siddamreddy²,

Sheng³

et al. 2020

Cureus

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Background: It is uncertain if patients with prior ischemic stroke are vulnerable to coronavirus disease 2019 (COVID-19) and its complications. Methods: We used TriNetX, a global health collaborative clinical research platform with a large global COVID-19 database. COVID-19 infection was identified with a positive lab value for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and related ribonucleic acid (RNA). Findings: A total of 604,258 patients with history of ischemic stroke were identified, of which 891 patients (study cohort) were diagnosed with COVID-19. A control cohort with 32,136 patients diagnosed with COVID-19 after January 20 th 2020 without a history of ischemic stroke were identified. A comparison between study cohort and control cohort showed patients with prior history of stroke (study cohort) were older (69.5 vs 47.8; p<0.0001) and had more comorbidities contributing to worse clinical outcomes. After propensity matching for demographic variables and comorbidities, only rate of hospitalization (287 vs 231; p=0.0035) and need for critical care services (85 vs 55; p=0.0082) remained statistically significant while intubation (51 vs 43; p=0.39) and death (119 vs 115; p=0.77) showed trends towards worse outcomes but were not statistically significant. Interpretation: Patients with history of ischemic stroke tend to be significantly older with several comorbid conditions contributing to worse clinical outcomes after COVID-19, which makes them a vulnerable population.

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Spectrum of neuropsychiatric manifestations in COVID-19

Cited by 221 publications

References 29 publications

Neurological manifestations of patients infected with the SARS-CoV-2: a systematic review of the literature

Neurological manifestations of patients infected with the SARS-CoV-2: a systematic review of the literature

Cognitive and Neuropsychiatric Manifestations of COVID-19 and Effects on Elderly Individuals With Dementia

Coronavirus Disease 2019 in Patients With Prior Ischemic Stroke

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