Neurological Outcomes 1 Year after COVID-19 Diagnosis
European Journal of Neurology:
Neurological complications associated with acute coronavirus disease 2019 (COVID-19) are well described. Now, increasing evidence suggests that symptoms may persist even beyond 4–12 weeks after disease onset
Frequent neurological, cognitive and neuropsychiatric long-term symptoms after COVID-19 include but are not limited to headache, dizziness, difficulty in concentration, attention and memory, fatigue, insomnia, depression and anxiety.
In line with this, a meta-analysis including 15 follow-up studies of COVID-19 patients evaluated between 14 and 110 days post-infection, identified 55 long-term effects of COVID-19 with fatigue, headache, attention disorder, hair loss and dyspnoea as the most common symptoms.
TAKE-HOME MESSAGE
Interest in the neurological complications of COVID-19 remains high, and this prospective study assessed the natural history of neurological manifestations over a 1-year period in 81 survivors of COVID-19.
FIGURE
Self-reported symptoms quantified based on the duration (any time, >4 weeks, >3 months, ≥1 year)
More than half of the patients reported symptoms at 1 year, the most common being fatigue, concentration difficulties, forgetfulness, sleep disturbances, myalgia, limb weakness, headache, impaired sensation, and hyposmia.
Cognitive impairment, objectively assessed using the MoCA, was prevalent and persistent in almost one-fifth of the patients, while almost one-fourth of the patients reported persistent forgetfulness and concentration difficulties 1 year after acute COVID-19.
FIGURE
Neurological sequelae 3 months and 1 year after being diagnosed with COVID-19. SS-16, 16-item Sniffin' Sticks identification test; MoCA, Montreal Cognitive Assessment; PCL-5, Post-traumatic Stress Disorder Checklist; HADS, Hospital Anxiety and Depression Scale.
A high prevalence of neurological signs was found — almost up to two-thirds of the patients if objective hyposmia was included.
The authors report a significant prevalence of neurological complaints 1 year after COVID-19, with 12% having a new onset neurological disease within 12 months post COVID-19.
This data underline the high global post-acute disease burden calling for long-term multidisciplinary management of these patients.
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BACKGROUND AND PURPOSE
Neurological sequelae from coronavirus disease 2019 (COVID-19) may persist after recovery from acute infection. Here, the aim was to describe the natural history of neurological manifestations over 1 year after COVID-19.
METHODS
A prospective, multicentre, longitudinal cohort study in COVID-19 survivors was performed. At a 3-month and 1-year follow-up, patients were assessed for neurological impairments by a neurological examination and a standardized test battery including the assessment of hyposmia (16-item Sniffin' Sticks test), cognitive deficits (Montreal Cognitive Assessment < 26) and mental health (Hospital Anxiety and Depression Scale and Post-traumatic Stress Disorder Checklist 5).
RESULTS
Eighty-one patients were evaluated 1 year after COVID-19, out of which 76 (94%) patients completed a 3-month and 1-year follow-up. Patients were 54 (47-64) years old and 59% were male. New and persistent neurological disorders were found in 15% (3 months) and 12% (10/81; 1 year). Symptoms at 1-year follow-up were reported by 48/81 (59%) patients, including fatigue (38%), concentration difficulties (25%), forgetfulness (25%), sleep disturbances (22%), myalgia (17%), limb weakness (17%), headache (16%), impaired sensation (16%) and hyposmia (15%). Neurological examination revealed findings in 52/81 (64%) patients without improvement over time (3 months, 61%,) including objective hyposmia (Sniffin' Sticks test <13; 51%). Cognitive deficits were apparent in 18%, whereas signs of depression, anxiety and post-traumatic stress disorders were found in 6%, 29% and 10% respectively 1 year after infection. These mental and cognitive disorders had not improved after the 3-month follow-up.
CONCLUSION
Our data indicate that a significant patient number still suffer from neurological sequelae including neuropsychiatric symptoms 1 year after COVID-19 calling for interdisciplinary management of these patients.
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