COVID-19 in the brain: Neurological symptoms persist in most carriers for a long time

Summary: Six months after COVID-19 infection, two-thirds of patients still experienced neurological symptoms, including headache, memory impairment, and decreased concentration, which affected their quality of life.

A source: UCSD

Researchers at the University of California, San Diego School of Medicine are conducting a longitudinal study to monitor neurological symptoms in COVID-19 “long-distance carriers.”

The first round of results was announced on June 15, 2022 Annals of Clinical and Translational NeurologyAlthough the discovery of the prevalence of various short- and long-term symptoms showed that many patients had improved, six months later found that most neurological symptoms were still present.

Some individuals also showed significant coordination and cognitive problems that had not been described before.

From October 2020 to October 2021, 56 people with neurological symptoms were involved in the study after mild and moderate SARS-CoV-2 infections. They underwent neurological examinations, cognitive assessments, self-reported questionnaires, and additional brain scans. Baseline measurements were taken several times after the initial infection and repeated three and six months later.

At the first visit, 89 percent reported fatigue and 80 percent headaches. Other common neurological symptoms include memory loss, insomnia, and decreased concentration. Eighty percent of the participants said that these symptoms affected their quality of life.

When participants returned for a six-month follow-up, only one-third reported complete resolution of symptoms. The remaining two-thirds of participants reported persistent neurological symptoms, but most had severe stiffness. For six months, the most common symptoms were memory impairment and decreased concentration.

The authors note that none of the people with persistent symptoms for six months had pre-existing neurological conditions prior to SARS-CoV-2 infections.

“Most people are happy that there has been a slight improvement in six months, but that hasn’t been the case for everyone,” said senior author Jennifer S. Graves, MD, PhD, Associate Professor, UC San Diego School of Medicine and UC Neurologist. San Diego Health.

“Some of these participants were high-level professionals who expected to be above average in their cognitive assessment, but a few months after receiving COVID-19, they are still gaining abnormal scores.”

Researchers were surprised to find a new phenotype inside the cohort. Seven percent of participants reported previously unknown symptoms, including cognitive deficits, tremors, and difficulty maintaining balance. The authors noted the phenotype of acute post-seizure effects of COVID-19 infection with tremor, ataxia, and cognitive impairment (PASC-TAC).

At the first visit, 89 percent reported fatigue and 80 percent headaches. Image in public domain

“These people are people who didn’t have neurological problems before COVID-19, and now their bodies are uncoordinated and they can coordinate their thoughts,” Graves said. “We didn’t expect to find it, so if other doctors see it, we want to have a say.”

Researchers are still studying how directly the SARS-CoV-2 virus enters the brain, but Graves said these delayed neurological symptoms may be due to an infection that triggers an inflammatory autoimmune reaction in the brain.

The team plans to continue monitoring participants’ symptoms annually for up to 10 years. Additional efforts will assess the effects of different COVID-19 variants and vaccines on long-term neurological symptoms.

“As a society, we need to take it seriously so that it can still affect people’s consciousness and quality of life after infection,” Graves said. “We still need to know how common it is, what biological processes are occurring and what kind of regular medical care these people need. This is an important first step in getting there. “

Co-authors: Jacqueline E. Shanley, Andrew F. Valenciano, Garrett Timmons, Annaliz E. Miner, Visesha Kakarla, Jennifer H. Young, Amanda Gooding, Mark A. Norman, Sarah J. Banks, NeuCovid Team, Michelle L. Ritter, Ronald J. of San Diego. Ellis and Lucy Horton, as well as Torge Rempe at the University of Florida.

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Author: Nicole Mlinaryk
A source: UCSD
The connection: Nicole Mlinaryk – UCSD
Photo: Image in public domain

Original study: Open access.
Jennifer S. Graves Annals of Clinical and Translational Neurology


Abstract

Longitudinal assessment of neurological and acute consequences of SARS-CoV-2 infection

The goal

To assess the initial features and evolution of the neurological postacute consequences of SARS-CoV-2 infection (neuro-PASC) in patients with and without previous neurological disease.

Methods

Participants with neurological symptoms following acute SARS-CoV-2 infection were admitted from October 9, 2020 to October 11, 2021. Clinical data include history of SARS-CoV-2 infection, systemic neurological examination, neurological examination, and Cognitive Assessment (MoCA) in Montreal. ) and self-reported symptom-based studies (conducted after acute infection) and a 6-month follow-up assessment.

Results

Fifty-six participants (69% women, mean age 50 years, 29% with previous neurological disorders, such as multiple sclerosis) were registered, of whom 27 underwent a 6-month follow-up in this ongoing study. The severity of SARS-CoV-2 infection was generally characterized as mild (39.3%) or moderate (42.9%). Initially, after acute infection, the most common neurological symptoms were fatigue (89.3%) and headache (80.4%). Memory impairment (68.8%) and decreased concentration (61.5%) were the most common in the 6-month follow-up, but on average, all symptoms indicated a decrease in the severity score reported in the follow-up follow-up. 33.3% of the participants reported complete resolution of symptoms within 6 months. Within 6 months of baseline, average MoCA scores improved overall, but decreased by 26.3% of participants ’scores. The syndrome of tremor, ataxia and cognitive dysfunction (PASC-TAC) was observed in 7.1% of patients.

interpretation

At the beginning of Neuro-PASC syndrome, fatigue and headaches are the most commonly reported symptoms. At 6 months, the most noticeable was memory impairment and decreased concentration. Only one-third of participants completed neuro-PASK in 6 months, but persistent symptoms tended to improve in the following period.

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