Incidence and Long-term Functional Outcome of Neurologic Disorders in Hospitalized Patients With COVID-19 Infected With Pre-Omicron Variants

Abstract

Background and ObjectiveA variety of neurological disorders has been reported as presentations or complications of COVID-19 infection. The objective of this study was to determine their incidence dynamics and long-term functional outcome.MethodsThe Neuro-COVID Italy study was a multicentre, observational, cohort study with ambispective recruitment and prospective follow-up. Consecutive hospitalized patients presenting new neurological disorders associated with COVID-19 infection (neuro-COVID), independently from respiratory severity, were systematically screened and actively recruited by neurology specialists in 38 centers in Italy and the Republic of San Marino. The primary outcomes were incidence of neuro-COVID cases during the first 70 weeks of the pandemic (March 2020 to June 2021) and long-term functional outcome at 6 months, categorized as full recovery, mild symptoms, disabling symptoms or death.ResultsAmong 52759 hospitalized COVID patients, 1865 patients presenting 2881 new neurological disorders associated with COVID-19 infection (neuro-COVID) were recruited. Incidence of neuro-COVID cases significantly declined over time, comparing the first three pandemic waves (8.4%, 95% CI [7.9, 8.9]; 5.0%, 95% CI [4.7, 5.3]; 3.3%, 95% CI [3.0, 3.6], respectively; p = 0.027). The most frequent neurological disorders were acute encephalopathy (25.2%), hyposmia-hypogeusia (20.2%), acute ischemic stroke (18.4%) and cognitive impairment (13.7%). The onset of neurological disorders was more common in the prodromic phase (44.3%) or during the acute respiratory illness (40.9%), except for cognitive impairment whose onset prevailed during recovery (48.4%). A good functional outcome was achieved by the majority of neuro-COVID patients (64.6%) during follow-up (median 6.7 months) and the proportion of good outcome increased throughout the study period (r = 0.29, 95% CI [0.05, 0.50]; p = 0.019). Mild residual symptoms were frequently reported (28.1%), while disabling symptoms were common only in stroke survivors (47.6%).DiscussionIncidence of COVID-associated neurologic disorders decreased during the pre-vaccination phase of the pandemic. Long-term functional outcome was favourable in most neuro-COVID disorders, although mild symptoms commonly lasted over 6 months after infection.

Acute blood biomarker profiles predict cognitive deficits 6 and 12 months after COVID-19 hospitalization

“…7 ). Among these symptoms, cognitive deficits (including ‘brain fog’) are particularly worrisome; they are common 8 – 10 , persistent 11 and they affect the ability to work 12 .…”

Hyperbaric Oxygen Therapy Counters Oxidative Stress/Inflammation-Driven Symptoms in Long COVID-19 Patients: Preliminary Outcomes

“…In support of this, after the complete HBOT protocol, the NRS fatigue decreased from 5.6 to 2.8, considering all of the subjects in our study together. According to several authors, long COVID-19 fatigue might be characterized by altered cortical excitability and neurotransmission [75][76][77]; HBOT might have an effect on some brain excitability and neurotransmission parameters, as some authors have discussed [78][79][80]. Furthermore, some therapeutic approaches, such as nutraceuticals, might improve symptoms through this modulation [80,81] in adjuvant to HBOT.…”

A Comprehensive Review of Neurodegenerative Manifestations of SARS-CoV-2

“…This is particularly concerning given the severe clinical impact of COVID-19 on the elderly. Additionally, the age range at which neurodegenerative or cerebrovascular diseases typically manifest aligns significantly with the age group most susceptible to severe COVID-19 cases (refer to Table 2 ) [ 29 ]. This overlap underscores the necessity for proactive neurological monitoring and comprehensive care [ 15 ].…”