Mid and long-term neurological and neuropsychiatric manifestations of post-COVID-19 syndrome: A meta-analysis

Abstract

Importance: Neurological and neuropsychiatric symptoms that persist or develop three months after the onset of COVID-19 pose a significant threat to the global healthcare system. These symptoms are yet to be synthesized and quantified via meta-analysis. Objective: To determine the prevalence of neurological and neuropsychiatric symptoms reported 12 weeks (3 months) or more after acute COVID-19 onset in adults. Data sources: A systematic search of PubMed, EMBASE, Web of Science, Google Scholar and Scopus was conducted for studies published between January 1st, 2020 and August 1st, 2021. The systematic review was guided by Preferred Reporting Items for Systematic Review and Meta-Analyses. Study selection: Studies were included if the length of follow-up satisfied the National Institute for Healthcare Excellence (NICE) definition of post-COVID-19 syndrome (symptoms that develop or persist ≥3 months after the onset of COVID-19). Additional criteria included the reporting of neurological or neuropsychiatric symptoms in individuals with COVID-19. Data extraction and synthesis: Two authors independently extracted data on patient characteristics, hospital and/ or ICU admission, acute-phase COVID-19 symptoms, length of follow-up, and neurological and neuropsychiatric symptoms. Main outcome(s) and measure(s):The primary outcome was the prevalence of neurological and neuropsychiatric symptoms reported ≥3 months post onset of COVID-19. We also compared post-COVID-19 syndrome in hospitalised vs. non-hospitalised patients, with vs. without ICU admission during the acute phase of infection, and with mid-term (3 to 6 months) and long-term (>6 months) follow-up. Results: Of 1458 articles, 19 studies, encompassing a total of 11,324 patients, were analysed. Overall prevalence for neurological post-COVID-19 symptoms were: fatigue (37%, 95% CI: 24%-50%), brain fog (32%, 9%-55%), memory issues (27%, 18%-36%), attention disorder (22%, 10%-34%), myalgia (18%, 4%-32%), anosmia (12%, 7%-17%), dysgeusia (11%, 4%-17%) and headache (10%, 1%-21%). Neuropsychiatric conditions included sleep disturbances (31%, 18%-43%), anxiety (23%, 13%-33%) and depression (12%, 7%-21%). Neuropsychiatric symptoms substantially increased in prevalence between mid-and long-term follow-up. Compared to nonhospitalised patients, patients hospitalised for acute COVID-19 had reduced frequency of anosmia, anxiety,

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

“…A recent meta-analysis confirmed that fatigue, cognitive dysfunction and sleep disturbances are key features of post-COVID-19, but also highlighted that psychiatric manifestations such as sleep disturbances, anxiety, and depression increase significantly in prevalence over time [7]. Investigation of neuropsychiatric impacts and the pathophysiological drivers underlying the risk factors associated with COVID-19 are important in surveillance and in the development of evidence-based therapeutic strategies.…”

“…Symptoms include fatigue, headache, cognitive compromise, dyspnea, and anosmia [5]. The association with higher number of symptoms [6] and the slow decrease of people having lasting symptoms [5, 7] suggests that the pathophysiological drivers underlying the presence of symptoms might be transient, such as inflammatory response. However, recent data shows that mild COVID-19 is related to important long-lasting symptoms, including neurological and psychiatric manifestations, and persistent sequelae, in about 30% of those patients, with increasing prevalence in aged individuals [8].…”

A Review of SARS-CoV-2 Disease (COVID-19): Pandemic in Our Time

“…These were reported to have included cognitive dysfunction involving memory concentration, attention disorder, and in some cases sleep deprivation, which appeared to be the key features of post-COVID-19 syndrome. Normally, sleep deprivation and depression are the most common symptoms over time [ 99 , 100 , 101 , 102 ].…”

Examining Association of Personality Characteristics and Neuropsychiatric Symptoms in Post-COVID Syndrome

“…According to the WHO, the most common symptoms include fatigue, shortness of breath, and cognitive dysfunction. Other common symptoms include depression, anxiety, headache, joint and muscle pain, sleep problems, and smell or taste disorders [ 2 , 3 ].…”