Patient-reported outcomes of neurologic and neuropsychiatric symptoms in mild COVID-19: a prospective cohort study

Abstract

Background: Various neurologic manifestations have been reported in patients with COVID-19, mostly in retrospective studies of patients admitted to hospital, but there are few data on patients with mild COVID-19. We examined the frequency and persistence of neurologic/neuropsychiatric symptoms in patients with mild COVID-19 in a 1-year prospective cohort study, as well as assessment of use of health care services and patient-reported outcomes. Methods: Participants in the Alberta HOPE COVID-19 trial (hydroxychloroquine v. placebo for 5 d), managed as outpatients, were prospectively assessed 3 months and 1 year after their positive test result. They completed detailed neurologic/neuropsychiatric symptom questionnaires, the telephone version of the Montreal Cognitive Assessment (T-MoCA), the Kessler Psychological Distress Scale (K10) and the EuroQol EQ-5D-3L (measure of quality of life). Close informants completed the Mild Behavioural Impairment Checklist (MBI-C) and the Informant Questionnaire on Cognitive Decline in the Elderly. We also tracked use of health care services and neurologic investigations. Results: The cohort consisted of 198 participants (87 female [43.9%] median age 45 yr, interquartile range 37–54 yr). Of the 179 participants with symptom assessments, 139 (77.6%) reported at least 1 neurologic symptom, the most common being anosmia/dysgeusia (99 [55.3%]), myalgia (76 [42.5%]) and headache (75 [41.9%]). Forty patients (22.3%) reported persistent symptoms at 1 year, including confusion (20 [50.0%]), headache (21 [52.5%]), insomnia (16 [40.0%]) and depression (14 [35.0%]); 27/179 (15.1%) reported no improvement. Body mass index (BMI), a history of asthma and lack of full-time employment were associated with the presence and persistence of neurologic/neuropsychiatric symptoms; female sex was independently associated with both (presence: odds ratio [OR] adjusted for age, race, BMI, history of asthma and neuropsychiatric history 5.04, 95% confidence interval [CI] 1.58 to 16.10). Compared to participants without persistent symptoms, those with persistent symptoms had more hospital admissions and family physician visits, and worse MBI-C scores and less frequent independence for instrumental activities at 1 year (83.8% v. 97.8%, p = 0.005). Patients with any or persistent neurologic symptoms had worse psychologic distress (K10 score ≥ 20: adjusted OR 12.1, 95% CI 1.4 to 97.2) and quality of life (median EQ-5D-3L visual analogue scale rating 75 v. 90, p < 0.001); 42/84 (50.0%) had a T-MoCA score less than 18 at 3 months, as did 36 (42.9%) at 1 year. Participants who reported memory loss were more likely than those who did not report such symptoms to have informant-reported cognitive-behavioural decline (1-yr MBI-C score ≥ 6.5: adjusted OR 15.0, 95% CI 2.42 to 92.60). Interpretation: Neurologic/neuropsychiatric symptoms were commonly reported in surviv...

Comparable Psychotropic Prescription Rates After Hospital Discharge Between Patients with COVID-19 and Those With Non-COVID-19-Related Respiratory Infection

“…Long COVID includes physical symptoms, such as general fatigue and breathlessness, as well as psychiatric symptoms, such as insomnia, anxiety, and depression. Previous studies have found that these psychiatric symptoms occur among 1.4-22.7 % of patients who recover from acute symptoms of COVID-19 [7][8][9]. However, there are several limitations or challenges in those reports.…”

Neurological risks of COVID-19 in women: the complex immunology underpinning sex differences

“…A recent prospective cohort study of patients with mild COVID-19 found that female patients reported more neurologic and neuropsychiatric symptoms, like cognitive deficits, headaches, and hyposmia compared to males ( 77 ). However, the study did not compare COVID-19 patients to a control group without COVID-19, thus it remains unclear whether the observed sex differences represent increased neuro-autoimmunity, specifically caused by COVID-19 in women ( 77 ).…”

“…A recent prospective cohort study of patients with mild COVID-19 found that female patients reported more neurologic and neuropsychiatric symptoms, like cognitive deficits, headaches, and hyposmia compared to males ( 77 ). However, the study did not compare COVID-19 patients to a control group without COVID-19, thus it remains unclear whether the observed sex differences represent increased neuro-autoimmunity, specifically caused by COVID-19 in women ( 77 ). Several factors like autoantibody-mediated microvascular damage may underlie the sex differences in neurological manifestations of COVID-19 ( 78 ), a retrospective study also found female patients had a higher frequency of certain neurological post-COVID symptoms, though mechanisms need further study ( 79 ).…”

“…Several factors like autoantibody-mediated microvascular damage may underlie the sex differences in neurological manifestations of COVID-19 ( 78 ), a retrospective study also found female patients had a higher frequency of certain neurological post-COVID symptoms, though mechanisms need further study ( 79 ). More research is still needed to elucidate the pathological mechanisms and determine if female sex is truly a risk factor for neurological sequelae after COVID-19 infection ( 77 ).…”