Post-acute Sequelae of SARS-CoV-2 Infection and Subjective Memory Problems

Oh, Esther S.; Vannorsdall, Tracy D.; Parker, Ann M.

doi:10.1001/jamanetworkopen.2021.19335

Cited by 12 publications

(7 citation statements)

References 11 publications

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“…40 Survivors of COVID-19 commonly report cognitive impairment. 41 In this COVID-19 population, 37 of 85 (44%) re-ported memory problems after 6 months, and self-reported memory problems still persisted in more than 10% by 8 months even after a mild infection. 42 This raises concerns about longterm consequences, as subjective memory problems even without objective deficits is a risk factor for future cognitive impairment.…”

Section: Cognitive Deficits and Neurologic Complicationsmentioning

confidence: 74%

Neuropsychiatric and Cognitive Outcomes in Patients 6 Months After COVID-19 Requiring Hospitalization Compared With Matched Control Patients Hospitalized for Non–COVID-19 Illness

et al. 2022

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IMPORTANCE Prolonged neuropsychiatric and cognitive symptoms are increasingly reported in patients after COVID-19, but studies with well-matched controls are lacking.OBJECTIVE To investigate cognitive impairment, neuropsychiatric diagnoses, and symptoms in survivors of COVID-19 compared with patients hospitalized for non-COVID-19 illness. DESIGN, SETTING, AND PARTICIPANTSThis prospective case-control study from a tertiary referral hospital in Copenhagen, Denmark, conducted between July 2020 and July 2021, followed up hospitalized COVID-19 survivors and control patients hospitalized for non-COVID-19 illness, matched for age, sex, and intensive care unit (ICU) status 6 months after symptom onset. EXPOSURES Hospitalization for COVID-19.MAIN OUTCOMES AND MEASURES Participants were investigated with the Mini-International Neuropsychiatric Interview, the Montreal Cognitive Assessment (MoCA), neurologic examination, and a semi-structured interview for subjective symptoms. Primary outcomes were total MoCA score and new onset of International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) psychiatric diagnoses. Secondary outcomes included specific psychiatric diagnoses, subjective symptoms, and neurologic examination results. All outcomes were adjusted for age, sex, ICU admission, admission length, and days of follow-up. Secondary outcomes were adjusted for multiple testing. RESULTS A total of 85 COVID-19 survivors (36 [42%] women; mean [SD] age 56.8 [14] years) after hospitalization and 61 matched control patients with non-COVID-19 illness (27 [44%] women, mean age 59.4 years [SD, 13]) were enrolled. Cognitive status measured by total geometric mean MoCA scores at 6-month follow-up was lower (P = .01) among 95% CI, 95% CI,). The cognitive status improved substantially (P = .004), from 19.2 (95% CI, 15.2-23.2) at discharge to 26.1 (95% CI, 23.1-29.1) for 15 patients with COVID-19 with MoCA evaluations from hospital discharge. A total of 16 of 85 patients with COVID-19 (19%) and 12 of 61 control patients (20%) had a new-onset psychiatric diagnosis at 6-month follow-up, which was not significantly different (odds ratio, 0.93; 95% CI, 0.39-2.27; P = .87). In fully adjusted models, secondary outcomes were not significantly different, except anosmia, which was more common after COVID-19 (odds ratio, 4.56; 95% CI, 1.52-17.42; P = .006); but no longer when adjusting for multiple testing. CONCLUSIONS AND RELEVANCEIn this prospective case-control study, cognitive status at 6 months was worse among survivors of COVID-19, but the overall burden of neuropsychiatric and neurologic signs and symptoms among survivors of COVID-19 requiring hospitalization was comparable with the burden observed among matched survivors hospitalized for non-COVID-19 causes.

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Section: Cognitive Deficits and Neurologic Complicationsmentioning

confidence: 74%

Neuropsychiatric and Cognitive Outcomes in Patients 6 Months After COVID-19 Requiring Hospitalization Compared With Matched Control Patients Hospitalized for Non–COVID-19 Illness

et al. 2022

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“…We emphasize here that both Pfizer/BioNTech and Moderna vaccines are exceptionally safe in the vast majority of individuals, with the benefits far outweighing any possible downsides, despite rare allergic responses such as the one in this report. In light of the severe long-term health consequences of COVID-19 observed even in some recovered patients (28)(29)(30)(31)(32), the small risk of PEG allergy (which can be readily cared for when it occurs) is justifiable. It should be further noted that the majority of the population already possesses low levels of APA of varying isotypes [perhaps >70% of people (33)].…”

Section: Discussionmentioning

confidence: 99%

Anaphylaxis to Pfizer/BioNTech mRNA COVID-19 Vaccine in a Patient With Clinically Confirmed PEG Allergy

McSweeney¹,

Mohan

Commins

et al. 2021

Front. Allergy

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Although allergic responses to the mRNA COVID-19 vaccines are rare, recent reports have suggested that a small number of individuals with allergy to polyethylene glycol (PEG), a component of the mRNA lipid nanoshell, may be at increased risk of anaphylaxis following vaccination. In this report, we describe a case of a patient who received an mRNA COVID-19 vaccine, experienced anaphylaxis, and was subsequently confirmed to have anti-PEG allergy by skin prick testing. The patient had previously noticed urticaria after handling PEG powder for their occupation and had a history of severe allergic response to multiple other allergens. Importantly, as many as 70% of people possess detectable levels of anti-PEG antibodies, indicating that the detection of such antibodies does not imply high risk for an anaphylactic response to vaccination. However, in people with pre-existing anti-PEG antibodies, the administration of PEGylated liposomes may induce higher levels of antibodies, which may cause accelerated clearance of other PEGylated therapeutics a patient may be receiving. It is important to improve awareness of PEG allergy among patients and clinicians.

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“…2,3 The term ‘long-COVID’ was, in fact, first coined and disseminated through social media by patients, who, already during the first months of the pandemic, acknowledged a more complex disease course than laid out in early reports from Wuhan. 4,5 Subsequently, cognate terms were introduced, 6–8 including ‘long-haul’, 9,10 ‘post-COVID’, 11,12 ‘post-acute COVID syndrome (PACS)’, 13 and ‘post-acute sequelae of SARS-CoV-2 (PASC)’, 14 to refer to persistent symptoms and/or delayed or long-term complications beyond acute COVID-19 (Table 1). 13 Currently, despite the emergence of new variants, following the implementation of mass vaccination campaigns, many countries have witnessed significant decreases in the number of new COVID-19 cases and hospitalizations.…”

Section: Introductionmentioning

confidence: 99%

Neurological manifestations of long-COVID syndrome: a narrative review

Stefanou

Palaiodimou

Bakola

et al. 2022

Therapeutic Advances in Chronic Disease

176

128

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Accumulating evidence points toward a very high prevalence of prolonged neurological symptoms among coronavirus disease 2019 (COVID-19) survivors. To date, there are no solidified criteria for ‘long-COVID’ diagnosis. Nevertheless, ‘long-COVID’ is conceptualized as a multi-organ disorder with a wide spectrum of clinical manifestations that may be indicative of underlying pulmonary, cardiovascular, endocrine, hematologic, renal, gastrointestinal, dermatologic, immunological, psychiatric, or neurological disease. Involvement of the central or peripheral nervous system is noted in more than one-third of patients with antecedent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, while an approximately threefold higher incidence of neurological symptoms is recorded in observational studies including patient-reported data. The most frequent neurological manifestations of ‘long-COVID’ encompass fatigue; ‘brain fog’; headache; cognitive impairment; sleep, mood, smell, or taste disorders; myalgias; sensorimotor deficits; and dysautonomia. Although very limited evidence exists to date on the pathophysiological mechanisms implicated in the manifestation of ‘long-COVID’, neuroinflammatory and oxidative stress processes are thought to prevail in propagating neurological ‘long-COVID’ sequelae. In this narrative review, we sought to present a comprehensive overview of our current understanding of clinical features, risk factors, and pathophysiological processes of neurological ‘long-COVID’ sequelae. Moreover, we propose diagnostic and therapeutic algorithms that may aid in the prompt recognition and management of underlying causes of neurological symptoms that persist beyond the resolution of acute COVID-19. Furthermore, as causal treatments for ‘long-COVID’ are currently unavailable, we propose therapeutic approaches for symptom-oriented management of neurological ‘long-COVID’ symptoms. In addition, we emphasize that collaborative research initiatives are urgently needed to expedite the development of preventive and therapeutic strategies for neurological ‘long-COVID’ sequelae.

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Post-acute Sequelae of SARS-CoV-2 Infection and Subjective Memory Problems

Cited by 12 publications

References 11 publications

Neuropsychiatric and Cognitive Outcomes in Patients 6 Months After COVID-19 Requiring Hospitalization Compared With Matched Control Patients Hospitalized for Non–COVID-19 Illness

Neuropsychiatric and Cognitive Outcomes in Patients 6 Months After COVID-19 Requiring Hospitalization Compared With Matched Control Patients Hospitalized for Non–COVID-19 Illness

Anaphylaxis to Pfizer/BioNTech mRNA COVID-19 Vaccine in a Patient With Clinically Confirmed PEG Allergy

Neurological manifestations of long-COVID syndrome: a narrative review

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