Subjective neurological symptoms frequently occur in patients with SARS-CoV2 infection

Liguori, Claudio; Pierantozzi, Mariangela; Spanetta, Matteo; Sarmati, Loredana; Cesta, Novella; Iannetta, Marco; Ora, Josuel; Mina, Grazia Genga; Puxeddu, Ermanno; Balbi, Ottavia; Pezzuto, Gabriella; Magrini, Andrea; Rogliani, Paola; Andreoni, Massimo; Mercuri, Nicola Biagio

doi:10.1016/j.bbi.2020.05.037

Cited by 186 publications

(231 citation statements)

References 41 publications

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“…Custom screening tools were used by four Chinese studies [70][71][72][73] for evaluating depression, anxiety, and/or sleep disturbances. Two studies 74,75 used interviews for evaluating depression, anxiety, and sleep disturbances. The interview results were reviewed and confirmed by expert neurologists; however, the exact diagnostic criteria and interview questions were not disclosed in these studies.…”

Section: Outcomes and Measuresmentioning

confidence: 99%

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The prevalence of depression, anxiety, and sleep disturbances in COVID‐19 patients: a meta‐analysis

Deng

Zhou

Hou

et al. 2020

Annals of the New York Academy of Sciences

630

499

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Evidence from previous coronavirus outbreaks has shown that infected patients are at risk for developing psychiatric and mental health disorders, such as depression, anxiety, and sleep disturbances. To construct a comprehensive picture of the mental health status in COVID-19 patients, we conducted a systematic review and randomeffects meta-analysis to assess the prevalence of depression, anxiety, and sleep disturbances in this population. We searched MEDLINE, EMBASE, PubMed, Web of Science, CINAHL, Wanfang Data, Wangfang Med Online, CNKI, and CQVIP for relevant articles, and we included 31 studies (n = 5153) in our analyses. We found that the pooled prevalence of depression was 45% (95% CI: 37-54%, I 2 = 96%), the pooled prevalence of anxiety was 47% (95% CI: 37-57%, I 2 = 97%), and the pooled prevalence of sleeping disturbances was 34% (95% CI: 19-50%, I 2 = 98%). We did not find any significant differences in the prevalence estimates between different genders; however, the depression and anxiety prevalence estimates varied based on different screening tools. More observational studies assessing the mental wellness of COVID-19 outpatients and COVID-19 patients from countries other than China are needed to further examine the psychological implications of COVID-19 infections.

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Section: Outcomes and Measuresmentioning

confidence: 99%

“…We included 31 studies 43,44,[70][71][72][73][74][75] with 5153 patients in our analysis, including two preprint articles 43,93 (see Fig. 1).…”

Section: Study Characteristicsmentioning

confidence: 99%

The prevalence of depression, anxiety, and sleep disturbances in COVID‐19 patients: a meta‐analysis

Deng

Zhou

Hou

et al. 2020

Annals of the New York Academy of Sciences

630

499

View full text Add to dashboard Cite

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“…Manifestations such as insomnia, anxiety, post-traumatic stress symptoms (PTSD), psychosis and mood disorders have been described in several reports (see Table 1; Dinakaran et al, 2020;Liguori et al, 2020;Nalleballe et al, 2020;Rogers et al, 2020;Romero-Sanchez et al, 2020;Vindegaard and Benros, 2020). A study that retrieved data from a global health collaborative platform that included medical records of 40,469 COVID-19 positive cases, mostly from the United States (US) (76%), found that 22.5% had neurological and/or psychiatric manifestations, being anxiety and related disorders the most prevalent (4.6%) (Nalleballe et al, 2020).…”

Section: Neuropsychiatric Manifestations Of Covid-19mentioning

confidence: 99%

Cognitive and Neuropsychiatric Manifestations of COVID-19 and Effects on Elderly Individuals With Dementia

Alonso‐Lana

Marquié

Ruiz

et al. 2020

Front. Aging Neurosci.

150

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The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread worldwide and has had unprecedented effects in healthcare systems, economies and society. COVID-19 clinical presentation primarily affects the respiratory system causing bilateral pneumonia, but it is increasingly being recognized as a systemic disease, with neurologic manifestations reported in patients with mild symptoms but, most frequently, in those in a severe condition. Elderly individuals are at high risk of developing severe forms of COVID-19 due to factors associated with aging and a higher prevalence of medical comorbidities and, therefore, they are more vulnerable to possible lasting neuropsychiatric and cognitive impairments. Several reports have described insomnia, depressed mood, anxiety, post-traumatic stress disorder and cognitive impairment in a proportion of patients after discharge from the hospital. The potential mechanisms underlying these symptoms are not fully understood but are probably multifactorial, involving direct neurotrophic effect of SARS-CoV-2, consequences of long intensive care unit stays, the use of mechanical ventilation and sedative drugs, brain hypoxia, systemic inflammation, secondary effects of medications used to treat COVID-19 and dysfunction of peripheral organs. Chronic diseases such as dementia are a particular concern not only because they are associated with higher rates of hospitalization and mortality but also because COVID-19 further exacerbates the vulnerability of those with cognitive impairment. In patients with dementia, COVID-19 frequently has an atypical presentation with mental status changes complicating the early identification of cases. COVID-19 has had a dramatical impact in long-term care facilities, where rates of infection and mortality have been very high. Community measures implemented to slow the spread of the virus have forced to social distancing and cancelation of cognitive stimulation programs, which may have contributed to generate loneliness, behavioral symptoms and worsening of cognition in patients with dementia. COVID-19 has impacted the functioning of Memory Clinics, research programs and clinical trials in the Alzheimer's field, triggering the

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“…An Italian surveybased study observed sleep impairment as the most commonly reported neurological symptom (94/103 patients). 73 A prospective cross-sectional study from the USA showed that impaired sense of smell was associated with anxiety and depressed mood. 74 Finally, a UK-wide surveillance study recorded 23 patients with neuropsychiatric disorders, among them new-onset psychosis (10 patients, 43%), neurocognitive syndrome (6 patients, 26%), and affective disorders (4 patients, 17%).…”

Section: Neurological Complicationsmentioning

confidence: 99%

Neurological manifestations of coronavirus infections – a systematic review

Almqvist

Granberg

Tzortzakakis

et al. 2020

Ann Clin Transl Neurol

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To optimize diagnostic workup of the current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, we systematically reviewed neurological and neuroradiological manifestations of SARS-CoV-2 and all other known human coronavirus species (HCoV). Which lessons can we learn? We identified relevant publications (until 26 July 2020) using systematic searches in PubMed, Web of Science, and Ovid EMBASE with predefined search strings. A total of 4571 unique publications were retrieved, out of which 378 publications were selected for in-depth analysis by two raters, including a total of 17549 (out of which were 14418 SARS-CoV-2) patients. Neurological complications and associated neuroradiological manifestations are prevalent for all HCoVs (HCoV-229E, HKU1, NL63, OC43, Middle East respiratory syndrome (MERS)-CoV, SARS-CoV-1, and SARS-CoV-2). Moreover there are similarities in symptomatology across different HCoVs, particularly between SARS-CoV-1 and SARS-CoV-2. Common neurological manifestations include fatigue, headache, and smell/taste disorders. Additionally, clinicians need to be attentive for at least five classes of neurological complications: (1) Cerebrovascular disorders including ischemic stroke and macro/micro-hemorrhages, (2) encephalopathies, (3) para-/postinfectious immune-mediated complications such as Guillain-Barr e syndrome and acute disseminated encephalomyelitis, (4) (meningo-)encephalitis, potentially with concomitant seizures, and (5) neuropsychiatric complications such as psychosis and mood disorders. Our systematic review highlights the need for vigilance regarding neurological complications in patients infected by SARS-CoV-2 and other HCoVs, especially since some complications may result in chronic disability. Neuroimaging protocols should be designed to specifically screen for these complications. Therefore, we propose practical imaging guidelines to facilitate the diagnostic workup and monitoring of patients infected with HCoVs. additional HCoV species (HCoV-229E, HCoV-HKU1, HCoV-NL63, and HCoV-OC43) cause disease in humans, albeit typically with milder clinical courses. 3 While coronaviruses primarily target the human respiratory system, 4 they can also enter the central nervous system (CNS). This is evident from pre-clinical research, where murine coronaviruses have been used to model human encephalitis for decades. 5 HCoVs also show neurotropism. SARS-CoV-1 6 and SARS-CoV-2 7 both use the cell membrane-bound human angiotensin-converting enzyme 2 for cellular entry, which is, among other tissues, expressed on vascular endothelial cells in the brain. 8 Yet, SARS-CoV-2 seems to have an even higher affinity to bind to this receptor compared to SARS-CoV-1. 9 SARS-CoV-1 and SARS-CoV-2 are also most related genetically, with 79% genome homology. 10 Therefore, it is not surprising that several studies have described neurological symptomatology in both SARS-CoV-1 and SARS-CoV-2 infections. 3,11 Neurological complications have also been described in other HCoVs. 12 The aim of this study ...

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Subjective neurological symptoms frequently occur in patients with SARS-CoV2 infection

Cited by 186 publications

References 41 publications

The prevalence of depression, anxiety, and sleep disturbances in COVID‐19 patients: a meta‐analysis

The prevalence of depression, anxiety, and sleep disturbances in COVID‐19 patients: a meta‐analysis

Cognitive and Neuropsychiatric Manifestations of COVID-19 and Effects on Elderly Individuals With Dementia

Neurological manifestations of coronavirus infections – a systematic review

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