The wide spectrum of COVID-19 neuropsychiatric complications within a multidisciplinary centre

Abstract

A variety of neuropsychiatric complications has been described in association with Covid-19 infection. Large scale studies presenting a wider picture of these complications and their relative frequency are lacking. The objective of our study was to describe the spectrum of neurological and psychiatric complications in patients with Covid-19 seen in a multidisciplinary hospital center over six months. We conducted a retrospective, observational study on all patients showing neurological or psychiatric symptoms in the context of Covid-19 seen in the medical and university neuroscience department of Assistance Publique Hopitaux de Paris -Sorbonne University. We collected demographic data, comorbidities, symptoms and severity of Covid-19 infection, neurological and psychiatric symptoms, neurological and psychiatric examination data and, when available, results from CSF analysis, MRI, EEG and EMG. A total of 249 Covid-19 patients with a de novo neurological or psychiatric manifestation were included in the database and 245 were included in the final analyses. One-hundred fourteen patients (47%) were admitted to the intensive care unit and 10 (4%) died. The most frequent neuropsychiatric complications diagnosed were encephalopathy (43%), critical illness polyneuropathy and myopathy (26%), isolated psychiatric disturbance (18%), and cerebrovascular disorders (16%). No patients showed CSF evidence of SARS-CoV-2. Encephalopathy was associated with older age and higher risk of death. Critical illness neuromyopathy was associated with an extended stay in the intensive care unit. The majority of these neuropsychiatric complications could be imputed to critical illness, intensive care and systemic inflammation, which contrasts with the paucity of more direct SARS-CoV-2-related complications or post-infection disorders.

Dynamic Changes in Central and Peripheral Neuro-Injury vs. Neuroprotective Serum Markers in COVID-19 Are Modulated by Different Types of Anti-Viral Treatments but Do Not Affect the Incidence of Late and Early Strokes

“…Contrary to this, neuroprotective factors (fetuin, clusterin, TREM-2) were highly variable across the observed time periods. Thus, our study suggests an emergence of imbalance strongly favoring the neurodegeneration process in individuals with acute COVID-19, a suggestion that was theorized but not clinically examined [ 1 , 9 , 10 , 13 , 14 , 87 ].…”

“…This acute TREM-2 initial decline would result in the increased vulnerability of COVID-19 survivors to secondary insults, further impairing their ability to successfully recover from neurological sequela. This raises concerns about the ability of survivors to recover fully from the disease if the initial insult deprived a host of some neuroprotective mechanisms [ 1 , 9 , 13 , 14 , 16 ]. An alteration in the spectrum of neurobiomarkers (protective vs. injury vs. degeneration) suggests a loss of autoregulated homeostasis and has been proposed to explain the origin of dementia [ 99 , 108 ].…”

“…Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been linked to abnormalities in the central nervous system such as the loss of smell and taste, cognitive decline, delirium, cerebrovascular accidents, neuronal autoimmune illnesses, and psychiatric disorders [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ]. However, the heterogeneity of symptoms remains puzzling [ 1 , 3 , 7 , 8 , 9 , 10 ]. The development of these abnormalities often occurs within two days from the onset of symptoms [ 1 , 5 , 7 , 11 , 12 ].…”

“…This somewhat complex landscape indicates the heterogeneity of the dementias and cognitive decline in general. It also raises the question of how the heterogeneity of COVID-19 neurological presentations reflects the diverse ways SARS-CoV-2 interacts with neuronal systems instead of one particular disease [ 1 , 9 , 10 ]. Several biomarkers of neurological dysfunction have been reported as altered in neurodegenerative cognitive disorders, psychosis, schizophrenia, and neurodysfunctional processes: ailments commonly found in COVID-19 patients [ 51 , 52 , 53 , 54 , 55 ].…”

Is loss of smell an early predictor of COVID-19 severity: a systematic review and meta-analysis

“…In total, 34 studies provided information on the severity of COVID-19 disease. Of them, four studies were preprints (Al Harthi et al 2020;Bertlich et al 2020;Papizadeh et al 2020;Patel et al 2020), and 30 articles were published studies (Aggarwal et al 2020;Alasia et al 2021;Alizadehsani et al 2021;Allenbach et al 2020;Amanat et al 2021;Borobia et al 2020;Delorme et al 2021;Elimian et al 2020;Ermis et al 2021;García-Azorín et al 2021;Ghaffari et al 2021;Goyal et al 2021;Izquierdo et al 2020;Kadiane-Oussou et al 2020;Kocayığıt et al 2021;Lechien et al 2021;Liotta et al 2020;Mao et al 2020;McElvaney et al 2020;Muñoz-Rodríguez et al 2021;Printza et al 2021;Romero-Sánchez et al 2020;Salepci et al 2021;Sobhani et al 20212021;Song et al 2021;Studart-Neto et al 2020;Sun et al 2021;Tomlins et al 2020;Vaira et al 2020;Vial et al 2020). The OD were present in 482 severely ill and 2640 non-severely ill patients with COVID-19.…”