Neurological burden of COVID-19 substantial and likely underestimated

Public health

By Natasha Doyle

2 Sep 2021

Australian researchers are calling for better reporting around COVID-19-related neurologic outcomes after finding the pandemic poses a substantial, and likely underestimated, neurological burden.

A University of Queensland-led study reviewed severe neurological manifestations in 8577 hospitalised COVID-19 patients across Europe, Asia and America in 2020.

It found 1.3% (102/7715) of hospitalised patients and 2.3% (9/318) in ICU had an ischaemic stroke, while 0.4% of all patients had an intracranial haemorrhage (6/1006).

Seventy-nine patients experienced delirium, 21 had Guillain-Barrè Syndrome, 13 had meningoencephalitis, six had seizures or other peripheral neuropathies and two had acute demyelinating encephalitis, University of Queensland PhD candidate Samuel Huth and his team wrote in Frontiers in Neurology.

However they cautioned that the lack of quality evidence prevented them from gauging the true prevalence of these conditions.

Preliminary reports on SARS-COV-2 infection have frequently identified a host of severe central and peripheral nervous system manifestations in up to 36% of patients, they noted.

“The COVID-19 pandemic exerts a substantial neurologic burden which may have residual effects on patients and healthcare systems for years,” they wrote.

“As the SARS-COV-2 pandemic continues to grow in magnitude, with more than 54 million people infected and 1.3 million deaths worldwide, a thorough investigation of the neurologic manifestations of SARS-COV-2 is vital to identifying risk factors, optimising management, and predicting the long-term impact of the virus,” they added.

Assessment of neurological complications should include a systematic approach to data analysis, clear case definitions and controlled screening methodology, they wrote — a sentiment shared by the global NeuroCOVID Neuropsychology Taskforce.

Led by UNSW research fellow Dr Lucette Cysique, the taskforce recently recommended a set of neurocognitive and mental health tests to help standardise long COVID assessments.

Dr Cysique said she hoped the work will lead to the creation of a large global database which shows the frequency of long COVID-associated neurocognitive problems and can inform patient management and health policies.

“Because COVID-19 is a new disease and the research deriving from it is new, we need to develop excellent research methods to address questions, such as: how many people have the problem, how long does it last, how many patients fully recover, do these neurocognitive difficulties precipitate dementia in some people?” she said in a  statement issued on 1 Sept.

According to Dr Cysique, the recommended methods showed up to 23% of study participants had neurocognitive difficulties six months after COVID-19 infection.

“Importantly, we found that these neurocognitive difficulties were not associated with depression or anxiety but were associated with an increased immune response,” she said.

“We know that some people develop a ‘brain fog’ such as difficulties in concentrating and paying attention and this can persist months after infection. In some patients, such difficulties are associated with a feeling of generalised fatigue which can be severe enough that people cannot work as efficiently as they used to.”

The recommendations are published in the Journal of the International Neuropsychological Society.

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